Dementia: Proactive Prevention. Yes, Prevention!

March 20, 2024 Dr Mitchell Clionsky Season 4 Episode 73
Dementia: Proactive Prevention. Yes, Prevention! Podcast
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Dementia: Proactive Prevention. Yes, Prevention!
Mar 20, 2024 Season 4 Episode 73
Dr Mitchell Clionsky

Can you prevent Dementia? Join us on a journey of hope and empowerment with our latest podcast episode featuring the esteemed Dr. Clionsky  a board-certified neuropsychologist  and co-author of the book, "Dementia Prevention: Using Your Head to Save Your Brain", who debunks the myth that our genetic makeup is the sole dictator of our dementia destiny. Discover the impactful ways in which our daily habits, sleep patterns and medical decisions can dramatically sway the odds in our favor.
 As we gracefully tackle the complexities of aging, this discussion takes a turn towards the sensitive subject of driving with dementia, and the intricate dance of intergenerational care. We share heartfelt insights on how to navigate these waters with compassion and wisdom, all while keeping an eye on proactive measures that fortify brain health. Plus, get privy to my personal 10 by 3 formula—an easy-to-adopt plan to keep your body and mind in peak condition. It's all about taking actionable steps toward a healthier future, with practical advice that resonates with listeners from all walks of life.

Cap off the episode with a deep dive into the crucial, yet often overlooked, role of sleep in cognitive function and ADHD.  The conversation expands to touch on the surprising health implications of sleep apnea, while also addressing common misconceptions. Podcast sponsored by TransMed Care Long Distance Medical Transportation

The background music is written, performed and produced exclusively by

* Webinars and Podcast represents the opinions and expertise of our guests. The content here is for informational and educational purposes. It does not necessarily represent the views, recommendations, opinions or advice of Fairfax Publishing/ or its employees

Show Notes Transcript

Can you prevent Dementia? Join us on a journey of hope and empowerment with our latest podcast episode featuring the esteemed Dr. Clionsky  a board-certified neuropsychologist  and co-author of the book, "Dementia Prevention: Using Your Head to Save Your Brain", who debunks the myth that our genetic makeup is the sole dictator of our dementia destiny. Discover the impactful ways in which our daily habits, sleep patterns and medical decisions can dramatically sway the odds in our favor.
 As we gracefully tackle the complexities of aging, this discussion takes a turn towards the sensitive subject of driving with dementia, and the intricate dance of intergenerational care. We share heartfelt insights on how to navigate these waters with compassion and wisdom, all while keeping an eye on proactive measures that fortify brain health. Plus, get privy to my personal 10 by 3 formula—an easy-to-adopt plan to keep your body and mind in peak condition. It's all about taking actionable steps toward a healthier future, with practical advice that resonates with listeners from all walks of life.

Cap off the episode with a deep dive into the crucial, yet often overlooked, role of sleep in cognitive function and ADHD.  The conversation expands to touch on the surprising health implications of sleep apnea, while also addressing common misconceptions. Podcast sponsored by TransMed Care Long Distance Medical Transportation

The background music is written, performed and produced exclusively by

* Webinars and Podcast represents the opinions and expertise of our guests. The content here is for informational and educational purposes. It does not necessarily represent the views, recommendations, opinions or advice of Fairfax Publishing/ or its employees

Hi everyone. It's Darleen with Podcast. Can you believe that we are celebrating our 73rd episode, which puts us into Season Four? Over the last three years, we've covered so many amazing topics and content that we are hoping is an incredible resource for our seniors, their families and their caregivers. If you have enjoyed this podcast, please continue to share with those you think will benefit the most, and thank you so much for your support, because it is without our listeners that we would not have as much success as we've had over the last several years. Thank you. 

Speaker 2: 1:40 

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Speaker 2: 3:38 

And I'm super excited to have Dr Clionsky , who is a PhD. He is a board certified neuro psychologist who specializes in evaluating and treating patients with cognitive impairment, dementia, adhd and traumatic brain injury, and he's joining us today. He's written a book called Dementia Prevention Using your Head to Save your Brain. I love that title. Welcome to the podcast. 

Speaker 5: 4:03 

Pleasure to be here today, very exciting. 

Speaker 2: 4:06 

I know it's very exciting and you know I've talked to you a little bit about some of your research that you've done on dementia and it's great stuff, so I'm excited to share it with our listeners so that it can be more information for them and etc. To make better decisions about overall health and life and really understanding dementia. So, talking about dementia prevention, that's really the first part of the title of your book. So tell us, can you prevent dementia? 

Speaker 5: 4:36 

No, oh yeah, of course. Now we just wrote a whole book. It's one page. It says no, I can't do this Absolutely. You can't prevent dementia. 

Speaker 2: 4:46 

Shortest book in history, right. 

Speaker 5: 4:49 

It's only slightly larger than the width of Mitchell Clionsky. That's only about a line or two. 

Speaker 5: 4:54 

But, you get past that, it's a little better. No, actually, the surprising thing is that while most people midlife and older and even younger people are very worried about dementia, statistics showed that about 80% are either somewhat or very concerned about developing Alzheimer's disease, vascular dementia, frontotemporal dementia, some of the different kinds of dementias that while that many people are worried about it, most people don't think they can do anything about it. They just view it as sort of the fickle finger of fate. It's going to point down and say, yeah, you, or that it's going to be genetic and they're because they have a parent who has dementia, that they're doomed to have this. And the answer is that's not true. 

Speaker 5: 5:44 

Genetics only account for about 5% of the amount of information that determines if someone becomes demented, except for a very few number of people who have these very strong family histories and everyone in their family, pretty much at the age of 50 or so, becomes demented. So there's no grandparents very much in those generations. They know it going into it. But the rest of us, the other 95% or more, what we're looking at here is lifestyle, a lot of medical conditions, things that we can actually change, that could reduce our risk, so that only one out of two cases actually turns into dementia 50% between 40 and 60, depending on which research study you read. But these are all very large-scale research studies. One group finds about 40 to 42% are preventable. The other group found about 60% were preventable. So I feel really comfortable in saying that one out of two cases can be prevented or avoided. 

Speaker 2: 6:48 

Yeah, and I agree, I feel like the younger generations are becoming more in tune to dementia and Alzheimer's, because the numbers definitely are increasing in cases of the illness. And then also, I think you become more aware when you do have a family member, or a parent more specifically, that is diagnosed with it, because all of a sudden you go, oh yikes, especially if you you know you've been living your life doing your thing and not thinking about this, but when it comes and hits your own family, it's a game changer. 

Speaker 5: 7:18 

I went through that with my mother. So I spent my 50th birthday in a psychiatric unit where my mother had just recently been admitted for working up why her behavior had become so strange. We had known for a couple years that she was episodically not thinking so well, episodically acting very differently than she used to, but she was very resistant to considering that there was anything that was all that unusual and pretty much, you know, things really intensified right around that time. She was about 74 at that time and at that point we got the official diagnosis. So you don't get that diagnosis for a family member because she's certainly not going to believe me. 

Speaker 5: 8:08 

I'm her son and I didn't want to make that diagnosis with her because I'm her son. But after that things very much changed and my brother and I had to look at okay, what do we do? Where can she live? Because she can't live by herself anymore. She's now not functioning well enough to be able to make decisions, to be able to do things, and how do we best treat her with medications and other potential kinds of interventions? So I get it. I've sat on that side, as well as being a neuropsychologist giving the diagnosis and advising people. I've also been on the side where I'm hearing that from someone else and having to live through those changes. 

Speaker 2: 8:48 

Yeah, absolutely, you know, with my dad, because my dad had dementia as well. He had vascular dementia. We knew that's probably what he had, but when we got the official diagnosis I didn't know whether to tell him or not, because he had a lot of memory issues and understanding of basic things going on in life. So I didn't know if I should tell him or not tell him, and I decided to tell him because I thought that was only fair, and whether he really understood it or not, I don't know. 

Speaker 2: 9:15 

He accepted it though, which was unusual for him, because if there was something he didn't like, he would put up a little bit of a fuss and deny it, because when we even trying to get him to the doctor, I don't know why I'm here. There's no reason why I should be here, I'm fine, I'm fine, I'm fine. So I think that probably he, even with suffering with the dementia, knew it. He just didn't want to be, he just didn't want to admit it. But then, when he's confronted with it, he was okay to accept it, because I have a feeling he probably knew it for a while. 

Speaker 5: 9:45 

He probably did. You know, people all the time ask me you know, should I tell mom or dad what should I do? I always involve the patient in the decision process, unless they are so far gone by the time they walk into my office that they can't possibly understand it, and that's because I think it's respectful number one. It's their life. But also it's helpful if we can form an alliance between the family, the doctor and the patient, because there's a lot of things I want them to do that can potentially stabilize this and some cases even make it better. So I want everyone on the same page and that works best. When the person understands what the diagnosis is, it also means that I can take the blame if I'm telling them that they can't drive a car anymore. They need someone to oversee their financial transactions. 

Speaker 5: 10:39 

But it's different for different people. Some people put up a fight. Other people say yeah, you know, I sort of knew it, I just didn't want to know it until you told me. So you have to play it by ear. But for most people it's actually a way of saying you're not crazy, you are having these problems, you're not imagining this, and here's the plan, here's how we're going to attack this, and that's very important having a forward looking outlook and that's basically what we do in treatment and as well as prevention. We just start earlier with prevention. 

Speaker 2: 11:13 

Right, right, you know, even telling my dad, with sitting him down, telling him that he did have a vascular dementia, and he was like, okay, it's like his little wheels were turning. And I said what this means, dad, is you don't have to worry about money anymore, because we're taking care of everything. And I will tell you, I feel like that was such a relief you could just see it in his eyes. I don't have to worry about that anymore. I don't have to worry about trying to pay those. I don't have to worry about figuring all that out, because that was one of the things I could tell. 

Speaker 2: 11:45 

Like the whole dining room table was like bills and spreadsheets and all these things that he was writing down and trying to keep track of, and I could tell that it was something that he was really struggling with just from a bird's eye view, just walking into the kitchen, because I'd never seen him do that before, and then he wasn't able to remember any of his passwords, which was a dead ringer that there's an issue. But so I think that there is a somewhat of relief. I have this diagnosis, I know that I have it now and it takes a weight off of them versus not understanding, maybe, what's going on in their life and their brain and their world, and then, as the person telling them, the ability to take off some of those life pressures, like the money, the financial side, that kind of thing, the driving side. So we're taking that away, but it's okay because we're going to make sure you're, you know, still provided for. It provides them some stress relief, which the stress, as we know, can make dementia worse. 

Speaker 5: 12:39 

It's also great if the person has a family member that is competent, which it sounds like you are, and caring, which it sounds like you are. We don't always see that. Sometimes the person says you're just trying to put me away, you're just trying to take my stuff, you want my money, you want my car, you don't want to take care of me, and so those are very different kinds of dynamics. It's great if you have a relationship that is built up over the course of years where the parent recognizes well, I've got really intact kids and they really do love me. So I got to trust them. And when I tell patients I say you know, a lot of times to them you know you've done a really good job as a parent, and the reason I can tell that is because you've got really great kids and they're going to do that for you now they're going to take care of you the way you took care of them. So thank you for being such a great parent. 

Speaker 2: 13:35 

Well, I'm telling you, that's the way it should be. We should be able to take care of our parents after they took care of us and raised us and provided for us. I think that sometimes adults get to be adults and they don't realize that until it happens to them. And then, all of a sudden, maybe this is, I don't want to say karma, but I didn't take very good care of my parents, so are my children going to take good care of me? So, because you are a role model, regardless of the age of your kids, you're a role model on how you treat your own parents, et cetera. So I totally, I totally agree with that. And I will say my dad got a little fussy prior to the diagnosis when we did take the keys away, but I do think that he did fill a relief. I mean, he got very ticked at the very beginning of that conversation, but by the end I think he was now relieved, because I do think he was getting scared driving. 

Speaker 5: 14:22 

And I typically want to make that decision for the family so they don't have to so much do that with their own parents, because they're left with a real bad taste in their mouth as a result of it, whereas they only have to see me maybe every six months. So I can be the bad guy and say you know, I'm going to make this decision for you because that's my job. I don't love doing this. In fact, I hate it. It's usually one of the last recommendations in a series of recommendations that I will make with them, because I know that for many people, once you make that one, that's all they're going to think about. They don't hear anything beyond that statement, so it gets pushed to the end after we talk about treatment options, lifestyle changes oh, by the way, let's talk about driving. 

Speaker 2: 15:15 

Yeah Well, and the reason we had that conversation before his diagnosis because we knew we were still waiting for that to come in is he had an interaction with the police. Honestly, we put it the police said you can't drive anymore and he was a rule follower. So if the police said you're not driving, you're not driving. 

Speaker 5: 15:33 

So good for everybody, good for them. 

Speaker 2: 15:36 

Exactly, I felt a little sneaky, but the timing I mean it was meant to be, because he didn't do anything where he was in trouble. He just like reported his car missing when it was sitting in his driveway. 

Speaker 5: 15:46 

So the tough thing about that decision is that it's not that the person who has lost their mental abilities is going to drive poorly every time. It's just that driving poorly even one time is often more than we can tolerate. Those are the people who you know. They're in the parking lot in front of the convenience store and they're about to put their car into reverse so they can back out of the parking space, but they actually put it into drive and go crashing through the glass window in the front. It only takes one of those for this to happen, so they can drive 95% of the time. Really well, it's the other 5% that you have to worry about. 

Speaker 2: 16:27 

And then also worry about them getting lost, where they get confused to where they're at. One of the things or the thing that you talked about in your book is the prevention. So now we've talked about folks that have already been diagnosed with it and kind of how to navigate some of that. So I really want to dig deep into prevention, because that's something we've never talked about other than, you know, eating a proper diet and doing some of the general things that people recommend if you are getting to that age, or just general lifestyle. 

Speaker 5: 17:00 

Sure. So there's a couple things that people always say what's the one thing that I can do that would really reduce my risk of dementia? And the answer to that is there isn't one thing, there are a variety of things. It's even better if you can target it to your particular case, and that's one of the reasons why on our website, we include a dementia prevention checklist where people can actually self assess the areas where their behaviors, their lifestyles, their health is on target versus off target, or, if they fall in the middle, where they're near target, just have to make a couple improvements, for example, blood pressure. 

Speaker 5: 17:44 

We know that high blood pressure is a real problem because it interferes with the flow of blood and the nerves around the blood vessels and can be the basis for vascular dementia, like your dad had. Well, a lot of people, because they don't perceive their blood pressure to be high when it is, they don't always take their blood pressure medicine. Well, that could be something that, if their blood pressure is elevated more often than not, that just by changing that part of their health behavior, that could make a difference in lowering their risk. Someone else with high blood pressure who's taking their blood pressure meds might not need to do anything in that direction. They may want to focus more on their exercise and the fact that they're spending a lot of time being very sedentary, sitting in chair, watching TV, not really getting up and moving. If there's one thing that we've repeatedly found out over the last 30 years or more of research and we're talking about all kinds of different studies exercise, movement is critical to brain health, nothing we can substitute. A couple of years ago, there was a study that came out showing they'd given some new kind of medication to mice that mimicked the effectiveness of exercise, even though the mice were sedentary. 

Speaker 5: 19:13 

And I had really mixed feelings about this. Part of this was wow, that sounds like a game changer. You want to get behind that research and maybe buy stock in that company, because I can't think of anybody who wouldn't want to have that pill. On the other hand, I'm wondering is that really good? Is it really good to take that shortcut? I don't know. I don't think they ever advanced that research because I've never seen it on either larger animals or translated into humans, but when it came out it was like sort of artificial intelligence. Is this a good thing or a bad thing for our future? Movement is really important, and a lot of people do a lot less of that than they should. So that's one thing where we can really get people moving. That's going to make a difference. 

Speaker 2: 19:56 

It's definitely a generational problem, but I also think with our seniors, it's harder for them to get out. They may have those aches and those pains, which makes it to where they don't want to get out. I'm not even talking to seniors. I'm talking about when you hit your 40s and your 50s. You start my knees ache, this hurts, and then you're working and you're just running like a crazy person and by the end of the day you're working, has been sitting at a desk all day, but you're so exhausted that all you want to do is pop on the couch. So that's the other thing. 

Speaker 5: 20:29 

I've got a fix for that. So here's my recipe. I call it the 10 by 3 formula. Take a 10 minute walk three times a day. Here's why this works. 

Speaker 5: 20:42 

Number one it's easy to do. It gets around most of your avoidances and excuses. You're never too busy to squeeze in 10 minutes of walking three times a day. You can do it all kinds of different weather. You are unlikely to hurt yourself. You're not going to need a membership or special equipment, aside from a decent pair of shoes. It's cumulative. 

Speaker 5: 21:10 

So 10 minutes three times a day is 210 minutes a week of exercise. Well, hey, that's right in the sweet spot of the 150 to 300 minutes that all the major health organizations are promoting. And if you walk briskly which means that you're walking fast enough that your heart rate goes up, but not so fast that you can't talk you're going to do about nine or 10 miles a week. And for most of those people say well, my legs hurt. When do they start hurting? Well, usually it's about 20 minutes of the walking. You get around that. 

Speaker 5: 21:45 

By walking for 10 minutes You're going to be able to also do other things. That's the other beauty of this. I like double dipping. I like being able to take a walk and listen to sports radio or podcasts or music. I like being able to call people up, whether it's get back to someone who's called me and I need to touch base with them, or I call my brother, who lives in four states away, and we'll take an hour walk on a Saturday morning. We're talking to each other while we're walking as if we were there. In fact, it's even better because I can turn them off if I need to. But it's really a great formula to get people up and moving and it really, really works. 

Speaker 2: 22:28 

Yeah, when I walk because I'll walk my dog every day I do talk to people on the phone and I'm less distracted. Or if I'm at home, I find that I do other things or I get distracted. So I'm having a conversation but they're not getting my full attention. So walking, the full attention is definitely there because you really can get into a deeper conversation than if you're trying to multitask inside your home. So I agree with that and definitely you can listen to podcasts. Boom, there you go. So you know what. I think we're going to take a quick break for our podcast sponsors. Transmedcare Long Distance Medical Transportation. 

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Speaker 5: 23:32 

And you know the thing is, once you get someone started on a positive health behavior like that, other health behaviors become easier. For one thing, if you're exercising and you hadn't been before, chances are it's easier to maintain the weight that you want. Chances are, if you're doing that, you're also likely to reduce type 2 diabetes, which is a major risk for your health as well as for your brain, because that excess sugar in your bloodstream is also causing deterioration in the nerves and the blood vessels, which will then impact your thinking abilities. So you start to make those positive changes. If you quit smoking, you're going to be able to walk without losing your breath. In fact, anybody these days who is smoking cigarettes should really stop. It's not so much the cancer risk that's certainly been known for years and years and years it's the cerebral, vascular and cardiovascular risk, the risk of heart attacks and strokes that are caused by the loss of oxygen and the elevation in your blood pressure. But just making that change is a big step forward for a lot of folks. 

Speaker 2: 24:44 

I find when I'm walking it de-stresses me, so there's that positive aspect of it as well. 

Speaker 5: 24:51 

People with ADHD, which I see you know. Adults with ADHD. 

Speaker 2: 24:55 

I raised my hand. There's a lot of us around. 

Speaker 5: 25:00 

It turns out that there's research showing that if you exercise, you're able to focus better following exercise. So when I see people who are saying I keep falling down these rabbit holes of you know the next link on the internet or my social media or whatever, and I can't seem to get out of it two hours has passed, I haven't gotten what I wanted to get done I say look, when you start doing that, get up and take a walk. You'll achieve two goals you get your exercise and when you come back, you're going to be focused and you're going to be able to get back to work again. So that's an intervention that works in a lot of ways. 

Speaker 2: 25:35 

Yeah, absolutely, that's perfect. That's perfect. And keeping your blood pressure down whatever means necessary on that. So what else would you recommend? 

Speaker 5: 25:46 

So there's one issue, one medical condition that turns out to occur in half of all adults 55 years old and older that most people aren't even thinking about. That impacts your brain and your energy and your attention and your sex ability and all kinds of things. It's an amazingly overriding issue. It has to do with breathing and it's specifically breathing while you're sleeping. It's called obstructive sleep apnea. Yes, most people have heard of sleep apnea. They associated with really fat men who snore and sit down and fall asleep shortly after sitting. There's a very old number of those people, but that's not the majority. Turns out that it occurs in women as much as men and that the most recent research which came out in was it the late summer of 2023, I think it was. Maybe it was a little later than that even looked at 6,000 people from about seven different places in the United States. 

Speaker 5: 27:00 

All of these places were research centers that routinely take in people in midlife from the general population and then test them every several years to see how diseases and other lifestyle things are affecting each other. One place here in Massachusetts I'm in Western Mass is the Framingham Heart Study. That's been around for ages, but the Mayo Clinic and a number of the other centers are also doing this kind of work. They decided, as a group to give every single person who came in in the last cohort there were 6,000 people an overnight sleep study, one night in their bed, with the little device that they wore. What they found is that half of them 50% had diagnosable obstructive sleep apnea. In other words, five times or more every hour. While they were asleep they either stopped breathing or their oxygen levels desaturated by 4%. It's sort of like someone putting a pillow over your face for 10 seconds or more, that many times per hour. That's the bad news, because if you've got sleep apnea and not enough air is getting down your lungs, therefore not enough oxygen gets pulled out of your lungs, gets attached to red blood cells, gets up to your brain, to your heart, all the end organs of your body. 

Speaker 5: 28:28 

You don't make enough energy molecules and while you're sleeping there's a system that's supposed to flush out the waste products of thinking. You sit in your desk all day and you've got pieces of paper. You throw them in the trash or they're on the table. Something spills. You get a cleaning crew that comes in if you're lucky, or you clean it yourself if you're not, and you clean all that up and you throw the trash away. Well, there's a system in our brain that does this. It's called the glimphatic system. This works while we're sleeping, but only if there's enough oxygen. So if you're not getting enough air down your lungs, not enough oxygen gets up to your brain, you don't concentrate well, you don't make memories well, you don't have enough energy and you're more likely to have a decline in your thinking as you get older. 

Speaker 5: 29:18 

Here's something else. It's a high overlap with people with ADHD. So whenever I see someone with ADHD, if I have any suspicion whatsoever that they might have sleep apnea, I have them take a home sleep test, because there's a high percentage of them that are just not getting enough oxygen to their brain. And you fix that and suddenly their ADHD medicines work better and they find that they don't need ADHD medications as much as they used to and they're now better with follow through and organization and at focus. It's amazing thing, this oxygen. We should have more of it. 

Speaker 2: 29:58 

I know, right, keep the trees, keep the trees. But I always think about that. That's just funny. But one of the things that I was wondering is does the snoring always accompany the sleep apnea? Can you have someone that's having issues without you know having the snoring? 

Speaker 5: 30:15 

Yes, you can, and you can also have people snore but don't have sleep apnea. Usually then it's because it's more in their nose as opposed to the back of their throat. But the only way to really get the best diagnosis is this home sleep study or an in-lapse study, when things I mean a lot of places used to be that we'd send people out to get tested overnight in a place that was either in a hospital or that looked sort of like a hotel room with lots of monitors. Now they have gotten the technology down so well that you take a little device and wear it one night in your own bed and they're able to upload the information to an expert who's able to read all of the numbers and make the diagnosis in that way. 

Speaker 2: 31:03 

That is super interesting and I've never heard this before. So I've had a lot of podcast panelists that have shared so much information about dementia. It's really mind-blowing, but this is really the first that there's been any kind of correlation with the sleep. What is it? It's not sleep apnea. Say that one more time. 

Speaker 5: 31:21 

There's different kinds of sleep apnea. The most common is obstructive, where your airway collapses, but you can also have central sleep apnea is where your brain is not signaling a breathing response, so it's just not clicking, that you need to take a breath. The reason that we're able to talk about this and it's just not me, the other person involved in this whole venture is my wife, who is a physician Emily Klianski lead author on the book, actually and she brings this whole medical perspective. That augments my experience as a neuropsychologist and has really upped my game in terms of understanding all of this, because it turns out that when you're dealing with dementia, you're really dealing also with cardiology, endocrinology, neurology and psychiatry, of course, but also pulmonary medicine, sleep medicine, exercise, physiology, alcohol and substance abuse. There's all these different areas. 

Speaker 5: 32:23 

The problem is most people don't look widely enough. Most medical people are focused on their specialties. That's what they read and that's what they look at, and the people doing sleep medicine are really focused on sleep medicine. They're not thinking about what it does to your brain. The neurologists are not paying enough attention to this unless they're also sleep medicine experts. Psychiatrists are hardly ever looking at this and, woefully, most of the neuropsychologists I know are only beginning to pay attention to this, so that's why it's really important to pull it all together, create a model of what's going on that you can then explain to people, so they can use this information 100% and it makes sense If you really think about it. 

Speaker 2: 33:09 

it does completely make sense that the sleep apnea would have an effect on your brain. It's something you definitely want to explore and put that out there, as people are starting to think more and more about dementia prevention or different things that they can do to help maybe prolong it or whatever the case may be. I mean you just have to have all I would say all the tools in your toolbox. 

Speaker 5: 33:34 

Absolutely, and you know they're all related. One of the things we talk about in our book is the fact that this model that we create chapter by chapter looks at all the different parts. We have 20 different factors, all of which impinge on your dementia risk. But not only are they impinging on your dementia risk individually, they're related. So let's take sleep apnea. If you're treating your sleep apnea and you now have more energy, you're going to exercise. Ah, now you're getting two things that are going to work. Now your blood pressure is going to be more manageable. You may be able to cut back on your medicine with your doctor's input. You may have lost more weight. 

Speaker 5: 34:15 

Because it turns out, sleep apnea also impacts the relationship between two hormones in our brain leptin and ghrelin. And no, they are not part of a fairy tale. Leptin and ghrelin existed a dynamic balance, turning on and turning off your satiety centers, the part of your brain that says I've had enough. Well, it turns out that it does get out of balance when there's not enough oxygen. So one of the funny things that happens is when people treat their sleep apnea, they oftentimes start losing weight because they're not hungry at weird times, because they've got this imbalance where something's triggering eat something. You need more energy. So we're looking at a very interrelated process. 

Speaker 2: 35:00 

Yeah, and you're getting a better night's sleep. 

Speaker 5: 35:02 

Yes, so you're not getting up to pee in the middle of the night as much. That's the other thing that happens. That's also related. 

Speaker 2: 35:09 

That is a bonus. 

Speaker 5: 35:11 

It really is. Yeah, and for all the guys out there, you know, when we look at who goes to get the little blue pills at the ED clinic, the sex clinic, turns out that 50% of those men have sleep apnea. Oh, it's circulation. Yeah, it's blood flow. If you're not getting good blood flow, things don't work the way they should. In fact, one of the recent advances is that they're now finding that you can help prevent dementia in some people by treating them with Viagra or Cialis. 

Speaker 2: 35:50 

So that is definitely interesting and that could be a whole separate podcast. 

Speaker 5: 35:56 

Can I tell you a quick story? 

Speaker 2: 35:57 

You have time for a quick story, oh, 100% Go for it. 

Speaker 5: 35:59 

Okay, so there's this couple that comes in to see me, a man and a woman and she is complaining about her husband's memory, and she goes on and on and on. So I'm sitting through this because I'd already heard what he had to say and I sort of knew what she was going to say. She's going on and on and on and she says to me what else is there? We've got them on memory medications. It's not really helping so much. What else can we do? And I said well, there's recently been research published showing that Viagra may help with memory. She looks at me, takes a beat, she says you know, I don't think his memory is that bad. 

Speaker 2: 36:39 

Oh Lord, I have no words for that one. 

Speaker 5: 36:41 

You can't make this up. Real life is funny, you cannot make this up. 

Speaker 2: 36:44 

You can't, yeah, oh, that's great. That's great and that's you know. Probably one of the nice things about your job is you get to know so many people and their personalities and different things that are going on their lives. That definitely adds to your repertoire of information and stories, I'm sure. 

Speaker 5: 37:00 

It does, it does and it makes the job interesting. I've been doing this for 45 years. I still love going in to see my patients. Every day. I see about to this point about 600 to 700 dementia patients and people you know developing dementia every year and I enjoy it because everyone is a little different and there's a lot of interesting things I'm going to learn from them and that's really for me. If I haven't learned something new today, it's really not been a good day. 

Speaker 2: 37:30 

Yeah, no, I love that. So, as we're wrapping up, tell us a little bit more about your book, where our listeners can purchase and read your book, and then also, I want you to share that link of the checklist, so where that would be. 

Speaker 5: 37:45 

Good, absolutely so. Dementia prevention using your head to save your brain is both in regular book form as a paperback, also on Kindle and on Apple Store and on audiobook. It's narrated by an excellent actor, a Woman named Nan Mac the Mara. So if you like listening to books, you can get it on all the major outlets for that. It's on Amazon you can get through Barnes and Noble. Online you can get it in a lot of libraries. So if you don't have the money to buy it, you could certainly borrow it for free. 

Speaker 5: 38:22 

The checklist you can get through a link in our book or simply by going to our website, which is called brain doc brin doc Dot com. Click on the dementia prevention Link on there and it's going to take you to the checklist which you can fill out. Either live online and then download print, or you can print out a PDF and fill it out. What we're now going to be having in the next hopefully month or so is a bonus feature that's going to allow people to then translate their output Into a nicely colored graph that's going to show them exactly where their weak points and strong points are and Give them more of a game plan for Making some changes. But that'll be coming out soon. Right now you can it's live. You can get the whole checklist and fill it out. 

Speaker 2: 39:18 

I think that's great because I think you could print it out and even take it to your doctor and have that conversation with him If there's things on that end that could Help them achieve whatever goals they may be missing out. You know, clearly, the walking. That's something that you're going to have to kind of figure out on your own, but you could do a walking pad in your home if you're not someone that can get out and you know, if you're having Issues with stairs or whatever, I mean the walking pads you can order. They're in your home, they can slide under a bed. That's still an option. So there's all kinds of different solutions and then talking with your doctor who can provide those solutions, especially when they can really kind of see like the whole picture and there's certain medications that you should take and shouldn't take. 

Speaker 5: 40:00 

By the way, any memory medication that's advertised on TV without a prescription. Either save your money or send it to me, because they don't work. 

Speaker 2: 40:10 

I agree with that. Yep, yep. I know that we started like ushering some of those into my dad's vitamins and I never saw any kind of the research on them, if it's existing, is horrible and there's a lot of placebo. 

Speaker 5: 40:23 

If you're taking something that you think is going to help, chances are other people will say well, you know, I think it may be helping, it really doesn't. The research doesn't show benefits, so I don't recommend those for anyone because it's just not worth their money. There's other things that you can do and there's some blood tests that should be done. We also talk about that in the book, so doctors can be very helpful in this regard. 

Speaker 2: 40:45 

Yeah, that's perfect. Well, before we wrap it up, is there anything that we missed, that we want to talk about? 

Speaker 5: 40:51 

There's tons of things. You have to have me come back another time because I haven't even got. I've a scratch the surface yet. We haven't talked about alcohol, we haven't talked about marijuana, we haven't talked about hearing loss, vision problems, social connection, all kinds of stuff. 

Speaker 2: 41:07 

So we're definitely going to do that. We're going to schedule a part two so we can dig into some of those things for sure, because all of those have an impact, I'm sure. So I want to hear more details on that, but in the meantime, go ahead and Connect with the book, which is available on Amazon and the other places that dr Koynsky recommended, and then also the checklist. I think the checklist is fabulous. Check that out, and we appreciate you being on our podcast today. 

Speaker 5: 41:34 

Thank you so much for having me. 

Speaker 2: 41:36 

It was fabulous and definitely we're going to do another one. So if you enjoyed this podcast, please share this podcast with someone that you care about, that you love or you think we'll get some great information out of it. And we can be found on Spotify, Apple Podcast, Goodpods, Alexa and more.