Podcast Summary: "Cognitive Decline Expert: The Disease That Starts in Your 30s but Kills You in Your 70s"

The Diary Of A CEO with Steven Bartlett
Guest: Dr. Louisa Nicola
Date: February 5, 2026

Overview

In this episode, Steven Bartlett sits down with Dr. Louisa Nicola, a clinician, academic, and brain health expert, to discuss Alzheimer’s disease – a progressive cognitive disorder that silently begins its course in our 30s and, in many cases, proves fatal decades later. The conversation centers on the reality that Alzheimer’s is largely preventable, the unique risks women face, the importance of lifestyle interventions, and the actionable steps listeners can take to protect their brains and cognitive function across their lifespan.

Key Discussion Points & Insights

1. Alzheimer’s: Not Just Old Age (00:04–06:09)

• Alzheimer’s isn’t a disease of old age alone: Biological changes often begin in one's 30s, though symptoms emerge decades later.
• "60 million people worldwide have Alzheimer's, 70% being women... and it's a preventable disease." – Dr. Louisa Nicola (00:04)
• Alzheimer's is under the dementia umbrella, which includes various subtypes with differing causes.
• Key Insight: 95% of Alzheimer’s cases are rooted in lifestyle, not genetics (04:34–04:36).

2. Risk Factors and Genetics (03:30–05:24)

• Only about 3% of Alzheimer’s cases are purely due to genetic mutations (PSEN1, PSEN2, amyloid precursor protein genes).
• The APOE4 gene increases Alzheimer’s risk, especially for women (15:00–16:24).
  • Females with one copy are at sixfold risk; two copies, up to 15-fold.
• Notable Quote: "Being a woman is a risk factor." – Louisa (03:30)

3. Cognitive Reserve and Brain Health (08:41–12:34)

• Cognitive reserve: The brain’s capacity to buffer damage before symptoms appear; lifestyle choices (learning, handwriting, exercise) boost reserve.
• "Handwriting and reading preserve cognitive functions. Exercise is one of the most potent stimuli for brain health." – Louisa (12:00)
• Brain health and sharpness vary dramatically among older adults due to cognitive reserve differences.

4. The Power of Exercise & Sedentarism (13:47–25:14)

• Resistance training, especially heavy lifting (80% of 1RM), is the strongest lifestyle intervention for brain health and Alzheimer’s prevention.
• Notable Study: SMART trial – Resistance training twice/thrice weekly improved processing speed, intelligence, and preserved gray matter.
  • "The more you exercise, the bigger your brain." (13:22)
• Even "active sedentary" lifestyles (exercise + 10+ hours sitting) are dangerous; 10 air squats each hour can help offset risks (24:18–25:17).

5. Aerobic Training & Heart Remodeling (25:42–35:12)

• Cardiovascular fitness (VO2 max) and high-intensity workouts (Zone 5) remodel the heart and reverse aging-related deficits if started before 65.
• Four exercise types balance optimal benefit: weekly high-intensity intervals, long moderate sessions, moderate-intensity "talk test" cardio, and resistance training.
• Landmark Study: Dr. Ben Levine’s protocol reversed 20 years of cardiac aging with 4 hours of varied weekly exercise.

6. Women's Unique Risks: Menopause, Hormones, and the Brain (44:13–53:38)

• Menopausal estrogen decline causes a 30% drop in brain glucose metabolism, increasing Alzheimer’s risk.
• Ketogenic diets and hormone replacement therapy (HRT) may help, though HRT evidence is nuanced.
• "Being a woman is the next strongest risk factor for getting this disease." – Louisa (46:34)

7. Sleep: The Ultimate Brain Cleaner (57:54–64:04)

• Deep sleep activates the glymphatic system, washing out toxic amyloid beta.
• "One night of sleep deprivation raises your risk of amyloid beta by 4%." (07:00, 62:17)
• Sleep hygiene, temperature regulation, supplements (glycine, GABA, ashwagandha), and nightly "warm-down" routines protect cognition.

8. Supplements for Cognitive Health (69:50–77:45)

• Omega-3 (DHA): Crucial for cell membrane fluidity and blood-brain barrier integrity. Needs proper storage (refrigeration), verified brands (NSF certified).
  • "60% of our brain is made of fat. 70% of that is made of DHA." (71:55)
• Vitamin D: Deficiency increases dementia risk by 40%; high levels lower Alzheimer’s risk by 80%.
• Creatine: Shown to support brain energy and function. Higher doses (20g/day in some studies) benefited Alzheimer’s patients, with additional anti-cancer and anti-stress properties.
  • "You can creatine your way out of sleep deprivation… It protects your brain." (00:04, 79:15)

9. Novelty & Neural Challenge: Growing the "Willpower Muscle" (88:29–103:07)

• Cognitive drills: Processing speed games; hand-eye coordination using tennis balls and eye patches improve executive function and build neural connections.
• "Doing hard things is what is going to improve brain function over the lifespan. Doing hard things tells your brain that you can do hard things. Have you heard of the anterior mid cingulate cortex (AMCC)?" (96:27)
• The AMCC, known as the "willpower muscle," grows through challenge and withers with avoidance/sedentarism.
• Superagers have larger AMCCs; sedentary, risk-averse people have atrophy.

10. Women, Representation, and Prevention (105:12–109:27)

• Women are underrepresented in research, downplay symptoms, and are affected by misinformation (e.g., hormone therapy fears).
• Louisa’s personal narrative: Driven by her grandmother’s illness and loss, she’s passionate about advocacy for women’s brain health.
  • "I'm angry and I'm passionate because women have been lied to, they've been underrepresented, they downplay their symptoms." (00:04, 105:32)

11. Maintaining Brain States & Success (115:26–116:29)

• For Dr. Nicola, success is the ability to shift brain states—engage focused, motivated, or restful modes at will.
• "I think the ultimate form of success... is being able to go from brain state to brain state and then be able to recover." (115:32)

12. Faith, Science, and the Limits of Biology (120:21–124:22)

• On God and hope amidst cognitive decline: There are mysteries and recoveries science still can't fully explain.
• Belief, faith, and meaning provide solace where medicine cannot reach.
  • "There’s just some things that medicine can't answer." (123:08)

Notable Quotes & Memorable Moments

• On Prevention:
  • "95% of it could have been prevented." – Louisa (04:34)
• On Women’s Risk:
  • "Being a woman is a risk factor." (03:30)
• On Cognitive Reserve:
  • "Handwriting and reading preserve cognitive functions. Exercise is one of the most potent stimulus for brain health." (12:00)
• On Exercise:
  • "Having strong legs is by far the most important tool in your toolbox for the prevention of Alzheimer's disease." (16:40)
  • "The more you exercise, the bigger your brain." (13:22)
• On the Willpower Muscle (AMCC):
  • "Doing hard things is what is going to improve brain function over the lifespan. Doing hard things tells your brain that you can do hard things.... This area of the brain gets bigger." (96:27, 98:00)
• On Supplements:
  • "I don't care who you are, you should definitely be having creatine." (00:04, 79:15)
• Personal Motivation:
  • "My grandmother... never asked for what she wanted, and she never asked for what she needed, which was help.... I think about her every day." (105:32–109:03)

Timestamps for Key Segments

• [00:04] — Opening context; creatine as a brain supplement; Louisa’s motivation
• [03:00] — Why Alzheimer’s is a modern crisis
• [04:34] — 95% of Alzheimer’s is preventable
• [09:20] — Sharpness & cognitive reserve in older adults
• [13:47] — Exercise’s impact, resistance training vs. other forms
• [16:40] — Leg strength and identical twins study
• [24:18] — The “active sedentary” risk and hourly squats
• [32:15] — Remodeling the heart with exercise
• [44:13] — Menopause, estrogen, and women’s unique Alzheimer’s risks
• [57:54] — Amyloid, tau, and the role of sleep
• [62:17] — Sleep deprivation raises Alzheimer’s risk
• [69:50] — Omega-3: storage, certification, function
• [75:34] — Creatine’s brain benefits and proper dosing
• [88:29] — Processing speed games; brain training
• [96:27] — AMCC, doing hard things, and building resilience
• [105:32] — Louisa’s family, women’s advocacy
• [115:32] — What success means to Louisa
• [120:30] — God, faith, and the limits of medical science

Actionable Takeaways

• Start early: Brain changes start in your 30s—prioritize prevention now.
• Exercise: Regular, heavy resistance plus aerobic training (especially before age 65) are neuroprotective; work legs; avoid sedentarism.
• Supplement wisely: Omega-3 (refrigerated, NSF-certified), Vitamin D, creatine (5–20g/day as studied), possibly glycine, ashwagandha, GABA for sleep/stress.
• Manage your sleep: 7-8 hours nightly; prepare environment; prioritize deep sleep.
• Women-specific: Consider ketogenic diets and discuss HRT with your physician during menopause transition.
• Challenge your brain: Seek novelty, complexity, and difficulty; hand-eye drills, reading, social engagement, and intellectual challenge all matter.
• Routine testing: Monitor blood pressure, vitamins, and—if high-risk—consider cognitive biomarkers as technology improves.
• Advocate for yourself: Especially for women, don’t ignore symptoms—seek answers and push for prevention.

Tone & Style

The episode is direct, passionate, and evidence-driven, with Louisa balancing scientific rigor with personal candor and emotional resonance. Steven Bartlett's probing brings out both the technical and human sides of the Alzheimer’s crisis, and the conversation is motivating, occasionally urgent, but never alarmist.

Final Message:
“Memories are the essence of life. If Alzheimer’s steals them, it takes everything. But science now shows: most of us can fight back—starting today.”