Dementia Prevention with Emily Clionsky, MD and Mitchell Clionsky, PhD

Episode Transcript
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(00:07):
I used to think time was myenemy. My future wasn't looking good.
So worried about the things I couldn'tsee, I couldn't see the things I
could. I was aging fearfully,worrying my life away, when all along

(00:32):
I should have been thankful for everyday. Finally made a friend of time.
Now you could say that I'm Aginggratefully, Aging gratefully, broadcasting across

(00:58):
this amazing nation and spanning the universe. You're listening to Aging Gratefully. I'm
your host, Garontologist Holly Kelly,bringing you exceptional guests and novel information to
ensure you age great, livefool andembrace each extraordinary day for the incredible gift
it is. We broadcast on allyour favorite players, brought to you all
over the world. Welcome to AgingGratefully, most amazing listeners, So happy

(01:22):
you're tuning into the show today.We welcome you with our signature posts,
our smiles across the miles. Soif you're not yet smiling, it's time
to kick off the hour with oursmiling spandemic and where your smile, Share
your smile. Now that feels amazing. I call it our alcohol free cognitive
Cocktail Party. Self care that's notonly shareable but makes us feel great.

(01:48):
We aim to remind you in everyepisode the magic of smiling. In other
words, we try not to forgetbecause we don't like forgetting things as we
grow older through it's not only frustrating, but for some there's that little tinge
of oh no, I'm not startingto forget things, am I Does this

(02:09):
mean something? Thoughts, followed byyour mind raising all the possibilities that forgetfulness
could turn into. But we allforget things from time to time. As
for me, it's usually deep intoFebruary when I'm still putting last year's year
on everything I date. I forgetthat we're in a new year, or

(02:30):
I forget to be cognizant of itanyway, So why do we worry about
a pattern of forgetfulness presenting itself?Well, we all know someone, or
know someone who knows someone, orknow those who care for an individual who
suffer from a cognitive disorder. Withdementia, memory can begin to fade away

(02:51):
and swept up with that is theability to think or even reason like we
once did. Of course, thisnot only impacts the daily life and activities
of the individual, but also affectsthose close to them. Yes, we
fear that this too could be us, that normal memory transitions into forgetfulness and

(03:12):
continue decline. Fear, angst,worry, and even a grim perspective of
what life would be like can surfacecontemplating about if that were the case.
But what if I told you thatyour outlook can actually impact the likelihood of
developing dementia, or that dementia isnot inevitable? What if I told you

(03:37):
that something as simple as how youbreathe during sleep actually impacts your brain and
how our precious brain's function is affectedby sugar levels, blood circulation, and
a slew of other things, Butmostly, what if I told you that
there is a laundry list of dementiarisk factors that we as adults have the

(03:59):
capacity to change. Mega awesome empowermentjust smith that worry we spoke of earlier,
And because we are known as thepower hour of enlighten you meant,
I'd like to make the word empowerment, our aging, gratefully, show dedication
this week. It's a noun andmeans the process of becoming stronger and more

(04:20):
confident, especially in controlling controlling one'slife and claiming one's rights and that brings
us to our aging Gratefully alphabet suitfor the Psyche this week. And that
is your body is the only thingyou are guaranteed to carry with you throughout
your entire life. It is absolutelyworth an investment of your time to learn

(04:42):
how to maintain and repair it.What I love about our Aging Rebels is
that you are so invested in takingtime to learn new ways towards maintaining your
highest self. And it is soamazing when we discover ways to not only
be empowered, but being proactive stakeholdersand our health and well being so that
we can live longer, happier livesof purpose driven vitality. But wait,

(05:08):
there's more. What if I toldyou that all the what ifs I just
mentioned were in one great book toeducate, inspire and enlighten. And well
there's one more. What if Itold you the authors of these proven psychological
methods that can change your habits inhealth to literally alter your brain's future we're

(05:30):
here with us today. Well,of course they are, and I couldn't
be more excited to share them andtheir amazing work with you. So I'm
so excited that Emily Kleonsky, MDand Mitchell Kleonsky, PhD, authors of
the new book Dementia Prevention, UsingYour Head to Save Your Brain, are

(05:53):
joining us today. Emily Kleonsky,MD is an internal medicine doctor with twenty
five years of experience and is adiploma of American Board of Psychiatry and Neurology.
She has treated thousands of patients withmemory loss at her private practice.
Mitchell Kleionsky, PhD is a Boardcertified clinical neuropsychologist with forty five years of

(06:17):
experience evaluating and treating patients with cognitiveimpairment, dementia ADHD, and traumatic brain
injury. Together day they developed theMemory Orientation Screening Test otherwise known as MOST,
which has been used by hundreds ofdoctors. It is with great pleasures,

(06:38):
so excited to welcome both of you, Emily Kleionsky, MD Mitchell Kleionsky,
PhD, to the Aging Great Felicia. Welcome to the show. Hi
there, Holly, Thanks for havingus. Holly, I'm going to start
off. This is Mitchell. I'llgo to start off by just making your
listeners' lives easier. They want tofind anything about us, They go to

(06:59):
braindoc dot com. It's our website, it'll connect with the book, it'll
connect with our backgrounds, so allof that stuff that's going to be much
easier. Just brainc dot com.Easy to remember, easy to look up.
I love that. Okay, that'sfantastic. I'm so excited about this
book and this is so needed bythe world at large. Just incredible work

(07:21):
that you're doing. When I sawyour work, I knew absolutely had to
bring you on the show. Youare like the dynamic duo doing great things
for the world, and this isjust amazing. And I wanted to start
the show by one question that Ifeel is really important because many people may

(07:44):
not know what dementia is, orthey may be, you know, it's
a little convoluted, assume that Alzheimer'sis dementia, Dementia's is Alzheimer's, and
feel that they can't delineate between thetwo. Doctor Emily Kleonski, could you
tell us kind of how to tellthe difference between the two. Actually,

(08:09):
Hollie, I'm going to defer toMitch because he has done a really good,
simple job of explaining that. Solet's up, let's dump this first
one on him. We're Gonnas thatbook with your spouse by the way,
so you know you think about dementia. It really is a number one question
that people ask us like all thetime. So I'm glad that you started

(08:31):
off with this. But basically,dementia is a progressive neurological decline. So
it's a disease of the brain.It affects the size of the brain,
the internal connections within the brain,the very structure that determines how people are
able to think. So when someonehas dementia, we see things that start

(08:56):
off as normal for age and thenslowly in most cases, get worse and
worse and worse unless we intervene insome way. Now, the question about
dementia Alzheimer's is also this important questionbecause there Alzheimer's is a type of dementia.

(09:20):
So if you think about if thiswere cars, Afford is a type
of car, but Sosa Chevrolet andSosa Toyota, etc. Etc. We
have Alzheimer's as a major form ofdementia, but we also have vascular dementias

(09:41):
caused by circulation problems in blood gettingto the brain and carrying oxygen and nutrients
to brain cells. There's also dementiasthat are caused by Parkinson's disease in about
a quarter of the people with thismovement disorder. They also experience a loss
of thinking and memoryabilities. You've gotdementias which are now people are rarely aware

(10:07):
of. Bruce willis with a specifictype of dementia called fronto temporal dementia,
which is really different in many waysbut just as bad as Alzheimer's disease or
vascular dementia. And then there's allthe kinds of things that are caused by
people having concussions, caused by excessivedrinking of alcohol, use of drugs.

(10:30):
So there's a whole variety of differenttypes of dementia and causes for dementia.
But unfortunately, the ultimate outcome formost people is that they're on a downward
slide at some point, usually becomesapparent in their seventies, more apparent in

(10:52):
their eighties, but really begins muchearlier. And that's where we really want
to intervene whatever possible is back inmidlife, back in your twenties, and
we may even look at some thingsgoing back to childhood. Wow, okay,
well, that is an excellent definitionto give us kind of the framework

(11:15):
of that But I think what's mostimportant about the work that both of you
are doing is that Emily, yousay that dementia both of you share this
is that it's not inevitable, right, Holly, It's not. And that's

(11:37):
the really great thing about putting thisbook together. We want to put in
one place a list of all thereversible or modifiable factors that have been proven
to enable somebody to stave off dementiaor completely prevent it. So when we

(11:58):
talk talk about prevention, we're talkingabout one out of two people actually not
getting demented. And it goes withactually reversing things that are correctable, like
the high blood sugars that you mentioned, like not getting enough oxygen in your
brain at night when you sleep,like controlling your blood pressure, like getting

(12:24):
enough exercise, like staying socially connected. So these are all things that are
within our control. You know,we can't fix who our parents were,
so we can't control our genetics.But short of that, there's a lot
that we can do and prevent actuallydementia occurring in our brain. Yes,

(12:46):
And so I think what's interesting aboutboth of you is that your story is
that you both care for parents thathave dementia, and so you have a
particular literally unique angle in that youdon't you know, you don't only specialize
truly in this work, you alsoare caregivers. True, I would not

(13:11):
suggest this as a great path toenlightenment. Yeah, it's but it does
give us a perspective that I thinkis really helpful because when we sit down
and talk with our patients and theirfamilies, we're able to really share with
them the fact that we've seen thisfrom both sides of the desk, and

(13:33):
that we understand the initial time inwhich they're trying to figure out is this
something that's significant or is this justnormal? Forgetfulness, the kind of bargaining
they go through where they write itoff and say, well, you know,
this person's under stress. We knowthat they're just having some other medical
problems. Maybe it's nothing. Thoseare all very common and we've experienced them.

(13:58):
And the one thing that we're ableto do better is then say,
but we also went through this,but now let's go into the other early
interventions that we can do. Andthat's where being able to diagnose early in
the process, whether it's dementia orhas not yet become dementia and as in
a stage we call mild cognitive impairment, there's a really wake up call that

(14:22):
gives us a lot of opportunities fortaking a look at what's contributing to the
situation and being able to motivate andget people to really start looking at how
they might change the situation. Soit's being on both sides of the desk
does have its advantages, it's justnot something we both, neither one of

(14:46):
us set out to accomplish. Andin addition to empathy and some real firsthand
knowledge of what it feels like asa caregiver, the other thing it helps
us understand is that when someone comesin to see if they are generally brought
in by their loved one, andit's generally a son or a daughter,

(15:09):
when we're looking at that son ora daughter, that's as much an imperative
to us to intervene in that person'slife as it is in the patient's life.
Because that son or daughter got thosegenes, that son or daughter potentially
has a higher risk of getting dementia, and the sooner we can get them

(15:33):
on the right track, the greaterthe likelihood is is that they will avoid
their parents' fate. And that's reallycritical to us. It's also part of
what gets us motivated to go eachday and to take things more head on
than we might if we hadn't alreadyseen this happen with the people we cared

(15:54):
for. Yes, because that's whatI was going to ask. What does
research tell us about dementia and genetics, because you know, I guess you
said it's not inevitable that you know, one in two cases are preventable,
but how does that impact those whoare genetically predisposed to potentially having the likelihood

(16:22):
to have dementia? Well, andthat's a good question to frame, Holly.
Thanks, So there's a couple ofways of looking at genetics. I'm
going to break this down into twomajor parts. The first is the genetics
that are involved in actually getting aprimary disease that will result in dementia,

(16:42):
such as Alzheimer's disease, Parkinson's disease, a frontotemporal dementia. Those have definite
genetic risks. Then there's the othertype of genetic risk, for instance,
where you're carrying a high risk fora disease that can contribute to you're getting

(17:03):
dementia, like diabetes. So inboth cases. I want to stress the
fact that you can modify your risknot by eliminating the genetic risk, but
by doing everything that you can toovercome the expression of that risk. So,

(17:27):
for instance, if somebody has ahigh genetic risk of Parkinson's, then
they know that they really need tocontrol and identify early sleep apting it.
They need to control their blood pressure, they need to exercise, just like
someone who has a high risk ofgetting diabetes, which if you get diabetes,

(17:52):
in fact, if you just havehigh normal levels of blood sugar,
you have three and four times therisk of getting dementia us from that one
factor alone. Well, we alsoknow that if your parent had type two
diabetes, your risk of getting thatis twenty five percent. So what those
people need to do is pay particularattention to making sure that they keep their

(18:18):
weight down, they keep their exerciseup, they control their cholesterol, they
control their blood pressure, because thosetwo factors do interact with diabetes. By
doing all those things, they canreduce their risk of getting insulin resistance,
which will reduce their risk of gettingdementia. So there is a it's a

(18:41):
long, convoluted Unfortunately, it's acomplex answer to a very good question.
But the bottom line is, evenif your risk is very high genetically,
what you need to do is controlall the other risk factors that you possibly
can to minimize the impact that thegenetic risk is going to have. This

(19:07):
is so important and extremely empowering becauseit lets us know that we're not set
up on a certain path that isan absolute that you know, we actually
have a stakeholdership, and how thiscan turn out and it's not as grim
as we might think. And Ilove that you have actually laid this out

(19:32):
for people to empower them and makethem realize that they can turn this around.
How hard is it for them toturn this around? I mean,
is there like a you know,if they're seventy years old, is should
they feel like, oh my goodness, it's too late. Do they need

(19:52):
to start when they're twenty? Ilove the idea that it's never too late.
Of course, on aging gratefully,we like to embrace that primit so
is a little bit helpful and it'snever too late. How do you embrace
that, Mitchell? As far ashow somebody can begin, I agree with

(20:15):
you it is never too late.And in fact, that's a big part
of what we talk about when counselingwith our patients, and really the message
in the book is I consider it, even though I'm not a golf player,
I consider it to be like playinggolf, where you play it where
it lays. You know, sometimesyou're on the fairway, sometimes you're on
the green, but a lot oftimes you may be in the woods or
in the rough, and you havedifferent choices to make and each sometimes you

(20:40):
only have a couple of clubs thatyou can use in that situation, and
so you're sort of limited. Butthat's okay. That's where you start,
and any kind of change requires startingin small steps. Change is really hard
for anybody, and the older weget, I think, the harder it
becomes. So the idea is whatcan you And what we try to do

(21:03):
in the book is to help themidentify a starting point, something that is
close to being on target, sothat they can start there and say,
okay, I can reduce three drinksof alcoholiday to two drinks. That would
be a start. I don't haveto cut it out entirely right now,
but let me just do that andsee what things are like. Or I'm

(21:25):
snacking in the evening and I knowthis is keeping me from losing those ten
or fifteen pounds that I want tolose. Let me start by examining why
I'm doing that and what alternatives Imight have, because if I can make
a small change and do something alittle differently, then that's going to pay
off over time. How many stepsam I actually walking every day? I

(21:47):
encourage people to download a pedometer ontheir cell phone or to use a fitbit,
just because they all say, well, I do enough walking, And
I say, well, really,how far do you walk? How many
steps? And they say, well, I don't I don't know, And
I said, well, let's findout, because if you could start there,
that'll really give you information about maybeyou could do it a little more,

(22:08):
maybe you can do it more frequently, maybe you don't have to just
do it when it's nice weather.And then you start to see how change
can be made, which gives peoplethe impetus, the experience, the encouragement
to make other changes, and nowyou really have things moving in the right
direction. Yes, I actually thinkthat's a great advice, and I really

(22:32):
appreciate that you focused on the varioustypes of dementia. I actually knew someone
who you know, I didn't knowthem well, but I had gone to
school with them and they had comedown with alcohol induced dementia and it was
a terrible, terrible disease. Sureis absolutely, I mean, it is

(22:59):
just all well, and I'd neverheard of it until I heard that this
had happened to them, and it'sjust it completely changed who they were.
They weren't even the same person.So I was just so glad that you
actually focus on this, because Ithink it's more rare than people and I

(23:22):
just don't think it's something that peopleknow a lot about. It's far more
common than people are taught about.Well. First of all, doctors don't
tell you about stuff like this.That's part of the problem. And it's
so I'm glad that you're bringing itup, actually, because anybody can be
at risk for this. You don'thave to, you know, have You
don't have to drink a half agallon of booze a day to have this

(23:45):
happen to you. All you haveto do is drink some quantity of alcohol
and not have enough vitamins and nutrientsbeing absorbed by your gastro intestinal system the
way they need to be, andyou can be at risk for alcohol induced
dementia, and I didn't think thatthey That's the thing. I think that's

(24:07):
what was the enigma is I didn'tthink that they were like a rampant alcoholic,
and they probably weren't. And womenare a greater risk for this than
men are. By the way,we actually have a fewer enzymes in our
gut system that processes alcohol appropriately thanmen do, so it actually increases our

(24:30):
risk. But I'd like to getback to something that Mitch made me think
of when he was answering your lastquestion, which is everything it's in this
book, Holly is research based.That means this is not just our opinion
and it's not just what sounds good. We actually decided to write this book

(24:52):
because when we looked at the dataon patients when I first started my practice
back in two thousand and seven,with the premise that I wanted to fix
everything that was possibly fixable in thesepeople. You know, I can't cure

(25:12):
Alzheimer's, We do not have asilver bullet for treating any type of a
dementia. So therefore it made senseto me, well, what other things
can I fix for this person thatwill improve their overall brain health, so
that their brain will have more cognativereserve and that they'll be able to better

(25:37):
resist the disease. And so Ilooked at all the literature and came up
with things like hyper homocystinemia, thisis in the book, by the way.
I came up with vitamin B twelvedeficiency, vitamin D deficiency, sleep
apter or a lack of oxygen inyour brain at low. And behold,

(26:00):
when Mitch and I looked at thenumbers on the patients that were aggressively treated
for all these other conditions and weused good dementia sparing medications on them,
a significant number of these people improvedtheir level of impaired cognition, came back

(26:21):
to normal, and then stayed thereinstead of progressing downwards. So we actually
had a lot of years of experiencein reversing the correctible conditions that are modifiable,
and we actually published this kind ofdata. So that's what led to

(26:42):
the book, and that's why we'reso convinced that if you can get your
readers, your listeners to take alook at this dementia prevention checklist, it
might just have that same effect intheir lives. So incredible because you really
focus on things that I think areoften overlooked. You talk about things like,

(27:07):
you know, vision and hearing,we don't think about how these sorts
of things affect our brain, Like, I just don't think that that's something
that we're really itemizing. Hearing probablyis the hottest topic right now in dementia
prevention because the last couple of yearsthere's been an explosion of studies showing changes

(27:32):
in the structure of the brain,as well as in the connectivity of areas
of the brain, the background restingareas for people who have even subtle hearing
loss. So with the growing numberof people who've been exposed to industrial noise,
environmental noise, rock and roll music, all of these things that we

(27:55):
took for granted, maybe even youknow, listening with our headphone on in
our EarPods in at a level wherewe really want to appreciate just how loud
we can get it. That eventuallyleads to some problems that we then view.
Everyone else is mumbling. We said, well, there, you know,
I think I hear just fine,and you know this is the TV's

(28:17):
just not working as well, soI have to crank it up. Well,
it turns out that we're probably experiencinga very subtle kind of progressive hearing
loss, which causes some forms ofmemory loss. And if you can get
people's hearing fixed through things like hearingaids, their cognition improves. So it's

(28:37):
really nice to be able to seethe fact that the Number One, you
can get hearing aids so much easierright now than you could even a year
ago. Number Two, the qualityof these is getting increasingly better and will
continue to improve as a result ofartificial intelligence being able to change the levels
of where you're getting the input.So right now the circuit tree in the

(29:00):
hearing aids is getting increasingly better.That's extraordinary. I know a lot of
people have suffered hearing loss because ofa certain antibiotic and so you know this
is really something they think that there'ssomething wrong with them, when in fact
they're not associating it with the factthat you know they have hearing loss.

(29:26):
Once they get the hearing aids,then the question is when do they use
them. And as we like totell patients, they're not the crown jewels.
Don't bring them out just for specialstate occasions. You want to put
them in first thing in the morningand leave them in throughout the day.
For one thing, you're less likelyto lose them. The next thing is
that they're going to pick up allthat important background sound those birds chirping outside,

(29:52):
or your refrigerator motor turning on andoff, the kind of stuff that
you don't even think about but isactually stimulating your rain in ways that connects
with your memory centers. So allthat background stuff that we don't pay attention
to, which is fine, isreally going on in a background mode and
helping your brain. I'm really gladthat you spoke to that, because I

(30:15):
think that people do tend to somesay, Okay, I'm going to dinner
tonight, so I'm going to goahead and put the hearing aids in,
but they don't have them in useall of the time for the just the
daily use. So that was important. Listen to Mitchell Koyonski, PhD.

(30:36):
He's giving you very good information.So on the other side of break,
I was hoping that we could continuethe conversation and talk about some things you've
cared for your parents. There maybe something that you want to share with
people that they may not realize aboutcaring for a loved one with dementia.

(30:56):
Maybe there's some rewards and some thingswe can learn about a life of caring
for another person. And I'd alsolike to continue the conversation about this deep
research that you've done that's so important, if you'd be willing to sure,
Holy thank you, You're very welcome. Don't go anywhere, because this fantastic

(31:18):
conversation will continue today. We're sograteful to be with Emila Kleonsky, MD
and Mitchell Kleonski, PhD, talkingabout their new book, Dementia Prevention,
Using Your Head to Save Your Brain. You can learn more about them by
visiting them at brain dot dot com. That's an easy website, and I

(31:38):
hope you check that out. Sowe'll continue the conversation on the other side
of break. Before we continue,I would like you to check out I
know you love our show's theme song. That's jim Byloff and you can visit
him at Flea Market Music dot com. Amazing guy. He's an extraordinary musician
and he wrote our theme song,Aging Gratefully, so amazing. It's one

(32:00):
of my favorite songs, So checkthat out. It's in his album Dreams
I Left in Pockets. So manygreat songs on that album. You'll love
them all. Of course, myfavorite is always going to be Aging Gratefully,
but go check that out and givehim some Aging Gratefully love and special
thanks to you out there, Agingrebels tuning in all over the world.
Thank you so much. I sawwe were charting on Apple Podcasts in Australia,

(32:22):
Let's see the Philippines, Great,Britain, Canada. We love you
guys so much. Thank you somuch for putting us on the Apple podcast
charts and all the different places aroundthe globe. So appreciate it. And
thank you for making us a topthree show on aging worldwide. We really
appreciate it. Thank you beat Spotfor recognizing us in the lineup. And

(32:44):
I haven't told you my truth sinceour last broadcast, and that is that
you are the greatest listeners, andyou rock and you role model and I'm
grateful for each of you. I'myour host, You're intologist Holly Kelly,
and will be right back Hi.I'm Annie Anderson, author of Find Your

(33:07):
Soul's Agenda, and I think thatHolly Kelly's Aging Gratefully is such a wonderful
show and we should all listen toit to learn how to never act our
age. The Latter Life Planning Instituteis the ultimate guidance for life's inevitable destiny
and your path to passionate aging andinspirational Advanced care Planning. LLPI offers tools

(33:30):
that educate, inspire and enlighten.Live vibrantly, plan thoughtfully, age dynamically.
Visit LLLPI for business and individual consultingservices, professional and keynote, speaking
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(33:50):
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Live extraordinary, age dynamically visit LatterLife Planning Institute dot com. Hi,
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(34:16):
over to my website to grab manyfree joy starters today to get you kick
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Show is a truly beautiful experience.Holly creates such a wonderful experience for all
of her listeners to find more joyand to age gratefully every day. Thank

(34:47):
you so much, best listeners inthe world. Welcome back to Aging Gratefully.
I'm your host. You're ontologist HollyKelly here today with Emily Kliowski,
m d D and Mitchell Kleiowsky,MBA physician in neuro psychologist CUP who have
cared for their own parents with dementiaand are sharing ways to improve our brain's
future. So awesome. I'm soexcited to have them here with us today,

(35:09):
and I know you are too.So we're going to continue the conversation,
but before we do, I'd liketo give our listener appreciations shout out
to a listener who wrote me anemail. Thank you. I so appreciate
it when you guys reach out inthe many ways that you do. You
send me direct messages. I appreciatethose. You leave us reviews, so
cherish those. But this listeners sentme an email, and we have our

(35:32):
email in the show notes, andyou wrote, I've been listening to Aging
gratefully for over a year now,but I'm almost two hundred and fifty episodes
in. I think we have overthree hundred and fifty episodes, so anyway,
you wrote, so, I've takenin many past episodes and loved them
all. You've really helped me changethe way I view aging. I'm more
excited about what's ahead in using alot of what you and the guests have

(35:55):
shared to improve my life. Ijust want to say thank you, Holly,
because it's working. God bless youwell. Thank you. I really
appreciate that that was very kind ofyou. I appreciate all the messages that
you'll send me, and I'm gladthat it's working. I'm glad that you
love what the guests share because Ichoose each one deliberately. We receive so

(36:15):
many guest proposals that I can't respondto them all, and they're all great,
but I try to think about whatyou out there need to hear,
and because I can't do a showevery day, I just have to pick
as carefully as possible. And Iknow that you're loving today's show. And

(36:37):
I think today's show is so valuablefor you out there because this is such
an important topic. So I'm lovingit and I know you are too.
I want you to visit brain dotdot com and check out this incredible new
book, Dementia Prevention, Using yourHead to Save your Brain. Well it's
a great title, but the contentis just really so valuable. Everything we're

(37:01):
talking about is in there, everythingthat I talked about in the opening is
in there. I didn't make thatstuff up. I don't know all these
things, but I'm burning along withyou out there. So I wonder.
You know, Mitchell, what issomething that people may not realize about caring

(37:23):
for a loved one with dementia?Because I think it is one of the
most generous of spirit of humankind.Generosity of spirit kind of things you can
do for another human being, butat great sacrifice, I mean, because

(37:47):
it requires so much of oneself.You're absolutely right, And I'll tell you
the story that I tell from mypatient caregivers. It's something I learned when
I was about eleven years old.I took a course in junior life saving.
So part of the course at theend of junior life saving was this

(38:10):
very large, muscular guy who wasthe life guard, went into the deep
end of the pool, which isabout thirteen fourteen feet deep, and your
job was to go down and pullhim out without him basically grabbing onto you
and causing you to drown. Now, truth be told, I failed the

(38:34):
course. I never became a juniorlife saver, never went on. But
I learned something really helpful in theprocess that was very important. Both for
myself when I was caring for mymother and also when I'm talking with my
patients. And here's the nub.Nobody ever saved anyone by drowning themselves.

(38:58):
In other words, you have tobuild in time for yourself, a break
for yourself, somebody else to commitand care for that person. If you're
doing it in your home, youhave to figure out can I still do
it at home or does this personneed to be in a more supervised caregiving

(39:19):
facility like a nursing home or assistedliving. There's a variety of different options
at different points and for different people. The important thing is that I was
actually talking just this morning with oneof my patients about it, whose husband.
She's the caregiver. Her husband hasmoderate dementia, and she doesn't go

(39:40):
anywhere. She says, she doesn'tgo to the senior center. She doesn't
want to leave him for any timeat all. And I was saying,
you have this is not a sprint, This is a marathon. This could
go on for some years right now, and you've got to bring people in.
You've got to negotiate with your kidsso they're overgiving you help. You

(40:01):
need to do things to take timefor yourself because if you go down,
he goes down. And I thinkthat's probably the most important advice that I
ever give to the caregivers, becauseI agree with you, they are an
incredible group of people. And thekind of caring that is involved for someone

(40:22):
with dementia is it's greater than givingto a child. With a child,
you know that a child's going togrow out of it, So all those
things that you're correcting and fixing andavoiding, you know, don't touch this,
don't go there, don't do that. All of those things they're going
to not need in a while,whereas somebody with dementia they're going to need
it more probably. And so it'sa real burnout job if you're not giving

(40:45):
yourself a break. Yes, AndI imagine that the individuals that find it
challenging to give themselves that break arecaught up in kind of a codependency role
that they're just unable. They justcan't let go sometimes and sometimes they are

(41:05):
not. They're thinking this has gotto be their thing to do. A
good wife or a good husband,or a good child does all of these
things for their parent, and they'relooking for some level of good that really
doesn't exist, and they need tobe able to step back and hear from
other people. That's why support groupsare very helpful, because they get to

(41:30):
see other versions of caregiving and theyget to find out from other people that
they're really doing a great job.It's not a perfect job, but that's
okay. And the other thing,Holly, is that what a lot of
us need to understand is that eventhough the person may be demented, that

(41:50):
brain still requires stimulation, novel stimulation. So if there's just one person in
their life providing all the care,that's less stimulation than they could possibly get
if there were more people that theywere involved with. In other words,
if they were going to a seniorcenter for daycaring every single morning and so

(42:14):
at least would be involved with otherpeople at the daycare center, if they
were at an assistant living center,if they had a physical therapist or an
occupational therapist coming in to work withthem, if they that need was justified.
So actually, it's healthier for theperson who's being cared for in the

(42:37):
long run to have more people involvedin their support and their care then just
have the one person alone. Iwould also share one more thing for any
of the doctors or nurses that youhave in your audience. And this is
something I learned from Emily when Isaw her stop at the end of a

(42:58):
visit and turn to the caregiver andsay to them, you're doing a really
excellent job. And the woman's facejust lit up and she said, you
know, I've never seen a doctorwho's told me that before. Oh that's
great, but yeah, but it'strue that the people who care for our

(43:21):
patients, as you pointed out,really are doing a self sacrificing amount of
love is involved in that process,and pain is involved in that process,
and we need to respect that somuch so because I mean for a great

(43:43):
amount of time, literally their lifeis on hold. Their life, you
know that may have been lived otherwiseanother way, is so committed and dedicated
to ensuring the sanctuary of another.It's also a role we don't get any
training for, right. You don'tthink a class and is you don't expect

(44:05):
this. This is and in manycases, especially with couples, that person
loses their best friend in the process. Yes, yes, very true,
so much so so. Rewards.Do any of you want to share some
of the rewards that go along withthis, you know, job of caregiving

(44:28):
for me. I think with mymother, who developed dementia in her mid
seventies and lived with it for thenext nine years, it was very much
a payback kind of thing, andthe reward was I got an opportunity to
pay her back for being a reallygreat mother. So I think there is

(44:52):
value. I know there's value incaregiving that extends beyond just you know the
fact that you're doing something that's goodfor someone. There's a sense of you
know, when we look at familiesof commen and they've got three or four
children that are incredibly supportive of theirparents with dementia, I always tell the

(45:14):
parent that they did such a greatjob of raising their kids, because that's
what we're seeing in the caregiving thatthey're offering. Yes, I'm remembering Naomi
File, who you know, dida lot of work in dementia, you
know, historically, and she hadkind of brought some when you were talking

(45:37):
about different stimulation, and she hadbrought this lady who had you know,
just kind of gone into herself andsaying a Bible verse that the lady had
sung so much as a young childand connected with her on that level and

(45:58):
brought her out and it was kindof a beautiful thing to see, to
be able to watch her stimulate herin that way. And you know,
I think that it's important that somebodyis able to have different types of stimulation,
you know. And I think thatyou know, caregivers do need to

(46:22):
offer maybe adult daycare and you know, give themselves that break, that respite
so that they're able to be wholetoo. Can we plug another book while
we're on Sure? It's also fromJohns Hopkins. Like our book, it's
called The Thirty six Hour Day,and I bet a lot of the people
who are listening will recognize the title, both because it's now in a seventh

(46:45):
edition and it's been out for aboutforty years and updated editions. I always
recommend it because it's sort of theBible. It's the manual, the owner's
manual for taking care of somebody withdementia. And we're really prey that we're
from the same press as The Thirtysix Hour Day, So it's worth the

(47:05):
listen. It's on audiobook, it'sworth a read, Okay, great,
Yes, And that can be foundon John Hopkins Press, yes as well,
Yes, where your book is aswell. So I love that you've
talked about so many different ways thatwe can prevent that you know, dementia

(47:25):
is not inevitable, and you talkabout one thing that I really appreciate because
we focus on mindset a lot.In fact, so many studies have been
done about aging and that your agingtrajectory can be completely changed as as it

(47:45):
regards how you actually view aging canchange your chan change longevity and everything else.
And so you talk about how doesmental outlook affect the likelihood of developing
dementia? And so I really,you know, was interested in that because

(48:08):
a mental outlook impacts so much ofwhat we do in life, and so
I was hoping that you could kindof speak to that. One of the
phrases we use in the book isthat we tell people we don't want them
to be a dementia warrior, Wewant them to be a prevention warrior.

(48:28):
The whole view is this is whatyou know, the stuff that's behind you,
that's in your rear view mirror.If you're driving looking your rear view
mirror, you're going to crash.You've got to be looking far enough ahead
that you can see some intermediate goals, some things that you're striving for and
we know that people who are moreactive mentally, more active, socially,

(48:51):
more active in life are going toreduce their risk of dementia. So the
attitude of starting out saying I'm goingto make the most of each day,
I'm going to look ahead and havegoals for myself. You know, that's
really important. Retirement is not foreveryone. Being active is really an ongoing

(49:13):
occupation, whether it's lifelong learning orvolunteering, or being in social groups or
exercise or all those things. It'sattitude. Yes, And another thing that
you focus on in your studies isthat we're seeing more and more in learning

(49:34):
more and more about contact sports andconcussions. Emily, can you speak to
how this is relative to chances ofdementia? Yes, And it's really this
is a really scary thing. AndI hope that all the grandparents and parents
out there are listening because we takea very benign attitude towards like soccer and

(50:00):
football, but anything involving head impacthas the potential to drastically change someone's trajectory
for cognition for the rest of theirlives. You know, concussions are considered
mild traumatic brain injury. Well,there's nothing mild about it at all.

(50:22):
And depending on what age and stageof life you are, the effect can
be really devastating. So you can'ttake back a traumatic brain injury or a
car accident that you had, youknow, thirty years ago. But again,
knowing that you've had that as amajor risk factor, you need to

(50:43):
do everything that you possibly can tofocus on the things that are modifiable.
But I will absolutely concur with you. Concussions are one of the top ten
preventable causes of dementia. They canincrease your earlier mortality. They increase the
risk of heart attack and stroke anddiabetes, and so they not only increase

(51:08):
the risk of primary neurologic disease,they increase the risk of the conditions that
can actually influence your risk of gettingdementia. It's devastating. So where are
your helmets when you're riding a bike, when you're doing anything that's risky at

(51:29):
all. And if you're already fallingand you're an elder, please talk to
your doctor or your nurse practitioner andlet them know that this is happening,
because one little knock on the headif you're older particularly, can really advance
more rapidly cause a more rapid formof dementia. Wow, And you know

(51:54):
some of these are voluntary, youknow, I mean, some of them
are accidents, just general accidents justfor being in life. But some of
these, you know, are achoice that we make. And so at
a certain age you want to stayoff the roof, yes, they don't.
You don't want to be cleaning thosegutters. That commercial agency on television

(52:16):
is really just yes. So there'sother risk factors, a variety of them
that impact dementia risk that do eitherof you want to bring any of those
up for listeners to know about.Why do you start with sleep app Yeah,
I think the breathing while you're sleepingpart is really something that most people

(52:37):
don't pay attention to. And weboth have sleep apnea, so we're going
to tell you that right up front. How do you know if you have
sleep apnea? And the question isthat you don't exactly, But there's a
bunch of symptoms that are common inpeople with sleep apnia. By the way,
they now think that about one outof five people anywhere has sleep apnea,

(53:00):
recent data that was just published.But it becomes more common as you
get older, So you start gettingover the age of seventy and a large
percente what was the percentage we foundin your survey, oh, is actually
seventy people over the age of seventywho have cognitive questions cognitive concerns have a

(53:20):
problem with breathing while they're sleeping.And the other thing that's really important,
Holly, for people like you andme, we need to keep this in
mind is that while estrogen protects usbefore we become post menopausal, we have
women have a lower rate a lowerincidents of having sleep bapny and than men.

(53:42):
But the minute we lose that estrogen, we develop the sleep bapty at
the same rate that men do.So yeah, so when you think and
when you think perimenopausal, I wantyou to start thinking the age of forty
two, not at the age offifty two that we used to think of
in this country. So basically,if you have sleep apnea, it means

(54:04):
not enough airs getting down your lungs, so you stop breathing or your oxygen
levels dropped by three or four percentat least five times every hour. Now
that's like someone putting a pillow overyour face for ten seconds or more.
Five times every hour most of uswould not want to have that happen,

(54:27):
and yet that's the equivalent of what'sgoing on if we have sleep apnea.
That's the bad news. The goodnews is because it contributes so much to
fatigue during the day, so muchto problems paying attention, so much to
problems remembering that. If we canfix the sleep apnea or treat the sleep

(54:52):
apnea so that we're not losing ouroxygen five times an hour, we get
down to maybe zero to one timesper hour while we're sleeping. Suddenly our
brains wake up. Well, notsuddenly, but over the course of several
months, our brains will wake up, and we're able to have more energy,
so we're more interested in doing things. We are probably not snoring,

(55:15):
so our bed partner isn't waking upin the other room every morning because they
had to leave because we were makingso much noise. We're probably not thrashing
around in bed so much. We'renot getting up multiple times to go to
the bathroom every night, because mostpeople don't realize. But that's related also
as it be caused by not gettingenough oxygen, and so this is something

(55:42):
that can actually improve and change thetrajectory of whether or not we have dementia.
If you've got mild cognitive problems andyou've got sleep apnea, treating your
sleep apnea will dramatically reduce your riskof having dementia within the next five years.
And just to give you this scientificbackground for that, there's a lot

(56:05):
of data, but we've known sincetwo thousand and six, Holly, that
when you have a lack of oxygenin your brain, it allows that enzyme
that makes that beta amyloid plaque ofAlzheimer's disease, and that's also found in
vascular dementia to happen. So ifyou can prevent having a lack of oxygen

(56:27):
in your brain cells when you aresleeping, you will be forming less of
that damaging injurious ameloid plaque that actuallyis known to be part of two dimensia
diseases. Very important. Yes,wow, So what does somebody do for

(56:51):
sleep apnea. Well, first ofall, they get a test, which
these days, in many cases canbe done in their own bedded home.
It's pass it's not very expensive coveredby most insurances, so you have to
get your primary care provider to orderthat test. Then, if you find
out that you have sleep apnea,and they tell you it's mild sleep apnea.

(57:16):
You have to translate in your brainthat that does not mean non important
sleep apnea. Mild means you onlystop breathing five to fifteen times per hour,
but still a lot. And thenyou have to treat it. And
the most effective treatment for this iscaused by what we call continuous positive airway

(57:38):
pressure CPAPCPAP, which is a machinethat it's not a drug. It's a
machine that takes room air, putsit under pressure so that it will then
go through a hose to a maskthat you wear. Sometimes a very small
thing just goes under your nose,sometimes something as big as going over your

(58:01):
nose in your mouth that if yousleep with this, it keeps your airway
open, make sure that enough airis getting down there, so enough oxygen
gets pulled out of the air andattaches to the red blood cells and gets
up to your brain, as wellas to all the other parts of your
body that need it, such asyour eyes and your extremities in your heart.

(58:23):
Of course, so it's a matterof it's one of those active things
that you can't just have it doneto you. Every night. You make
a decision that says, I'm goingto put this thing on. I'm going
to turn my machine on, andin doing so, I'm going to increase
the amount of oxygen getting to mybrain. Let me give you a real

(58:47):
world example of what that felt like. Before I had my sleep bapania diagnosed
and treated, I was literally fallingasleep in front of my computer around three
o'clock in the afternoon. I wasforgetting three of the ten things I needed
to pick up in the grocery store. I was getting into little spats with

(59:07):
Mitchell over conversations that he knew thatwe had the week before that I was
wearing that he had never told meabout because I couldn't remember them. Because
what happens is when you've got sleepapnea during the day, when you're awake,
your brain is actually taking these littlemicro naps, and your attention and

(59:29):
your ability to pay attention to thingsin the world around you is significantly diminished.
So I wasn't really listening to whathe was saying. I was tired
during the day, I was zoningon out, and I was forgetting to
do things. I was actually forgettingwords that I had learned in medical school,
medical vocabulary. It was very scary. It took about six months of

(59:52):
my using my SEPAP for about sixhours a night, and all of a
sudden, I felt like, insteadbeing sixty five, my brain felt like
I was fifty or fifty five again, and it stayed that way. Well,
well, I'm sure that you're speakingto a lot of people and they're
going to be like, Okay,I need to do this. You know,

(01:00:15):
he still doesn't listen to me allthe time, right, but now
that just might be stops at all. Well, these hours go so quickly.
I just want to ask, isthere anything that you want listeners to
know about that we haven't covered thatyou just feel it's really really important for
them to hear. No, you'vedone a great job of getting all the

(01:00:36):
important data out, all the nuggets. Yeah. Where we do have a
book down on audiobooks, So Ijust want to mention that just May thirtieth,
that happened and it's it's read bya woman, an actress named Nan
McNamara, who is incredible. Andwhen I heard the sample of it for
the first time, was like,Wow, that's really good. That's all

(01:01:00):
we wrote that before that had neverdawned on me. How how good.
It sounded, but the audiobook isincredible. So if people many people these
days, they like to listen tosomething while they're walking, they like to
listen to while they're in the youknow, they're taking a tub bath and
relaxing in the evening or whatever.But you know, it's uh, I
asked the question, what do youlike to listen to? And this is

(01:01:23):
a good thing, good way ofgetting the information that's growling out. Are
there links to the audiobook from braindot dot dot com. It's all on
any of the major you know,you can get it through Amazon audible places.
Okay, listeners, that's dementia prevention, using your head to save your

(01:01:45):
brain. Okay, you were goingto say something, Emily Holly, I
just want to we both want tothank you very much for doing the good
work, the solid work that youare doing for everybody out there. You
bring really important topic to the forefront, and you do it very thoughtfully,
with a lot of insight and withsensitivity. So thank you for that.

(01:02:07):
Oh, thank you. I justreally appreciate, well, thank you for
the compliment, but I just reallyappreciate the deep dive of research and important
content that both of you are bringingto the world. And I'm just so
grateful to have been able to shareyour work with our Aging Gratefully family of

(01:02:27):
listeners. I just love what you'redoing. It's you're changing lives and it's
so amazing, and we can't havethe hour end without knowing first Emily,
how you age gratefully? That's reallya very interesting question. I'll try and
be succinct, but on a dailybasis, it's going to sound a little
tripe, But on a daily basis, I literally thank God for the fact

(01:02:52):
that I was born in this country, that I have so many advantages,
that I had the brain to becomea doctor, that I've had great patience,
that I have eyes to be ableto see, and God has given
me so much that and I amincredibly grateful for that. And anytime I

(01:03:16):
feel really snitty about something, Ijust remind myself how many people in this
world don't have even one percent ofwhat I have. It's so beautiful.
And you have beautiful eyes, bythe way, and you, Mitchell,
how do you age gratefully? Iage gratefully by being married to Emily.

(01:03:37):
Oh, it's true. Not everyonehas that opportunity, and it's it's really
that kind of connectedness. To havea soul mate, to have somebody that
you can ask anything and listen tothem and be really in awe of them
is from me, just miraculous.So that's how I age gratefully. Y'all

(01:03:59):
are beautiful couple, brilliant, andI love how you have brought your beautiful
minds together to create something amazing tobenefit the world. And I just think
that that is an incredible gym toshare to enhance the lives of others.
So we're grateful today to have spentthe hour with you. Thank you so

(01:04:24):
much. Thank you, Holly,Thank you, Holly. You're very welcome.
You've been listening to Aging Gratefully,and I'm your host gerontologists Holly Kelly,
thank you so much for tuning in. If you enjoy our message,
I invite you to subscribe and sharewith others. May you remember to never
at your age and that age isjust a number, and may you enjoy
an embrace the coming week in thespirit of gratitude. Until we meet again,

(01:04:45):
here's to living your best life now. I used to think time was
my enemy. My future wasn't lookinggood, so worried about the things I

(01:05:08):
couldn't see. I couldn't see thethings I could. I was aging,
fearfully, worrying my life away,when all along I should have been thankful
for every day. Finally made afriend of time. Now you could say

(01:05:32):
that I am aging gratefully, Aginggratefully

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