[Speaker 1] (0:00 - 0:01)
Good morning, everyone.

[Speaker 1] (0:03 - 0:04)
Hi, everybody.

[Speaker 1] (0:06 - 0:08)
Welcome to the Swampscott Senior Center.

[Speaker 1] (0:08 - 0:10)
We're so glad we've filled the room today.

[Speaker 1] (0:11 - 0:15)
We're excited to do a fabulous presentation with Dr.

[Speaker 1] (0:15 - 0:20)
Abrams, but I just wanted to give you a quick second to meet Jill Rhodes.

[Speaker 1] (0:20 - 0:23)
Jill is with the Current in Beverly,

[Speaker 1] (0:24 - 0:28)
and I'm going to ask her to speak a few minutes because the Current sponsored our lunch today.

[Speaker 1] (0:29 - 0:29)
So.

[Speaker 1] (0:35 - 0:45)
Yeah, so my name is Jill Rhodes. I am in sales at the current in Beverly. We are a senior living community featuring independent living,

[Speaker 1] (0:46 - 0:48)
assisted living and memory care.

[Speaker 1] (0:49 - 0:58)
We are in downtown Beverly with a beautiful view of the water from our wraparound deck on our top floor.

[Speaker 2] (0:59 - 1:26)
It's really something. Um if you are familiar with the building at all it was an old school, um it's been renovated uh a couple of times, but this recent renovation was phenomenal. We have mostly uh studios and one bedrooms. There is eighty six apartments. They have um a refrigerator, a and a microwave and a sink.

[Speaker 2] (1:26 - 1:32)
No cooking is needed because included in the rent is three meals a day,

[Speaker 2] (1:33 - 1:34)
your utilities,

[Speaker 2] (1:34 - 1:35)
laundry service,

[Speaker 2] (1:36 - 1:37)
and housekeeping.

[Speaker 2] (1:38 - 1:42)
We're happy to give tours anytime you'd like to come,

[Speaker 2] (1:43 - 1:45)
and activities,

[Speaker 2] (1:45 - 1:52)
programming, we have a van that could take you here or anywhere you'd like to go within a fifteen mile radius.

[Speaker 2] (1:54 - 2:16)
And that's the current. Uh any any questions? Anybody have any questions? I'll leave some brochures up here um and visit the website if you like. It gives you full colour pictures. It's it's really a stunning property. And if you're thinking about making a move at all, just give us a call and we'd love to talk you through it.

[Speaker 2] (2:18 - 2:20)
And enjoy your lunch, and the presentation.

[Speaker 1] (2:24 - 2:51)
Thank you Jill. Um I'm next gonna call up Izzy, but I'm gonna make a announcement first. Um so today we have the Swampscott High School will be taping us, so this presentation will be up on YouTube and our town website soon. That being said, I'm gonna ask you all just to stay in your seats till the presentation is over. If you have questions or comments we need to use the microphone so we have one on a stand and we'll

[Speaker 1] (2:51 - 2:53)
then we'll bring it to you to ask the questions.

[Speaker 1] (2:55 - 3:06)
Okay? Cool. So the the plates and stuff we'll just leave here, just enjoy the cookies and whatever while we do the presentation. And now I'm gonna ask Isy Abrams to come up.

[Speaker 1] (3:10 - 3:20)
Isy Abrams is the current president of Seaglass Village and Seaglass Village is also co-sponsoring this this programme today for the lunch. So Isy is going to do a little introduction for us.

[Speaker 3] (3:25 - 3:26)
Thank you, Heidi.

[Speaker 3] (3:27 - 3:31)
It's a pleasure to be here. I know many of you that are here today,

[Speaker 3] (3:31 - 3:31)
which is great.

[Speaker 3] (3:32 - 3:37)
And I officially became a member of, yes,

[Speaker 3] (3:37 - 3:38)
the Senior Center.

[Speaker 3] (3:38 - 3:41)
And I'm happy to be a member of both.

[Speaker 3] (3:42 - 3:50)
I am the president of Seaglass. I've been involved with them for probably close to four years now.

[Speaker 3] (3:51 - 4:03)
Just a little bit about Seaglass, and then I want to show you something really special that we were able to receive because what we've been doing here in Marblehead,

[Speaker 3] (4:03 - 4:04)
Swampscott,

[Speaker 3] (4:04 - 4:07)
and Ahant, and moving into Salem,

[Speaker 3] (4:07 - 4:09)
we will be hopefully doing that.

[Speaker 3] (4:09 - 4:11)
within the next year.

[Speaker 3] (4:11 - 4:14)
We are very, let's put it this way,

[Speaker 3] (4:14 - 4:22)
among the people that was at this particular conference, and it was Essex County Women's

[Speaker 3] (4:22 - 4:24)
breakfast,

[Speaker 3] (4:24 - 4:27)
we were the only group of people, Seaglass Village,

[Speaker 3] (4:28 - 4:30)
to service seniors.

[Speaker 3] (4:30 - 4:39)
Everybody else was servicing women and children in other ways, and we were thrilled to be able to receive,

[Speaker 3] (4:39 - 4:42)
and I'm just going to hold one up.

[Speaker 3] (4:43 - 4:44)
This is the...

[Speaker 3] (4:45 - 4:50)
From the House of Representatives, from the state of Massachusetts,

[Speaker 3] (4:50 - 4:53)
a special appreciation award,

[Speaker 3] (4:53 - 5:05)
and we got it from the Senate and from the House of Representatives. We were the only group to get it and we're thrilled that we're able to be here today to present a program to you.

[Speaker 3] (5:06 - 5:11)
You might wonder how you become a member of both.

[Speaker 3] (5:11 - 5:12)
You know,

[Speaker 3] (5:12 - 5:17)
senior center and Seaglass. Seaglass does a lot of...

[Speaker 3] (5:18 - 5:22)
Things to help people stay in their homes here,

[Speaker 3] (5:22 - 5:25)
you know, in Marblehead Swamp, Scotland, or wherever.

[Speaker 3] (5:26 - 5:30)
We do a number of educational programs.

[Speaker 3] (5:30 - 5:37)
One that we're doing with the Senior Center from Seaglass is today's program,

[Speaker 3] (5:37 - 5:46)
and we do programs throughout the year. And it's great that we have both the Senior Center and Seaglass working together on these. Because it's great that we have both the Senior Center and Seaglass working together on these.

[Speaker 3] (5:46 - 5:53)
Because it just gives us as seniors more strength and more visibility in the community.

[Speaker 3] (5:53 - 5:59)
And I think, you know, this is something I kind of came up with.

[Speaker 3] (5:59 - 6:04)
I asked my husband who you will be hearing from shortly,

[Speaker 3] (6:04 - 6:08)
would you consider giving a talk for the group?

[Speaker 3] (6:09 - 6:11)
And he said, most definitely.

[Speaker 3] (6:11 - 6:14)
And here he is today.

[Speaker 3] (6:14 - 6:15)
Um,

[Speaker 3] (6:15 - 6:17)
Howie Abrams.

[Speaker 3] (6:17 - 6:21)
Um, so I think you will learn a lot from what you hear today.

[Speaker 3] (6:22 - 6:24)
I've seen part of it that he's going to present.

[Speaker 3] (6:25 - 6:38)
Sinklass is also here to help people stay in their homes if they give up driving and they need someone to help get them to some appointments.

[Speaker 3] (6:38 - 6:41)
It's something you should think about joining.

[Speaker 3] (6:41 - 6:42)
Okay?

[Speaker 3] (6:42 - 6:48)
We have a lot of people that do call us and we have a lot of great volunteers who do do the driving,

[Speaker 3] (6:48 - 6:52)
but we're looking for more volunteers if you're not ready yet.

[Speaker 3] (6:52 - 7:03)
yet to join Singlass, you can come on as a volunteer and it can be, you know, one afternoon a week or three hours, you know, a day or whatever,

[Speaker 3] (7:03 - 7:04)
whenever you can do it.

[Speaker 3] (7:05 - 7:07)
And we're also,

[Speaker 3] (7:07 - 7:08)
we're looking for new members too.

[Speaker 3] (7:08 - 7:16)
We have a little over a hundred members now that actually get the services of what CGlass offers.

[Speaker 3] (7:17 - 7:17)
So.

[Speaker 3] (7:18 - 7:22)
Should I be introducing, who's going to be introducing Howie? Me!

[Speaker 3] (7:23 - 7:24)
Got it.

[Speaker 3] (7:24 - 7:26)
Heidi says it's me.

[Speaker 3] (7:26 - 7:31)
So it's my pleasure to introduce my husband,

[Speaker 3] (7:31 - 7:31)
Dr.

[Speaker 3] (7:32 - 7:43)
Howard Abrams, who has been practicing here in the North Shore for many years to enlighten you with this talk about dementia.

[Speaker 3] (7:43 - 7:44)
So please enjoy.

[Speaker 4] (7:55 - 8:01)
I'm wondering whether there's a difference between being volunteered or being voluntold to go to do a talk.

[Speaker 4] (8:03 - 8:09)
It's a pleasure to be here today. It's so nice to see some familiar faces,

[Speaker 4] (8:09 - 8:11)
whatever your names are.

[Speaker 4] (8:13 - 8:25)
Well, I hope we'll be able to keep some sense of humor. If you happen to have a sense of humor, hold on to it. That's actually one of the key takeaways today because what we're going to be talking about is serious stuff.

[Speaker 4] (8:26 - 8:30)
We're going to talk about the myths and the reality of dementia.

[Speaker 4] (8:30 - 8:34)
We're going to talk a little about what it is, what it isn't, what you can do about it, how you work it up,

[Speaker 4] (8:35 - 8:36)
what the,

[Speaker 4] (8:36 - 8:40)
some of the history. I won't talk too much about the history.

[Speaker 4] (8:40 - 8:41)
I'll talk more about what.

[Speaker 4] (8:41 - 8:47)
The exciting thing is going on and some of the hopes for the future and some of the things going on. Okay.

[Speaker 4] (8:48 - 8:49)
So let me start with,

[Speaker 4] (8:50 - 8:51)
hopefully,

[Speaker 4] (8:51 - 8:52)
the myths.

[Speaker 4] (8:54 - 8:55)
Can you see okay?

[Speaker 4] (8:56 - 8:56)
All right.

[Speaker 4] (8:57 - 9:00)
As a patient walked into my office with this T-shirt on,

[Speaker 4] (9:00 - 9:01)
I said, this is perfect.

[Speaker 4] (9:02 - 9:03)
This is perfect.

[Speaker 4] (9:03 - 9:04)
Does anybody here not get this?

[Speaker 4] (9:04 - 9:05)
You know,

[Speaker 4] (9:05 - 9:06)
this is easy,

[Speaker 4] (9:06 - 9:06)
right?

[Speaker 4] (9:07 - 9:08)
I tell people,

[Speaker 4] (9:08 - 9:11)
you know, that somewhere between 50 and 60,

[Speaker 4] (9:11 - 9:19)
the warranty runs out, you know, and you start having problems and aches and pains in places that you didn't know you had,

[Speaker 4] (9:19 - 9:21)
right? You didn't know you had the places,

[Speaker 4] (9:21 - 9:22)
and you learn to live with this,

[Speaker 4] (9:22 - 9:23)
the golden years.

[Speaker 4] (9:24 - 9:25)
Is it really the golden years?

[Speaker 4] (9:25 - 9:34)
The key is about learning and adapting to what it is that you got to deal with because unless somebody here knows how to turn back the clock,

[Speaker 4] (9:35 - 9:37)
we're all dealing with it, everybody here.

[Speaker 4] (9:38 - 9:41)
So let's get to it. Let's talk a little bit about dementia.

[Speaker 4] (9:42 - 9:48)
call different things through the years. When I grew up, nobody talked about any illness,

[Speaker 4] (9:48 - 9:48)
right?

[Speaker 4] (9:49 - 9:50)
What did they used to call it for you?

[Speaker 4] (9:51 - 9:51)
What?

[Speaker 4] (9:52 - 9:54)
Sonility is one. What else?

[Speaker 4] (9:55 - 9:57)
Hardening of the arteries. Good group. What else?

[Speaker 4] (9:58 - 9:59)
Anything else?

[Speaker 1] (9:58 - 9:59)
Anything else?

[Speaker 1] (9:59 - 10:04)
It was always whispered in my house, you know, or the people are losing it, or they just aren't right,

[Speaker 1] (10:04 - 10:06)
or the marbles thing.

[Speaker 1] (10:07 - 10:10)
I don't know where people got the idea that one doesn't have marbles, but anyways,

[Speaker 1] (10:10 - 10:12)
I've never seen any marbles in the brain,

[Speaker 1] (10:12 - 10:14)
but somehow that's a concern.

[Speaker 1] (10:14 - 10:16)
But here's the definition we're going to use today.

[Speaker 1] (10:16 - 10:20)
But before I even say that, to let you know that this is already changing,

[Speaker 1] (10:20 - 10:27)
this term dementia has been around since the 1797, so that's the 18th century.

[Speaker 1] (10:28 - 10:42)
Dr. Pennell is a psychiatrist who is using it, but before that you can find references to what we call today dementia as far back in the writings as the 13th century.

[Speaker 1] (10:42 - 10:45)
It's been around a long time. It's nothing new.

[Speaker 1] (10:45 - 10:46)
And as people,

[Speaker 1] (10:46 - 10:47)
as more people...

[Speaker 1] (10:48 - 10:49)
age and stick around,

[Speaker 1] (10:49 - 10:51)
guess what? There's more of it.

[Speaker 1] (10:51 - 10:54)
So that's certainly something that's growing.

[Speaker 1] (10:54 - 11:07)
It's already been renamed. The American Psychiatric Society has decided we've got to have a new name for it, but there's a reason for it. It's today called part of the major neurocognitive disorders,

[Speaker 1] (11:07 - 11:08)
MND,

[Speaker 1] (11:08 - 11:15)
in the abbreviation that the kids all use. I can't keep up with all the abbreviations they keep coming up with. I've got to look them up every time.

[Speaker 1] (11:15 - 11:16)
I M and D,

[Speaker 1] (11:16 - 11:25)
major neurocognitive disorder to be distinguished from minor neurocognitive disorder.

[Speaker 1] (11:25 - 11:28)
Important distinction because I want to talk about it a little bit.

[Speaker 1] (11:28 - 11:30)
I also want to get out of the way so you can see this.

[Speaker 1] (11:33 - 11:45)
I got to remember to keep track of the thousands of people who remember to tune in and figured out the way to get their equipment to actually work. A challenge for anybody else besides me to get some equipment to work?

[Speaker 1] (11:46 - 11:47)
Uh it doesn't get easier.

[Speaker 1] (11:48 - 11:54)
I think I like my iPhone six better than whatever one I'm getting now. I don't know what they're up to. iPhone what number?

[Speaker 1] (11:55 - 11:57)
Anybody here have an iPhone seventeen yet?

[Speaker 1] (12:00 - 12:03)
Anybody have an iPhone 6 left? No, no, those are gone.

[Speaker 1] (12:03 - 12:05)
All right, so dementia,

[Speaker 1] (12:05 - 12:11)
what is it? A general term referring to a group of conditions that causes a decline in cognitive abilities,

[Speaker 1] (12:11 - 12:11)
memory,

[Speaker 1] (12:11 - 12:16)
thinking skills that interfere with daily life and that last part.

[Speaker 1] (12:17 - 12:19)
Interfering with daily life is really the key,

[Speaker 1] (12:19 - 12:21)
functioning on their own.

[Speaker 1] (12:21 - 12:25)
That's got to happen in order to be able to make a diagnosis of...

[Speaker 1] (12:25 - 12:26)
of dementia.

[Speaker 1] (12:26 - 12:30)
It turns out, of course, that that's a fuzzy area.

[Speaker 1] (12:30 - 12:38)
I struggled with this a number of times. There was a woman in the hospital I was doing an exam on and I said to her, you know, what's today's date?

[Speaker 1] (12:38 - 12:41)
She says, you really want to know? I said, yeah, just,

[Speaker 1] (12:41 - 12:41)
you know, what's today's date?

[Speaker 1] (12:42 - 12:44)
She says, you really want to know the right date? I said, yeah. She says,

[Speaker 1] (12:45 - 12:46)
wait a minute, nurse!

[Speaker 1] (12:48 - 12:49)
I didn't know how to code that.

[Speaker 1] (12:49 - 12:52)
I didn't know how to code that. But you know, what does that mean?

[Speaker 1] (12:52 - 12:55)
She knew how to find out. She didn't know it,

[Speaker 1] (12:55 - 12:57)
but she knew how to find out.

[Speaker 1] (12:57 - 13:05)
Another situation actually fairly common, people in the hospital, I worked actually still working on a limited basis at Salem Hospital for many years.

[Speaker 1] (13:06 - 13:07)
There was a,

[Speaker 1] (13:07 - 13:10)
and it happens frequently, people come into the hospital,

[Speaker 1] (13:10 - 13:12)
they're confused,

[Speaker 1] (13:12 - 13:14)
they can't find their room, they don't know what.

[Speaker 1] (13:14 - 13:18)
Know what day it is and you ask their family how they function at home they say fine

[Speaker 1] (13:19 - 13:21)
So what do you mean fine? They don't have any problems.

[Speaker 1] (13:21 - 13:23)
They don't know how to use the phone.

[Speaker 1] (13:23 - 13:24)
They can do all those things.

[Speaker 1] (13:25 - 13:33)
But when you put them in a strange place around new people and a new routine and the bells and things going off, they get very confused.

[Speaker 1] (13:34 - 13:35)
Happened to anybody here?

[Speaker 1] (13:35 - 13:36)
Happened to me actually.

[Speaker 1] (13:36 - 13:37)
It happens.

[Speaker 1] (13:37 - 13:40)
But this is a little different.

[Speaker 1] (13:40 - 13:45)
This is called mild cognitive impairment or minor neuro...

[Speaker 1] (13:45 - 13:46)
chronic cognitive disorder.

[Speaker 1] (13:46 - 13:49)
This is the important distinction.

[Speaker 1] (13:49 - 13:59)
It's a cognitive decline in excess of what is to be expected because of age or educational background without functional impairment,

[Speaker 1] (13:59 - 13:59)
okay?

[Speaker 1] (14:00 - 14:02)
Now, to complicate things a little bit,

[Speaker 1] (14:03 - 14:08)
it happens to be on the spectrum of what we're going to talk a lot about, Alzheimer's disease.

[Speaker 1] (14:09 - 14:25)
Because Alzheimer's disease doesn't start overnight and for you know this stuff It's been going on for a while and then as I often talk about with families There's like a cliff they go along they go along and they go along and fall off the cliff and they can't function Well, when did it start? Oh years ago

[Speaker 1] (14:25 - 14:38)
But they functioned. So it's when that function changes that it's really serious. So that early stage is called mild cognitive impairment, but it can be caused by lots of other things.

[Speaker 1] (14:39 - 14:41)
Miss a night's sleep, have an infection,

[Speaker 1] (14:41 - 14:43)
be under a special stress,

[Speaker 1] (14:43 - 14:44)
moving,

[Speaker 1] (14:44 - 14:45)
doing construction,

[Speaker 1] (14:45 - 14:49)
doing all those fun things, you get all mixed up, right?

[Speaker 1] (14:50 - 14:51)
It's happened.

[Speaker 1] (14:51 - 14:53)
And then as things settle down,

[Speaker 1] (14:53 - 14:54)
you feel better.

[Speaker 1] (14:54 - 14:59)
And particularly if it's a medical condition that can be reversed,

[Speaker 1] (14:59 - 15:03)
you can look very much like a Alzheimer or a demented patient,

[Speaker 1] (15:04 - 15:07)
but you get much better once the underlying problem.

[Speaker 1] (15:07 - 15:11)
problem is taken care of. So, it's on the spectrum and

[Speaker 1] (15:12 - 15:27)
There's a proportion of people that, as I mentioned, are already on the road to having Alzheimer's disease and that will be an early stage, but most of the people, 75, 80 percent I think was the number I saw,

[Speaker 1] (15:28 - 15:32)
will not progress to Alzheimer's disease. They'll look better.

[Speaker 1] (15:32 - 15:38)
So this is trying to help you understand that you don't have to worry as much when you have those moments.

[Speaker 1] (15:38 - 15:40)
It's not so much the moment,

[Speaker 1] (15:41 - 15:47)
it's as we're going to see, it's the persistence of the moments and its influence on all different areas of your life.

[Speaker 1] (15:48 - 15:52)
And Alzheimer's disease, which we're going to talk a lot about,

[Speaker 1] (15:52 - 15:53)
maybe.

[Speaker 1] (15:55 - 16:20)
Alzheimer's disease is the, of the various causes of dementia clearly the most common, somewhere between fifty to seventy percent. I saw eighty percent in one. It's the most common of the causes of the group of disorders that cause dementia. Let me show you some of the other ones. Vascular dementia, people who have had strokes, multiple strokes, various multiple things. It's a different kind of progression.

[Speaker 1] (16:21 - 16:23)
Because what happens is they have,

[Speaker 1] (16:23 - 16:27)
you know this stuff, if you have a stroke,

[Speaker 1] (16:27 - 16:29)
drop in a level of function and stay along,

[Speaker 1] (16:30 - 16:30)
do fine,

[Speaker 1] (16:30 - 16:30)
do fine.

[Speaker 1] (16:31 - 16:32)
If you have more,

[Speaker 1] (16:32 - 16:42)
you go down. But you don't do the persistent slow decline that you see in Alzheimer's disease. Different pathology. That's why it is that we're beginning to do that.

[Speaker 1] (16:42 - 16:45)
And that's, these two consist,

[Speaker 1] (16:45 - 16:48)
now you're up in the 80s percentage of all the dimensions,

[Speaker 1] (16:48 - 16:49)
but there's others.

[Speaker 1] (16:49 - 16:52)
There's others. I'm just going to show you a couple of them.

[Speaker 1] (16:52 - 17:04)
Dementia with Lewy bodies, a specific kind of dementia because of the bodies that are there in the brain called Lewy bodies that can be diagnosed and it's different than Alzheimer's disease and vascular dementia.

[Speaker 1] (17:05 - 17:06)
Another one.

[Speaker 1] (17:07 - 17:08)
frontotemporal dementia.

[Speaker 1] (17:08 - 17:22)
It's an area of the brain that's affected by a different kind of process also can cause a dementia and a drop in level of functioning. And naturally, of course, there is mixed that you can have more than one type of it.

[Speaker 1] (17:22 - 17:26)
So you get the idea that this is not just one disorder.

[Speaker 1] (17:26 - 17:31)
It's split off by the different ways that the underlying causes.

[Speaker 1] (17:33 - 17:33)
Ahem.

[Speaker 1] (17:35 - 17:35)
Alright.

[Speaker 1] (17:37 - 17:38)
You like that? That's

[Speaker 1] (17:42 - 17:44)
My teenage grandson showed me how to do this,

[Speaker 1] (17:44 - 17:49)
but you know, I couldn't have figured it out. I said do something cool. He showed me how to do it. Very simple.

[Speaker 1] (17:49 - 17:50)
Alright,

[Speaker 1] (17:50 - 17:53)
this is a little clip to give us some idea to start talking about forgetfulness.

[Speaker 1] (17:54 - 17:55)
Whether it's normal or not.

[Speaker 1] (17:56 - 17:58)
Can we do it? Hopefully this will work.

[Speaker 2] (18:00 - 18:01)
Forgetfulness normal or not.

[Speaker 2] (18:02 - 18:05)
Many people can't become more forgetful as they age.

[Speaker 2] (18:05 - 18:11)
How can you tell the difference between mild forgetfulness and serious memory problems like Alzheimer's disease?

[Speaker 2] (18:13 - 18:15)
What's typical and what's not?

[Speaker 2] (18:17 - 18:21)
Normal aging includes making a bad decision once in a while,

[Speaker 2] (18:22 - 18:23)
missing a monthly payment,

[Speaker 2] (18:24 - 18:26)
Forgetting which day it is and remembering later.

[Speaker 2] (18:27 - 18:30)
Sometimes forgetting which word to use.

[Speaker 2] (18:30 - 18:32)
Losing things from time to time.

[Speaker 2] (18:33 - 18:34)
With Alzheimer's disease,

[Speaker 2] (18:35 - 18:39)
people experience making poor judgments and decisions a lot of the time.

[Speaker 2] (18:40 - 18:42)
Problems taking care of monthly bills.

[Speaker 2] (18:43 - 18:46)
Losing track of the date or time of year.

[Speaker 2] (18:46 - 18:48)
Trouble having a conversation.

[Speaker 2] (18:49 - 18:52)
Misplacing things often and being unable to find them.

[Speaker 2] (18:54 - 18:56)
Although some forgetfulness comes with age,

[Speaker 2] (18:57 - 19:00)
don't ignore changes in memory or thinking that concern you.

[Speaker 2] (19:01 - 19:06)
Talk with your doctor if you notice you have more serious memory problems than normal.

[Speaker 1] (19:07 - 19:08)
Okay.

[Speaker 1] (19:08 - 19:11)
You get the feel that we're talking about a spectrum here,

[Speaker 1] (19:11 - 19:16)
and we're that tipping point where that changes for an individual is highly

[Speaker 1] (19:17 - 19:31)
individualized okay let me ask you guys of those things that happen which of them bother you the most forgetting things losing things missing payments what is it that because it's different go ahead taking

[Speaker 3] (19:31 - 19:33)
Taking longer to remember something.

[Speaker 3] (19:33 - 19:33)
So I

[Speaker 1] (19:33 - 19:45)
longer to remember something okay yeah okay but but you remember go ahead forgetting names that's one of mine too I have trouble with that one

[Speaker 1] (19:46 - 19:49)
For any words, we're going to talk about that as well.

[Speaker 3] (19:51 - 19:52)
Initiating the conversation.

[Speaker 1] (19:52 - 19:54)
Initiating a conversation.

[Speaker 1] (19:54 - 19:57)
They talk about that as one of the things that's there absolutely.

[Speaker 1] (20:00 - 20:01)
Losing things.

[Speaker 1] (20:02 - 20:03)
That they're there.

[Speaker 1] (20:03 - 20:06)
Yeah, you haven't had to find my phone yet?

[Speaker 1] (20:07 - 20:08)
Just press the button.

[Speaker 1] (20:08 - 20:10)
Then you have to find your watch to find your phone.

[Speaker 1] (20:10 - 20:11)
Remember that.

[Speaker 1] (20:12 - 20:13)
What else?

[Speaker 1] (20:16 - 20:20)
Ha, ha, ha. That's right. Oh boy.

[Speaker 2] (20:20 - 20:20)
Nick,

[Speaker 1] (20:20 - 20:21)
Right.

[Speaker 2] (20:21 - 20:22)
okay that's right.

[Speaker 1] (20:22 - 20:25)
You've eventually figure it out, but you're wandering and you get distracted.

[Speaker 2] (20:26 - 20:26)
Yeah.

[Speaker 1] (20:26 - 20:29)
Right, right. Anybody else? Go ahead.

[Speaker 1] (20:31 - 20:36)
I'm getting the right words. Absolutely. Go ahead.

[Speaker 2] (20:36 - 20:37)
Forget where I put my pants.

[Speaker 1] (20:37 - 20:38)
Ah.

[Speaker 1] (20:39 - 20:43)
Oh yes. It doesn't work very well unless it's with you, right? Right.

[Speaker 1] (20:44 - 20:45)
Go ahead.

[Speaker 2] (20:45 - 20:47)
The beginning mids, do I take it, do they not

[Speaker 1] (20:47 - 20:47)
If

[Speaker 2] (20:47 - 20:47)
take it?

[Speaker 1] (20:47 - 20:49)
they're taking medication,

[Speaker 1] (20:49 - 20:50)
important one.

[Speaker 1] (20:51 - 20:53)
You notice no one's talked about the bills.

[Speaker 1] (20:53 - 20:54)
Nobody seems to care if they miss a bill.

[Speaker 1] (20:56 - 20:59)
You know, how annoying is it, you know, particularly with the claims,

[Speaker 1] (21:00 - 21:00)
the insurance,

[Speaker 1] (21:00 - 21:02)
you know, you miss a payment on a premium,

[Speaker 1] (21:02 - 21:11)
the next day you get, you know, the big message, and then you try to collect money from them, oh, a few weeks, maybe we'll talk to you, and a few more weeks, oh, maybe we'll cut you a check,

[Speaker 1] (21:11 - 21:11)
oh,

[Speaker 1] (21:11 - 21:12)
maybe it's in the mail.

[Speaker 1] (21:12 - 21:16)
It's a little different, but it does happen, missing a payment.

[Speaker 1] (21:16 - 21:22)
You try, I try to do that, and I still miss occasional ones, and I'll sit there and I'll feel badly about it.

[Speaker 1] (21:22 - 21:24)
What can you do? What else?

[Speaker 1] (21:26 - 21:27)
Ah.

[Speaker 1] (21:27 - 21:28)
Ah.

[Speaker 1] (21:29 - 21:40)
Hearing that or doing it yourself or asking a hearing that you made? Yeah, that's right. I would do repetition. That can be part of it. So there's a lot of things that go on. So we're going to talk some more about.

[Speaker 1] (21:42 - 21:43)
I hate doing this next one.

[Speaker 1] (21:45 - 21:45)
Maybe.

[Speaker 1] (21:48 - 21:50)
This is a depressing slide.

[Speaker 1] (21:50 - 21:53)
I wanted to get it over with so then we could talk about the fun stuff.

[Speaker 1] (21:54 - 21:55)
Starting it at age 60,

[Speaker 1] (21:56 - 21:57)
no matter what,

[Speaker 1] (21:57 - 22:01)
starting it at age 60 you can start to see demonstrable

[Speaker 1] (22:02 - 22:29)
drop-offs and all of these levels of functioning processing speed how quickly you've already you were talking about it uh the memory learning new things episodic what was it what year did i go to where did i sit who sat next to me you know those kinds of things that become harder executive functions like keeping attention planning flexibility the appointment the medication you already mentioned the language the word finding object naming the big deal i haven't

[Speaker 1] (22:29 - 22:37)
Having, and I loved telling this one because this was actually from a patient when we were talking about that and she was saying how hard it was to remember words, but she had a trick.

[Speaker 1] (22:37 - 22:38)
She said, please,

[Speaker 1] (22:38 - 22:42)
please tell me that her trick was, I don't think of the words or the names as lost.

[Speaker 1] (22:43 - 22:45)
I think of them as hiding.

[Speaker 1] (22:46 - 22:49)
And when they're ready to come out, they come out.

[Speaker 1] (22:51 - 22:54)
I personally have found that very helpful to say, okay,

[Speaker 1] (22:54 - 22:56)
forget a little, and sure enough,

[Speaker 1] (22:56 - 22:56)
right,

[Speaker 1] (22:56 - 22:57)
ten minutes,

[Speaker 1] (22:57 - 22:58)
middle of the night, whatever,

[Speaker 1] (22:58 - 22:59)
you pop up, oh,

[Speaker 1] (22:59 - 23:00)
that's the word I was looking for.

[Speaker 1] (23:01 - 23:02)
They're hiding.

[Speaker 1] (23:03 - 23:05)
Reasoning and fluid intelligence.

[Speaker 1] (23:05 - 23:09)
Fluid intelligence is, here's your cell phone,

[Speaker 1] (23:09 - 23:11)
program it. How quick are you at doing that,

[Speaker 1] (23:11 - 23:11)
right?

[Speaker 1] (23:12 - 23:20)
You may have been very good at one point, but I can guarantee you over time you can measure the drop-off that starts to happen.

[Speaker 1] (23:20 - 23:21)
Spatial ability,

[Speaker 1] (23:21 - 23:24)
the same sort of thing. You can be very good at it,

[Speaker 1] (23:24 - 23:26)
and you know this, that it's a little bit harder,

[Speaker 1] (23:26 - 23:31)
and some people are really bothered by it, some people are bothered less by it. It depends on the person,

[Speaker 1] (23:31 - 23:33)
it depends on the particular task,

[Speaker 1] (23:33 - 23:34)
depends on your image of yourself.

[Speaker 1] (23:35 - 23:36)
Let's get rid of this.

[Speaker 1] (23:38 - 23:40)
Now let's talk about the good stuff,

[Speaker 1] (23:40 - 23:42)
the stuff that stays with you.

[Speaker 1] (23:43 - 23:44)
Crystallized intelligence it's called.

[Speaker 1] (23:45 - 23:49)
That's the language you were born with, the lullabies your mother used to sing to,

[Speaker 1] (23:50 - 23:54)
the newsletters that Penny used to do. It was easy to do because she's always done it.

[Speaker 1] (23:55 - 23:59)
What else? Songs, you know, all of that stuff that stays with you.

[Speaker 1] (23:59 - 24:01)
You don't lose that stuff,

[Speaker 1] (24:01 - 24:01)
right?

[Speaker 1] (24:01 - 24:02)
We know that.

[Speaker 1] (24:03 - 24:06)
You can remember that stuff, but you can't remember what you had for breakfast,

[Speaker 1] (24:06 - 24:06)
right?

[Speaker 1] (24:06 - 24:07)
Vocabulary.

[Speaker 1] (24:08 - 24:11)
Vocabulary stays the same, remains stable.

[Speaker 1] (24:11 - 24:15)
even improves a bit as you can improve as you age.

[Speaker 1] (24:16 - 24:17)
These are good things.

[Speaker 1] (24:18 - 24:18)
Verbal reasoning,

[Speaker 1] (24:19 - 24:24)
I always think it was a relative in my family who knew how to get what she wanted.

[Speaker 1] (24:24 - 24:28)
She was very good at it, and you could not argue with her. And as she got older,

[Speaker 1] (24:28 - 24:30)
she got better at getting what she wanted,

[Speaker 1] (24:30 - 24:37)
but it stays with you, that you're able to use your voice, use your reasoning, and lastly, your general knowledge.

[Speaker 1] (24:38 - 24:40)
You know the capital of Delaware?

[Speaker 1] (24:40 - 24:41)
You know the capital of Delaware.

[Speaker 1] (24:41 - 24:45)
I don't happen to remember it at this moment. But capital of Delaware is?

[Speaker 1] (24:46 - 24:47)
What?

[Speaker 1] (24:47 - 24:49)
Dover, thank you. See?

[Speaker 1] (24:49 - 24:51)
General knowledge is right there.

[Speaker 1] (24:51 - 24:54)
I wonder if I can get it into my general knowledge.

[Speaker 1] (24:55 - 25:00)
So that stuff stays with you. The things that you know, you know and you don't lose those things.

[Speaker 1] (25:00 - 25:01)
That's, I find,

[Speaker 1] (25:02 - 25:02)
reassuring.

[Speaker 1] (25:02 - 25:07)
But what I'm beginning to show you is that memory,

[Speaker 1] (25:07 - 25:10)
cognitive functioning has different domains, they're called,

[Speaker 1] (25:10 - 25:16)
some of which deteriorate at different rates, some of which are more important depending on who you are, what you do.

[Speaker 1] (25:16 - 25:20)
what you do and what your responsibilities are than others. It's not simple.

[Speaker 1] (25:20 - 25:22)
It's a little it's nuanced.

[Speaker 1] (25:24 - 25:24)
Okay.

[Speaker 1] (25:25 - 25:31)
Let me introduce one of my wife's favorite writers. This is Lisa Genova.

[Speaker 1] (25:31 - 25:35)
Lisa Genova is a neuroscientist for Mass General. She wrote you know the book.

[Speaker 1] (25:37 - 25:42)
Still Alice, wonderful book. She wrote that. That was actually, I think, her first book. Yes,

[Speaker 1] (25:42 - 25:42)
no?

[Speaker 1] (25:42 - 25:44)
Her first book became a movie,

[Speaker 1] (25:44 - 25:46)
a wonderful movie.

[Speaker 1] (25:46 - 25:48)
Depressing story, though,

[Speaker 1] (25:48 - 25:49)
the way they told it was.

[Speaker 1] (25:49 - 25:50)
All right?

[Speaker 1] (25:50 - 25:53)
This is from her TED talk that she gave a few years ago,

[Speaker 1] (25:53 - 25:59)
helping us understand the mechanisms of Alzheimer's disease.

[Speaker 1] (25:59 - 26:00)
And she does it a lot better than I can,

[Speaker 1] (26:01 - 26:02)
so I'm going to let her do it.

[Speaker 3] (26:03 - 26:06)
Let's begin by looking at what we currently understand about the neuroscience of autism.

[Speaker 3] (26:14 - 26:14)
Each

[Speaker 1] (26:14 - 26:14)
You can

[Speaker 3] (26:14 - 26:14)
circle

[Speaker 1] (26:14 - 26:14)
see.

[Speaker 3] (26:14 - 26:16)
in red is called a synapse.

[Speaker 3] (26:16 - 26:19)
The synapse is where neurotransmitters are released.

[Speaker 3] (26:19 - 26:21)
This is where signals are transmitted,

[Speaker 3] (26:22 - 26:23)
where communication happens.

[Speaker 3] (26:23 - 26:26)
This is where we think, feel,

[Speaker 3] (26:26 - 26:27)
see,

[Speaker 3] (26:27 - 26:28)
hear,

[Speaker 3] (26:28 - 26:30)
desire and remember.

[Speaker 3] (26:30 - 26:33)
And the synapse is where Alzheimer's happens.

[Speaker 3] (26:33 - 26:38)
Let's zoom in on the synapse and look at a cartoon representation of what's going on.

[Speaker 3] (26:39 - 26:50)
During the business of communicating information, in addition to releasing neurotransmitters like glutamate into the synapse, neurons also release a small peptide called amyloid beta.

[Speaker 3] (26:51 - 26:58)
Normally, amyloid beta is cleared away and metabolized by microglia, the janitor cells of our brains.

[Speaker 3] (26:59 - 27:02)
One of the molecular causes of Alzheimer's are still debated.

[Speaker 3] (27:03 - 27:08)
Most neuroscientists believe that the disease begins when amyloid beta begins to accumulate.

[Speaker 3] (27:09 - 27:15)
Too much is released or not enough is cleared away and the synapse begins to pile up with amyloid beta.

[Speaker 3] (27:15 - 27:21)
And when this happens it binds to itself, forming sticky aggregates called amyloid plaques.

[Speaker 3] (27:22 - 27:25)
How many people here are 40 years old or older?

[Speaker 3] (27:25 - 27:27)
You're afraid to admit it now.

[Speaker 3] (27:28 - 27:36)
This initial step into the disease, this presence of amyloid plaques accumulating, can already be found in your brains.

[Speaker 3] (27:36 - 27:43)
Now the only way we could be sure of this would be through a PET scan because at this point you are blissfully unaware.

[Speaker 3] (27:44 - 27:46)
You're not showing any impairments in memory,

[Speaker 3] (27:46 - 27:47)
language,

[Speaker 3] (27:47 - 27:47)
or cognition.

[Speaker 3] (27:48 - 27:49)
Yes.

[Speaker 3] (27:50 - 28:01)
We think it takes at least 15 to 20 years of amyloid plaque accumulation before it reaches a tipping point, then triggering a molecular cascade that causes the clinical symptoms of the disease.

[Speaker 3] (28:02 - 28:04)
Prior to the tipping point,

[Speaker 3] (28:04 - 28:09)
your lapses in memory might include things like, why did I come in this room?

[Speaker 3] (28:10 - 28:12)
Or, oh, what's his name?

[Speaker 3] (28:12 - 28:13)
Or,

[Speaker 3] (28:13 - 28:15)
where did I put my keys?

[Speaker 3] (28:16 - 28:23)
Yeah, now before you all start freaking out again because I know half of you did at least one of those in the last 24 hours,

[Speaker 3] (28:23 - 28:26)
these are all normal kinds of forgetting.

[Speaker 3] (28:27 - 28:35)
In fact, I would argue that these examples might not even involve your memory because you didn't pay attention to where you put your keys in the first place.

[Speaker 3] (28:36 - 28:37)
After the tipping point,

[Speaker 3] (28:37 - 28:40)
the glitches in memory language and cognition are different.

[Speaker 3] (28:41 - 28:46)
Instead of eventually finding your keys in your coat pocket or on the table by the door,

[Speaker 3] (28:46 - 28:48)
you find them in the refrigerator.

[Speaker 3] (28:48 - 28:52)
Or you find them and you think, what are these for?

[Speaker 3] (28:53 - 28:58)
Okay, so what happens when amyloid plaques accumulate to this tipping point?

[Speaker 3] (28:58 - 29:10)
Our microglia janitor cells become hyperactivated, releasing chemicals that cause inflammation and cellular damage. We think they might actually start clearing away the synapses themselves.

[Speaker 3] (29:11 - 29:20)
A crucial neural transport protein called Tau becomes hyperphosphorylated and twists itself into something called tangles, which choke off the neurons from the inside.

[Speaker 3] (29:21 - 29:28)
By mid-stage Alzheimer's, we have massive inflammation and tangles, and all out war at the synapse and cell death.

[Speaker 1] (29:31 - 29:34)
Okay, so everything you need to know, right?

[Speaker 1] (29:35 - 29:38)
If you want to hear more, it's a wonderful talk.

[Speaker 1] (29:38 - 29:45)
You can get it online just by Googling Lisa Genova TED Talk on Alzheimer's disease.

[Speaker 1] (29:46 - 29:49)
It really does help. I'll make a couple of comments before we...

[Speaker 1] (29:56 - 29:59)
that's for sure, and it's not entirely accepted, also not for sure.

[Speaker 1] (30:00 - 30:07)
But we are much further along than we used to be. You can find people who will tell that this is all baloney, that she has it all wrong.

[Speaker 1] (30:08 - 30:11)
And there's a lot of people, a lot of research going.

[Speaker 1] (30:11 - 30:15)
going on right now trying to figure out the details,

[Speaker 1] (30:15 - 30:28)
what they are, or what is going on in the brain, how to d how to uh uh understand it, how to diagnose it, how to eventually uh treat it and make it make it go away. I hope that someday see that see that happen.

[Speaker 1] (30:29 - 30:36)
Uh she has lots of good comments and she presents it nicely. So let's move on to the next part.

[Speaker 1] (30:37 - 30:39)
What do you do? Some of you have probably been through this.

[Speaker 1] (30:39 - 30:50)
What do you do when either you or a loved one has significant cognitive loss and may have been at that tipping point she talked about? That's the transition that I was talking about earlier.

[Speaker 1] (30:51 - 30:52)
What do you do? Well,

[Speaker 1] (30:52 - 30:53)
the first thing is pretty clear.

[Speaker 1] (30:54 - 30:59)
She mentions it in that little clip earlier.

[Speaker 1] (30:59 - 31:06)
Go see your doctor, because there's multiple other things that can cause those cognitive

[Speaker 1] (31:05 - 31:06)
Those cognitive changes,

[Speaker 1] (31:06 - 31:07)
as I mentioned,

[Speaker 1] (31:07 - 31:11)
and the other key point is don't go alone.

[Speaker 1] (31:12 - 31:15)
Have someone with you, or if you're bringing someone,

[Speaker 1] (31:15 - 31:23)
make sure to be there as well, because people who have memory deficits sometimes don't like to talk about it. What a surprise, right?

[Speaker 1] (31:23 - 31:24)
We're proud people,

[Speaker 1] (31:25 - 31:30)
particularly men more than women, but maybe on both sides for sure.

[Speaker 1] (31:30 - 31:32)
But I just...

[Speaker 1] (31:31 - 32:00)
just was with someone not otherwise the guy said there's nothing wrong with me and the wife is going you know no no no no no let me tell you so then i have to stop and ask her and then and then he'll sheepishly say oh yeah yeah that happened no big deal well it was a big deal in that particular case but he didn't want to uh deal with that so go bring someone go see a doctor and then the next thing that typically will happen is that there'll be a an exam and a variety of routine blood tests as i mentioned there are a number of things

[Speaker 1] (32:00 - 32:11)
These reversible things that can cause changes in cognition that can be diagnosed easily with routine blood tests. I want to mention genetic testing a little bit,

[Speaker 1] (32:11 - 32:12)
APOE,

[Speaker 1] (32:13 - 32:15)
apolipoprotein E.

[Speaker 1] (32:15 - 32:19)
Here we go. This is a birds and the bees. We each have chromosomes,

[Speaker 1] (32:19 - 32:22)
one each from each parent, right?

[Speaker 1] (32:22 - 32:26)
And there's a whole variety of genes that come from each parent.

[Speaker 1] (32:26 - 32:40)
and there have been genes that have been identified that are associated with vulnerability to Alzheimer disease and dementia and that they can be diagnosed through genetic testing.

[Speaker 1] (32:40 - 32:41)
Nothing is guaranteed.

[Speaker 1] (32:42 - 32:44)
That's one of the things I suppose I want to leave you with.

[Speaker 1] (32:44 - 32:53)
There's never been, never been in any illness known that has caused 100% of problems with every person.

[Speaker 1] (32:54 - 32:57)
You know, it doesn't mean even if you have some of the genetic mutations,

[Speaker 1] (32:57 - 33:01)
it does not guarantee it certainly increases your risk.

[Speaker 1] (33:01 - 33:08)
And that's what we're going to talk most of the rest of the time on is the idea of risk and how you can manage it and what you can do about it.

[Speaker 1] (33:10 - 33:12)
There is a small percentage,

[Speaker 1] (33:12 - 33:18)
one percent I think I read of, it's a different, it's not the ApoE genes,

[Speaker 1] (33:18 - 33:21)
it's called presenolin,

[Speaker 1] (33:21 - 33:23)
presenolin, presenile,

[Speaker 1] (33:23 - 33:24)
presenolin.

[Speaker 1] (33:25 - 33:34)
That's those of the familial, unfortunate familial inheritance of a very severe early onset as in 40, 50.

[Speaker 1] (33:34 - 33:35)
They just diagnosed,

[Speaker 1] (33:36 - 33:37)
I just saw it the other day.

[Speaker 1] (33:37 - 33:50)
a nineteen year old in one of those families. Nineteen. But at the same time there was an article this week in the Times about one of the people from that family out in where was he, I think Seattle or where was it?

[Speaker 1] (33:51 - 33:53)
There you go. I was out there too.

[Speaker 1] (33:53 - 33:56)
He was one of those families and he had brothers,

[Speaker 1] (33:56 - 33:57)
sisters, parents,

[Speaker 1] (33:57 - 34:02)
all who died young and he's 75 and doesn't have any problems with his cognition.

[Speaker 1] (34:02 - 34:05)
And of course the big problem is how, why not?

[Speaker 1] (34:05 - 34:08)
What does, what does he have that's protecting him?

[Speaker 1] (34:08 - 34:13)
How can they identify he's doing all sorts of testing and it's really interesting. Again,

[Speaker 1] (34:13 - 34:15)
it's not, nothing's a hundred percent.

[Speaker 1] (34:15 - 34:17)
It is kind of scary though.

[Speaker 1] (34:17 - 34:18)
All right.

[Speaker 1] (34:18 - 34:24)
So that's enough about the genetic testing. Now let's go to the imaging you know about these things,

[Speaker 1] (34:24 - 34:26)
CAT scans, MRI.

[Speaker 1] (34:26 - 34:38)
And there's this new thing that's been around about 10 years now called an amyloid PET scan to be able to determine whether or not there is a burden of amyloid in your brain.

[Speaker 1] (34:38 - 34:39)
It's available.

[Speaker 1] (34:39 - 34:43)
They've been doing it at Salem Hospital for about 10 years, I found out.

[Speaker 1] (34:43 - 34:46)
And most of the times the doctors won't order it unless there's...

[Speaker 1] (34:46 - 34:50)
This is very clear evidence and suspicion of an Alzheimer's diagnosis.

[Speaker 1] (34:50 - 34:51)
Why?

[Speaker 1] (34:51 - 34:56)
Because if it comes back positive, you know, and you don't have the other associated things,

[Speaker 1] (34:56 - 34:58)
then you're worrying for nothing.

[Speaker 1] (34:58 - 35:01)
So it's not ordered all that frequently,

[Speaker 1] (35:01 - 35:07)
but it is there and it's very helpful to make an accurate diagnosis and be able to know what you're dealing with.

[Speaker 1] (35:08 - 35:11)
She mentioned also some of the other proteins,

[Speaker 1] (35:11 - 35:12)
the tau protein she mentioned.

[Speaker 1] (35:13 - 35:23)
That's another one of the proteins that are there that's involved in the, considered by some, the tipping point, that it's not just the amyloid, it's the tau.

[Speaker 1] (35:23 - 35:27)
There was an interesting study a few years ago called the Nunn Study,

[Speaker 1] (35:27 - 35:28)
some of you may have heard about,

[Speaker 1] (35:28 - 35:30)
where this guy in Ohio,

[Speaker 1] (35:30 - 35:33)
I think it was, made an arrangement with a

[Speaker 1] (35:34 - 35:51)
a group of nuns to not only study them but also be able to after they deceased to get their brains to be able to look at what there is there in the brains and make an association what he was fine and what he found was some of the nuns who were

[Speaker 1] (35:52 - 36:01)
Very cognitively impaired had very little of the amyloid and others had huge amounts of amyloid and didn't have any clinical impairment.

[Speaker 1] (36:02 - 36:03)
Really interesting.

[Speaker 1] (36:03 - 36:03)
Why?

[Speaker 1] (36:04 - 36:09)
What does that all that mean? The nuns because there was a relative stability in their lifestyle,

[Speaker 1] (36:09 - 36:13)
in their diet, in their routine. It was actually fairly well controlled.

[Speaker 1] (36:13 - 36:13)
But again,

[Speaker 1] (36:14 - 36:17)
raises questions and gives us more to look at and more to think about.

[Speaker 1] (36:18 - 36:19)
So let's take it to the next step.

[Speaker 1] (36:21 - 36:25)
If your doctor thinks that there's some concerns based on the earlier testing,

[Speaker 1] (36:25 - 36:29)
they may refer you to a neurologist or to a memory clinic.

[Speaker 1] (36:30 - 36:31)
We don't have a memory clinic at Salem,

[Speaker 1] (36:31 - 36:46)
but I actually met with the neurology group Essex Neuro out in Peabody, which they wanted me to make sure to remind everybody they are open for business. They have a new young person so that people can get referred. It doesn't take quite as long as it used to. They did indeed.

[Speaker 1] (36:46 - 36:50)
lose some of their earlier partners who retired or moved on.

[Speaker 1] (36:52 - 36:56)
And, you know, I was trying to get a feel for how excited to get,

[Speaker 1] (36:56 - 37:13)
first of all, about some of the new advances in testing and treatment and the mechanism of how you go about doing this. I mean, I've been in the business a long time and watching this and not terribly excited by what it is that we've had to date reading one negative study after another.

[Speaker 1] (37:13 - 37:20)
And watching lots of people that I know and love having to deal with this and just not be able to do much to change it. That's been tough.

[Speaker 1] (37:21 - 37:22)
That's starting to change,

[Speaker 1] (37:22 - 37:23)
which is good,

[Speaker 1] (37:23 - 37:25)
which is good.

[Speaker 1] (37:26 - 37:27)
Neuropsychological testing,

[Speaker 1] (37:27 - 37:28)
another set of testing,

[Speaker 1] (37:29 - 37:32)
some of you may have it or know about these series of pencil and paper,

[Speaker 1] (37:32 - 37:43)
standardized tests to be able to tell you how you function relative to where you are in your age and your educational background,

[Speaker 1] (37:43 - 37:44)
very useful thing.

[Speaker 1] (37:44 - 37:48)
Just because you can't remember as well as you think you used to,

[Speaker 1] (37:48 - 37:52)
is that unusual for who you are or is it...

[Speaker 1] (37:52 - 37:54)
just part of growing older.

[Speaker 1] (37:54 - 37:59)
Remember I said that inevitable inevitable downswing that starts to happen.

[Speaker 1] (38:03 - 38:06)
Anybody heard about these, the amyloid blood tests that are out there?

[Speaker 1] (38:07 - 38:13)
The 31 amyloid blood tests that are either already available or in the process of development,

[Speaker 1] (38:14 - 38:15)
right?

[Speaker 1] (38:15 - 38:19)
And they have all sorts of different relationships between amyloid and tau,

[Speaker 1] (38:19 - 38:22)
one kind of amyloid, another kind of amyloid.

[Speaker 1] (38:23 - 38:27)
I liked what the neurologist said to me, they're just not ready for prime time.

[Speaker 1] (38:27 - 38:28)
They're just,

[Speaker 1] (38:28 - 38:33)
they aren't as specific or as sensitive as we like to see it. There's too many false positives.

[Speaker 1] (38:33 - 38:33)
False positives,

[Speaker 1] (38:33 - 38:35)
too many false negatives,

[Speaker 1] (38:35 - 38:36)
in their opinion.

[Speaker 1] (38:36 - 38:40)
I've never ordered it, so I can't really say one way or the other, I guess.

[Speaker 1] (38:40 - 38:50)
But the idea that there will be something that we can tell you without having to do a biopsy of your brain is very exciting without doing much of,

[Speaker 1] (38:50 - 38:53)
it's not an invasive test, it's a blood test.

[Speaker 1] (38:53 - 38:54)
So it's there,

[Speaker 1] (38:54 - 38:56)
but don't rush to do it.

[Speaker 1] (38:56 - 38:59)
Definitely, you know, the concern they would.

[Speaker 1] (38:59 - 39:25)
that they shared is that people are just calling up labs and ordering them and without all the other things to use you don't know what it means when you get a result so don't do it yet but keep an eye on it lastly I just want to mention spinal taps not much fun I had to do that I remember doing those when I was an intern in medicine and oh I never I always thought the needle you know what the needle looks like that big needle some of you probably had that

[Speaker 1] (39:25 - 39:27)
It's very useful information,

[Speaker 1] (39:27 - 39:30)
but it's somewhat of an invasive test and it can be uncomfortable.

[Speaker 1] (39:30 - 39:31)
It's not that bad.

[Speaker 1] (39:31 - 39:33)
I'm overstating it.

[Speaker 1] (39:33 - 39:36)
But it'd be nice to be able to have something besides a spinal tap.

[Speaker 1] (39:36 - 39:38)
You get spinal fluid,

[Speaker 1] (39:38 - 39:44)
that's the fluid that's washing around the brain, so you can then look at those proteins that we were talking about to see.

[Speaker 1] (39:53 - 39:56)
Here's the good, well, let's do this, then we'll get to the really good part.

[Speaker 1] (39:56 - 40:02)
The treatment options. I already said I don't want to spend too much time on this because particularly the early,

[Speaker 1] (40:02 - 40:05)
these are the things that have been around a long time,

[Speaker 1] (40:05 - 40:09)
the cholinesterase inhibitors and the NMDA antagonist.

[Speaker 1] (40:09 - 40:11)
These medications are not great.

[Speaker 1] (40:11 - 40:14)
Some of you probably are taking them. I prescribe them. They're there.

[Speaker 1] (40:14 - 40:17)
The neurologist had a very different take.

[Speaker 1] (40:17 - 40:18)
I said, do you use these?

[Speaker 1] (40:18 - 40:19)
And they said,

[Speaker 1] (40:19 - 40:20)
oh yeah, we occasionally.

[Speaker 1] (40:20 - 40:22)
See some wonderful responses.

[Speaker 1] (40:22 - 40:26)
I think I'm zero for about 400 on that myself.

[Speaker 1] (40:27 - 40:28)
Maybe I'm doing it wrong.

[Speaker 1] (40:28 - 40:29)
I don't know.

[Speaker 1] (40:29 - 40:31)
But they've been around a long time.

[Speaker 1] (40:31 - 40:33)
Donepezil, galantamine,

[Speaker 1] (40:33 - 40:34)
rivastigmine,

[Speaker 1] (40:34 - 40:36)
and memantine are the four of them.

[Speaker 1] (40:36 - 40:39)
And they slow down,

[Speaker 1] (40:39 - 40:40)
at least in the clinical testing,

[Speaker 1] (40:40 - 40:42)
they slow down the decline.

[Speaker 1] (40:42 - 40:44)
But unfortunately,

[Speaker 1] (40:44 - 40:48)
they tend not to do much to turn around the functional ability.

[Speaker 1] (40:48 - 40:52)
But maybe you can get a few months, six months,

[Speaker 1] (40:52 - 40:55)
a year extra of independent living than some of the literature.

[Speaker 1] (40:55 - 40:57)
I never saw much of that.

[Speaker 1] (40:57 - 41:00)
But I think from the neurologist point of view,

[Speaker 1] (41:00 - 41:02)
I like what they said. They said, why not?

[Speaker 1] (41:02 - 41:04)
Why not use them?

[Speaker 1] (41:04 - 41:06)
Because if they can do something,

[Speaker 1] (41:06 - 41:06)
they can help.

[Speaker 1] (41:07 - 41:17)
So, I have a shifting idea on it. But what I do like is what we're going to talk about for a minute. The new anti-amyloid therapies being advertised everywhere.

[Speaker 1] (41:17 - 41:19)
People have seen the advertisements,

[Speaker 1] (41:19 - 41:20)
the infusions.

[Speaker 1] (41:20 - 41:22)
They're out there.

[Speaker 1] (41:22 - 41:23)
They're out there.

[Speaker 1] (41:23 - 41:28)
Naturally, they have names that have trouble pronouncing, the candamab and donanamab,

[Speaker 1] (41:28 - 41:30)
the chemby and kisunla.

[Speaker 1] (41:31 - 41:33)
They've only been out since 2024.

[Speaker 1] (41:34 - 41:56)
because the early studies in some of these, these are are monoclonal antibodies. That is uh manufactured antibodies that direct against amyloid and clear it. That's the idea, remember what Lisa Genova was saying, you wanna clear out the amyloid that's been accumulating all these years in your brain and hopefully that can can make a difference.

[Speaker 1] (41:57 - 42:02)
Trouble is these things, A_ are very expensive, thirty, thirty five thousand dollars a year.

[Speaker 1] (42:03 - 42:29)
insurance have made it very they have a very narrow range of eligibility you have to have certain test done you have to measure certainly on a certain number on some of the testing in order to be able to do that you have to be willing to come in for the Canemap it's every two weeks it's an IV infusion you have to get CAT scans and PET scans you spend lots of money

[Speaker 1] (42:29 - 42:36)
money, and time and effort, and you've got to be ready and willing to do all that to be able to do it. But you can.

[Speaker 1] (42:36 - 42:39)
There's about, they told me, about 30 patients in active treatment.

[Speaker 1] (42:40 - 42:43)
And I said to them, so have you seen anything?

[Speaker 1] (42:43 - 42:44)
You know, been doing it a year?

[Speaker 1] (42:44 - 42:47)
And they said, we don't expect to see much for three or four years.

[Speaker 1] (42:48 - 42:48)
I said, ooh,

[Speaker 1] (42:48 - 42:51)
we've got to do better than that. It's got to be quicker.

[Speaker 1] (42:51 - 42:52)
And indeed,

[Speaker 1] (42:52 - 43:00)
there are a number of these variations of the antibodies that are being looked at in various developments.

[Speaker 1] (43:02 - 43:09)
And I'm excited enough to be able to think there will be a day not too far along that they'll be able to have something that will not be that expensive,

[Speaker 1] (43:09 - 43:15)
that won't cause as many of the side effects as some of these do and can be simpler to take. They have one,

[Speaker 1] (43:15 - 43:16)
for example, that's going to be...

[Speaker 1] (43:16 - 43:20)
to be a subcutaneous shot as opposed to an infusion.

[Speaker 1] (43:20 - 43:25)
You know, it's like Manjaro or Ozempic. You know, that'll go over. People will do that.

[Speaker 1] (43:26 - 43:36)
But running to drive to Boston or somewhere and sit there for how many hours to get something that's not that much fun to get and risk some of the side effects,

[Speaker 1] (43:36 - 43:37)
that's a little bit tougher.

[Speaker 1] (43:37 - 43:38)
They're there.

[Speaker 1] (43:38 - 43:41)
Keep an eye on them is really what I'm here to say.

[Speaker 1] (43:42 - 43:44)
And I like the fact that they're there.

[Speaker 1] (43:45 - 44:07)
I really hope that they're going to show some real impact whether they're going to be disease modifying that is to turn around the curve or not I don't know they're not there yet but they are clearly showing 20 30 percent slower decline you know that's that's significant all right here's the things to watch out for

[Speaker 1] (44:09 - 44:11)
They're all over the place.

[Speaker 1] (44:11 - 44:12)
Prevagen,

[Speaker 1] (44:12 - 44:13)
brain boosters,

[Speaker 1] (44:14 - 44:14)
puzzles,

[Speaker 1] (44:14 - 44:15)
word games,

[Speaker 1] (44:15 - 44:17)
computerized, they're all over the place.

[Speaker 1] (44:17 - 44:19)
I wish I could tell you they work.

[Speaker 1] (44:20 - 44:21)
I wish I could,

[Speaker 1] (44:21 - 44:24)
but they don't. Not when it comes to dealing with serious dementia.

[Speaker 1] (44:24 - 44:27)
What they do is sometimes give you hope.

[Speaker 1] (44:27 - 44:29)
That's one thing. Nothing wrong with that,

[Speaker 1] (44:29 - 44:30)
having some hope.

[Speaker 1] (44:30 - 44:34)
They also get you very good at playing a certain game that you practice.

[Speaker 1] (44:35 - 44:41)
So you can move this one over to here, this one, and you get very good at it and you can demonstrate that. Wonderful.

[Speaker 1] (44:41 - 44:46)
But you still, if you're having an advancing cognitive decline, forget the, you know.

[Speaker 1] (44:46 - 44:48)
Go get dressed or can't find your keys or whatever.

[Speaker 1] (44:48 - 44:49)
So what good is it, right?

[Speaker 1] (44:50 - 44:51)
I wish I could tell you they work,

[Speaker 1] (44:51 - 45:01)
but they're, I know a lot of people who have bought into particularly the Prevagen that was all over the place. I think they ended up settling the lawsuit.

[Speaker 1] (45:01 - 45:08)
FDA went after them. They said you can no longer say that this is something that helps prevent dementia.

[Speaker 1] (45:08 - 45:11)
You can talk about it as it may help you with.

[Speaker 1] (45:12 - 45:24)
uh remembering certain things, but you can't you can't claim it as a health product 'cause the studies don't support it. The testimonials are there. There are people happy to say it turns out that many of those testimonials are paid.

[Speaker 1] (45:25 - 45:48)
You know marketing right so be careful be careful out there don't buy into it the computerized cognitive training anybody doing those anyone I forget what the some of the names are the ones that are out there their brain games that they have in there they indeed can show some improvement in tracking and picking out things but they don't do much to deal with dementia all right

[Speaker 1] (45:50 - 45:54)
Ah, here we are. Finally. So what can you do, right?

[Speaker 1] (45:54 - 45:56)
I know I've depressed everybody.

[Speaker 1] (45:58 - 46:00)
This is not my intent,

[Speaker 1] (46:00 - 46:08)
but there are some significant things to do. There was a paper that came out in Lancet last year,

[Speaker 1] (46:08 - 46:08)
2024.

[Speaker 1] (46:09 - 46:11)
There are now 14.

[Speaker 1] (46:12 - 46:21)
14 modifiable lifestyle factors that if you address them and do well with them, you reduce your risk.

[Speaker 1] (46:21 - 46:22)
Okay?

[Speaker 1] (46:22 - 46:24)
That's what we're going to talk about.

[Speaker 1] (46:24 - 46:24)
Unfortunately,

[Speaker 1] (46:24 - 46:29)
the number one risk, as I said earlier, far and away is aging.

[Speaker 1] (46:30 - 46:34)
You can't change that, nor can you change your genetic makeup too,

[Speaker 1] (46:34 - 46:35)
I suppose that's in there.

[Speaker 1] (46:35 - 46:40)
But you know, age is the big one that as you get older your risk just goes up.

[Speaker 1] (46:40 - 46:41)
But what can you do?

[Speaker 1] (46:42 - 46:43)
Well here are the things you can do.

[Speaker 1] (46:44 - 46:47)
In the early life if you didn't complete your secondary education,

[Speaker 1] (46:47 - 46:49)
I suppose you can go back and get a GED.

[Speaker 1] (46:49 - 46:56)
But this has shown that people who have completed a secondary education or gotten a GED,

[Speaker 1] (46:56 - 47:00)
they have a lower risk of dementia as an older person.

[Speaker 1] (47:00 - 47:01)
Hearing loss,

[Speaker 1] (47:01 - 47:10)
where's Joan? There you are. What's the, I don't remember the percentage of a loss of cognition for each ten decibels. What is it?

[Speaker 1] (47:21 - 47:23)
Right, right.

[Speaker 1] (47:24 - 47:24)
Absolutely.

[Speaker 1] (47:25 - 47:26)
If you haven't had it checked,

[Speaker 1] (47:26 - 47:28)
have it checked. If you do have a hearing aid,

[Speaker 1] (47:28 - 47:30)
wear it, change the battery,

[Speaker 1] (47:30 - 47:33)
don't lose it, pay attention to it.

[Speaker 1] (47:33 - 47:35)
Having high LDL cholesterol,

[Speaker 1] (47:36 - 47:40)
take those medications if you have it that you can reduce it.

[Speaker 1] (47:40 - 47:41)
Depression,

[Speaker 1] (47:41 - 47:42)
if that's going on,

[Speaker 1] (47:42 - 47:46)
find a way to deal with it, to see someone like me,

[Speaker 1] (47:46 - 47:47)
talk to your primary care physician,

[Speaker 1] (47:47 - 47:48)
see a therapist,

[Speaker 1] (47:48 - 47:52)
find ways to deal with it. It'll make a difference.

[Speaker 1] (47:52 - 47:53)
Traumatic brain injury,

[Speaker 1] (47:54 - 47:55)
who was talking about the cane?

[Speaker 1] (47:55 - 48:00)
Somebody was talking about the cane in the back that you have, I say that all the time.

[Speaker 1] (48:00 - 48:01)
Where's your cane?

[Speaker 1] (48:01 - 48:02)
It's in the car.

[Speaker 1] (48:02 - 48:04)
It's not going to help you in the car.

[Speaker 1] (48:05 - 48:09)
Falling down is not a good thing, and you know that.

[Speaker 1] (48:09 - 48:20)
Having a brain injury of any sort, a car accident is not a good thing. People who avoid that have a lower risk of developing dementia, physical inactivity, any.

[Speaker 1] (48:20 - 48:47)
physical activity walking chair yoga doing anything is better than not doing it and can make a difference controlling your blood sugars smoking if you're still smoking stop you can it's not easy not easy I don't pretend for a minute that it is hypertension control your blood pressure obesity work in your weight if you're drinking find a way to cut back or stop the

[Speaker 1] (48:48 - 48:56)
The levels of drinking have been adjusted. It's seven per week for women and 14 per week for men.

[Speaker 1] (48:56 - 48:57)
That's not a lot.

[Speaker 1] (48:57 - 49:01)
But if you're able to reduce or stop that,

[Speaker 1] (49:01 - 49:06)
you improve your chances of not getting it.

[Speaker 1] (49:06 - 49:08)
In later life, here we all are,

[Speaker 1] (49:08 - 49:09)
social isolation,

[Speaker 1] (49:09 - 49:10)
come to lectures,

[Speaker 1] (49:10 - 49:11)
come to the senior center,

[Speaker 1] (49:12 - 49:13)
come to the various things,

[Speaker 1] (49:13 - 49:17)
all of those, find ways to connect with other people can make a difference.

[Speaker 1] (49:18 - 49:19)
Air pollution they included,

[Speaker 1] (49:19 - 49:21)
there's 14 different things here.

[Speaker 1] (49:21 - 49:22)
Visual loss,

[Speaker 1] (49:22 - 49:25)
untreated visual loss causes an increased risk.

[Speaker 1] (49:26 - 49:32)
There's 14 lifestyle factors which individually don't do much, you know, 1 to 5 percent, something like that.

[Speaker 1] (49:33 - 49:39)
collectively you can drop your risk some close to half.

[Speaker 1] (49:40 - 49:40)
Isn't that wonderful?

[Speaker 1] (49:41 - 49:46)
I hope you appreciate this and I hope you try to do some of those things that you can do.

[Speaker 1] (49:46 - 49:48)
So let me summarize and then I'll take some questions.

[Speaker 1] (49:49 - 49:53)
This is the benefit of my grandmother getting old isn't for sissy.

[Speaker 1] (49:53 - 50:00)
She used to like to say that I had no idea what she was talking about growing up and suddenly it makes an awful lot of sense, right?

[Speaker 1] (50:01 - 50:03)
Secondly, cognitive decline is inevitable,

[Speaker 1] (50:03 - 50:04)
unfortunately,

[Speaker 1] (50:04 - 50:09)
but the lifestyle changes that I just outlined can indeed make a difference in dementia risk.

[Speaker 1] (50:10 - 50:19)
Mild cognitive impairment dementia are not the same thing. They're different. They're discrete clinical diagnosis, and I hope I gave you some appreciation for what the differences are and what you can do about it.

[Speaker 1] (50:21 - 50:26)
depend on your medical care team and science for diagnosis and treatment.

[Speaker 1] (50:26 - 50:33)
I'm always connected with science and there is such a thing as facts that really do not go away.

[Speaker 1] (50:34 - 50:36)
The treatments are available,

[Speaker 1] (50:36 - 50:47)
lots of ongoing research that must indeed continue in order to improve interventions and indeed I'm very hopeful of the future and I thank you for your attention.

[Speaker 1] (50:54 - 50:56)
Questions? What do you want to do?

[Speaker 1] (50:56 - 50:57)
Go ahead.

[Speaker 1] (50:58 - 50:58)
Oh.

[Speaker 1] (51:00 - 51:02)
Speak in the microphone so you can be recorded for posterity.

[Speaker 2] (51:02 - 51:05)
Do you think having a pet,

[Speaker 2] (51:05 - 51:07)
a dog or a cat,

[Speaker 2] (51:07 - 51:08)
helps?

[Speaker 1] (51:09 - 51:11)
As a pet person,

[Speaker 1] (51:11 - 51:13)
the answer of course is yes.

[Speaker 1] (51:13 - 51:17)
How much it helps whether it really impacts it, hard to know.

[Speaker 1] (51:17 - 51:22)
I don't think I've ever, I've never seen any study that shows that it will make a demonstrable change.

[Speaker 1] (51:23 - 51:23)
However,

[Speaker 1] (51:23 - 51:25)
in terms of people's mood,

[Speaker 1] (51:25 - 51:29)
there's no question that people connect with the animals and have something,

[Speaker 1] (51:29 - 51:30)
have a companion,

[Speaker 1] (51:30 - 51:30)
right?

[Speaker 1] (51:31 - 51:32)
Find it soothing?

[Speaker 1] (51:32 - 51:33)
Absolutely,

[Speaker 1] (51:33 - 51:35)
absolutely. So I think it's a good thing.

[Speaker 1] (51:36 - 51:36)
Okay.

[Speaker 1] (51:37 - 51:38)
No question?

[Speaker 2] (51:39 - 51:46)
I want to refer back to your first slide when you said one of the impacting factors might be educational background.

[Speaker 2] (51:46 - 51:48)
Can you elaborate on that a little bit?

[Speaker 1] (51:48 - 51:56)
That's just from the study that the Lancet published that they showed that people who didn't complete high school had a higher risk.

[Speaker 1] (51:56 - 51:56)
That's all.

[Speaker 1] (51:57 - 52:06)
That just the fact of completing high school lowers your risk of eventually getting the dementia by one or two percent.

[Speaker 1] (52:06 - 52:10)
It's not huge. All of these things of the 14 are all not huge impact,

[Speaker 1] (52:11 - 52:12)
but together they can make an impact.

[Speaker 1] (52:12 - 52:13)
That's all it was.

[Speaker 3] (52:18 - 52:25)
I was interested to note that you didn't mention anything about nutrition and the role that might play.

[Speaker 1] (52:26 - 52:27)
Good point.

[Speaker 1] (52:28 - 52:30)
See, I should have, I suppose.

[Speaker 1] (52:30 - 52:33)
And there's no question that eating well and taking care of yourself,

[Speaker 1] (52:33 - 52:40)
I did mention around the diabetes control and controlling that, eating well and sleep. I didn't mention sleep, too.

[Speaker 1] (52:40 - 52:41)
I should,

[Speaker 1] (52:41 - 52:41)
right?

[Speaker 1] (52:42 - 52:43)
So eating well and sleeping,

[Speaker 1] (52:43 - 52:44)
what is it now?

[Speaker 1] (52:44 - 52:47)
Seven hours is recommended for people.

[Speaker 1] (52:47 - 52:49)
And you don't, you know this,

[Speaker 1] (52:49 - 52:51)
you don't lose your need for sleep as you get older.

[Speaker 1] (52:52 - 52:55)
Some people used to think that, yeah, you're not doing anything. So you know what?

[Speaker 1] (52:55 - 53:11)
and what do you need to sleep well you still need to sleep so yes you need well thank you for reminding me as well as sleeping well and if you're going to nap during I'm a big napper if you're going to nap during the day keep it short because if you don't you'll be up at night and you have my wife is looking at me

[Speaker 1] (53:13 - 53:14)
Where it was... Go ahead.

[Speaker 4] (53:15 - 53:18)
My questions about the cholinesterase inhibitors,

[Speaker 1] (53:18 - 53:20)
Inhibitors? Yeah.

[Speaker 4] (53:20 - 53:26)
so you said that they work for a short time and mainly just to slow it down.

[Speaker 4] (53:26 - 53:32)
So what are your thoughts on continuing it over like a period?

[Speaker 4] (53:33 - 53:34)
after two years?

[Speaker 4] (53:35 - 53:36)
Does it make any sense?

[Speaker 1] (53:36 - 53:36)
You

[Speaker 4] (53:36 - 53:37)
Is

[Speaker 1] (53:37 - 53:37)
know, it's

[Speaker 4] (53:37 - 53:39)
it doing any good? Is it doing any harm?

[Speaker 1] (53:40 - 53:47)
probably not, they're not difficult medications to take. They're not full of lots of side effects as compared to some other medications.

[Speaker 1] (53:47 - 53:49)
So most people tolerate it. So that's the first thing.

[Speaker 1] (53:49 - 53:52)
Secondly, it's a hopeful kind of thing that indeed that,

[Speaker 1] (53:52 - 53:57)
you know, you have a hope that maybe it can help a little bit and even if it does, fine.

[Speaker 1] (53:57 - 53:59)
But if it doesn't, you're no worse off.

[Speaker 1] (53:59 - 54:01)
other than having to take the medication.

[Speaker 1] (54:02 - 54:12)
When they first came out, the National Health Service in Great Britain did a study looking at a controlled study where they had the families, the patient,

[Speaker 1] (54:12 - 54:20)
and the treating physicians tested to see if they could tell who was taking the medications and who wasn't, and they couldn't tell the difference.

[Speaker 1] (54:21 - 54:23)
So it wasn't obvious,

[Speaker 1] (54:23 - 54:31)
but when you test it, as I said, when you do some of those testing, you can see the decline maybe a little bit less that you can buy more time.

[Speaker 1] (54:31 - 54:34)
There's a lot of talk about time to nursing home placement,

[Speaker 1] (54:34 - 54:39)
for example, that people who are taking medication were able to live independently a little bit longer.

[Speaker 1] (54:39 - 54:41)
That's worth something,

[Speaker 1] (54:41 - 54:46)
but you know, it's going to turn around and get you back to being able to do what you did 10 years ago,

[Speaker 1] (54:46 - 54:47)
unfortunately.

[Speaker 1] (54:47 - 55:13)
really very unlikely but not a bad thing to do and not a bad thing to take and you know I wish I could tell you that I've seen people really say oh this has been a great drug for me I've really made a difference some people say I think I'm thinking better I think I'm not as agitated as I used to be fine so there's reasons to continue it they're not bad drugs but they're not wonder drugs does that give you a feel for it

[Speaker 1] (55:14 - 55:15)
I wish I wish I could tell you more.

[Speaker 1] (55:16 - 55:17)
Go ahead

[Speaker 2] (55:19 - 55:24)
I was just wondering, you said you'd cut back on your business.

[Speaker 1] (55:25 - 55:26)
Yeah

[Speaker 2] (55:26 - 55:30)
Are you taking on new patients to evaluate them?

[Speaker 2] (55:31 - 55:32)
Did I say something wrong?

[Speaker 2] (55:32 - 55:33)
Did we get...

[Speaker 1] (55:34 - 55:36)
Is this a shameless plug for my business?

[Speaker 2] (55:36 - 55:36)
No,

[Speaker 1] (55:36 - 55:37)
No,

[Speaker 2] (55:37 - 55:37)
no no. no.

[Speaker 1] (55:37 - 55:37)
No,

[Speaker 2] (55:37 - 55:38)
But...

[Speaker 1] (55:38 - 55:39)
I've cut way back.

[Speaker 1] (55:39 - 55:46)
People tell me I'm much more relaxed now that I only work a couple of days a week and I'm thinking, how bad did I look?

[Speaker 1] (55:48 - 55:49)
I don't know.

[Speaker 1] (55:49 - 55:51)
I am taking some, not many,

[Speaker 1] (55:52 - 56:01)
not many, but there are some new young clinicians in town who are opening up and interested and some of them are well trained so they're there, they're there.

[Speaker 2] (56:03 - 56:03)
Yes.

[Speaker 2] (56:04 - 56:05)
My sister has dementia.

[Speaker 2] (56:06 - 56:15)
They haven't been able to identify what kind of dementia she has because she doesn't have a lot of amyloid in her brain. They did the brain scan.

[Speaker 2] (56:15 - 56:17)
She's had the amyloid, everything,

[Speaker 2] (56:17 - 56:24)
but she does have significant dementia and she was put on lithium and a very,

[Speaker 2] (56:24 - 56:25)
very small.

[Speaker 2] (56:26 - 56:52)
dose of lithium and the difference was really I went to see her two years ago and I cried the whole time I was there because her memory loss was just so significant and then I came back for her birthday this year and she could go back years and years and years she could go back to when she was 12 13 14 15 all the way up and I

[Speaker 2] (56:52 - 56:55)
I was just really shocked by the difference.

[Speaker 2] (56:55 - 56:58)
And I don't know what you think about that drug.

[Speaker 2] (56:59 - 57:04)
I know it's very controversial because it's specific for depression,

[Speaker 2] (57:04 - 57:04)
isn't it?

[Speaker 1] (57:04 - 57:05)
for bipolar disorder.

[Speaker 1] (57:06 - 57:06)
Lithium

[Speaker 2] (57:06 - 57:06)
Bipolar

[Speaker 1] (57:06 - 57:06)
is

[Speaker 2] (57:06 - 57:07)
disorder.

[Speaker 1] (57:07 - 57:14)
a bipolar mood stabilizer. It is called the first of the mood stabilizer and also considered to be the most effective.

[Speaker 1] (57:14 - 57:18)
And there is indeed not only with that medication, there are other medications that they're looking at.

[Speaker 1] (57:18 - 57:22)
And in small doses, I was just looking at a video about that.

[Speaker 1] (57:22 - 57:31)
The problem is, particularly in that kind of situation, if she had myocognitive impairment, which can reverse on its own,

[Speaker 1] (57:31 - 57:33)
how do you differentiate that?

[Speaker 2] (57:35 - 57:36)
It's not that I easy

[Speaker 1] (57:36 - 57:37)
know. I understand that.

[Speaker 1] (57:37 - 57:42)
I mean, there are people who believe in it, and there are people who are researching it. But being able to make the distinction,

[Speaker 1] (57:42 - 57:48)
and I'm not aware of any controlled study where somebody was given lithium or given a placebo, and then the

[Speaker 2] (57:48 - 57:49)
There was a study that came out.

[Speaker 1] (57:50 - 57:56)
Yeah, they're looking at it. It's certainly not considered mainstream yet.

[Speaker 1] (57:56 - 57:57)
But maybe,

[Speaker 1] (57:57 - 57:58)
you know, look,

[Speaker 1] (57:58 - 58:03)
it'd be nice to be able to do that in selected cases, if people could figure it out.

[Speaker 1] (58:03 - 58:05)
That's one of the points I'm trying to get across,

[Speaker 1] (58:05 - 58:07)
that it's not monolithic.

[Speaker 1] (58:08 - 58:10)
There are, you know, there's nuances in different kinds of things,

[Speaker 1] (58:10 - 58:14)
and amyloid and tau may not even be the only peptides to be involved.

[Speaker 1] (58:14 - 58:16)
There may turn out to be other ones.

[Speaker 1] (58:16 - 58:18)
But what we know now, we know now,

[Speaker 1] (58:18 - 58:19)
okay?

[Speaker 5] (58:21 - 58:23)
Is this hereditary?

[Speaker 1] (58:23 - 58:27)
The, we all come from somewhere.

[Speaker 1] (58:29 - 58:39)
We all come from somewhere and indeed there are families where it does seem to be more common or seem to run in some families more than in others.

[Speaker 1] (58:40 - 58:48)
There are some genetic testing that do indeed do that. I'll tell you a little bit more then about the APOE various alleles that are there.

[Speaker 1] (58:48 - 58:56)
The most common is the APOE3. If you get one from each parent, you're considered to be homozygous for

[Speaker 1] (58:56 - 58:59)
APOE3, but there's a two and a four,

[Speaker 1] (58:59 - 59:04)
and the four increases your risk and the two decreases your risk.

[Speaker 1] (59:04 - 59:15)
So depending on what you get from each of your parents sets the stage for the risk, but there's all those other factors,

[Speaker 1] (59:15 - 59:16)
lifestyle factors.

[Speaker 1] (59:17 - 59:22)
The answer is, basically what I think about it, you can't change your genetic inheritance.

[Speaker 1] (59:22 - 59:26)
So I don't, you know, there's not much to think, why worry about it? However,

[Speaker 1] (59:26 - 59:27)
and here's the exciting thing,

[Speaker 1] (59:28 - 59:34)
there is some research on gene treatment being able to change from

[Speaker 1] (59:45 - 59:50)
So far we have some very smart mice, but that's where we are at the moment.

[Speaker 1] (59:50 - 59:54)
But maybe there'll be a time we could actually do that, not yet,

[Speaker 1] (59:54 - 59:56)
but it does.

[Speaker 1] (59:56 - 59:57)
Yeah.

[Speaker 1] (59:57 - 59:58)
Yeah,

[Speaker 1] (59:58 - 1:00:11)
but you can see that. You can see people who have a lot of cognitive decline or dementia in the family who don't get it, and you can see people who come from perfect families from the standpoint of cognitive decline who have very florid kinds of cases.

[Speaker 1] (1:00:11 - 1:00:15)
So it isn't 100%. We don't know enough about it yet.

[Speaker 2] (1:00:18 - 1:00:25)
I just had a little comment and I hope people take it and think of it positively when you talked about why does education make a difference,

[Speaker 2] (1:00:25 - 1:00:25)
right?

[Speaker 2] (1:00:25 - 1:00:42)
And in the same way I would say why does staying active and keeping yourself stimulated, it was explained to me if you think about your brain as a four-lane highway and something happens and you lose one lane, something maybe you have a vascular incident,

[Speaker 2] (1:00:42 - 1:00:43)
something goes on.

[Speaker 2] (1:00:44 - 1:00:45)
They're still pretty functional.

[Speaker 2] (1:00:46 - 1:00:49)
So I think that's why you see the range in people,

[Speaker 2] (1:00:49 - 1:00:49)
Dr.

[Speaker 2] (1:00:49 - 1:00:50)
Abrams said,

[Speaker 2] (1:00:50 - 1:01:04)
when they do the studies and somebody presented with a lot of plaque or they had lost a lot of their brain mass and other folks hadn't, I think that's, at least that's how it was explained to me, how education makes a difference.

[Speaker 2] (1:01:04 - 1:01:09)
And then I would say clearly also staying engaged and active and same kind of thing.

[Speaker 1] (1:01:09 - 1:01:12)
Now, what you're touching on is often called neuroplasticity.

[Speaker 1] (1:01:12 - 1:01:12)
city.

[Speaker 2] (1:01:12 - 1:01:13)
Mm-hmm.

[Speaker 1] (1:01:13 - 1:01:18)
Because you have a certain number of brain cells, the peak of which, I hate to say this, is when you're 22 years old.

[Speaker 1] (1:01:19 - 1:01:20)
After 22,

[Speaker 1] (1:01:20 - 1:01:21)
billions,

[Speaker 1] (1:01:22 - 1:01:23)
you have billions of brain cells,

[Speaker 1] (1:01:24 - 1:01:27)
but after age 22, because you don't grow more brain cells.

[Speaker 1] (1:01:27 - 1:01:40)
But what you can do, as Joan pointed out, is you can begin to train different parts of the brain. People have had strokes, for example. They can lose language, but they can relearn it from another part of their brain. It may not quite be the same, but it's, again,

[Speaker 1] (1:01:41 - 1:01:43)
neuroplasticity or the multiple lanes,

[Speaker 1] (1:01:43 - 1:01:44)
nice way of thinking about it.

[Speaker 1] (1:01:45 - 1:01:48)
Okay, wait a minute, wait a minute, we got somebody,

[Speaker 1] (1:01:48 - 1:01:48)
we got to get the mic.

[Speaker 3] (1:01:48 - 1:01:51)
Where are we? I didn't hear. Margaret.

[Speaker 1] (1:01:52 - 1:01:55)
Maybe a couple more questions then I get worn out.

[Speaker 4] (1:02:02 - 1:02:10)
Hi. What do apps like Duolingo do where every single day you're doing language learning year after year?

[Speaker 4] (1:02:10 - 1:02:11)
Does that have any impact?

[Speaker 1] (1:02:12 - 1:02:19)
It's a good thing to do to sit to keep your brain active learning new languages learning new skills learning to play a new instrument

[Speaker 1] (1:02:20 - 1:02:30)
Seeing movies things that stimulate your brain. It's a it's basically the same issue You're using whatever you still have to its maximum function. That's really what you're talking about.

[Speaker 1] (1:02:30 - 1:02:31)
Is it going to prevent dementia?

[Speaker 1] (1:02:32 - 1:02:39)
I wish I could tell you that is guaranteed if you do that you're not good, but you feel better doing that It'll force you to socialize maybe a little bit more because

[Speaker 1] (1:02:40 - 1:02:43)
Now you go to a foreign country and know where you are and who you're talking to.

[Speaker 1] (1:02:44 - 1:02:45)
Last question,

[Speaker 1] (1:02:45 - 1:02:46)
okay?

[Speaker 3] (1:02:47 - 1:02:49)
I used to be a geriatric care manager and when I would see

[Speaker 3] (1:02:51 - 1:03:06)
significant cognition changes very often it was a UTI so very simple urine analysis and they don't always they go to the imaging they go to the spinal taps whatever do the simple stuff first they don't always do that in the hospital and I'd have to advocate

[Speaker 1] (1:03:06 - 1:03:07)
Yeah,

[Speaker 1] (1:03:07 - 1:03:07)
well,

[Speaker 1] (1:03:07 - 1:03:17)
I used to consult in nursing homes and depend endlessly on the people who knew what they were doing because they could pick up the change and they would say this person isn't always like this.

[Speaker 1] (1:03:17 - 1:03:23)
and that this is new for this person and that you're right, urinary tract infections or an other kinds of infections too.

[Speaker 1] (1:03:24 - 1:03:26)
Right, and they're reversible,

[Speaker 1] (1:03:26 - 1:03:30)
that's the key thing, they can make a difference, so don't give up. Alright,

[Speaker 1] (1:03:30 - 1:03:32)
well thank you for staying awake

[Speaker 4] (1:03:32 - 1:03:32)
Oh.

[Speaker 1] (1:03:32 - 1:03:34)
and being here and good luck.