Exploring the Mysteries of the Brain with UCSF Dementia Researchers

Support for KQED Podcasts comes from San Francisco International Airport. Did you know that SFO has a world-class museum? Get ready to be wowed by art, history, science, and cultural exhibitions throughout the terminal. Learn more at flysfo.com slash museum. Support for Forum comes from Broadway SF, presenting Parade, the musical revival based on a true story.

From three-time Tony-winning composer Jason Robert Brown comes the story of Leo and Lucille Frank, a newlywed Jewish couple struggling to make a life in Georgia. When Leo is accused of an unspeakable crime, it propels them into an unimaginable test of faith, humanity, justice, and devotion. The riveting and gloriously hopeful parade plays the Orpheum Theater for three weeks only, May 20th through June 8th. Tickets on sale now at BroadwaySF.com. Sweetie!

From KQED in San Francisco, I'm Mina Kim. Coming up on Forum, research from UC San Francisco's Memory and Aging Center suggests that a decline in one region of the brain can actually cause other regions to step in to help. unlocking surprising capacities like deeper empathy or creativity. We talked to two UCSF doctors about the implications for neurodegenerative disorders, including dementia, and about their new book, Mysteries of the Social Brain.

Have you seen a loved one experiencing memory loss exhibit a new creative skill? Tell us about it after this news.

Welcome to Forum. I'm Mina Kim. We tend to think of memory loss as a slow unraveling, but Dr. Bruce Miller's and Dr. Virginia Sturm's research find some people with dementia become more empathic, while others tap into a well of creativity. This hour we look at what these discoveries say about our social brain and its ability to adapt and change in remarkable ways.

Listeners have you seen a person with a neurodegenerative disorder develop an unexpected skill? What changes have you noticed in a loved one experiencing memory loss or cognitive decline that you want to ask our doctors about? The number is 866-733-6786. The email address forum at kqed.org or post in our social channels on Blue Sky Facebook, Instagram threads at kqedforum.

Bruce Miller is Distinguished Professor of Neurology and Psychiatry and Behavioral Sciences at UCSF, where he's founding director of their Memory and Aging Center. Welcome, Dr. Miller. Oh, it's great to be here. Thank you. Glad to have you. Also, Virginia Sturm is professor in the departments of Neurology and Psychiatry and Behavioral Sciences at UCSF. And at the Memory and Aging Center, she studies emotions, empathy, and social behavior.

in neurodegenerative disorders. Welcome Virginia Stern. Thank you. Glad to have you as well Dr. Stern and their new book together is Mysteries of the Social Brain.

Bruce, I want to ask you about your findings on how creativity can flourish even while the brain is experiencing a neurodegenerative disorder. And I'm wondering if you could tell the story. of Marcus who I understand never had an interest in art but suddenly started painting when he started losing his language. Yes, I was taught in the discipline of neurology, which is always focused on deficits.

In the 1990s, when I was starting my practice at UCLA, beginning to see patients with degenerative diseases, that was how I looked at patients. Suddenly Marcus came into my office dressed in a wild purple shirt and yellow pants. He was obsessed with colors. He was obsessed with purple and yellow. And this was a change in Marcus. His visual perceptions were changing. His son talked to me about his behavioral disturbance and his loss of language.

And as an afterthought, showed me some pictures that Marcus had been painting. He was a banker. So all of a sudden for Marcus to be painting was extraordinary for his son, a mystery. And I assumed it was a coincidence, but... started to think with Marcus and his caregivers about what had happened. And what had happened was that Early in his illness, as he started to lose words and lose meaning of words, his visual systems geared up. Seeing colors, feeling colors.

obsessed with painting. Every painting he made was purple and yellow. This really odd obsession with these colors that were very much part of his inner world. And over time, with practice, Marcus became an extraordinary artist. He won many art fair contests. with his pictures of parrots and dogs and turtles. They had a very surrealistic feeling.

but really captured something profound and emotional that you would not have ever guessed that was inside Marcus's brain. And what did you understand is or may be happening here? Yes.

This has become a bit of an obsession for me, just like the art is for our patients. I have worked with many people thinking about the artists that I've worked with. These are artists with degenerative diseases. And the theme is very, very similar. The left side of the brain, which produces language. is affected and it seems to be turned down.

And maybe our left hemisphere, our language hemisphere, unnecessarily dominates the rest of our brain's activity. So as that language system turns off, We've learned that even with imaging, that the back of the brain, the visual part of the brain, turns on. Not everyone becomes an artist, but in one group of my patients, almost 10% become artists in the setting of loss of function in the anterior temporal lobe on the left.

I think a really important story about how we work, how the brain works, and the real strengths of people with degenerative diseases that we have historically overlooked.

In Virginia, you study social behavior and neurodegenerative diseases and neurodevelopmental conditions, and you have actually found that enhancing emotional empathy can be a feature of Alzheimer's disease. Can you tell us more about that? Sure. As Bruce mentioned, a lot of studies that we typically conduct in people with dementia and disorders of aging focus on loss and decline and empathy and different social abilities.

Clinically we have noticed that some people with Alzheimer's tend to become more sensitive and more emotional than they used to be. Sometimes families describe this as people becoming a little bit nicer, a little bit sweeter. Sometimes they describe their relationships have become deeper with the family member who is having a bit of cognitive trouble.

And so we've done a series of different studies trying to unpack what that might be exactly. So emotions can be hard to study and we have a variety of tools that we can use to try to quantify these kinds of changes. One simple way is by asking the family members to describe the changes that they see.

their loved ones and with these kinds of informant ratings we call them we found that people who have mild cognitive impairment which is that very early phase Alzheimer's that precedes real functional problems but there's minor you know problems with memory or other cognitive problems.

that people begin to become more emotionally sensitive to other people's feelings. Emotional empathy is a very specific kind of empathy that's kind of older than more... human kinds of empathy in the sense of emotion recognition so we can all identify emotions in others but we can also kind of feel how people experience the world and that's the emotional part of empathy.

resonate with their autonomic nervous systems we can mirror their facial expressions and that's the part of empathy that we think is climbing in those very early stages of Alzheimer's

People with Alzheimer's, am I right, are less likely to suddenly develop a creative or never-before-seen artistic talent or skill. Yes. Why is that? I think we've learned a lot from thinking that these degenerative diseases are all alike. They hit the brain diffusely. They don't. They start in a really focal area.

And Alzheimer's disease tends to start in the memory systems, but sometimes in the back of the brain where we visualize, where we create visually, where we write books and make speeches. So very early on in Alzheimer's disease, we often see loss of visual creativity. I've seen artists who were brilliant artists when the Alzheimer's started, that visual creativity really dampened.

So it's all about geography, anatomy. It's, you know, what in the brain is affected. And then sometimes if it's affected, it releases other areas.

And so what Marcus had was affecting the front part of his brain, right? The frontotemporal lobe. You have called that the most important part of the social brain. Yes. So tell us what you mean by the social brain. Yes, and I would even take that a step further. I think it's the most important part of our brain. So, So, and we neglect that. So, you know, I think we have a cognitive language, a logical thinking side of the brain which is predominantly left.

We give a lot of credence to this part of the brain, and we award it in schools, and this is something that we all recognize. But probably the most important part of human evolution, it's not so much language, it's our ability to work together in groups, to socialize together, to empathize with other members of our tribe. to work collectively. And we have massive circuitry in the brain, more on the right, more on the front.

that is devoted to this eloquent system of social communication, empathy, fairness. caring about and respecting others. And this massive system needs to be recognized and taught and developed if we are going to be successful adults and if our society is going to succeed.

So this is, for Virginia and me, the mysterious part of the brain that has been neglected. Well, what I wanted to... ask you staying with the creativity side for just a moment is whether or not when somebody does show a real artistic ability suddenly while they're experiencing some of this

language loss, for example, which I think tends to be how it's correlated. Does that make it any easier to support this person, say, if you're a caregiver? It's a great question, and I'd say... definitively, yes. I think, you know, it begins, I think, with recognizing our loved one's strength. This is part of the journey. And then having something that we can do with our loved one that actually improves over time.

It gives us a much greater sense of hope. It gives the person with this ability more pride, more hope. And so I think I've generalized this to all caregiving and degenerative diseases. What are the strengths? How do we support that person? And I think one of the things that Virginia and I tell in the story is that the brains of caregivers who are in that process of support are growing. This is one of the most beautiful things a human being can do.

Well, let me ask listeners, have you noticed this? Have you noticed a neurodegenerative disorder? creating a new skill in a loved one or a loved one becoming more sensitive or empathic, a change in someone experiencing. memory loss or cognitive change that you want to ask our doctors about. What questions do you have about the social brain? Email forum at kqed.org. Find us on our social channels at kqedforum. or call us at 866-733-6786, 866-733-6786.

A listener writes for my mom, as everything else left her because of her dementia, piano stayed the same. She never lost the ability to just sit down and play. We'll have more after the break. I'm Mina Kim. Support for Forum comes from San Francisco Opera. Amidst a terrible storm, Idomeneo promises the god Neptune that he will sacrifice the first person he sees if he and his crew survive the tempestuous water.

But as he arrives safely to shore, his relief transforms into horror when the first person he lays eyes upon is his own son. This summer, venture into the storm with Mozart's sublime opera Ida Mineo, June 14 to 25. Learn more at sfopera.com. Greetings, Boomtown. is booming Xfinity combines the power of internet and mobile so we've all got lightning fast speeds at home and on the go that's where our producers got the idea to mash our radio shows together

Through June 23rd, new customers can get 400 megabit Xfinity Internet and get one unlimited mobile line included, all for $40 a month for one year. Visit Xfinity.com to learn more. With paperless billing and auto paper store bank account, restrictions apply. Xfinity Internet required. Texas fees extra. After one year, rate increases to $110 a month. After two years, regular rates... Regular rate supply. Actual speeds vary.

You're listening to Forum. I'm Mina Kim. We're talking this hour about how a decline in one region of the brain can cause other regions to step in to help unlocking surprising capacities like deeper empathy or creativity we're talking about it with dr bruce miller aw and mary margaret clausen distinguished professor in neurology at ucsf director of the ucsf memory and aging center

Dr. Virginia Sturm is professor in the departments of Neurology and Psychiatry and Behavioral Sciences at UCSF. Together, they've written a new book called Mysteries of the Social Brain, Understanding Human Behavior Through Science. Let's just have you noticed this. in a loved one or maybe even in yourself that another region of the brain is experiencing sort of a support with regard to a new creative skill or new sensitivity to someone else's.

feelings, what questions would you like to ask our doctors about this type of dementia? So one of the things that you were mentioning about Marcus with regard to the language faculty decline, this is a function of what's called frontal temporal or frontotemporal dementia. Is that right? And so tell me a little bit about this. How prevalent is this, Virginia? I know that you also have studied this significantly. And I often hear that it's difficult to diagnose.

Well, we think that frontotemporal dementia or FTD is probably more common than is realized, especially when people have symptoms under the age of 65. So if people have early changes in thinking or behavior or sometimes movement. FTD might be an important disorder to consider. And this is one that does tend to start relatively young? Yes, this is one that does tend to start relatively young, even in people's 40s, 50s, 60s.

So it can be hard to diagnose FTD, one, because it's very heterogeneous. It has lots of symptoms associated with it, so people can have stark changes in their personality and their actions their empathy their emotions or they can have changes in their speech and their language and have trouble understanding words or producing speech So, given all of these complexities, it can be difficult to disentangle those symptoms from

more common diseases such as Alzheimer's, which is more frequently observed in our families and communities. So Bruce has done a lot of pioneering work in convincing people that you can diagnose FTD with a really careful, comprehensive evaluation that often includes a whole team of experts. who look at how people are moving, what they feel, perceive in their bodies, also how different kinds of their thinking are working, as well as their social behavior.

Well, we've got caller Lucinda on the line in Sausalito. Hi, Lucinda. Join us. Hey, good morning. Good morning. Go right ahead. I've been a watercolor for over 30 years, and I'm thinking about one student in particular. His name was Jack. He was an engineer, and when he started to show signs of Alzheimer's, his wife put him in my class.

And a few years later, he did ultimately pass away. The wife said, you have to come to the memorial. So I went to the memorial, and I opened up the memorial book. And there in the book it said what helped him in the end were my watercolor classes. And from what I understand, when you're creating, you're using different paths in your brain to connect to, you know, whatever you're doing. And I understand that this...

Helps people create new paths to functions. Listen to things. You know what this is making me think of, Bruce, is descriptions of people who... functionally and deliberately sort of turn off parts of their brain so that they can get in the zone of something? Yes. Is this similar to sort of almost what you're seeing? It's a very astute observation. I think what we've learned is doing something over and over again. eventually it becomes subconscious. It becomes natural.

And I think musicians talk about that space where... Suddenly, you know, the music just pours out without any deliberate conscious effort. When you watch someone like Steph Curry on a run of three-pointers. you get the sense that he is not conscious. This is happening deep in the brain where we are most effective at carrying out these skills. Absolutely. I think it's a paradox. It's an irony.

that to do something really well, you have to turn off, not turn on everything. That's not the way it works. Yeah. Though this ability to turn on a creative part of yourself when you are experiencing frontotemporal... dementia is relatively rare, right? Yes, I would say that in the study that was just done by one of our fellows, Adit Friedberg and Bill Seeley, we found that...

Most of the patients with frontotemporal dementia did not become visually creative, but there was close to 10% of those where the anterior temporal lobe was affected. And I think that underestimates. the actual creativity because You know, there are many people who become, you know, brilliant gardeners or, you know, within their own home reshape the

the architecture and the knickknacks in a way that is truly extraordinary. So I think one of the universal things that happens in front of temporal dementia is the back part of the brain is upregulated. It's rich soil for visual creativity, but you have to have the right fertilizer, the right environment. But I think Lucinda's story is very moving. And I've heard it before, and that is, you know, getting someone involved in this visual, emotional process.

can be the absolute saving part of their last years with a dementia. And it sounds like, Virginia, a role that a caregiver can play to create what, as Bruce is saying, is the right environment, the right fertilizer.

I think being open to seeing new strengths is the first step you know some people just Obviously, there's a lot of pain and struggling and it's easy to be overwhelmed and overtaken by that. But yeah, keeping an open mind to looking for these glimmers of preservation or new interest and kind of... cultivating those and helping to give opportunities to grow those I think is the first step.

So one of the reasons I ask about it being rare is because the book you co-authored with Bruce really gave a lot of examples of if this social part of your brain the frontotemporal lobe is degenerating. It actually has very significant consequences with regard to people's social faculties. I'm wondering if you could tell the story of Thomas.

Sure. Yeah, so a lot of people with frontotemporal dementia who have predominant atrophy or tissue loss in the anterior temporal lobes, especially in the right hemisphere, can have profound changes in empathy.

Thomas was a man who had been a very caring kind husband and father and over time his wife noticed that he became a bit more distant and disconnected and There was one kind of striking example where she had cut herself in the garden with some gardening shears and you know was bleeding and crying and his response was really cold and pragmatic and just like

well, you know, I need to return the gardening shares to the neighbor who they had borrowed them for, and she wanted to go to the hospital, and he really just missed all of the pain. and suffering that she was clearly exhibiting, and to her it was this very striking moment where she realized something was very wrong and very different in Thomas, like he thought wasn't the person he used to be. In the past, he would have been much more responsive to her pain.

So empathy is this ability that connects us to people and helps us to not only understand how other people are feeling, but to be motivated to help them in times of need. So if you can't recognize that someone is in pain or you can't feel and share that pain, then you're not motivated to do anything. You don't really think there's a problem.

We think that's what happens when there's this prominent atrophy in the right interior temporal lobe and the insula, another part of the brain that's nearby that helps us to know how we're feeling in our own bodies. Bruce, I'm wondering if you could contrast Thomas with another patient, Jamie. Tell us about Jamie. Jamie was a really like Marcus, one of the first patients that I ever saw with frontotemporal dementia, really seared into my brain, you know.

facts that I never understood before so Jamie as it turned out had a genetic form of frontotemporal dementia and she was incredibly creative with this illness, designed special swimming programs for college athletes. at the same time was incredibly cruel and disinhibited. She ended up with great good fortune. having someone from her high school coming back and meeting her in midlife and actually marrying her.

He protected her throughout the course of her very sad illness. At one point she even tried to strangle him, right? In my office it was the most startling thing I ever saw. She was totally mute. She had no use of her left hand. The right hemisphere of the social brain was really down to a little walnut in size. And as he was talking, suddenly her right hand reached out. And without a major effort on my part and her caregiver's part, you know, she could have killed him.

And so this incredible sociopathy that she developed. remarkably, actually ran in the family, was associated with this gene. So her mother had made a major invention, but burned down the factory in her 40s to get insurance. within 10 years was in a nursing home with the same degenerative dementia. So my friend Dan Geschwin and I studied this family with sociopathy.

lots of creativity associated with it, and eventually we helped to find the gene that was responsible for this subtype of frontotemporal dementia. The reason that I asked you to contrast this is because And I guess in Jamie's case, it's genetic, but that, you know, both Thomas and

Jamie were sort of different in their pre-degenerative lives. Thomas was actually a very empathic, caring, very giving soul, whereas Jamie was less so. And then when the degeneration occurred, Jamie's social circuitry was so weak that she was quite violent against her own caregiver who sounds like an extraordinary person.

whereas Thomas was cold and not responding appropriately, as one would expect one to do when someone is hurt, which I think is interesting. So I guess what I'm wondering is, Can you do something in your lifestyle?

to improve your social circuitry so that if you experience sort of degeneration in this front part of your brain, you're more likely to be a little bit like Thomas than maybe like Jamie, Virginia.

Yeah, that's a really great question. I mean, we think like all abilities, there's a normal range of you know empathy and kindness kind of in all of us some are just born very empathic and some of us aren't and that's not necessarily problematic or a sign of any disorder or illness but like you said if there's a significant change in where you started, then we start to worry about a disease and that's kind of what happened in Thomas. He had a nice healthy social brain.

But for some reason that we don't understand, at some point this disease process began in his brain and then attacked his social systems and he lost those abilities. We do think that we can all kind of bolster systems in our brain deliberately with effort and intention. People focus a lot on...

different cognitive games or crossword puzzles, things like that. And those could be great for those kinds of skills. But for social interactions or for social behavior, we think that really interacting with people is kind of at the heart of it you know so doing the things that um make your brain more responsive to others and more attentive to their needs

by interacting with people. There's research on things like volunteering and interacting intergenerationally can be great for the social brain, but doing things that give you a sense of purpose meaning I think in addition to just increasing your social engagement. can be great for boosting the social brain. So then is interacting online or on social media just as fortifying, Bruce? Absolutely. Every caller that is calling in today is...

benefiting the social brain, so absolutely. Well, let's get to some more callers. Let me go to Bill in Danville. Hi, Bill, you're on. Yes, hi. I'd like to share what I think is a relevant story. My mother-in-law, who was Japanese, was

went to skilled nursing with Parkinson's disease at age 95. And at age 96, she began painting. through an organization called Art with Elders that works with a bunch of senior facilities in the Bay Area that the folks might be familiar with. But she did that for five years while physically debilitated. It gave her a renewed purpose. She was of sound mind until she passed at 103, stopped painting when she was 101 after losing her eyesight. So this is a story very close to me.

How beautiful. Bill, thanks for sharing it. We love Art with Elders, by the way, Bill. Thank you for this. We have a show of... These elders, I think it's the most beautiful art that ever comes into the Memory and Aging Center, but once a year. And I bet your mother-in-law had one of those paintings on our walls, but absolutely. There's no age that is too old for either kindness or creativity and bringing out the best in people as

You know, one of the finest occupations that one can ever have. Bill, I heard you say so. Was there a thought you wanted to finish there? Only that she did participate in the annual exhibit, and boy, it just lifted her spirit. Bruce called and he said, I bet her art was there. Yes, it was. So thank you very much for the topic and the show. Regular listener. Thanks for the call.

Jean writes, I grew up with a very angry, critical, and suicidally depressed mother. When she developed dementia in her later years, she changed. As the dementia progressed, she became increasingly more pleasant, easygoing, and accepting. It was almost as though the brain damage that caused the dementia released her from the negative prison she'd been living in all her life. What a shame it took serious brain damage for her true self to shine through.

Release. I feel like I hear that a lot. Why does that word feel applicable, feel appropriate? Yeah, it's a common word used in behavioral neurology too. suggest that there was kind of some unleashing of an ability that was always lying dormant and couldn't be freed until unfortunately a disease process. kind of unchanged it from their shackles yeah um so it suggests that we all have these abilities kind of within us that are hidden and tucked away that um

if for whatever reason we could let them out, we'd all have greater human abilities and potential. Is this probably what you mean, Bruce, when you were saying at the top That you were taught to think of the degenerative process as deficits? Yes. How would you want to reframe it? I would want to reframe it around loss of function and specific circumstances. And that's how this works for many, many years. A circuit is slowly eroded.

We have great hope now that the new medicines and the new approaches will stop that erosion. Emily Dickinson called it decay. But we also know that sometimes circuits are turned on too strongly. that domineering, aggressive, self-oriented circuit that works in some ways in life prevented our caller from you know really connecting with her mom the kinder gentler side that was really suppressed. Well I definitely want to hear more about those

those potential therapies, maybe even cures right after the break. We're talking with Dr. Bruce Miller and Dr. Virginia Sturm of UCSF, both professors in the departments of neurology and also Emery and Aging Center there. Stay with us. Support for Forum comes from San Francisco Opera. Amidst a terrible storm, Idomeneo promises the god Neptune that he will sacrifice the first person he sees if he and his crew survive the tempestuous waters.

But as he arrives safely to shore, his relief transforms into horror when the first person he lays eyes upon is his own son. This summer, venture into the storm with Mozart's sublime opera Idomeneo, June 14-25. Learn more at sfopera.com. Support for Forum comes from Broadway SF, presenting Parade, the musical revival based on a true story.

From three-time Tony-winning composer Jason Robert Brown comes the story of Leo and Lucille Frank, a newlywed Jewish couple struggling to make a life in Georgia. When Leo is accused of an unspeakable crime, it propels them into an unimaginable test of faith, humanity, justice, and devotion. The riveting and gloriously hopeful parade plays the Orpheum Theater for three weeks only, May 20th through June 8th. Tickets on sale now at BroadwaySF.com.

You're listening to Forum. I'm Mina Kim. We're talking about dementia and the mysteries of the social brain, in particular how a decline in one region of the brain can cause another region to step in to help. Cases like this are being studied. UC San Francisco's Memory and Aging Center and they're being studied by Dr. Bruce Miller.

a director of the Memory and Aging Center and professor in neurology at UCSF, and with Dr. Virginia Sturm, professor in the departments of neurology and psychiatry and behavioral sciences at UCSF. Their new book is Mysteries of the Social Brain, Understanding Human Behavior Through Science.

Listeners, have you noticed a person with a neurodegenerative disorder develop a particular artistic skill or become more sensitive or empathic Have you noticed a change in a loved one experiencing memory loss or cognitive change that you want to ask our doctors about? What would you like to know about the social brain or what questions do you have about the best ways to strengthen our social circuitry? 866-733-6786, the number, email address, forum, at kqed.org.

find us on blue sky facebook instagram and threads we're at kqed forum ross writes as my wife's condition developed her artistic ability failed her and her social skills were overwhelmed but her loving personality seemed to survive As her caregiver over many years, I think I emerged after her death as an avatar of her higher qualities. I am a more generous person, possibly wiser, and I write poetry where I did not before my experience with her. Wow. Jamie writes,

My grandmother had vascular dementia and she indeed became much kinder and gentler as her disease progressed. She was a bitter woman. I always interpreted her softening as related to her decreased ability to ruminate on the pains of her past. Is this possibly a factor in these attitudinal shifts? What do you think? I think it's definitely possible. You know, the ability to produce emotions in our body doesn't require a lot of complicated cognitive processes.

as these different kinds of dementia do often disrupt memory and executive functions, things that the frontal lobes can do, planning and organizing. Things can become a bit more simple, you know, and people are in the present and feeling what they're feeling without a lot of maybe more complicated like was described rumination or holding on to grudges or you know things like that that can really kind of get in our way from just feeling emotions in the present.

Let me go to caller Sam in Oakland next. Hi, Sam. You're on. Hi, thanks for the topic. I can actually empathize with what folks are saying about their parents having personality changes. I think my father became... much more emotional and less reserved. But in his case, it actually was kind of a sad thing. But I was calling because... He has vascular dementia, and there's not a lot of services for people who are still, I like to say,

80, 85% there. And he is, you know, able to feed and close himself and cook for himself and things like that. But he definitely has some, you know, deficits. And I always felt like... you know, art therapy, social interaction, that sort of thing would be so helpful. We, you know, we love the Berkeley Senior Center and they do a wonderful job. I'm wondering if there's any, are there any other resources that you would recommend and help?

We can get folks like this into exploring art. Thank you so much for the program. Do you have thoughts on that, Bruce? Yeah. I mean, I think everyone is different. I think this is one of the things I've increasingly realized. For some people, music and dance is the absolute right thing to do. For others it may be visual creativity. I think a lot of data suggests that exercise is really good for the brain we release

compounds that we call exerkines, these decrease anxiety, depression, irritability. So, you know, I think Someday, as we get more sophisticated, and I hope it happens soon with regards to the caller's question, we will have a personalized approach. to everyone with these disorders and you know in her father's case maybe just socializing, just talking. Virginia did, I think, a gorgeous study around gratitude and awe. which maybe she could say a word about how this affects people. Please.

Sure. Well, in this study, we tried to use Emotions and specifically positive emotions are what we call pro-social emotions. So these are emotions like awe, compassion and gratitude to see if we could benefit people who as they were aging. And so awe is a very interesting emotion because it helps us feel more connected to this larger world around us and We feel small when we feel awe because we feel in the presence of something vast, but we feel

more a part of this larger world. And so it has this very important social function. So we did this study where we asked older adults to take awe walks. And these were just very simple outdoor walks once a week for 15 minutes. And we ask them to just pay attention to the details of the world around them, stop and appreciate the details of a leaf or flower or... the lighting and a set of tree leaves and then we followed them for a couple months to see what happened and

We compared them to other people who were just taking regular walks. So walking, we know, is very good for you. Being outside, a little bit of exercise is all good. So all walks had to kind of go above and beyond any benefits of exercise to convince us that they had...

special kind of role and we did find that the people who took awe walks did feel more awe but they also felt more compassion and gratitude and less fear and anger and sadness on a day-to-day basis than the people who took those control walks.

they also felt more connected to this kind of larger world around them. So we thought it had really kind of striking effects given that it was this very brief conversation that we had with people kind of just shifting their mindset to look around and pay attention while they were outside. And so those various kinds of simple mind shifts, changes, I think can be actually really powerful. And we underestimate what they can do over time, I think.

listener kim writes my 92 year old my 92 year old mother has expressive aphasia with other aspects of neurodegeneration she has lost her ability to speak but yet there are times when she can speak clearly usually after we prompt her with a memory or a photo of a family member Is there any attempt to understand how we can rewire a brain for speech? Yeah, much to my surprise when we started to look at the patients who had the progressive aphasia, progressive loss of speech and language.

they actually improved with formal rehabilitative therapy. So this to me was remarkable. It's a degenerative disease affecting the circuits in the left side of the brain that allow us to speak and understand. Yet, even in the setting of that illness, Regular work with a speech and language therapist made a difference, and it seemed to last for approximately a year.

So for me, this was a surprise. I didn't think that we could rehabilitate the brain in a degenerative disease, but, you know, it's not a cure. But in terms of quality of life for people with these illnesses, it's a first step. And as the medicines start to come, this will be unbelievably critical. I promised our listeners we would talk about where things stand with treatments. Where do things stand with treatments, Bruce?

I think we're really on the verge of something very profound, in the same way in our society with vaccines related to polio, suddenly an illness disappeared. I think that more and more we understand the molecules that are responsible for these diseases, understand the genes. realize that if we intervene in an early way that we might even prevent these diseases from happening.

and we have some really specific targets. I'm a tauist when it comes to this. The protein tau, I think, is absolutely the critical molecule that we must lower if we are going to treat these degenerative diseases. You know, UCSF, San Francisco, is just an extraordinary place. We work with Jennifer Doudna, our Nobel laureate, who invented CRISPR, Claire Cleland, and Fyodor Umhoff, they're all working.

thinking about lowering tau with CRISPR therapies. So gene editing, I guess, is the shorthand for it. You've got it, gene editing. And, you know, isn't it remarkable that a discovery just a few years ago suddenly is being applied to these horrible diseases. Yeah, I imagine gene editing, though, that is before it. pretty advanced to be really effective. It's everything. It's getting in very early.

I think we don't think we're going to be very effective in people with advanced disease. We've learned this in Alzheimer's. We must get people in the very earliest stages. And then we start to even imagine cures. so the key is detecting it early and know knowing what the the markers are yes and knowing how maybe social um what appears to be social degeneration is in fact a marker when we consider

The power of our social brain. Exactly. That's what we're talking about with Dr. Bruce Miller and with Dr. Virginia Sturm and their book Mysteries of the Social Brain. Let me go next to caller Amy. Looks like maybe we lost Amy. Let me go next to caller Nell in San Francisco. Hi, Nell. You're on.

Obrigado. hi thank you so much this topic is so fascinating both of my parents suffered with dementia. My dad's still alive, though, and he's been an artist his whole life, pre-accomplished, and watching the progression of his work, change over as his disease progressed. And the subject matter changing to this kind of extreme and disturbing subject for periods. And then mellowing out a bit. He's always had a great sense of humor. And there's humor in his work, but there was a very dark period.

fascinating you know upsetting but fascinating and at times I've almost wondered if there were drug interactions that were bringing up certain things or if it was just a phase of his disease. He still draws almost every day with not much what we would call facility. really look like his work at all anymore but he picks up bits of trash and glues it to other things and it's um you know he's in his mid 80s now it's just really

amazing to me. I always held on. Well, Nell, thanks for sharing that. I saw you nodding, Virginia, as Nell was sharing that story. What were you connecting to there and what Nell was saying? Well these diseases are very slow and gradual and we think that they progress not randomly through the brain but through these very specific connected neurons.

And so I was just kind of thinking about whether the changes in art that you noticed might reflect how the disease had affected a new part of the brain. or a different side of the brain, or there's some kind of tipping point that caused some shift in the art you know or um a dark period like you described that then resolved as the disease kind of moved on you know and um so it makes sense to me that there could be these kinds of um waves of

different kinds of themes or feelings in the art. I don't think we have the studies that have done it, you know, longitudinal deep analyses of themes across degenerative processes, but that would be very, very interesting to kind of map those things together. So I just wondered if that's what, you know, I'd be explaining her observations. Well, let me remind listeners, you are listening to Forum. I'm Mina Kim. And I believe Amy's back. Amy and Berkeley, are you there? Join us.

Yes, thank you so much. Thank you so much for this really meaningful show. I've had the honor of being caregiver to both of my grandparents. when they had dementia. And one of the things that I really noticed was, well, there were a few things, and then I have a question. But the importance of... family and friend connections and people staying connected and how that was so important to their social interaction.

as well as the day centers that they went to. But along those lines, like my grandfather had had a trade. He was a tradesman, but he also had been a boxer when he was very young. And when he got older, he didn't remember. anything about his identity, hardly except that he was a poet, that he did just, you know, for his own pleasure, as well as boxing. And one of the things that was really helpful for him was, although he could hardly walk,

even with a walker, the day center got a speed bag for him. So he was every day boxing that speed bag until a few days before. But another thing was that my grandmother... who very sadly, in her bad times, would have flashbacks to being sexually assaulted, but my mom said it never happened. And my grandfather would alternately be sometimes very angry.

That seemed very related to his experiences as a World War II soldier. And then afterwards, incredibly remorseful for both how he had treated his caregivers.

as well as what he had done in the war. And how much of what people, so my question is, how much of what people What experience do you think are these parts of themselves that were not known before? are actually based on experiences they had when they were younger. that they didn't talk about or were suppressed. Or even modulate their behavior. So not being angry, but maybe they felt angry when they were younger. Amy thanks. Virginia.

Yeah, it kind of reminds me of what we were talking about earlier with release. You know, one thing the frontal lobes do is they inhibit and suppress thoughts and behaviors. And so I think. You know, we all have had experiences that we don't want to be thinking about all the time or we don't want to be reliving stressful, negative life events all the time. So the frontal lobes probably...

are really adaptively helping us not feel those things all the time. But if you have a disease that affecting your frontal lobes all of those feelings might kind of be again kind of released from that suppression and then come up much more easily or much more powerfully like they had a long time ago

So I can imagine that those feelings don't disappear and that as people have these different forms of dementia they may be just hard to harder to keep them in check and so they kind of become overwhelming and take over sometimes. Well, listener on Blue Sky writes, my grandfather was diagnosed with dementia after what we were told was a flurry of small strokes. When we would fly back east for visits, he would come in and out of focus.

I had never once heard him crack a joke, but on one trip, he thumped my belly and said, I see they have food in California. So we've talked a lot about sort of reframing the way we think about neurodegenerative disorders.

I'm wondering if you feel like what you're learning and finding, Bruce, has implications for how we think about aging. I do think that there is a lot of fear that people do have about the fact that they will develop a neurodegenerative disease. I... I think my father always used to say, old age, you wouldn't want to live without experiencing it. And I agree. I think You know, we change. I'm changing. And I love and embrace the changes.

I think myself has gotten smaller. My grandchildren are bigger. There's an emotional world that I was too self-absorbed, really. realize. But yes, I think aging should be joyful, should be wonderful. And the brain is remodeling, and we play a role in that remodeling. What we do determines the outcomes of this. So we are not passive observers of this.

And if we are actively engaged in empathic behaviors, if we are actively engaged in exercise, building up our muscle systems, We are much better prepared for this last part of our incredible journey. Bruce Miller. Director of the Memory and Aging Center and Professor of Neurology at UCSF. Virginia Stern, Professor in Neurology and Psychiatry and Behavioral Sciences at UCSF as well.

Their new book is Mysteries of the Social Brain. Thank you both so much for joining us. Mysteries of the Social Brain, Understanding Human Behavior Through Science. Thank you, listeners. You've been listening to Forum. I'm Nina. Funds for the production of Forum are provided by the John S. and James L. Knight Foundation, the Generosity Foundation and the Corporation for Public Broadcasting.

Support for Forum comes from San Francisco Opera. Amidst a terrible storm, Idomeneo promises the god Neptune that he will sacrifice the first person he sees if he and his crew survive the tempestuous waters. but as he arrives safely to shore his relief transforms into horror when the first person he lays eyes upon is his own son This summer, venture into the storm with Mozart's sublime opera Idomeneo.

June 14 to 25. Learn more at sfopera.com. Support for Forum comes from Broadway SF, presenting Parade, the musical revival based on a true story. From three-time Tony-winning composer Jason Robert Brown comes the story of Leo and Lucille Frank, a newlywed Jewish couple struggling to make a life in Georgia. When Leo is accused of an unspeakable crime, it propels them into an unimaginable test of faith, humanity, justice, and devotion.

The riveting and gloriously hopeful parade plays the Orpheum Theater for three weeks only, May 20th through June 8th. Tickets on sale now at BroadwaySF.com Hey Forum listeners, it's Mina. I have exciting news. We're taking Forum Beyond the Airwaves, Beyond Podcasts, to your screen. Now you can watch the forum conversations you love and be in the room with me, Alexis, and our guests as we talk about the Bay Area, California, and beyond. at youtube.com slash kqbd news youtube.com slash kqbd news