November 19, 2015 • 47 mins
The number of people suffering from dementia is expected to explode in the coming decades and, in a pleasant surprise, countries around the world are taking steps to plan for the increase in friendly, caring ways.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff you Should Know from the house stuff
Works dot Com. Hey, and welcome to the podcast. I'm
Josh Clark with Charles W Chuck Bryant and Noel. The
Stint of Noel continues. Everybody's like, stuff you should know. No, no,
(00:22):
that's not what we're calling it. It's the stint of Noel,
all right, stuff you should know? Well, that's too clever. Yeah,
it's a little cutie. Yeah that's all. That's my only
aversion to it. What do you are you with stuff
you should know? Changing the name of our show after
(00:43):
eight years? No, just the Noel stint the name of it.
Remember the Summer of Sam? Oh? Yeah, yeah, sure, why not?
I don't like it? All right? Should we come up
with the third idea? Yeah? The Stint of Noel sounds
too much like so something's wrong with nol. That's why
I like it. It's hilarious. There's nothing wrong with Noel,
(01:06):
by God, And if you think there is, you need
to answer to me. There's something you should know. M
And I see that's what I'm saying. It sounds like
something Strickland would have come up with. Oh, you know,
and we haven't been in a flame war with Strickland
in a while. It's been too long, gotten soft, you
just launched one across the bowl. So um, chuck, Yes,
(01:29):
are you familiar with dementia? Uh? Yeah, sure, are you
running your family? And doesn't run in the family. But
my grandmother who lived to be a hundred, I had
to mention at some point, which you know, when you
live to be a hundred, that's I don't know about likely,
but it's not surprising. It's probably pretty likely. It's Um,
(01:49):
it's not from what I understand, it's not a uh
just a natural consequence of age, but it's pretty prevalent um.
And dementia is actually super misunderstood. Gets confused with Alzheimer's
a lot or there's a lot of different kinds of dementia,
but dementia is actually it's not a disease. It's a
(02:10):
set of symptoms that's broad on. But disease. Yeah, I
think that is widely misunderstood. But you are totally correct,
a set of symptoms and um, it is not just
your garden variety um forgetfulness that comes as you age, No,
because that is age related and that is a totally
(02:31):
age related things called age associated memory. Impairment, and that
is uh, I think, I mean that happens to everyone, right,
It's just like you forget your keys more often, that
kind of stuff. But when you do forget your keys
more often, you can snap your finger and go, I
forgot my keys again, what is wrong with me? Yeah,
that's normal. One of the big tales of true dementia
(02:52):
is when you don't realize that you're forgetting right. So
that's that's when it gets scary. And um we said
that it's not a natural, real consequence of age. And
one of the things that I turned up in researching
this is we're not exactly sure what causes dementia. We
don't even know if some of the tell tale signs
of dementia are the cause of dementia in some cases
(03:14):
or the result of dementia. Not entirely certain, but um,
it is very widespread among the aged population in the
United States. I think five point three million Americans have
dementia right now. And as our population ages, because the
baby boomers are starting to get older, um, I think
they're expecting something like sixteen million Americans are going to
(03:37):
have it. By sixteen million, is I think how many?
About how many people have it around the world right now,
and in America alone, we're gonna have that number in
twenty fifty. And it's very expensive. Actually, Uh, how much
money a lot? You're ready for this? In two thousand fifteen,
we have spent two hundred and twenty six billion dollars
(03:59):
on health care for dementia, while um, and they're expecting,
by I believe, when we are caring for sixteen million
in two thousand fifteen dollars not futuristic, much more inflated.
In two thousand fifteen dollars will be spending about one
point two trillion dollars on dementia. If somebody doesn't do something. Man, Yeah,
(04:24):
it's it's very expensive. It's also extraordinarily sad as far
as UM diseases or symptoms of diseases. Yeah, yeah, and uh.
I also want to recommend our May eleven episode a
podcast to remember our memory episode ties sevenly into this.
So if you haven't listened to that one yet, go
listen to that one, either before or after, or if
(04:45):
you listen to it and forgot, go back and listen
to it. That's right. So dementia itself is not UM diagnosed. Uh,
it's not simply memory loss. It's memory loss UM along
with one of the following at least one of the
following one or more. Um aphasia, which is UH if
you can't understand or produce language any longer. A praxia
(05:07):
and all these are super sad if you've ever seen
him up close. A praxia if you cannot make certain
movements even though your body physically is healthy. UM agnosia,
which is UH you don't recognize UM objects like the
remote control or your grandkids stuff like that. UH. And
then executive dysfunction UM when you have a lot of
(05:28):
troubles planning and organizing and reasoning. So that, along with
the memory loss, at least one of these you could
be diagnosed with dementia. And so, like we said, dementia
is a set of symptoms, right, yes, it's it's actually
brought on by disease. And the most common cause of dementia.
I think something like UM sixty or seventy or something
(05:48):
like that of dementia UM cases is brought on by
Alzheimer's disease. I could have sworn we did one in Alzheimer's,
but we have not. Yeah, I don't think we have.
I don't know. We've talked about it enough. I think, yeah,
it's popped up plenty of times, but we've never just
done a straight up Alzheimer's one. Alzheimer's brings on dementia
through um something called neuro february fibrullary tangles also known
(06:13):
as beta I'm sorry, TOW protein tangles and um beta
amyloid plaques, right, yeah, and just a protein build up,
a sticky protein build up, yeah, which is so when
you when your neurons fire and you have a thought,
it's an electrochemical process, and there's residual that is left behind,
(06:33):
and these residuals can build up in your synapses and
cause your synapses to not fire as well. And when
your synapses don't fire as well, they start to die
off in the neurons that are there that lead from
these synapses or lead to these synapses die themselves, and
you have neural loss. Like literally, the brain cells in
your brain are dying off at a rapid rate. And
(06:55):
when it's caused by beta proteins and TOW or beta
amaloid plaques and TOW proteins in the cells, than what
you have is Alzheimer's. Yeah, and they aren't sure the
cause of Alzheimer's still UM. Genetics is uh. They think
has a lot to do with it. UM. And you
can live with Alzheimer's for a while up to a
(07:15):
decade all they they sit in this article, Moley says
three to five years is more common, so it definitely
shortened your lifespan. And like you said, UM, genes are
definitely part of the risk factors. UM. A polypo protein,
a pop protein eka, I think, UM, which is weird.
(07:38):
If you have a mutation on this gene, you have
a higher risk of Alzheimer's, even though the gene just
codes for a protein that carries cholesterol through your bloodstream. Yeah,
it doesn't have anything to do with the tow protein
tangles or anything like that as far as I know.
That's weird. Um. Also, if you have a family history
of dementia you're you have of Alzheimer's, you have a
(07:59):
higher likelihood UM. And then if you have down syndrome,
you are at a higher risk of developing Alzheimer's in
middle age. Interesting. So UM, that's and we will do
one in Alzheimer's. But that's how Alzheimer's can cause dementia. Uh,
there's also vascular dementia, which is that was the case
(08:21):
with my grandfather who he had a stroke, and it
accounts for about twenty of dementia cases. And uh, you know,
stroke is when you have a loss of blood supply
to the to the brain or a hemorrhage and or
blood clot and it can be either um, one big
stroke event which causes a lot of damage and that's
(08:42):
a single in farct dementia, or it can be a
lot of the accumulation of symptoms because of a lot
of little many strokes you have over the years, and
then the damage just builds up and you finally once
once that last one, that that is the straw that
breaks the camel's back. Yeah, and you have dementia. Um,
(09:02):
that happens pretty rapidly after that last that last one,
that last stroke you had. Yeah, and that's a multi
infarc when it's a bunch of them. Um, and little
mini strokes are common a lot. Sometimes you have them
and don't even realize you've had him. Uh. With my grandfather,
he he had the big one. And yeah, we talked
about this before and I think something about speech, but um, yeah,
(09:25):
he lost his ability to speak you know English. Uh,
so that would be a phasia. Yes, he couldn't produce language. Well,
he produced Yes, he cannot produce language. He said things,
but it you know, it didn't make any sense, but
he had an understanding. You could see the frustration. Uh,
you know, I know how to how I'm supposed to. Uh,
(09:46):
my grandmother is driving us, let's say, and he she
doesn't know how to get there. He does and he
can't tell her, but he's telling her. Yeah, it's just
coming out all mixed up. And that's that's a hallmark
of dementia, is um. There's emotional changes in the person
because they they're not communicating like they want to say,
(10:06):
people aren't responding like they want the people to, and
they'll get snippy and then ultimately say withdrawal. They'll just
give up on communicating at all because it's too frustrating
or just too sad, you know, um, which is it's
one of the common results of dementia. It's a comorbidity.
Now it's a complication. Yeah. And then and with the
(10:26):
single stroke event um or actually or with the multi
uh strokes, it's different for everyone. There isn't any single
like well, this is going to happen because this person
had a stroke. It could be a variety of different
things from you know, paralysis on one side of the
face or body bow and bladder control problems. He didn't
(10:47):
have any of those. He looked totally the same physically,
He walked and talked this same except for the fact
that they weren't real words. That was like the most
noticeable thing. I remember you telling me about your grandfather before.
I don't remember what it was a long time. We
were talking about speech, like we're Nikki's area or Broca's area, Yeah,
something like that. So with Alzheimer's, it first attacks the hippocampus,
(11:10):
which means that it's going to take away your um
episodic memory, which is your memory of recent events, right. Uh.
And then it starts to move its way into other
areas of the brain where your judgment is affected, your
speech patterns are going to be affected, your personality is
very much affected in changes with Alzheimer's. With Alzheimer's, but
(11:32):
not as much with the stroke. Yeah, with vascular dementia,
you know, there might be some other things um where
like part of the faces sagging, or or the patient
can't move their arm or something like that. But yeah,
the personality will remain intact because those regions of the
brain aren't affected like they are in Alzheimer's. And then
in about five of dementia cases, Uh, it stems from
(11:52):
something called Louis body dementia UM, which we were just
talking about. They think Robin Williams might have suffered from
He definitely did. He definitely did. They found in his
autopsy he had. I think he was diagnosed with it
before he died. That was one of the reasons why
he took his life. Yeah, because that can cause severe
intense hallucinations. Uh, big time. Did you look those up? Oh? Yeah,
(12:15):
many scary stuff like very apparently a typical one is
very brightly colored animal or person. Yeah, that you see
in great detail for many minutes on daily daily basis,
Like just intense hallucinations. I'm sure you think you're you know,
losing it, right. And that's one of the first symptoms
of a Louis body dementia. And it was discovered by
Frederick Louis and nineteen twelve and has has nothing to
(12:39):
do with your body. A Louis body is Uh, there
are are deposits again, protein deposits of the alpha uh
sinucleon that appear on the brain. So don't think of
body in the terms of like your physical body. Uh.
And this is also president Louis bodies and Parkinson's. So
as a result, not only are you going to have
(12:59):
some them similar to Alzheimer's with Louis body dementia, but
also some of the tremors and balance issues of Parkinson's,
which is uh, super sad as well. Is that what
Michael J. Fox, Yes, Parkinson's. Yeah, and that's what the
movie Awakenings was about. When they wasn't it like a
group of Parkinson's patients that like L. Dobo worked on,
(13:21):
is that Parkinson's I can't remember. I think they didn't.
They didn't realize what they thought they were locked in
or something, and then realized their Parkinson's trummers were so
acute that they were like they were not even shaking,
they were just yeah, interesting, They're just their muscles were
totally contracted rather than contracting and relaxing again and again.
And Robert Williams, Yeah, how about that? Yeah. Uh. Then
(13:44):
we have something that used to be well it's called
now front o temporal dementia, used to be called picks disease,
but now Picks disease is a uh specific version which
I couldn't really sus out what the difference is, could
you know? I couldn't as long as it wasn't just me,
I feel better. But f t D is it's really
(14:07):
an umbrella term. Um. It's about five percent of dementia
cases and it's going to affect personality and behavior and
language time, big time. And it's where your frontal and
temporal lobes are actually atrophying and shrinking, right, And the
reason why is um. You remember, with Alzheimer's you have
beta amyloid plaques and tow protein tangles. Well, with the
(14:29):
frontal temporal dementia, you don't have the beta amaloid plaques.
You just have the tow protein t angles. But it's
enough to cause massive neuronal loss. Yeah, and this is
like I think a lot of people at first think
they might have UM tourette. Yeah, because you can yell
things out inappropriate behaviors. Uh. Yeah, Like if your grandfather
(14:52):
suddenly becomes hyper interested in sex and like likes to
talk about it in public or exposes himself to people
in public, there's a pretty good chance that he has
developed front o temporal um dementia or if I did,
because um, it's unusual in that it attacks younger people. Um,
it's gonna on set between forty and seventy years old,
(15:13):
which distinguishes it from other types of dementia. And if
your grandfather used to do that stuff already, then that's
not the case. The key here is that like this
has come out of the blue, somebody has really just
completely changed in their personality. They might get into really
risky behavior like gambling all of a sudden, shop lifting,
(15:34):
and like risky investments are like pulling all their money
out of the bank and with picks disease too. Um,
the apparently apathy is a big indicator of this. There's
a big personality change and the person is no longer
they have no empathy, they have blunted emotions, and then
they may also be engaging in risky behavior. So basically,
(15:57):
your grandpa or your grandma has just turned into like
the trans border you know, or me or you, well, yeah,
you lack empathy. No no, no, I'm just saying it's
because it affects you. Something turned into you. Oh no, no, no,
you have blunted emotions and you gamble. Uh, there's also
Huntington's disease. Uh. This is uh, it seems like much
(16:20):
more physical in nature, uncontrollable movements, although there are changes
in in personality. But um real fidgety, herky jerky. Uh.
Your brain loses the ability to control coordination essentially, right,
which is I think, uh fifty chance of inheriting the gene.
(16:40):
But you can live with it for up to twenty years. Yeah,
which seems like as far as dementiao is one of
the longer life expectancies. But again, I mean, like I
would guess this has kind of become clear. The hallmark
of dementia is memory loss paired with some other problem
like not being able to create speech any longer recognized speech,
(17:03):
or not being able to move that kind of thing,
or not being able to plan um. And like we said,
well we should probably take a break. Huh. Yeah, we
got a couple of more types that we'll talk about
and then some other good stuff. Okay, right after this,
(17:37):
the last two, actually the last three we're gonna talk
about because there are many, many other kinds of dementia.
Like we could spend hours and hours talking about all
the different kinds hours, but we have talked about kreitz
Felt yakup disease, and I can't remember which one. And
is there a disease that kills by preventing sleep? Oh?
(17:59):
Is that the one which we should have rightly called
how prion diseases worked? Yeah, because it is is a
prion infection. It's very rare, about one um out of
a million people will be affected in any given year,
like mad cow disease. Yeah, exactly. Um, it's a sponge
of form disease. So crazy it is. It's very interesting.
(18:23):
It could be genetic. Um. But and I thought we
also talked about it an organ transplant. We I think so,
because it can occur because of infected tissue that you
are implanted with or from an organ. Yeah. And this
is neuronal loss due to the like holes literally being
eaten into your brain by this disease. Yeah. Um. And
(18:47):
then you can also get dementia UM from from when
you have HIV. If you are a boxer or say
a football player in the NFL, you may have dementia
from a traumatic brain injury, a concussion or repeated concussions. Um.
And there are plenty of diseases. There's also um reversible
(19:08):
dementia too. If you have a vitamin deficiency, if you
um uh take certain medications, um, you can develop dementia.
But this is reversible for the most part. Though age
associated dementia is not reversible. And like we said, it's
kind of tricky to diagnose this stuff because it is
(19:30):
normal for people to become more forgetful as you age,
and then to make it even more confounding if you're
a diagnostician, not only are do people get more forgetful.
There's an intermediate stage between dementia, a dementia diagnosis, and
just normal age related forgetfulness, and that is um called
(19:53):
mild cognitive impairment. So if you can catch this from
what I understand, and we'll talk about treat and said
everything later. But if you can catch things like Alzheimer's
and other um other diseases that lead to dementia early,
although there's no cure for any of them, you can
you can manage them a lot better and delay say
(20:14):
death or like the real devastation associated with it by
a significant amount of time. But it's catching is the
tricky part. And especially if you have dementia, you don't
really realize that there's any kind of problem. Um, So
you're probably not going to take yourself to the doctor. No,
but you what you should do is listen to your
(20:36):
loved ones because they are going to be looking at
you a little more closely uh than you can. You
know that that they're more perspective. Yeah, exactly, that's what
you're looking for. Um, So don't get you know, don't
get offended if if a loved one says, let's go
get you checked out, because you can do something if
you catch it early on. Unless you're very wealthy and
(20:57):
it's you're no good nephew that you've never trusted anyone,
you know, then maybe bring a lawyer in on it. Uh.
So if you do go get checked out. Um, from
the second you walk in the door, your doctor is
gonna be eyeball on you and looking for any signs,
um just from their their trained eye, like you know,
(21:18):
from how you walk to the way you answer questions,
to how they interact with you. Uh, they want to
know you're They're gonna have to know your history, um
because they need to have some context to compare it to. Right,
like were you always a compulsive gambler? Is just like
new behavior yeah, and it helps to bring you know
if if um, if you're older, maybe bring your grown
(21:40):
son or daughter with you or whoever has a lot
of contact, although your spouse you never know what, I
don't know, maybe trying to get ready you. Oh yeah
like that, No good, nephew, Yeah exactly. Um, I'm just kidding,
of course, although I'm sure that happens. Then there are
a couple of tests that they usually do in conjunction
with one another, um, the Mini Mental State Examination the
(22:05):
m m s E UM just a lot of basic
questions there um for mental tasks, but they're coded. The
tasks are yeah, and they're scored individually. Yeah. Um. And
when you when you M say question three, this person
got an eid on, you can go over and be like, yeah, dementia.
(22:25):
It's actually pretty effective actually. And there's another test that
ties into the mm SC that um. There they both
indicate one another, which apparently they're both really good at
indicating dementia. But there's other tests called the clock drawing test.
Did you look this thing up? Yeah? I thought that's
pretty fascinating. It really is. It seems really like, why
(22:46):
would someone tell someone to draw a clock at a
certain time of the day. Yeah. Usually they say draw
a clock showing that it's ten after eleven. And it
makes a lot of sense in a lot of way
because it draws on all these different kinds or different
regions of the brain, different um skills. Right, So, like,
(23:07):
first of all, you have to remember what a clock
is and what it signifies. That's a big one. What
it looks like. Uh, yeah, as clock isn't made of
like squiggly lines or anything like that. Um, you have
to remember how a clock is laid out, the order
that the numbers go in that it doesn't keep going
after twelve to thirteen, fourteen, fifteen. And then once you
(23:27):
got all this, you have to show the hands showing
that it's ten after eleven. So the hands won't be
pointing at ten and eleven, it should be uh, the
longer hand should be pointing at the two, and the
shorter hand should be just past the eleven. Right. This
requires a tremendous amount of brain power, even though it's
very simple and straightforward, and you can tell a lot
(23:48):
about a person's mental faculties just by having them draw this. Yeah,
the four specific things that requires their verbal understanding memory
spatially coded knowledge and constructive skills, and if any of
those are off in conjunction with the MMS, then they're
gonna have a pretty good idea where you fall on
the dementia scale. If you don't have the constructive skills
(24:08):
to pay the bills, you may have dementia. That's right.
And they actually, um, I looked at one study about
the clock drawing tests. Basically I think it was just
a more recent like, hey, let's go in and really
look at this thing again and it checks out. Yeah.
They stood behind and said, yeah, it's actually a really
good indicator. Yeah, like it really holds up. And they
think they developed it in the sixties, but it didn't
(24:30):
take off until the eighties. And then they do you know,
but it's something you can do anywhere. And now they're
starting to gather these um different clocks that people with
different types of dementia drawing and basically compiling them into
a database so you know what to look for. Even
more like, oh, somebody draws a clock that has like
a thirteen fourteen on it, they may have this type
(24:51):
of dimension, right, and this one looks like Sabod or
Dali drew it. Uh, then they might have this kind
of dementia, or they might just be super talented creative.
You never know. Um, all right, let's uh should we
take another break? Why not? Is it time? Sure? All right,
we'll be back after this talk about treatment and some
of the other pitfalls of dementia. So Chuck, we've kind
(25:34):
of um, I think it's almost goes without saying, like
the problems associated with with dementia, like you lose your
ability to um reason in a lot of cases, you
lose your ability to to move and take care of yourself.
You lose your memories, you have trouble forming new memories,
you have trouble recognizing people. Um. So living life is
(25:56):
extremely difficult. Um. But there's also like other complications that
you may or may not think of. Right. So, let's
say you're an elderly person and you have a battery
of medications that you need to take for unrelated heart disease.
Do you think you're going to remember to take those medications?
Probably not. Even if you have like a time or
(26:17):
set or some sort of calendar or something like that,
you may have trouble even remembering that you have a
calendar that you need to go check out to see
what's on there. Let alone to take the medication that's
indicated that's on that calendar. Yeah, that's a big problem. Uh,
nutrition itself is a big problem. Either you forget to
eat altogether, or you think you've already eaten, or you
(26:41):
physically have deteriorated so that you can't control the muscles,
the true and to chew and swallow. A good joke.
It's a real danger. So when people die from Alzheimer's
it sounds kind of strange if you think about it.
It's like, well, no, they forgot they lost their memory
or whatever. No, the brain is actually being slowly destroyed
period aodically, and eventually it's going to reach the parts
(27:02):
of the brain where like you can't swallow any longer.
Then you die from that kind of thing. Um, you
also can lose your sense of hunger, like you just
aren't hungry anymore. Kind of tough to eat, especially when
you're not thinking or remembering that you should eat, um,
when you're just not hungry. Ever. Yeah, this to one. Hygiene.
(27:23):
Reduced hygiene is a big one. UM. A lot of
times in severe dementia cases, you either are unable to
bathe and dress yourself and brush your teeth or you
forget to. Uh, it just falls by the wayside um.
I know that was the case with my grandmother. She needed,
you know, she needed to be bathed by my dad
because she lost interest in it or because she just
(27:44):
couldn't do it anymore. Uh, I think both. Yeah, yeah, um,
that's another indicator. You said that when you go in
for a diagnosis, the doctor is going to be watching
you and just kind of sizing you up. One of
the things you'll look for is whether you look disheveled.
That's a big one. And especially if your son or
daughter is saying, like, this is really bizarre behavior because
(28:06):
mom always like dressed to the nines. She just wears
this dirty old bathrobe all the time and doesn't ever
want to take a shower. That's that's usually an indicator
of dementia. Yeah, it's not like she just gave up
and doesn't care anymore. It's it's part of the symptoms. Hold. Although,
another problem with dementia, and one of the confounding factors,
(28:28):
is that depression can be a byproduct or come morbidity
of dementia because you recognize that your life is changing
in ways that you're not happy about you can't communicate anymore,
you forget stuff all the time. You can become depressed. Um.
So then that could lead to you giving up on
taking showers and dressing as well. Yeah. And not only depressed,
(28:49):
but um agitated and aggressive um riddle with anxiety. A
lot of your emotional well being and emotional health will
be uh slipping away from you. Yeah. And again this
can be a direct result of chemical changes in your
brain due to dementia, or it can be like your
this is the result of you recognizing these changes and
(29:12):
and just be coming upset about them. We talked about communication, UM,
and the hallucinations. You're gonna have trouble sleeping as well
in a lot of cases. Uh. And then personal safety UM.
A lot of people die every day because of accidents
that happened as a result of dementia, people who shouldn't
be driving it into cars. Um. And there's this there's
(29:35):
a push that's going on now, I think in the
last year or so UM as part of the Council
on Aging, like the United States Council and Aging, there's
a new initiative called the Dementia Friendly America Initiative. Really
neat Yeah, it's basically saying, look, we've got about one
in eight people over sixty five and the US have dementia.
We're about to have way more than that in the
(29:57):
next couple of decades. We need to be prepared for
this kind of thing. So let's start training America how
to recognize the signs of dementia and then how to
react to it in a friendly and helpful manner so
that people who are wandering around with dementia don't withdraw
eighty thousand dollars from their bank account and and walk
(30:17):
around with it in their pockets outside. Yeah, and how
do you do that? You you get some money uh
from the government as a grant to go out and
hire people to literally go to businesses and go to
restaurants and talk to waiters and waitresses or should I
just say waitron's uh. Go to banks and talk to tellers,
(30:38):
go to uh anywhere where there's interaction with another human,
grocery store checkout people, and literally train them on, like
you said, how to recognize it and how to kindly
deal with these people, right exactly. Um. Apparently one of
the things you teach people in service industries is not
take it personally. That if somebody's behaving around clear or
(31:00):
they're using incorrect words, and they're of a certain age,
the chances are they probably have dementia. And there's ways
of dealing with it. Um. Apparently, responding to it in
a soft, friendly manner tends to get results from the
dementia patient. Um, especially if you are not being an
(31:21):
aggressive jerking right exactly. It just being nice will will
frequently get good results. Um. And Yeah, it is a
pretty neat initiative absolute um and and necessary. Yeah, you know,
but it's it's I'm stricken by the idea that people
are planning out this far ahead for this kind of thing.
(31:44):
It's exceptional, it is and scary. Uh So if you
do have a family member, one thing that's I'm important
to remember. There's something called the caregiver burden that my
dad and his wife definitely experienced. It is really really
on you, on your family. Uh and it can actually
take a physical toll. Um. They have some stats here
(32:07):
if you your risk of death as a woman if
your husband has dementia increases in the first year after
they're diagnosed, and only for a husband whose wife is diagnosed.
Um and then a little pretty significant inco just from
(32:27):
the dementia diagnosis. Yeah, and um, what they recommend in
this article is to take care of yourself first, because
they found that if you are not going into this
with the right attitude and you are upset or have anxiety,
you're just gonna do more harm anyway. So get yourself right,
(32:47):
take care of yourself, and go into it in the
right frame of mind, and you'll actually be able to
help better. Yeah, and this, this caregiver burden or caregiver
burnout is a very real thing physically too. Like you,
um have low energy, you'r you have low productivity, You
become snippy, resentful, angry, and you can end up basically
mistreating your own parents or spouse because you're so upset
(33:11):
with this horrific disease. One of the hallmarks of dementia
is that that that there's no two days that are alike,
and when you're dealing with the dementia patient, what worked
yesterday isn't gonna necessarily work today. Well, if you can
no longer predict what your life is going to be
like from day to day and you're spending I think
(33:33):
I saw this one study that found an average of
twenty two hours a week of unpaid care by spouses, wives, daughters,
that kind of thing. Um, your you can very easily
get stressed out. The main thing you have to do
is ask for a respect care. Like. You can't do
it by yourself. You have to have other family members,
(33:54):
members of your church, your community come and give you
a break so you can go do other stuff for
a while. Absolutely, And I mean you could totally see
how you could just very easily evolve a really unhealthy
dynamic if you're just trying to do it yourself. Because
you lose perspective. This becomes your norm, even though it's
totally abnormal. Yeah, and boy you talk about it's a
(34:16):
really sad way to damage what previously was a good
relationship with a parent or something. It is devastating, you know. Um.
So there are drugs that they use to help stave
off dementia. Um, mainly right now. They are colon estras inhibitors,
(34:39):
uh and they suppress colonestras, which is an enzyme that
breaks down uh uh cta CEO lathing which we talked
about before. That's what helps transmit messages between neurons. So
that will help. Yeah, because if you're not commu indicating
(35:00):
as much as you were before. At least the communication
that is going on can stick around longer. You know.
It's seems primitive as far as like brain drugs go,
but it makes sense, you know. Yeah. And then there's
another one. Are they still using this believes momanten uh,
And it inhibitates inhibits glutamate, which we talked about before,
(35:24):
which causes neuron death when over stimulated. Yeah. I can't
remember where we talked about that one either. I just
remember glutamate from the Umami episode. Yeah, I was definitely
that one. Um. And then there's also stuff you can
so these drugs will help some. That's for non vascular dementia, right.
With with vascular dementia, you're gonna want to take blood thinners, yeah,
(35:48):
to keep more strokes from coming along and making the
whole thing worse. Um. And then with like Louis body disease,
to deal with things like the hallucinations and stuff, you'll
probably also be given anti psychotics as well. Um. And
one thing that they're starting to realize more and more,
it's very difficult to really figure out what kind of
dementia people have just from um uh, what's the scan. Yeah,
(36:12):
MRI I scan UM, and you can really go back
and accurately identify types of UM dementia from autopsies, right,
And so for more and more autosies, they're finding that
there's a lot of what's called mixed dementia, where you
have Alzheimer's and vascular dementia, or where you have Alzheimer's
and Louis Bodies disease UM. And so it can be
(36:36):
really tough to suss out all the different kinds of
dementia person might have. But if you can do that,
then you can you can put them on a drug
regimen that could really kind of help more than just
treating the Alzheimer's and letting the Louis body go unrecognized
and rampant or unchecked. There's also preventative stuff you can
do too. Oh yeah, yeah, like what cross or puzzles. Yeah,
(37:01):
I told you. Emily's grandmother, Mary is ninety five and
very sharp. Uh, and she does word puzzles all the
live long day and uh this is sodoku. Yeah, she does.
She does all kinds of word puzzles. Yeah, things that
I have never even heard of. It supposedly that helps
stave it off apparently, Um, this one's great. Alcohol. Moderate
(37:24):
alcohol consumption, which is two a day or for men
or one a day for women. Okay, Uh, has a
protective effect. It staves off all stays off dementia. They're
not sure why, they're not sure what kind of alcohol
is the best. They just know that for some reason,
alcohol has a protective effect. Uh. Probably up to that
(37:46):
to drinks, and then it's probably bad after that. Then
it becomes very bad after that. So you want to
just moderate amount, right in all things, people, moderation, moderation. Uh.
And then uh, there are some things that you can do.
Here's the thing. There's a a debate on whether or not, um,
(38:07):
you're tricking your loved one by doing things like, um,
giving them an appliance that doesn't work, so they can
pretend that they're ironing or something because they used to
love to take care of their laundry themselves. So here,
let me remove the cord from this iron. And uh.
(38:28):
And is that tricking someone? Is it not? Uh? And
a lot of people think, no, that's what you should
do because it makes them feel like they're being useful.
They're not gonna get hurt with a hot iron. So
it's all good. Other people say no, that means that
they're not hanging onto that last bit of reality they
may have. I think it's fine. I think it's fine too.
(38:50):
And there's actually, um, there's a an entire village set
up in I think like just outside of Amsterdam. Yeah,
this is awesome, right, Yeah, how would you say that?
I have because Dutch is the weirdest, the weirdest language,
we'll say that, okay, Um, And uh, it's a it
(39:11):
is a it's an what's called the Dementia village. Basically
where everyone who lives in this village, I think a
hundred and fifty people all have dementia and they live
in group houses there. Well there's caretakers that live there too,
but okay, yes, you're right, um, And they live in
the group houses with them, and a lot of the
people realize that this is their nurse or just think
(39:34):
it's a good friend of theirs. They don't really remember
where when they became friends. Yeah, exactly. Um. And the
houses they live in have different themes according to how
the people lived, depending on whether they are blue collar,
whether they their memories go back to the seventies. This
whole place is basically set up so that it's a very, um,
(39:55):
non threatening safe place because people just kind of live
and um move about within safely. Yeah, safely. Um. And
so they can go to the grocery store, they can
go to the movies, they can go ride a bike,
and everyone, the people at the movie theater, I know
that the people there have dementia, right like every They're
(40:16):
real movie theater workers and reil waiters in the restaurant
especially trained exactly. So it's a less clinical setting than
say a nursing home. And a lot of people say
this is awesome because it's as close to real normal
life that they were used to as they're gonna get.
Yeah exactly. Uh. Then of course there's other people that
poople would say, no, you're tricking these people. But but
(40:38):
you can say, hey, okay, here's here's the big difference
with this place. If this if this dementia patient gets
lost in Manhattan and they run across the city worker
who's collecting garbage, that city worker may do absolutely nothing
to help them. In Hovey Village, that city worker especially
(40:59):
trained to get that person back to their house or
alert their caretaker that this person is having a crisis.
Or something like that. That's what we're trying to train
people to do in the future. Yes, they've just isolated
it to a community. Yeah, so there's I mean, when
you break it down to that distinction, I don't really
see anything wrong with it, especially when you are protecting
(41:21):
the patients themselves. It's not like you're doing it to
experiment on them, you know, or because they'll they'll produce
gold in their urine or something like that. You know,
like this is strictly for their protection, but also allowing
them to to live a free life outside of a
clinical setting. I don't see much wrong with that. I
(41:42):
do get what the bioethicists are saying, like, yes, you're
robbing someone of their dignity by lying to them, by
deluding them, or playing into their fantasies. Strictly speaking, Yes,
in the real practical world, I think this is great.
If I'm at that point, then play into my fantasy exactly. Um,
it is not four all the time. Uh. In fact,
(42:04):
one of the people that work there say that people
that do criticize it at a very good point. He's like,
they don't understand what we're doing here. These aren't actors,
they're like real employees of these places. They're just helping out,
you know, And so jog Ve Village. I hope I'm
staying that right because I'm really putting myself out there. Oh,
I'm sure you're not. It's become this kind of ideal
(42:26):
standard of care, but it's also really expensive. So in
a country where there's a lot of socialized medicine, it
could do pretty well, like in the Netherlands or in Canada,
when they take care of people even though they don't
have money, right exactly. There's there's one called UM in Canada.
It's called UM Pentanginguish pentanguishin Ontario they have one. It's
(42:51):
a little smaller than the one in in Amsterdam. They're
also building one in Miami as well. So it is
starting to take hold. People do believe in it, and
apparently the patients families are very happy with this kind
of thing too well. And hopefully with the initiative of
what's it called America d f A. Uh yeah, hopefully
(43:15):
with those efforts, UM, more and more people will because
it's coming. Oh yeah, it's coming. A lot more folks
are going to be out there that we need to
take care of. Yeah, we don't know. How do you
cure dementia? We just know it's coming. I'm gonna be
one of them, do you think so? Sure at some
point if I if I make it that long. But
you know, not everybody gets dementia no matter how long
(43:37):
you live. I don't know. I got a feeling really Yeah.
It does run in my family a little bit. Yeah,
and I have the my father's family genes more than
my mother's. I feel like, uh so, if if I
had my mother's jeans, they all died from heart attacks
and strokes and heart disease. Young, not a lot of cancer, yeah,
(44:02):
pretty young. Yeah. Um so if you make it past yeah,
you you beat the heart stuff. Then the Bryant genes,
the dimension, well we're all going down one, you know.
Um Man, I thought it's something. Oh yeah, I wonder, Chuck,
(44:23):
if like our specific like us, you and me specifically,
creaming all this information in every week is actually beneficial,
or if we're just setting ourselves up for massive cases
of dementia because we're just pushing stuff in and getting
it out, pushing a new stuff and getting it out,
Like are we are we abusing our brains? Or are
we exercising it. I question that. Sometimes I bet someone
(44:44):
out there. I bet there's a neurologist who has a
good gut instincts let us know. I want to know
good news are bad? Okay, neurologists. There's gonna be a
subject a line that just says neurologists, guys, you're screwed. Yeah,
I have news. If you want to know more about dementia,
you can type that word into your favorite search engine
(45:05):
and it will bring up tons of information and great resources.
You can also type it into the search part how
stiff works and it'll bring up a great article. Since
I said search parts, time for listener mail. I'm gonna
call this one. Hecky Krasnall lives okay, although I don't
think he is with us. Hey, guys, only just started
(45:27):
recently listening to the show. It's been a fantastic way
to pass time and learn something interesting. I'm a home
taught high schooler, so every time I listen to an
episode of your show, I get a history or science credit.
How about that? That is pretty great. But as great
as that is, that's not why I'm emailing. Actually have
a fun fact for you guys from your Plato episode
and once you mentioned Captain Kangaroo. Well, my great grandfather
(45:51):
worked on that show. He produced the songs for it,
as well as several several Christmas carols, including Frosty the
Snowman and his biggest claim to fame, Rudolph the Red
Nose Reindeer. That is awesome. I've always thought it was
very funny that a Jewish guy was responsible for the
popularity of Christmas carols. My family all still Jewish watches
(46:12):
the Claimation Rudolph movie every year because of that, our
own little taste of that irony. I don't want to
tell you what to do, because I'm sure you have
a lot of episodes on your plate already, But I'm
just saying, Hecky Krasnaw was a pretty interesting person. Uh,
there might just be enough material for an episode on him.
Up to you. Thanks for helping with my school work.
(46:34):
That is from Aiden in Maryland. Awesome. Thank you very much. Aiden.
And when I say Hecky Krasnow lives, I mean lives
on like Viva La Hecky. Yeah. Uh, if you want
to tell us about someone interesting in your family, we
love that kind of stuff. Also, if you're caring for
them into patient we want to hear the highs and
(46:54):
the lows of that. UM just kind of bring it
on home for us, will you? You can tweet too,
said s y esk podcast. You can join us on Facebook,
dot com, slash stuff you Should Know. You can send
us an email to Stuff Podcast at how stuff works
dot com, and as always, joined us at our home
on the web, Stuff you Should Know dot com. For
(47:17):
more on this and thousands of other topics, is it
how stuff Works dot com.
Welcome to Stuff you Should Know from the house stuff
Works dot Com. Hey, and welcome to the podcast. I'm
Josh Clark with Charles W Chuck Bryant and Noel. The
Stint of Noel continues. Everybody's like, stuff you should know. No, no,
(00:22):
that's not what we're calling it. It's the stint of Noel,
all right, stuff you should know? Well, that's too clever. Yeah,
it's a little cutie. Yeah that's all. That's my only
aversion to it. What do you are you with stuff
you should know? Changing the name of our show after
(00:43):
eight years? No, just the Noel stint the name of it.
Remember the Summer of Sam? Oh? Yeah, yeah, sure, why not?
I don't like it? All right? Should we come up
with the third idea? Yeah? The Stint of Noel sounds
too much like so something's wrong with nol. That's why
I like it. It's hilarious. There's nothing wrong with Noel,
(01:06):
by God, And if you think there is, you need
to answer to me. There's something you should know. M
And I see that's what I'm saying. It sounds like
something Strickland would have come up with. Oh, you know,
and we haven't been in a flame war with Strickland
in a while. It's been too long, gotten soft, you
just launched one across the bowl. So um, chuck, Yes,
(01:29):
are you familiar with dementia? Uh? Yeah, sure, are you
running your family? And doesn't run in the family. But
my grandmother who lived to be a hundred, I had
to mention at some point, which you know, when you
live to be a hundred, that's I don't know about likely,
but it's not surprising. It's probably pretty likely. It's Um,
(01:49):
it's not from what I understand, it's not a uh
just a natural consequence of age, but it's pretty prevalent um.
And dementia is actually super misunderstood. Gets confused with Alzheimer's
a lot or there's a lot of different kinds of dementia,
but dementia is actually it's not a disease. It's a
(02:10):
set of symptoms that's broad on. But disease. Yeah, I
think that is widely misunderstood. But you are totally correct,
a set of symptoms and um, it is not just
your garden variety um forgetfulness that comes as you age, No,
because that is age related and that is a totally
(02:31):
age related things called age associated memory. Impairment, and that
is uh, I think, I mean that happens to everyone, right,
It's just like you forget your keys more often, that
kind of stuff. But when you do forget your keys
more often, you can snap your finger and go, I
forgot my keys again, what is wrong with me? Yeah,
that's normal. One of the big tales of true dementia
(02:52):
is when you don't realize that you're forgetting right. So
that's that's when it gets scary. And um we said
that it's not a natural, real consequence of age. And
one of the things that I turned up in researching
this is we're not exactly sure what causes dementia. We
don't even know if some of the tell tale signs
of dementia are the cause of dementia in some cases
(03:14):
or the result of dementia. Not entirely certain, but um,
it is very widespread among the aged population in the
United States. I think five point three million Americans have
dementia right now. And as our population ages, because the
baby boomers are starting to get older, um, I think
they're expecting something like sixteen million Americans are going to
(03:37):
have it. By sixteen million, is I think how many?
About how many people have it around the world right now,
and in America alone, we're gonna have that number in
twenty fifty. And it's very expensive. Actually, Uh, how much
money a lot? You're ready for this? In two thousand fifteen,
we have spent two hundred and twenty six billion dollars
(03:59):
on health care for dementia, while um, and they're expecting,
by I believe, when we are caring for sixteen million
in two thousand fifteen dollars not futuristic, much more inflated.
In two thousand fifteen dollars will be spending about one
point two trillion dollars on dementia. If somebody doesn't do something. Man, Yeah,
(04:24):
it's it's very expensive. It's also extraordinarily sad as far
as UM diseases or symptoms of diseases. Yeah, yeah, and uh.
I also want to recommend our May eleven episode a
podcast to remember our memory episode ties sevenly into this.
So if you haven't listened to that one yet, go
listen to that one, either before or after, or if
(04:45):
you listen to it and forgot, go back and listen
to it. That's right. So dementia itself is not UM diagnosed. Uh,
it's not simply memory loss. It's memory loss UM along
with one of the following at least one of the
following one or more. Um aphasia, which is UH if
you can't understand or produce language any longer. A praxia
(05:07):
and all these are super sad if you've ever seen
him up close. A praxia if you cannot make certain
movements even though your body physically is healthy. UM agnosia,
which is UH you don't recognize UM objects like the
remote control or your grandkids stuff like that. UH. And
then executive dysfunction UM when you have a lot of
(05:28):
troubles planning and organizing and reasoning. So that, along with
the memory loss, at least one of these you could
be diagnosed with dementia. And so, like we said, dementia
is a set of symptoms, right, yes, it's it's actually
brought on by disease. And the most common cause of dementia.
I think something like UM sixty or seventy or something
(05:48):
like that of dementia UM cases is brought on by
Alzheimer's disease. I could have sworn we did one in Alzheimer's,
but we have not. Yeah, I don't think we have.
I don't know. We've talked about it enough. I think, yeah,
it's popped up plenty of times, but we've never just
done a straight up Alzheimer's one. Alzheimer's brings on dementia
through um something called neuro february fibrullary tangles also known
(06:13):
as beta I'm sorry, TOW protein tangles and um beta
amyloid plaques, right, yeah, and just a protein build up,
a sticky protein build up, yeah, which is so when
you when your neurons fire and you have a thought,
it's an electrochemical process, and there's residual that is left behind,
(06:33):
and these residuals can build up in your synapses and
cause your synapses to not fire as well. And when
your synapses don't fire as well, they start to die
off in the neurons that are there that lead from
these synapses or lead to these synapses die themselves, and
you have neural loss. Like literally, the brain cells in
your brain are dying off at a rapid rate. And
(06:55):
when it's caused by beta proteins and TOW or beta
amaloid plaques and TOW proteins in the cells, than what
you have is Alzheimer's. Yeah, and they aren't sure the
cause of Alzheimer's still UM. Genetics is uh. They think
has a lot to do with it. UM. And you
can live with Alzheimer's for a while up to a
(07:15):
decade all they they sit in this article, Moley says
three to five years is more common, so it definitely
shortened your lifespan. And like you said, UM, genes are
definitely part of the risk factors. UM. A polypo protein,
a pop protein eka, I think, UM, which is weird.
(07:38):
If you have a mutation on this gene, you have
a higher risk of Alzheimer's, even though the gene just
codes for a protein that carries cholesterol through your bloodstream. Yeah,
it doesn't have anything to do with the tow protein
tangles or anything like that as far as I know.
That's weird. Um. Also, if you have a family history
of dementia you're you have of Alzheimer's, you have a
(07:59):
higher likelihood UM. And then if you have down syndrome,
you are at a higher risk of developing Alzheimer's in
middle age. Interesting. So UM, that's and we will do
one in Alzheimer's. But that's how Alzheimer's can cause dementia. Uh,
there's also vascular dementia, which is that was the case
(08:21):
with my grandfather who he had a stroke, and it
accounts for about twenty of dementia cases. And uh, you know,
stroke is when you have a loss of blood supply
to the to the brain or a hemorrhage and or
blood clot and it can be either um, one big
stroke event which causes a lot of damage and that's
(08:42):
a single in farct dementia, or it can be a
lot of the accumulation of symptoms because of a lot
of little many strokes you have over the years, and
then the damage just builds up and you finally once
once that last one, that that is the straw that
breaks the camel's back. Yeah, and you have dementia. Um,
(09:02):
that happens pretty rapidly after that last that last one,
that last stroke you had. Yeah, and that's a multi
infarc when it's a bunch of them. Um, and little
mini strokes are common a lot. Sometimes you have them
and don't even realize you've had him. Uh. With my grandfather,
he he had the big one. And yeah, we talked
about this before and I think something about speech, but um, yeah,
(09:25):
he lost his ability to speak you know English. Uh,
so that would be a phasia. Yes, he couldn't produce language. Well,
he produced Yes, he cannot produce language. He said things,
but it you know, it didn't make any sense, but
he had an understanding. You could see the frustration. Uh,
you know, I know how to how I'm supposed to. Uh,
(09:46):
my grandmother is driving us, let's say, and he she
doesn't know how to get there. He does and he
can't tell her, but he's telling her. Yeah, it's just
coming out all mixed up. And that's that's a hallmark
of dementia, is um. There's emotional changes in the person
because they they're not communicating like they want to say,
(10:06):
people aren't responding like they want the people to, and
they'll get snippy and then ultimately say withdrawal. They'll just
give up on communicating at all because it's too frustrating
or just too sad, you know, um, which is it's
one of the common results of dementia. It's a comorbidity.
Now it's a complication. Yeah. And then and with the
(10:26):
single stroke event um or actually or with the multi
uh strokes, it's different for everyone. There isn't any single
like well, this is going to happen because this person
had a stroke. It could be a variety of different
things from you know, paralysis on one side of the
face or body bow and bladder control problems. He didn't
(10:47):
have any of those. He looked totally the same physically,
He walked and talked this same except for the fact
that they weren't real words. That was like the most
noticeable thing. I remember you telling me about your grandfather before.
I don't remember what it was a long time. We
were talking about speech, like we're Nikki's area or Broca's area, Yeah,
something like that. So with Alzheimer's, it first attacks the hippocampus,
(11:10):
which means that it's going to take away your um
episodic memory, which is your memory of recent events, right. Uh.
And then it starts to move its way into other
areas of the brain where your judgment is affected, your
speech patterns are going to be affected, your personality is
very much affected in changes with Alzheimer's. With Alzheimer's, but
(11:32):
not as much with the stroke. Yeah, with vascular dementia,
you know, there might be some other things um where
like part of the faces sagging, or or the patient
can't move their arm or something like that. But yeah,
the personality will remain intact because those regions of the
brain aren't affected like they are in Alzheimer's. And then
in about five of dementia cases, Uh, it stems from
(11:52):
something called Louis body dementia UM, which we were just
talking about. They think Robin Williams might have suffered from
He definitely did. He definitely did. They found in his
autopsy he had. I think he was diagnosed with it
before he died. That was one of the reasons why
he took his life. Yeah, because that can cause severe
intense hallucinations. Uh, big time. Did you look those up? Oh? Yeah,
(12:15):
many scary stuff like very apparently a typical one is
very brightly colored animal or person. Yeah, that you see
in great detail for many minutes on daily daily basis,
Like just intense hallucinations. I'm sure you think you're you know,
losing it, right. And that's one of the first symptoms
of a Louis body dementia. And it was discovered by
Frederick Louis and nineteen twelve and has has nothing to
(12:39):
do with your body. A Louis body is Uh, there
are are deposits again, protein deposits of the alpha uh
sinucleon that appear on the brain. So don't think of
body in the terms of like your physical body. Uh.
And this is also president Louis bodies and Parkinson's. So
as a result, not only are you going to have
(12:59):
some them similar to Alzheimer's with Louis body dementia, but
also some of the tremors and balance issues of Parkinson's,
which is uh, super sad as well. Is that what
Michael J. Fox, Yes, Parkinson's. Yeah, and that's what the
movie Awakenings was about. When they wasn't it like a
group of Parkinson's patients that like L. Dobo worked on,
(13:21):
is that Parkinson's I can't remember. I think they didn't.
They didn't realize what they thought they were locked in
or something, and then realized their Parkinson's trummers were so
acute that they were like they were not even shaking,
they were just yeah, interesting, They're just their muscles were
totally contracted rather than contracting and relaxing again and again.
And Robert Williams, Yeah, how about that? Yeah. Uh. Then
(13:44):
we have something that used to be well it's called
now front o temporal dementia, used to be called picks disease,
but now Picks disease is a uh specific version which
I couldn't really sus out what the difference is, could
you know? I couldn't as long as it wasn't just me,
I feel better. But f t D is it's really
(14:07):
an umbrella term. Um. It's about five percent of dementia
cases and it's going to affect personality and behavior and
language time, big time. And it's where your frontal and
temporal lobes are actually atrophying and shrinking, right, And the
reason why is um. You remember, with Alzheimer's you have
beta amyloid plaques and tow protein tangles. Well, with the
(14:29):
frontal temporal dementia, you don't have the beta amaloid plaques.
You just have the tow protein t angles. But it's
enough to cause massive neuronal loss. Yeah, and this is
like I think a lot of people at first think
they might have UM tourette. Yeah, because you can yell
things out inappropriate behaviors. Uh. Yeah, Like if your grandfather
(14:52):
suddenly becomes hyper interested in sex and like likes to
talk about it in public or exposes himself to people
in public, there's a pretty good chance that he has
developed front o temporal um dementia or if I did,
because um, it's unusual in that it attacks younger people. Um,
it's gonna on set between forty and seventy years old,
(15:13):
which distinguishes it from other types of dementia. And if
your grandfather used to do that stuff already, then that's
not the case. The key here is that like this
has come out of the blue, somebody has really just
completely changed in their personality. They might get into really
risky behavior like gambling all of a sudden, shop lifting,
(15:34):
and like risky investments are like pulling all their money
out of the bank and with picks disease too. Um,
the apparently apathy is a big indicator of this. There's
a big personality change and the person is no longer
they have no empathy, they have blunted emotions, and then
they may also be engaging in risky behavior. So basically,
(15:57):
your grandpa or your grandma has just turned into like
the trans border you know, or me or you, well, yeah,
you lack empathy. No no, no, I'm just saying it's
because it affects you. Something turned into you. Oh no, no, no,
you have blunted emotions and you gamble. Uh, there's also
Huntington's disease. Uh. This is uh, it seems like much
(16:20):
more physical in nature, uncontrollable movements, although there are changes
in in personality. But um real fidgety, herky jerky. Uh.
Your brain loses the ability to control coordination essentially, right,
which is I think, uh fifty chance of inheriting the gene.
(16:40):
But you can live with it for up to twenty years. Yeah,
which seems like as far as dementiao is one of
the longer life expectancies. But again, I mean, like I
would guess this has kind of become clear. The hallmark
of dementia is memory loss paired with some other problem
like not being able to create speech any longer recognized speech,
(17:03):
or not being able to move that kind of thing,
or not being able to plan um. And like we said,
well we should probably take a break. Huh. Yeah, we
got a couple of more types that we'll talk about
and then some other good stuff. Okay, right after this,
(17:37):
the last two, actually the last three we're gonna talk
about because there are many, many other kinds of dementia.
Like we could spend hours and hours talking about all
the different kinds hours, but we have talked about kreitz
Felt yakup disease, and I can't remember which one. And
is there a disease that kills by preventing sleep? Oh?
(17:59):
Is that the one which we should have rightly called
how prion diseases worked? Yeah, because it is is a
prion infection. It's very rare, about one um out of
a million people will be affected in any given year,
like mad cow disease. Yeah, exactly. Um, it's a sponge
of form disease. So crazy it is. It's very interesting.
(18:23):
It could be genetic. Um. But and I thought we
also talked about it an organ transplant. We I think so,
because it can occur because of infected tissue that you
are implanted with or from an organ. Yeah. And this
is neuronal loss due to the like holes literally being
eaten into your brain by this disease. Yeah. Um. And
(18:47):
then you can also get dementia UM from from when
you have HIV. If you are a boxer or say
a football player in the NFL, you may have dementia
from a traumatic brain injury, a concussion or repeated concussions. Um.
And there are plenty of diseases. There's also um reversible
(19:08):
dementia too. If you have a vitamin deficiency, if you
um uh take certain medications, um, you can develop dementia.
But this is reversible for the most part. Though age
associated dementia is not reversible. And like we said, it's
kind of tricky to diagnose this stuff because it is
(19:30):
normal for people to become more forgetful as you age,
and then to make it even more confounding if you're
a diagnostician, not only are do people get more forgetful.
There's an intermediate stage between dementia, a dementia diagnosis, and
just normal age related forgetfulness, and that is um called
(19:53):
mild cognitive impairment. So if you can catch this from
what I understand, and we'll talk about treat and said
everything later. But if you can catch things like Alzheimer's
and other um other diseases that lead to dementia early,
although there's no cure for any of them, you can
you can manage them a lot better and delay say
(20:14):
death or like the real devastation associated with it by
a significant amount of time. But it's catching is the
tricky part. And especially if you have dementia, you don't
really realize that there's any kind of problem. Um, So
you're probably not going to take yourself to the doctor. No,
but you what you should do is listen to your
(20:36):
loved ones because they are going to be looking at
you a little more closely uh than you can. You
know that that they're more perspective. Yeah, exactly, that's what
you're looking for. Um, So don't get you know, don't
get offended if if a loved one says, let's go
get you checked out, because you can do something if
you catch it early on. Unless you're very wealthy and
(20:57):
it's you're no good nephew that you've never trusted anyone,
you know, then maybe bring a lawyer in on it. Uh.
So if you do go get checked out. Um, from
the second you walk in the door, your doctor is
gonna be eyeball on you and looking for any signs,
um just from their their trained eye, like you know,
(21:18):
from how you walk to the way you answer questions,
to how they interact with you. Uh, they want to
know you're They're gonna have to know your history, um
because they need to have some context to compare it to. Right,
like were you always a compulsive gambler? Is just like
new behavior yeah, and it helps to bring you know
if if um, if you're older, maybe bring your grown
(21:40):
son or daughter with you or whoever has a lot
of contact, although your spouse you never know what, I
don't know, maybe trying to get ready you. Oh yeah
like that, No good, nephew, Yeah exactly. Um, I'm just kidding,
of course, although I'm sure that happens. Then there are
a couple of tests that they usually do in conjunction
with one another, um, the Mini Mental State Examination the
(22:05):
m m s E UM just a lot of basic
questions there um for mental tasks, but they're coded. The
tasks are yeah, and they're scored individually. Yeah. Um. And
when you when you M say question three, this person
got an eid on, you can go over and be like, yeah, dementia.
(22:25):
It's actually pretty effective actually. And there's another test that
ties into the mm SC that um. There they both
indicate one another, which apparently they're both really good at
indicating dementia. But there's other tests called the clock drawing test.
Did you look this thing up? Yeah? I thought that's
pretty fascinating. It really is. It seems really like, why
(22:46):
would someone tell someone to draw a clock at a
certain time of the day. Yeah. Usually they say draw
a clock showing that it's ten after eleven. And it
makes a lot of sense in a lot of way
because it draws on all these different kinds or different
regions of the brain, different um skills. Right, So, like,
(23:07):
first of all, you have to remember what a clock
is and what it signifies. That's a big one. What
it looks like. Uh, yeah, as clock isn't made of
like squiggly lines or anything like that. Um, you have
to remember how a clock is laid out, the order
that the numbers go in that it doesn't keep going
after twelve to thirteen, fourteen, fifteen. And then once you
(23:27):
got all this, you have to show the hands showing
that it's ten after eleven. So the hands won't be
pointing at ten and eleven, it should be uh, the
longer hand should be pointing at the two, and the
shorter hand should be just past the eleven. Right. This
requires a tremendous amount of brain power, even though it's
very simple and straightforward, and you can tell a lot
(23:48):
about a person's mental faculties just by having them draw this. Yeah,
the four specific things that requires their verbal understanding memory
spatially coded knowledge and constructive skills, and if any of
those are off in conjunction with the MMS, then they're
gonna have a pretty good idea where you fall on
the dementia scale. If you don't have the constructive skills
(24:08):
to pay the bills, you may have dementia. That's right.
And they actually, um, I looked at one study about
the clock drawing tests. Basically I think it was just
a more recent like, hey, let's go in and really
look at this thing again and it checks out. Yeah.
They stood behind and said, yeah, it's actually a really
good indicator. Yeah, like it really holds up. And they
think they developed it in the sixties, but it didn't
(24:30):
take off until the eighties. And then they do you know,
but it's something you can do anywhere. And now they're
starting to gather these um different clocks that people with
different types of dementia drawing and basically compiling them into
a database so you know what to look for. Even
more like, oh, somebody draws a clock that has like
a thirteen fourteen on it, they may have this type
(24:51):
of dimension, right, and this one looks like Sabod or
Dali drew it. Uh, then they might have this kind
of dementia, or they might just be super talented creative.
You never know. Um, all right, let's uh should we
take another break? Why not? Is it time? Sure? All right,
we'll be back after this talk about treatment and some
of the other pitfalls of dementia. So Chuck, we've kind
(25:34):
of um, I think it's almost goes without saying, like
the problems associated with with dementia, like you lose your
ability to um reason in a lot of cases, you
lose your ability to to move and take care of yourself.
You lose your memories, you have trouble forming new memories,
you have trouble recognizing people. Um. So living life is
(25:56):
extremely difficult. Um. But there's also like other complications that
you may or may not think of. Right. So, let's
say you're an elderly person and you have a battery
of medications that you need to take for unrelated heart disease.
Do you think you're going to remember to take those medications?
Probably not. Even if you have like a time or
(26:17):
set or some sort of calendar or something like that,
you may have trouble even remembering that you have a
calendar that you need to go check out to see
what's on there. Let alone to take the medication that's
indicated that's on that calendar. Yeah, that's a big problem. Uh,
nutrition itself is a big problem. Either you forget to
eat altogether, or you think you've already eaten, or you
(26:41):
physically have deteriorated so that you can't control the muscles,
the true and to chew and swallow. A good joke.
It's a real danger. So when people die from Alzheimer's
it sounds kind of strange if you think about it.
It's like, well, no, they forgot they lost their memory
or whatever. No, the brain is actually being slowly destroyed
period aodically, and eventually it's going to reach the parts
(27:02):
of the brain where like you can't swallow any longer.
Then you die from that kind of thing. Um, you
also can lose your sense of hunger, like you just
aren't hungry anymore. Kind of tough to eat, especially when
you're not thinking or remembering that you should eat, um,
when you're just not hungry. Ever. Yeah, this to one. Hygiene.
(27:23):
Reduced hygiene is a big one. UM. A lot of
times in severe dementia cases, you either are unable to
bathe and dress yourself and brush your teeth or you
forget to. Uh, it just falls by the wayside um.
I know that was the case with my grandmother. She needed,
you know, she needed to be bathed by my dad
because she lost interest in it or because she just
(27:44):
couldn't do it anymore. Uh, I think both. Yeah, yeah, um,
that's another indicator. You said that when you go in
for a diagnosis, the doctor is going to be watching
you and just kind of sizing you up. One of
the things you'll look for is whether you look disheveled.
That's a big one. And especially if your son or
daughter is saying, like, this is really bizarre behavior because
(28:06):
mom always like dressed to the nines. She just wears
this dirty old bathrobe all the time and doesn't ever
want to take a shower. That's that's usually an indicator
of dementia. Yeah, it's not like she just gave up
and doesn't care anymore. It's it's part of the symptoms. Hold. Although,
another problem with dementia, and one of the confounding factors,
(28:28):
is that depression can be a byproduct or come morbidity
of dementia because you recognize that your life is changing
in ways that you're not happy about you can't communicate anymore,
you forget stuff all the time. You can become depressed. Um.
So then that could lead to you giving up on
taking showers and dressing as well. Yeah. And not only depressed,
(28:49):
but um agitated and aggressive um riddle with anxiety. A
lot of your emotional well being and emotional health will
be uh slipping away from you. Yeah. And again this
can be a direct result of chemical changes in your
brain due to dementia, or it can be like your
this is the result of you recognizing these changes and
(29:12):
and just be coming upset about them. We talked about communication, UM,
and the hallucinations. You're gonna have trouble sleeping as well
in a lot of cases. Uh. And then personal safety UM.
A lot of people die every day because of accidents
that happened as a result of dementia, people who shouldn't
be driving it into cars. Um. And there's this there's
(29:35):
a push that's going on now, I think in the
last year or so UM as part of the Council
on Aging, like the United States Council and Aging, there's
a new initiative called the Dementia Friendly America Initiative. Really
neat Yeah, it's basically saying, look, we've got about one
in eight people over sixty five and the US have dementia.
We're about to have way more than that in the
(29:57):
next couple of decades. We need to be prepared for
this kind of thing. So let's start training America how
to recognize the signs of dementia and then how to
react to it in a friendly and helpful manner so
that people who are wandering around with dementia don't withdraw
eighty thousand dollars from their bank account and and walk
(30:17):
around with it in their pockets outside. Yeah, and how
do you do that? You you get some money uh
from the government as a grant to go out and
hire people to literally go to businesses and go to
restaurants and talk to waiters and waitresses or should I
just say waitron's uh. Go to banks and talk to tellers,
(30:38):
go to uh anywhere where there's interaction with another human,
grocery store checkout people, and literally train them on, like
you said, how to recognize it and how to kindly
deal with these people, right exactly. Um. Apparently one of
the things you teach people in service industries is not
take it personally. That if somebody's behaving around clear or
(31:00):
they're using incorrect words, and they're of a certain age,
the chances are they probably have dementia. And there's ways
of dealing with it. Um. Apparently, responding to it in
a soft, friendly manner tends to get results from the
dementia patient. Um, especially if you are not being an
(31:21):
aggressive jerking right exactly. It just being nice will will
frequently get good results. Um. And Yeah, it is a
pretty neat initiative absolute um and and necessary. Yeah, you know,
but it's it's I'm stricken by the idea that people
are planning out this far ahead for this kind of thing.
(31:44):
It's exceptional, it is and scary. Uh So if you
do have a family member, one thing that's I'm important
to remember. There's something called the caregiver burden that my
dad and his wife definitely experienced. It is really really
on you, on your family. Uh and it can actually
take a physical toll. Um. They have some stats here
(32:07):
if you your risk of death as a woman if
your husband has dementia increases in the first year after
they're diagnosed, and only for a husband whose wife is diagnosed.
Um and then a little pretty significant inco just from
(32:27):
the dementia diagnosis. Yeah, and um, what they recommend in
this article is to take care of yourself first, because
they found that if you are not going into this
with the right attitude and you are upset or have anxiety,
you're just gonna do more harm anyway. So get yourself right,
(32:47):
take care of yourself, and go into it in the
right frame of mind, and you'll actually be able to
help better. Yeah, and this, this caregiver burden or caregiver
burnout is a very real thing physically too. Like you,
um have low energy, you'r you have low productivity, You
become snippy, resentful, angry, and you can end up basically
mistreating your own parents or spouse because you're so upset
(33:11):
with this horrific disease. One of the hallmarks of dementia
is that that that there's no two days that are alike,
and when you're dealing with the dementia patient, what worked
yesterday isn't gonna necessarily work today. Well, if you can
no longer predict what your life is going to be
like from day to day and you're spending I think
(33:33):
I saw this one study that found an average of
twenty two hours a week of unpaid care by spouses, wives, daughters,
that kind of thing. Um, your you can very easily
get stressed out. The main thing you have to do
is ask for a respect care. Like. You can't do
it by yourself. You have to have other family members,
(33:54):
members of your church, your community come and give you
a break so you can go do other stuff for
a while. Absolutely, And I mean you could totally see
how you could just very easily evolve a really unhealthy
dynamic if you're just trying to do it yourself. Because
you lose perspective. This becomes your norm, even though it's
totally abnormal. Yeah, and boy you talk about it's a
(34:16):
really sad way to damage what previously was a good
relationship with a parent or something. It is devastating, you know. Um.
So there are drugs that they use to help stave
off dementia. Um, mainly right now. They are colon estras inhibitors,
(34:39):
uh and they suppress colonestras, which is an enzyme that
breaks down uh uh cta CEO lathing which we talked
about before. That's what helps transmit messages between neurons. So
that will help. Yeah, because if you're not commu indicating
(35:00):
as much as you were before. At least the communication
that is going on can stick around longer. You know.
It's seems primitive as far as like brain drugs go,
but it makes sense, you know. Yeah. And then there's
another one. Are they still using this believes momanten uh,
And it inhibitates inhibits glutamate, which we talked about before,
(35:24):
which causes neuron death when over stimulated. Yeah. I can't
remember where we talked about that one either. I just
remember glutamate from the Umami episode. Yeah, I was definitely
that one. Um. And then there's also stuff you can
so these drugs will help some. That's for non vascular dementia, right.
With with vascular dementia, you're gonna want to take blood thinners, yeah,
(35:48):
to keep more strokes from coming along and making the
whole thing worse. Um. And then with like Louis body disease,
to deal with things like the hallucinations and stuff, you'll
probably also be given anti psychotics as well. Um. And
one thing that they're starting to realize more and more,
it's very difficult to really figure out what kind of
dementia people have just from um uh, what's the scan. Yeah,
(36:12):
MRI I scan UM, and you can really go back
and accurately identify types of UM dementia from autopsies, right,
And so for more and more autosies, they're finding that
there's a lot of what's called mixed dementia, where you
have Alzheimer's and vascular dementia, or where you have Alzheimer's
and Louis Bodies disease UM. And so it can be
(36:36):
really tough to suss out all the different kinds of
dementia person might have. But if you can do that,
then you can you can put them on a drug
regimen that could really kind of help more than just
treating the Alzheimer's and letting the Louis body go unrecognized
and rampant or unchecked. There's also preventative stuff you can
do too. Oh yeah, yeah, like what cross or puzzles. Yeah,
(37:01):
I told you. Emily's grandmother, Mary is ninety five and
very sharp. Uh, and she does word puzzles all the
live long day and uh this is sodoku. Yeah, she does.
She does all kinds of word puzzles. Yeah, things that
I have never even heard of. It supposedly that helps
stave it off apparently, Um, this one's great. Alcohol. Moderate
(37:24):
alcohol consumption, which is two a day or for men
or one a day for women. Okay, Uh, has a
protective effect. It staves off all stays off dementia. They're
not sure why, they're not sure what kind of alcohol
is the best. They just know that for some reason,
alcohol has a protective effect. Uh. Probably up to that
(37:46):
to drinks, and then it's probably bad after that. Then
it becomes very bad after that. So you want to
just moderate amount, right in all things, people, moderation, moderation. Uh.
And then uh, there are some things that you can do.
Here's the thing. There's a a debate on whether or not, um,
(38:07):
you're tricking your loved one by doing things like, um,
giving them an appliance that doesn't work, so they can
pretend that they're ironing or something because they used to
love to take care of their laundry themselves. So here,
let me remove the cord from this iron. And uh.
(38:28):
And is that tricking someone? Is it not? Uh? And
a lot of people think, no, that's what you should
do because it makes them feel like they're being useful.
They're not gonna get hurt with a hot iron. So
it's all good. Other people say no, that means that
they're not hanging onto that last bit of reality they
may have. I think it's fine. I think it's fine too.
(38:50):
And there's actually, um, there's a an entire village set
up in I think like just outside of Amsterdam. Yeah,
this is awesome, right, Yeah, how would you say that?
I have because Dutch is the weirdest, the weirdest language,
we'll say that, okay, Um, And uh, it's a it
(39:11):
is a it's an what's called the Dementia village. Basically
where everyone who lives in this village, I think a
hundred and fifty people all have dementia and they live
in group houses there. Well there's caretakers that live there too,
but okay, yes, you're right, um, And they live in
the group houses with them, and a lot of the
people realize that this is their nurse or just think
(39:34):
it's a good friend of theirs. They don't really remember
where when they became friends. Yeah, exactly. Um. And the
houses they live in have different themes according to how
the people lived, depending on whether they are blue collar,
whether they their memories go back to the seventies. This
whole place is basically set up so that it's a very, um,
(39:55):
non threatening safe place because people just kind of live
and um move about within safely. Yeah, safely. Um. And
so they can go to the grocery store, they can
go to the movies, they can go ride a bike,
and everyone, the people at the movie theater, I know
that the people there have dementia, right like every They're
(40:16):
real movie theater workers and reil waiters in the restaurant
especially trained exactly. So it's a less clinical setting than
say a nursing home. And a lot of people say
this is awesome because it's as close to real normal
life that they were used to as they're gonna get.
Yeah exactly. Uh. Then of course there's other people that
poople would say, no, you're tricking these people. But but
(40:38):
you can say, hey, okay, here's here's the big difference
with this place. If this if this dementia patient gets
lost in Manhattan and they run across the city worker
who's collecting garbage, that city worker may do absolutely nothing
to help them. In Hovey Village, that city worker especially
(40:59):
trained to get that person back to their house or
alert their caretaker that this person is having a crisis.
Or something like that. That's what we're trying to train
people to do in the future. Yes, they've just isolated
it to a community. Yeah, so there's I mean, when
you break it down to that distinction, I don't really
see anything wrong with it, especially when you are protecting
(41:21):
the patients themselves. It's not like you're doing it to
experiment on them, you know, or because they'll they'll produce
gold in their urine or something like that. You know,
like this is strictly for their protection, but also allowing
them to to live a free life outside of a
clinical setting. I don't see much wrong with that. I
(41:42):
do get what the bioethicists are saying, like, yes, you're
robbing someone of their dignity by lying to them, by
deluding them, or playing into their fantasies. Strictly speaking, Yes,
in the real practical world, I think this is great.
If I'm at that point, then play into my fantasy exactly. Um,
it is not four all the time. Uh. In fact,
(42:04):
one of the people that work there say that people
that do criticize it at a very good point. He's like,
they don't understand what we're doing here. These aren't actors,
they're like real employees of these places. They're just helping out,
you know, And so jog Ve Village. I hope I'm
staying that right because I'm really putting myself out there. Oh,
I'm sure you're not. It's become this kind of ideal
(42:26):
standard of care, but it's also really expensive. So in
a country where there's a lot of socialized medicine, it
could do pretty well, like in the Netherlands or in Canada,
when they take care of people even though they don't
have money, right exactly. There's there's one called UM in Canada.
It's called UM Pentanginguish pentanguishin Ontario they have one. It's
(42:51):
a little smaller than the one in in Amsterdam. They're
also building one in Miami as well. So it is
starting to take hold. People do believe in it, and
apparently the patients families are very happy with this kind
of thing too well. And hopefully with the initiative of
what's it called America d f A. Uh yeah, hopefully
(43:15):
with those efforts, UM, more and more people will because
it's coming. Oh yeah, it's coming. A lot more folks
are going to be out there that we need to
take care of. Yeah, we don't know. How do you
cure dementia? We just know it's coming. I'm gonna be
one of them, do you think so? Sure at some
point if I if I make it that long. But
you know, not everybody gets dementia no matter how long
(43:37):
you live. I don't know. I got a feeling really Yeah.
It does run in my family a little bit. Yeah,
and I have the my father's family genes more than
my mother's. I feel like, uh so, if if I
had my mother's jeans, they all died from heart attacks
and strokes and heart disease. Young, not a lot of cancer, yeah,
(44:02):
pretty young. Yeah. Um so if you make it past yeah,
you you beat the heart stuff. Then the Bryant genes,
the dimension, well we're all going down one, you know.
Um Man, I thought it's something. Oh yeah, I wonder, Chuck,
(44:23):
if like our specific like us, you and me specifically,
creaming all this information in every week is actually beneficial,
or if we're just setting ourselves up for massive cases
of dementia because we're just pushing stuff in and getting
it out, pushing a new stuff and getting it out,
Like are we are we abusing our brains? Or are
we exercising it. I question that. Sometimes I bet someone
(44:44):
out there. I bet there's a neurologist who has a
good gut instincts let us know. I want to know
good news are bad? Okay, neurologists. There's gonna be a
subject a line that just says neurologists, guys, you're screwed. Yeah,
I have news. If you want to know more about dementia,
you can type that word into your favorite search engine
(45:05):
and it will bring up tons of information and great resources.
You can also type it into the search part how
stiff works and it'll bring up a great article. Since
I said search parts, time for listener mail. I'm gonna
call this one. Hecky Krasnall lives okay, although I don't
think he is with us. Hey, guys, only just started
(45:27):
recently listening to the show. It's been a fantastic way
to pass time and learn something interesting. I'm a home
taught high schooler, so every time I listen to an
episode of your show, I get a history or science credit.
How about that? That is pretty great. But as great
as that is, that's not why I'm emailing. Actually have
a fun fact for you guys from your Plato episode
and once you mentioned Captain Kangaroo. Well, my great grandfather
(45:51):
worked on that show. He produced the songs for it,
as well as several several Christmas carols, including Frosty the
Snowman and his biggest claim to fame, Rudolph the Red
Nose Reindeer. That is awesome. I've always thought it was
very funny that a Jewish guy was responsible for the
popularity of Christmas carols. My family all still Jewish watches
(46:12):
the Claimation Rudolph movie every year because of that, our
own little taste of that irony. I don't want to
tell you what to do, because I'm sure you have
a lot of episodes on your plate already, But I'm
just saying, Hecky Krasnaw was a pretty interesting person. Uh,
there might just be enough material for an episode on him.
Up to you. Thanks for helping with my school work.
(46:34):
That is from Aiden in Maryland. Awesome. Thank you very much. Aiden.
And when I say Hecky Krasnow lives, I mean lives
on like Viva La Hecky. Yeah. Uh, if you want
to tell us about someone interesting in your family, we
love that kind of stuff. Also, if you're caring for
them into patient we want to hear the highs and
(46:54):
the lows of that. UM just kind of bring it
on home for us, will you? You can tweet too,
said s y esk podcast. You can join us on Facebook,
dot com, slash stuff you Should Know. You can send
us an email to Stuff Podcast at how stuff works
dot com, and as always, joined us at our home
on the web, Stuff you Should Know dot com. For
(47:17):
more on this and thousands of other topics, is it
how stuff Works dot com.
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