Professor Alan Gow: how we can look after our brain as we age

One of the pillars of Take Five is think – this is based on research that looks at ways in which we can support brain health as we age and reduce the risk of brain diseases such as dementia. Alan Gow is a Professor of Psychology at Heriot-Watt University in Edinburgh. He focuses on brain health, particularly how our lifestyles and behaviours might promote our thinking skills across the lifespan. We spoke to him about the research in this area and his tips for keeping those brain cells going.

Can you tell me a bit about your particular area of research within brain health?

We know that our thinking skills might change as we age and we know that there are factors that might determine those changes, so I'm particularly interested in identifying what might be good or bad for our brain health and then trying to think about interventions targeting those things. I’m primarily focusing on lifestyles and behaviours that we might have some control over.

Great, it sounds like your work links very well to Take Five, but could you tell me why you believe in Take Five and what has inspired you to get involved?

Take Five to Age Well is a project that is really trying to take what we know from research and act on it. We know that having information is a first part of changing our behaviours for the better, but it's only the first part. We also need support, motivation, help and advice. So, Take Five is great as it provides information and some of the motivation, support and advice needed to promote positive behaviours that can make a difference to our health.

What are the factors that seem to be influential in protecting our brain health?

Research has identified dozens of things that might be good or bad for our brain health as we age. There is no single ingredient, and many factors can have small but cumulative impacts on our brain health. These things include being physically active; so if we're reasonably sedentary, moving a bit more during the day, getting up out of our seats a wee bit more. Social connection; there’s no set level but are we socially engaged and supported? Do we have that sense of belonging? Learning new things is also important and that can mean different things at different stages. So school, further education and continuing to learn across the life course. Looking after our heads is another important one. That sounds simple, but reducing the risk of head injury by, for instance, wearing seatbelts, cycle helmets and safety equipment in contact sports. Stopping smoking and reducing alcohol consumption is something we might benefit from, and the effect of air pollution is a risk factor where there’s growing evidence. So, there are lots of these risk or protective factors but we do not want to overwhelm people – it’s about knowing what might be important, working out what each person can change and taking it from there. That’s way Take Five is so important because it’s flexible and allows people to choose what actions they want to change and hopefully those can become embedded as habits and built upon.

You mentioned education being a protective factor. And I find that really interesting because in my mind, I'm thinking about doing these actions later in life. But does education early in life have an influence in of brain health outcomes in later life?

People who receive more education early in life, on average, do better in terms of their thinking skills in later life. Some of that might be the education in and of itself but it might also be because those early opportunities open pathways to further education or certain types of jobs. However, while early education is one factor, learning and developing new skills at any point in life is supported as good for brain health. There are plenty of opportunities to build and protect brain health.

I think that's a really great message; the earlier, the better, but never too late. However, we know that for some people, it is easier to make lifestyle changes and harder for others. To what degree in your experience or opinion, do you feel that the wider determinants of health influence something like brain health?

Yeah, that's interesting. So, we know that many of the things that predict health and brain health specifically are modifiable. But just because something is modifiable doesn't mean to say that everybody has the same opportunity to make that change. For instance, some people living in areas of disadvantage may not have access to good community or sport facilities, or shops that sell fresh fruit and vegetables. That's why we've got to make sure we're working with different people in different communities; we need the health messages to be embedded within and supported by communities, and that those are mindful of each person’s own context. Some people may need some additional support and that's completely fine. It's finding the right message and then the right way to help that change so that everybody can benefit.

What are your kind of top tips for improving or maintaining brain health? And do you do them yourself…?

I think the things that we see the most robust evidence for are: being socially, physically and mentally engaged and active. In terms of whether I do all of those things, yeah, I get to meet varied people in my job, I get to meet students, colleagues and collaborators. I try to keep reading widely for leisure, though I do struggle with physical activity because I am often quite stuck to the keyboard!

I know there has been some controversy over the years around the effectiveness of brain training games. What are your opinions on brain training games, Wordle, those sorts of things?

Lots of people enjoy word puzzles, number puzzles, other kinds of games. Often, we see that the people attracted to do those things already had good word skills or number skills; so is the crossword benefiting their word skills or is it that their word skills allow them to do the crossword in the first place? I'm not suggesting that people don't continue to do the games, puzzles, activities that they enjoy, but there is little evidence for brain training benefitting brain health, versus being active, connected and engaged in other ways. That’s not to say games aren’t potentially interesting, and we're seeing researchers pushing towards more complex games, for instance those involving strategy or that combine mental challenge with physical movement.

What interesting facts from neurological research, your own research or outside of that, would you like to share with the Take Five community?

So, one of the things we did in my own team a little while back was a national survey about what people believe and understand about brain health. An early finding was that people had reasonably positive views; they believed that it is possible to maintain or improve brain health as they get older. But while they were open to the idea of protecting brain health they were a little less certain about what to do. People were more optimistic about the possibility of protecting brain health than I might have predicted, which I find that incredibly positive. But also, it gives us the nudge towards what we really need to focus on, behaviour change and how do we support people to do that? That links back to the aims of Take 5 to not only share information about healthy choice but to support how we might make those changes in our lives.

So can people genuinely prevent something like dementia through these sorts of activities that you've described?

At the moment, our phrasing is often around risk reduction. There are ongoing studies that are absolutely aiming towards prevention and looking at cures, but we are not there yet. So, we talk about risk reduction and for people who receive a diagnosis, about living well with dementia. People living with dementia are incredible advocates for research into reducing risk in future generations but also supporting good quality of life post-diagnosis; many people with dementia continue to live independently for many years, and we want to try and promote  those opportunities more widely. Again, something like Take Five is great as everyone can take part and benefit from these small manageable changes that promote health and wellbeing.

Besides the behaviours factors discussed, are there genetic factors that have been identified that contribute to either poorer or better brain health?

There are rare forms of dementia that are  more genetically determined, however, most dementia is what we call sporadic, so the genetic component is actually relatively small compared to other risk factors. Genes may play a role in other ways though; for instance, some people may be predisposed to more effectively break down alcohol and therefore this affects how alcohol consumption impacts the body and brain. Another aspect of genetics is called ‘epigenetics’ which is the interplay between genes and their environment as the environment can ‘switch off’ or ‘switch on’ genes. So, while genes are important for brain health, they're one part of the bigger picture. Our behaviours and environments are important too, and we can sometimes do something about those.

Do you think there's an argument to screen people to give them their genetic risk factors so that they can make more informed behavioural choices? What are your thoughts on that?

I don't think we're quite at that stage yet and I'd always be cautious. We do, unfortunately, sometimes see opportunities to screen for things running a little ahead of the evidence of what we might then do. I think we've got good information that people can make changes on, regardless of what their genetic markers might be, so it's about how we best influence and motivate behavioural changes that we know will benefit everyone. Behaviour change is hard. But moving more, being socially connected, protecting your head, avoiding smoking and heavy drinking – these are some of the best things we can do to maintain good brain health.

Good to hear it as obviously, taking part in Take Five to Age Well is part of that!

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Thanks to The Centre for Ageing Better for the images in this article.