Brain health snapshot: Social connection, blood pressure, AI, and creatine

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters, and this is the Brain Health Podcast.
We are back again, and we are now the Brain Health Podcast. It's sort of like, it's almost like shiny and new.

Dr. Correa:
Yes.

Dr. Peters:
Very shiny and new, Daniel. So today we're bringing highlights from four articles from brainhealth.com. And the first one is what our relationships can do for our brains, practical ways to manage blood pressure, how teens are using chatbots, wow, for emotional support. This is really interesting.

Dr. Correa:
It's coming everywhere.

Dr. Peters:
I know. I know. And then what's really interesting, there's also an article on creatine and brain health. So definitely we're going to delve into these articles. What do you think, Daniel?

Dr. Correa:
Yeah, we're going to look at each article, what it says, talk some about the evidence, what it can and can't tell us, and one thing you could try in your own life. We also will see if we can, if we have some time, I'll give you some updates from last week's 2026 Brain Health Summit in Washington DC.

Dr. Peters:
Yeah, I hope you had a great time there and you kept your brain healthy. Must have been a fun group. So the first one is about how a strong social network can help protect your brain health. And let's start with a question. Who notices when something is different about you, encourage you to take a walk or helps you get to an appointment? How does a strong social network help protect your brain health? Public health researcher Bernadette Boden-

Dr. Correa:
Albala, yes.

Dr. Peters:
Albala, sorry. Describes why these relationships matter for health.

Dr. Correa:
Yeah. Our social connections can ease stress and help us keep up healthy routines, but they're also a practical way of supporting our improved health and engagement for activity. The article describes research among people who had a stroke and those who were married or lived with a partner were more likely to reach emergency care within three hours, which we know and we've talked about before is a key component of the treatment window for certain types of strokes. That tells us something about the possible value of someone nearby who recognizes a change.
Well, one thing that in context is some people might interpret that as, oh, that a spouse or a partner is required for brain health. And I want to clarify that this is just within this study, they looked at whether or not someone had a spouse or partner. It does not mean that you need a spouse for good brain health. But I know that for me, my wife and social connections are essential to my own health.
The study does not prove that any single relationship prevents stroke, but that having those engagements could be a benefit towards prevention.

Dr. Peters:
One of my favorite talks at the AAN was by Dr. Louise McCullough. She's a stroke neurologist, and this is what she studies in her lab, is social isolation, even in mice and how it really translates to what happens in humans. And I think this article really makes a great point about how different people can serve different roles, having neighbors check in, a friend might walk with you, a family member might help you with a ride. Sometimes it also depends your social networks where you are in the time of your life, they can dynamically change. But I think it's also important to say who's in your network. I've been actually now using the analogy with my own patients is that we're sort of all on the plane together and we're all going to get to the same destination somehow. So I feel part of their social network too.
Now, Daniel, what do you do when you have a patient? It's so important for seizure patients, particularly in regards to driving or also knowing what those other colleagues or friends need to do if someone has a seizure. What do you say to someone when they say, "I don't have a big network?"

Dr. Correa:
So it means you get to start fresh. That's great. I encourage people to think about something that they enjoy, an activity, an aspect or hobby, and then pick from that a repeatable point of connection. And so what I mean is maybe you don't have a specific thing, you just want to connect with people. So you might invite people around you and your community and neighbor out for some coffee and try to make that a more regular interaction that you're having.
You might join a walking or community movement group. I know I'm part of that generation of certain males that just didn't have a whole lot of friends. A lot of my connections and social connections were through work. And several years ago looked for community groups in Harlem and one, as I've mentioned before, has been Harlem Run or a community run group. And through that has become a regular point of connection where I've broadened across ages and different perspectives, friends in my local community.
You might try to reconnect with someone that you trust. If there's just someone you've been thinking about wanting to regularly connect, you might sort of put that on your calendar and reach out to them at a regular interval. Quality and reliability matter the most in collecting these contacts and these social connections.
If you live with a neurologic condition, you might look for peer groups or community groups or a peer organization in that area. So we often talk about the value of community from these patient advocacy and community organizations that represent either disabilities or living with various different neurologic conditions. This can be another place to find people who understand your experience.
And in a possible stroke where someone might have a focal change, sudden face drooping, arm weakness, these are the kinds of things that people who know you would then be able to notice, and as like this article pointed out, would be there as a part of your initial rapid response to a possible change in your conditions. But if not, even if not about prevention of a specific condition, it's just about improvement in our quality of life and day.

Dr. Peters:
One of the things I always think about as we sort of inch towards the winter holidays is that finding a project with a group or planning something, our group decided to make a pet calendar for the holidays during the pandemic and that tradition has stuck. And so now it's a whole tradition, but we have a calendar group that comes together and plans. So it's a lot of fun that we do as a group and it's a mental activity. And so we don't get isolated and we celebrate our pets.

Dr. Correa:
I love that.

Dr. Peters:
I know, but I guess I love the exercise idea, Daniel. I agree, if there's one sort of takeaway, reach out to one person this week maybe and make an invitation, like would you like to take a 20, 10 minute walk? Maybe on a Thursday. Listen to the podcast together.

Dr. Correa:
Yes, yes. And maybe that ends at a coffee shop or somewhere for something delicious, or maybe it's just a trip to the grocery store together with someone in your building or a neighbor.
So one of the other articles that we really thought was a great highlight for our listeners talks about ways to think about your blood pressure. So a vascular neurologist, Andrew Sutherland, gives us top five tips for better blood pressure. High blood pressure is often something that doesn't necessarily come with symptoms, yet over time some symptoms or complications might develop, including an increase in stroke risk.
So his five suggested ideas was one, to know your numbers. So some awareness of what your blood pressure is and not just when it was two or three months ago at the last visit. But either going to a local center where you can get a health center, community health area, maybe even a CVS where you can check your blood pressure more regularly if you don't have a blood pressure cuff at home.
I often suggest to community members or patients before the next time you're going in for a visit with your primary care doctor or another doctor like a vascular neurologist or even your neurologist, check your blood pressure two or three times a day. Three is ideally best. And if one of those times can be while you're lying down or after getting up in the morning, that can help, because our blood pressure changes throughout the day and sometimes with different positions. And if we only use the number that when you come into the office, we might be missing something that's important.
So awareness and knowing your numbers, having a little bit of that written down for a few days or a week can be very helpful.
Think about making some sustainable food changes, adjustments in the salt content, and also we've talked about before, the MIND or the Mediterranean diet. And again, that these are inspirations for types of foods that should be included in your diet, not that the foods have to be from a Mediterranean style recipe.
And then discuss medication when it's needed. So whether that's with your primary care doctor or another doctor that's helping you manage your blood pressure. Understanding the other risk factors that might be contributing to your blood pressure or might be resulting from elevated or prolonged elevated blood pressure, and then connect those numbers to other things that might impact your daily living. So if you're having a challenge with your blood pressure and one of your medications makes you urinate or go to the bathroom more often and that's a limitation for an activity that you do or your work, it's important to have this in conversation with your doctor.
I remember a situation of someone after a stroke was really having a challenge with control of their blood pressure and the pumping of their heart or what we call heart failure. And we find out that he wasn't able to take his Lasix or his what is often described as a water pill more regularly or as recommended because he was a bus driver. And so until that conversation was had, we couldn't figure out and work out with the cardiologist maybe the best timing for that medicine so that way he could complete his shift as a bus driver, but then still get the effect of the Lasix before and after his shift.
So that's just some ideas along with the types of recommendations that Dr. Sutherland lays out.

Dr. Peters:
I think really getting to know your numbers and what those blood pressures are, I think you really hit on a good point, because you get those one-time numbers at your doctor's office and they often talk about white coat syndrome. I think if somebody has high blood pressure, they may even get a little anxious when they're taking their own blood pressure.
So Daniel, can you give our listeners a little bit more 411 on what does that mean to know your numbers and what is getting those readings beyond just being in a doctor's office? What would be your advice?

Dr. Correa:
Yeah, I think like I was saying, not just the one time, finding a place where you can check it a few different times a day. Or considering and discussing with your doctor, maybe does home monitoring make sense for you? And what's the value and the cost of that to buy a device? Or maybe if it's covered under your insurance with a prescription, they can help with a device that can either record your blood pressure for you or at least record it and then you add it to a journal.
And then for you and your risk factors, how often should you be checking it? The situations can be very different. It could be that you just have some slightly elevated blood pressure, you're on medicines, they just want you to check it every now and then, maybe the week before you go see the doctor. If it's a very regular challenge for you, they might ask you to check your blood pressure every day, twice or three times a day, and then that way to really help them until you're very clearly setting within goals.
It's important that you use a certified and validated blood pressure monitor that ideally is of the upper arm. There are some things out there that are sold that can be done at the wrist. They're not always very consistently accurate. And if your doctor really recommends monitoring more regularly, then you should be using a blood pressure cuff that monitors and goes on your upper arm.
You want to sit quietly for a few minutes before and then put both feet on the floor, have the arm that you're going to be recording on be supported and a little bit more relaxed, and then record your blood pressure at that time. And then ideally recording it a few times over several days.
So bring that record then to your primary care doctor or another doctor who's working with you with your blood pressure to help them interpret not just one high number in the office or on its own, but to see where you range throughout the day. And that might really help thinking about do you need medicine twice a day? Do you need a different medicine in the morning or different doses in the morning and evening?
In general, for a lot of people, the goal would be the high number, the systolic blood pressure being below 130, over the low number, the diastolic blood pressure being below 80. But there can be various different situations and reasons why other people's goals might be at a different point. So it may be really important to discuss where you fit within these ranges with your doctor. And I think because of past, some people might hear those numbers and think, "Well, that's lower than I thought." And that's because recommendations have changed and we've seen a big benefit to these lower ranges for various different conditions, including stroke prevention.

Dr. Peters:
And you mentioned diet before, Daniel. This article emphasized the Mediterranean style pattern, paying attention to your salt intake. Many packaged restaurant foods can be just so salty and have such a high content. What else did you see in the article that is sort of important for blood pressure control?

Dr. Correa:
I always end up leaning towards some activity, movement, exercise first. So that is a key thing, your activity level or exercise level has been shown to be associated with better control of your blood pressure. In a way, we're training our heart and the system that controls our blood pressure to have better control of our heart rate and the blood pressure with activity, which means we respond a little bit more controlled also to stress in other situations or might help us manage stress.
Reducing or stopping smoking, along with reducing or stopping alcohol intake are also areas that can help reduce and manage your blood pressure. Along with our sleep. And so there's two things in sleep, finding what is your right number for sleep. There are recommended numbers out there, yes, eight hours, but it varies for people, but seeing where you truly feel rested for numbers of hours. And a lot of people think for them that might be six or seven, but then how do you feel on the third day of vacation after getting a little bit more sleep? If you find, oh, I'm so much more rested after a few days of vacation getting seven or eight, then maybe you really day-to-day you should be working towards closer to that number.
But also determining or finding out if you have sleep apnea. So if you have partners or live with people that might be able to hear whether or not you're slurring at night, whether or not you wake up in the morning maybe with a headache or feeling just very poorly rested, dry mouth, or have periods at night where people notice that you have changes or stops in your breathing, then you might need to be screened for sleep apnea. And if there's not someone around you that can do that, then you might consider just discussing since you have high blood pressure, if you have other risk factors for sleep apnea and asking your doctors to send you for a screening.
Because we've seen that having untreated sleep apnea is just as risky for your medical condition, for high blood pressure control, for stroke and dementia risk as smoking in and of itself. So treating it and having it well controlled and using whatever device is recommended for you for most nights and at least five hours can actually resolve or remove that significant risk.
Medication might be, and often is going to be probably the right tool for some people, but it's not necessarily a personal change or failure if you need medicine. This is just important and part of the things that we do for our health. So if cost or side effects for a medication get in the way, like we talked about in the idea of our bus driver friend, tell your doctor, clinician so that they can help you work out things in terms of timing, different doses, different medicines, things that are generic. There's lots of different options to know, but we have to have a discussion about why you might be having a challenge or why you don't feel well on a certain medicine.

Dr. Peters:
I like that you stressed evaluation for sleep apnea to a great degree. I think it is critical and it's something that can be treated appropriately. And it's something now that we can get tested easier even in the home. So don't think you need to go to a formal sleep lab all the time.
And I think really the big takeaway is know what your blood pressure is. Some people don't know. It's not something that's monitored. If you don't know how to monitor it, figure out how to monitor it and bring a log to your doctor's office so that you can ask questions.
So our third one is a little bit about technology that I don't really know that much about, but I'm sure our teens do, and it's a story on how AI chatbots can affect teen mental health. And I mean, I don't even know how I would use a chatbot, but I know they're out there, but teens sometimes use them for homework or for curiosity, and they may also turn to them as a friend or a confidant when they feel lonely, stressed, or even sad or upset. So I think this technology is there and I think I need to become more informed, so I appreciate the article, because it's not something that I knew much about.

Dr. Correa:
Yeah. I think we're at a stage where we all have to be more aware about how AI impacts different aspects of our life, how it's being used in different settings, how it might impact our family members at all ages. Someone who's interacting with a chatbot should also really have an understanding of what it's doing and how it works, and they tend to reflect back some of your own, whatever the personality and the characteristics that you're feeding into it. So it could sound warm and very certain or clear even when its advice might be wrong or it actually might be just reflecting back what it thinks that the user or responder wants to hear, or its response might lead to unsafe, distressful concerns. It also cannot necessarily notice or understand like we do when we're talking together with a friend, the emotional situation or the full context of the situation that might be going on.
So it's important that we don't think of it as a replacement to a trusted medical provider or mental health professional who can really kind of take in some of these nonverbal signals or really ask directed follow-up questions in a way that sometimes these large language models or AI chatbots may not be really trained to do or then understand when there is an emergency. We need to distinguish it as a useful tool that someone might use within a specific task, whether it's for homework or something else, and from a actual substitute to a relationship or interaction or even clinical care. People are using it to interpret lots of data and information, but we have to be careful with that in whatever kind of data is being looked at. But especially when we think about our own healthcare and our own health data and even clinical care.
The long-term effects, overall we don't know, but it's being actually studied. There are researchers specifically looking at the effects on various age groups, but particularly teen development. We can't completely hide AI from them because they will be the generations to really truly use it, but we need to understand what are the safe and ethical ways to use this.

Dr. Peters:
It's interesting, Daniel, I think about who introduced me first to AI and it was my fellows. So it's people that were junior than me that I'm training and they're like, "You should try this and work with this." So I think there's temptation to want to be like, "Well, you shouldn't use this," or really question it or even maybe sort of lecture about it. And I think parents may feel that way. What sort of conversations do you think are sort of better guide learning about this for people that may be, us older people that don't necessarily use this that aren't in our teenage years anymore?

Dr. Correa:
Yeah, I think like you said, there's a lot we can learn from other generations, and especially the teens and adolescents, and understand about what's going on in the world, and not just the latest music. So I think leading with curiosity, asking them about what tools they do use. You might ask how they ask them or how they prompt these tools? Has a response ever felt uncomfortable? And this allows really a discussion for both of you to learn about how they're used, maybe the ways that they're kind of changing workflows.
And maybe then also help point out to your kids or this next generation possible ways where you see, oh, that might be a little bit concerning and you want to be aware of in this. Or I see how that might introduce errors with your own knowledge of writing or in the types of classes they might be using it for and it asking about questions for a professional thing or so maybe they're using it to help them with an application for a summer job. But you can help us point out to them ways that they really need to make sure they are carefully reviewing what it's using and what it puts out. So trying out a few prompts together and maybe even working on some of these tasks that they are using it for together can help you see the kinds of answers and interaction.
And then making a plan for who the teen can contact when something feels off or serious in whatever way they're using it, whether it's for a social kind of interaction or mental health related or anything that relates to just the work or how they're interacting with these tools. They're built in now to so many of the software, so even our email and Word documents might have some interaction or input from AI. So there's no way to completely avoid it.
But we also should look to, within our own community members and especially teens, to notice if there's changes in sleep, changes in the social interaction and time with friends, any distress when a tool like an AI or large language model becomes unavailable. Or if there's a belief that the chatbot is their most trusted or only confidant, then we really have to make sure that we are working to help support them with more trusted and true trusted interactions and support.
So settings and parental controls on computers and different things can help, but I imagine these things are changing so often that we can't just purely rely on screen time and parental control settings across all the different devices, because some of these things are just through your browser. And so it's important that we have a continuing and curious two-way conversation.

Dr. Peters:
I like that, a curious two-way conversation, because you need to sometimes ask the tough questions. And so if there is a teen that's talking about self-harm or suicide, you want to treat it very seriously. I mean, this is a real safety concern. You want to stay with them, seek emergent help, ask questions. In the United States, there is a suicide crisis lifeline or hotline. You can call or text 988 for a crisis support and call emergency services, of course, for any kind of immediate danger. Those are severe cases, but it's something that needs to be considered and taken seriously.
And I think it's important to just highlight that mental health is health and we need to care for it the same way we do when we were just talking about blood pressure. We need to also monitor for those really challenging feelings and crises that need help. So remember, call or text 988 for crisis support for the Suicide Crisis Lifeline.

Dr. Correa:
So maybe within our families and households, a practical question or prompt for our discussion would be what could you bring to a person instead of a chatbot when you're overwhelmed, and who would that person be? So just having that discussion of the types of challenges that people are using chatbots for, who are the other people that can be a resource for those family members?

Dr. Peters:
And then you can blend that together, Daniel, and you can go for a walk. And also after that, let's check some blood pressures, right?

Dr. Correa:
Yeah. Walk to the CVS and then line up for the little arm blood pressure machine.

Dr. Peters:
Exactly.

Dr. Correa:
Our fourth highlight, and this will be the last article we'll highlight for today, was talking about one of these supplements that has been in the news a lot recently, is a very substantially studied supplement out there. And thinking about what do we know about the brain, creatine in the brain, promise versus proof, can creatine improve brain health? So this highlight again on the brainhealth.com of can creatine improve brain health highlights this naturally occurring chemical and that is a supplement that's out there and it helps cells replenish energy as the broad or simple description of what it does chemically. And it's used and has been studied for a long time to support strength and high-intensity exercise. In general, the suggestion is that its effect is relatively shorter-lasting.
The question has been though of whether it can improve memory and whether it might prevent or help modify different neurologic conditions, which is a whole different question from the extensive research in the past on supporting strength and muscle building.

Dr. Peters:
Daniel, I think every time we sort of dip our toe into the supplement arena or sort of the other complementary alternative opportunities or therapies that can exist, you and I talk a lot about exercise and diet, and we promote brain-healthy diets, brain-healthy exercise. I think the problem I have personally with supplements is I know what the food is that I'm eating and I know when I'm moving my body that I'm moving my body. But for supplements, if it's something that's packaged in a pill or a powder, I have a hard time knowing what really is in there and what that means. And so that gives me a little discomfort whenever I have to think about it for my patients or myself.
I guess Daniel, what has actually been tested? What has been studied with creatine? What's been out there about it? Because it is not regulated.

Dr. Correa:
So this is a key thing. I think first that you're pointing out, there's a difference between the regulations of medications from the Federal Drug Administration, the FDA. And there's the consistency and the testing, its purity, and the focus of how much even the dose can vary in a tab or the medication is much stricter for things that are approved from the FDA, as opposed to supplements which don't go through those standards. And so supplements are allowed to vary in dose and have much less frequent testing a lot more.
So one thing is if you're looking at any supplement, I often would suggest to people that they maybe should look at supplements that have NSF or safe for sport certifications because those are things then that athletes know they can take because they're tested more often and have extra testing on them to make sure that they don't have anything that falls them in error with things that they're not allowed to take during athletics, whether that's collegiate or professional sports. Sometimes those supplements end up being a little bit more expensive because of that added testing.
But that would be one thing. And again, we're going to speak more to what's actually been tested on brain health or neurologic conditions. There's lots of past testing on muscle health and muscle strength.
So the article describes several small studies involving sleep deprivation or preventing people from getting enough sleep and their memory, plus a 20 person Alzheimer's disease study in which everyone received creatine. So without a placebo, that's a key thing that there wasn't a comparison to someone not receiving it, in that Alzheimer's study of 20 people, they showed improvements, but there wasn't clearly that you could attribute it to creatine. Also, because there was also no comparison to the placebo. In larger studies in Parkinson's disease and Huntington's disease, it didn't show that what we all would've hoped for, that there was some improvement and benefit. And so therefore not really suggesting any improvement that directly attributes to the brain, and also not necessarily whether or not there's an improvement related to the effects on the muscle in these conditions where there's a lot of movement related challenges.
We do not have an established dose from these studies and any of the larger studies that could impact brain health or evidence to recommend that creatine is a treatment that could help or modify Alzheimer's disease or other neurodegenerative diseases. What we do have is the evidence over time about creatine for people who are working on strength and muscle health.

Dr. Peters:
Yeah. I think when you look at this and people will say about dosing, they often say so many grams a day online. Sometimes it's in a gummy formulation. Sometimes there's other supplements mixed in. So I think you need to be extremely careful when you're looking at sort of... I as a doctor don't know a dose that I could tell you.

Dr. Correa:
Yeah. And so that 3 to 5 grams is what's out there and has been kind of described and studied more for muscle performance for healthy adults. It is not at all related to anything with brain health. No studies have really shown consistent evidence in that direction. If you already take creatine for exercise, let your clinician know. Because although it has not been associated to lead to any problems with kidney, but it can change some of your kidney numbers. And if you have kidney disease, they have to be aware of you using creatine and that interpretation.
Ask about supplement quality if you're going to be thinking about these like I suggested before, and any reasons why creatine use might be unsuitable for you. Always important to consider your situation. And don't use it in place of all the other things that we know are a benefit to your brain health, and even your body and systemic health, whether that's sleep, your movement and activity level, blood pressure care or other prescribed medications.
But I would admit, I do regular strength and endurance exercise work. And so based off of some of the evidence in the past, I use and have tried a 5 milligram supplementation in my routine somewhat consistently and my labs have been stable and I hope that maybe in time there'll be some better evidence to show I'm getting something else out of it, but I'm not counting on it. It's much more thinking about its benefit towards my time in the gym.

Dr. Peters:
Yeah. I think the takeaway before buying any supplement, whether it's involving brain health or really any supplement that you're essentially taking for maybe some type of health outcome, what has the outcome actually shown in who and compared it and then ask the amount of benefit that's been seen or described? And also how much does the supplement cost and is it available? I want to be careful with those before you know what's in there. And I guess I would always lean towards good old-fashioned exercise and a good healthy brain diet. Those would be my big recommendations.

Dr. Correa:
Absolutely. I think so too. That's the first place to start before trying to add any additional supplement.

Dr. Peters:
So, four very different articles; I think you could blend them all together. You need to connect with someone, you need to learn your blood pressure, be open to teens about their AI experiences, maybe even learn from them. And then I would also say look closely at what is going on with supplement research and what it actually shows.

Dr. Correa:
Absolutely. Yeah. Don't take the advertisements or what's on the front of a box or bottle as the primary evidence for why you should be taking something.
And you can find all four of these stories on brainhealth.com. We'll link them and some more information in the show notes. And what's one thing you can do for your brain health? Share it with us and share with others. We want to know what you are doing each day, and sharing this episode and the things that you find helpful on brainhealth.com could be one of your ways of connecting and inviting someone into a conversation.

Dr. Peters:
Thank you for joining us today on the Brain Health Podcast. Follow and subscribe so you don't miss our weekly episodes.

Dr. Correa:
Also, for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions and you can send these in by email to podcast@brainhealth.com, or leave us a message at 612-928-6206. I'm Dr. Daniel Correa connecting with you from New York City, and you can find me on social media at neurodrcorrea.

Dr. Peters:
And I am Dr. Katy Peters, joining you from Durham, North Carolina and online at Katy Peters MD PhD.

Dr. Correa:
But most importantly, thank you and all of our community members for letting us be part of your brain health journey. You make this podcast what it is, and by listening each week, you're helping us promote brain health for all.

Dr. Peters:
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