New Way to Navigating Dementia Care with Dr. Daniel Lesley

New Way to Navigating Dementia Care with Dr. Daniel Lesley

Navigating Dementia Care with Dr. Daniel Leslie

In this episode of Season seven of Open Forum in The Villages of Florida, host Mike Roth interviews Dr. Daniel Leslie, a general neurologist specializing in dementia care. Dr. Leslie shares insights from his background, his 15 years of service in the US Navy, and his subsequent work with the VA and Remo Health, a virtual dementia care company. He emphasizes the importance of caring for both patients and their caregivers, introduces the concept of dyads, discusses the unique challenges faced by veterans, and explains how Remo Health provides comprehensive support through telehealth to improve dementia care.

Here are the books Dr. Lesley would like to recommend to caregivers of a person living with dementia:

• Travelers to Unimaginable Lands: Stories of Dementia, the Caregiver, and the Human Brain by Dasha Kiper
• The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer's Disease, Other Dementias, and Memory Loss by Peter V. Rabins and Nancy L. Mace

 Over the next several weeks, while I'm out of town, I've decided to release some reedited and improved versions of the  most popular shows in the series,  as well as some totally new episodes.  I hope you enjoy them.  I'll be back in mid-November with some new episodes

Have you heard about mature adults with Donna Hoover and Mike Roth? Yes. This is my second podcast and Donna and I are going to be addressing subjects which are significant for seniors, especially seniors living here in the villages.

The easiest way to hear the show is to look it up on Apple Podcasts. Look for mature adults with Donna and Mike. We'll be looking for you there. 

You can also find us on mature adults with Donna and Mike. All spelled out. Dot buzz sprout.com

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Transcript

New Way to Navigating Dementia Care with Dr. Daniel Lesley

[00:00:00] Rita: Welcome to Season seven of Open Forum in The Villages of Florida. In this show, we talk to leaders of clubs and interesting folks who live in and around The Villages. We also talk to people who have information vital to seniors. You will get perspectives of what is happening in The Villages, Florida area.

We are a listener supported podcast. There will be shout outs for supporters. 

[00:00:29] Mike Roth: This is Mike Roth on Open Forum in The Villages here today with Dr. Daniel Leslie. Thanks for joining me, doctor.

[00:00:37] Daniel Lesley, MD: Thank you for having me, Mike.

[00:00:38] Mike Roth: Good. Dr. Leslie, why don't you tell our listeners a little bit about your background, how you became interested in medicine your path to working with veterans? Because we have a lot of veterans here in The Villages.

[00:00:51] Daniel Lesley, MD: Fantastic. So I'm Dr. Daniel Leslie. I'm a general neurologist, but I spend much my time working with people with dementia and a lot of my time working with veterans. I myself am a veteran. I was in the US Navy for 15 years working with both, blue side on ships, green side with Marines and in various hospitals like Walter Reed.

So I started my medical career well before medical school. I started it in a laboratory. I started it, with them asking me to join them, doing bench work, doing finding out anatomy, finding out all the cool things about how the brain works. And I said, this is really cool, but is it what people need?

And I said to myself, I don't know if it's what people need. I won't know until I ask people. And the only way to ask people is to be with people. So I figured I would do medical school, I would do medicine. I would see 10,000, 15,000, 20,000 people and find out from them what they need so that I can actually figure out what to do in terms of research, in terms of thinking, in terms of getting them the tools that they need without assuming that a lab is the place to answer people's needs.

Lab work is great. But I really like the people. So I started and wanted to do that field work with people, going out into the field, talking to people, listening to people, and I did it the hard way by joining the military, which really sent me out into the field. Into the field in Iraq. Into the field on ships, all the places where you're the only person for 500 miles with medical experience, and you might be doing anything at any time that crucible, that testier is the best way to really learn what's going on and what people need and who people are.

From there, military, I took off my uniform and I went to the VA so I could continue to take care of my family. My vets just, I got to wear my own duds doing so. so I worked at the VA for about 10 years and then decided to take a step back and say, now I've got all this information, I've got this wealth of experience with people.

Let me take a step back and see. What have people been needing? Where have people been having pain points and difficulties that nobody really realizes until they've worked with them? And some of those things that I realized on stepping back was what led me to my current job at Remo.

[00:03:29] Mike Roth: And tell our listeners a little bit more about Remo. Many of them probably never heard of it.

[00:03:34] Daniel Lesley, MD: So Remo Health is a virtual dementia care company, and they do so. With a focus on dyads, that was the realization I came to, which is that the people who have a condition, whether it is Alzheimer's or dementia with Lewy body or anything else, are only one part of the equation.

The big part is their whole support structure, their family, their spouse, their children, their neighbors who take care of them, all of whom are going to be affected in one way or the other. What I like about Remo, the reason I joined Remo Health is because they have a focus on the dyad, the caregiver, and the person who's getting care.

They have an interdisciplinary support team, so it's not just come to the doctor's office, get a diagnosis. Get a drug, go home. But instead have the doctor come to you virtually because we bring our care into their homes, through telehealth. Have the doctor come to where you are, see what your house is like, see what you're like, where you're comfortable, not in our uncomfortable offices, and then listen to you there, and then take care of you there by having a whole team of care navigators.

Nurses, pharmacists, all the different people to support your caregiver, support the person with a problem, do so with the best medicine possible, and give you the feeling that you can actually be part of the team and learn everything that you need to and feel empowered to actually not just be somebody who gets told, take this, go home, but you're in your home.

We're with you there. Does that make sense?

[00:05:20] Mike Roth: Yeah, it does. You used an unusual word, dyad. can you explain that fully for our listeners?

[00:05:27] Daniel Lesley, MD: Yeah. so the dyad is a term I learned from Remo, but it's used by other people too. It's the idea that you don't take care of just a disease. You don't say, this is the Alzheimer person that's. Disrespectful. You take care of the person who happens to have Alzheimer's or frontotemporal dementia, and you take care of the person who takes care of them, because if they burn out, then that's a problem for the person who has the condition and a problem for the person who's trying to take care of them.

[00:05:58] Mike Roth: It's 

a big problem.

[00:05:59] Daniel Lesley, MD: Only way to. Yeah, it is. And so that's one of the insights that I had from my first job, which is that the caregiver burnout problem is a huge one because for a wide variety of reasons, the number of people who are aging is increasing. As the number of people who age increases, the number of people with dementia increases.

But that doesn't mean that the number of people taking care of them. Is increasing and the number of people and all the people taking care of them are under more and more stress due to the need for dual incomes due to family sizes getting smaller. So there are few people to take care of more parents.

All those different kinds of things lead to burnout and make it so important that we recognize that the dyad is who we have to care for, not just the one person who comes to us in our clinic. Does that help you understand where my perspective.

[00:06:53] Mike Roth: At Remo, it really doesn't matter where you are located 'cause you can work with anyone really in the world. 

[00:06:58] Daniel Lesley, MD: At the moment we're, we do not work only with veterans, we work with anybody. Veterans who have Medicare, can work with us. People who are suitable for the guide path can work with us and we can talk more about the guide path at some point if you want. 

And

at the moment we are.

[00:07:15] Mike Roth: Do you mean both traditional and advantage plans?

[00:07:18] Daniel Lesley, MD: At this time, we are not able to do advantage because that's a separate kind of system. It doesn't fit into the guide path. That is one of the ways that was set up specifically for people who are in these circumstances.

Okay.

but we do, we are not serving everywhere in the world. Unfortunately. We are not serving everywhere in the US as yet.

We are starting in certain places and then working our way out as quickly as possible so we can take care of as many people as possible. But we aren't everywhere yet. We are not yet in Florida, but we hope to expand there as soon as possible.

[00:07:54] Mike Roth: Yeah, Florida does certainly need you. So , what areas do you serve?

[00:07:58] Daniel Lesley, MD: Right now we are starting out in Ohio and we have laid the groundwork to spread to a lot of other states. Once those become feasible, which we expect to be very soon.

[00:08:09] Mike Roth: Yeah. I lived in Cincinnati for 25 years before I moved down here. What part of Ohio are you in?

[00:08:15] Daniel Lesley, MD: I'm not actually in Ohio. So one of the things is that we are widely distributed. I for instance, am in Massachusetts taking care of people in Ohio. We have team in. The west coast, we have teams in, we have team members who help us out from all over different places, but because this is a telehealth company, we don't have to be there in the state for our telehealth things, but we make absolutely sure that the key people of our team, which is not me, I'm a good part of the team.

I'm important, but the important part of our team are the care navigators who help people navigate this complicated medical system, this complicated insurance system. we, that they are local so that they know the people, they know the places they are there to be able to help out.

[00:09:02] Mike Roth: Okay, so you have local navigators. When, when you have a telehealth call with a, patient, how long is the average teleco telehealth call?

[00:09:13] Daniel Lesley, MD: So for an initial visit at this time, it may range from 30 minutes to 60 minutes and sometimes longer. We try to give things the time that it needs, not just the 15 minutes that you might get from some other providers who are squeezed by all of the, facets that make things more difficult. We wanna make sure we get it right.

 As a veteran yourself, maybe you can tell us why veterans, are more at risk for cognitive decline and dementia than the general population. So there's a wide variety of reasons, and some of them differ based on which cohort of veteran you're talking about. So there are veterans from Vietnam who were exposed to Agent Orange. There are veterans from the most recent war who probably deployed 2, 3, 5, 10 times. For some of my guys there are veterans from World War ii.

Older and may have seen certain things or been exposed to certain things that other veterans, so each cohort of veterans may have some differences, but there are some things that they're gonna share in common. They've been under a lot of stress. They've been often separated from their community, from their family, from the people who knew them.

They've been forced into situations that most people don't have to face. They've been forced to experience things, whether those are. Explosions or toxins or just ship life and dysregulated sleep or danger, all those different kinds of things are very obvious things that they experience that other people don't.

But there are other differences. So PTSD itself is something that a lot of veterans experience, TBIs, traumatic brain injuries are things that a lot of veterans experience. But so do many people. Many people experience TBIs, not just veterans, but veterans may be at risk of certain types that others aren't.

We know that even without those explosions, even without those toxins, even without those other questions, the fact of PTSD seems to lead people to more risk. And that's even if they led a perfectly healthy life in all ways that they could. But in addition to that, PTSD can be so overwhelming that there may have been other things that affected them.

Again, that lack of sleep, that is a factor. Often in PTSD, sometimes self-medicating because that's the only way to get through, can lead to additional problems. All those different things can lead to a higher risk of dementia.

[00:11:39] Mike Roth: Let's take a short break and listen to an Alzheimer's tip from, Dr. Craig Curtis.

 Dr. Curtis, what can someone do if they know that they have Alzheimer's that runs in their family? 

[00:11:49] Dr. Craig Curtis: So there's a lot that they can do. So published actually in the Journal of the American Medical Association. In February of 2024. This was a study done primarily at Rush University in Chicago.

Looking at those with. Brain amyloid. So those people that already have amyloid can a healthy lifestyle protect them from developing dementia? And the answer was yes, by following these five, five healthy habits that were tracked. And those were, they did not smoke, they did moderate exercise. For at least 150 minutes a week, they kept their alcohol consumption diets.

 And they used autopsies. They actually used approximately 530 autopsies to prove that those that followed those healthy lifestyle habits or had those healthy lifestyle habits. Actually had less amyloid. It correlated those had less amyloid in their brain. 

[00:12:44] Warren: With over 20 years of experience studying brain health, Dr. Curtis's goal is to educate the village's community on how to live a longer, healthier life. To learn more, visit his website, craig curtis md.com, or call 3 5 2 5 0 0 5 2 5 2 to attend a free seminar.

[00:13:05] Mike Roth: Thank you, Dr. Curtis. Daniel, what can people who have served in our armed services do to reduce their risks?

[00:13:13] Daniel Lesley, MD: There are a wide variety of ways of reducing a person's risk and reducing the level of disability a person is experiencing. When I think about risks and I think about problems that a person is experiencing, I think about the way that a person wants to go through their life. And get their things done.

But sometimes they encounter a wall, and that wall is hard to get over. And if you think of a wall as a single object, then it's really daunting to think of taking down that wall. If you think of the wall as maybe being a big rock on a hill with a bunch of bricks just stacked on top of it, then you say, Hey, there are some things I cannot change.

I cannot change the past. I cannot change my genetics. I cannot change what I've been through. But all the things that are stacked, and those are the hill and the rock that are fixed objects, but all the things that have been stacked on top of that, whether that is health or diet or sleep or community, all those things.

If there are problems can be unstacked off from that wall and unstacked off from the risks that you have so that you can actually progress along the road where you want. What that means is that recognizing the reversible issues, such as if you are low in B12, such as if you are not sleeping very well or have sleep apnea, if you reduce those issues, then you reduce your risk.

Does that help to answer your question about some of the things that people can do or do you want more specifics?

[00:14:51] Mike Roth: A little, get a little

[00:14:52] Daniel Lesley, MD: Okay.

[00:14:53] Mike Roth: . But why is it that sometimes people, as they get older, seem to get worse? If they had an earlier exposure, which caused the 

[00:15:01] Mike Roth AI4: P-T-S-D?

[00:15:03] Daniel Lesley, MD: It can be for a variety of different reasons. Sometimes the world around can change. So the world that they were comfortable in, the world that they knew. When it changes, it means that they have less solid footing, and that can unlock some of their anxiety, some of their feeling like they're in a fight or flight mode.

So the way that the world has been changing so rapidly can make those things worse as you grow older and the world changes around you. That's one aspect.

[00:15:34] Mike Roth: So a veteran whose wife, dies significantly before them is in that, world of new world of adjustment.

[00:15:41] Daniel Lesley, MD: It is even more significant than that when you have a spouse who dies because often you share brains. You offload something to your spouse, you say, I can't remember people very well. That's your job. It's in your brain. I just have to remember one thing, and that's who to ask, and that's you. I don't have to remember 50 things, which is all of our friends' names, their birthdays and those other things.

There may be also other tasks that you've divided between yourselves for efficiency. When those tasks go away and you now not only have to learn those new tasks, but have to add them to your own, that adds a level of stress to the grief that you're experiencing so that external brain in a partner can lead to the.

PTSD being unleashed because of grief. 'cause it reminds you of the other grief you've had in the past because of the fact that you are overwhelmed. You are no longer able to cope because the mechanisms you were using to cope are not there to support you anymore. You had a broken leg. You were doing okay because you had a crutch.

That crutch has been kicked out from under you and now you're trying to walk in that broken leg.

[00:16:51] Mike Roth: Yeah,

[00:16:52] Daniel Lesley, MD: Does that make sense?

[00:16:53] Mike Roth: that, that makes a lot of sense.

[00:16:54] Daniel Lesley, MD: So that's the specific instance of a spouse. The other thing is that as brains deal with PTSD, they have certain things that they're trying to keep under control. The way I think about it is like if you have a car that goes really fast sometimes because it's rolling down a hill or because it's just a very fast car, sometimes you have to tap the brakes.

If those breaks get stripped and you try and tap the brakes and you can't slow yourself down, you can be in a world of trouble, especially if there's other things going on like slippery surfaces. So overt, at first when you're in the peak of your health, those breaks are in pretty good shape. As you get older, sometimes those braces get sh get, stripped.

And in addition to that, as you get certain kinds of brain changes that may come with dementia, those breaks can get totally removed, which means that the PTSD that you are controlling by tapping the brakes is now uncontrolled and you're skidding more and more whenever you make a turn, whenever you're on wet surfaces.

And whenever you are in a situation where you're scared or angry or uncertain. Does that make sense to you?

[00:18:01] Mike Roth: That makes sense. It makes sense. 

[00:18:03] Daniel Lesley, MD: So some of what you're talking about is very common and illustrates some of what we just talked about. So those old hobbies that you're talking about, that's a way of controlling the world and bringing the world back that he's most comfortable with, so that he can be in a place that he knows, in a space where he's competent.

That helps brain thinking because it means he doesn't have to think about all those changes, all those external. Uncertainties not leaving the house may be another way because you cannot control the world. When you leave the house. You can control the world inside your house, and by controlling your world, you control yourself.

The other thing is that we are trained to, in the military about being wary of. The outside threats. You never know when you're going into a hostile circumstance or when you're in a friendly circumstance. So you sort of have to assume it's hostile outside unless you've got a really good, no reason to not believe that.

So when he is inside, he knows it's safe, it's his base. There's a whole element of PTSD, which is staying within the perimeter because you can control that perimeter. Not leaving the house in many ways, functions to help him and. In many ways causes problems in just the same way that alcohol or cigarettes does, because the thing that keeps brains in shape is community, just as strongly as the way that we keep bodies in shape is exercised.

If you keep yourself inside, your brain gets worse and worse because it doesn't have all 

that stimulation it needs.

[00:19:38] Mike Roth: Right.

[00:19:39] Daniel Lesley, MD: is good for them too, but community is really key and that's one of the things I love about The Villages that you have, which is that community where people can help keep each other healthy, cognitively and physically.

[00:19:51] Mike Roth: It's, it's a wonderful community with over 3000 clubs and maybe 4,000 clubs and activities as I'd like to say it. and there's always something to do. I am too busy. I, I joined 21 clubs the first year I was here, and I've managed to resign from all but eight of them. But, it keeps you very busy and exercise is something else that keeps, that, takes an hour, at least an hour a day outta your schedule. 

What 

[00:20:16] Mike Roth AI4: resources , are available to veterans and their families who have dementia?

[00:20:21] Daniel Lesley, MD: There are a wide variety of services, some of which are available through the va. I be aware, I work for the va, so I cannot comment too much because that is not something that I've been authorized to do. I have not cleared it through them, but I can certainly tell you that the VA has help in a lot of different ways, whether that is assistance with medication, sometimes with housing, with care and support, obviously with diagnosis, and sometimes just with connection in various ways.

There are also other, agencies outside the VA, like the VSOs,

 the Veteran Service Organization 

 Can provide a great deal of help to veterans, whether that is helping them to, organize their documents so that they can have them for their medical appointments and their other kinds of care, whether it's acting as a liaison, as an advocate, or sometimes just somebody to give you, awareness of what resources there are out there.

There are many other organizations, some of which are, available to all people with dementia, like the Alzheimer's, organization of America, some of which are veteran specific. But I can't obviously comment on which ones, are worth going to.

[00:21:32] Mike Roth: Okay. Are there any particular books that a family member of someone who has the metrics should be reading?

[00:21:37] Daniel Lesley, MD: There's. A number of them. There's actually one which is fascinating because it talks about not just the condition that a person has, but also the impact that it has on the dyads on the family members. The book is called Travelers to Unimaginable Lands. If I can. If I remember correctly, I would have to look that up and I will send you the link to it if I am incorrect about that.

but it is an amazing book. There are also various books that are explaining the different stages of different kinds of dementia because as one of your other guests, Susan Ryan, Sue Ryan pointed out perfectly. Dementia is not one thing. It's many different sorts of things, and

 there are many different books that continue .

About dementia that is Alzheimer's versus dementia. That is frontotemporal versus Lewy body. So really being aware that dementia is not one thing, but that there are books and supports for each individual dementia, which really deserve their own treatment. That's an important insight that I think it's worthwhile having people know.

[00:22:39] Mike Roth: Good. So if someone wants to contact Remo to find out if they're inside the service area or when this, or when you're coming to their particular physical location, how do they do that?

[00:22:51] Daniel Lesley, MD: So there are a number of different ways. So going to Remo.Health, can not only let them, connect with us, but can also help them access our series of educational materials, many of which are free, and give insight to all aspects of caregiving and dementia.

Thank you. I appreciate that.

[00:23:11] Mike Roth: Anything else you add. 

[00:23:13] Daniel Lesley, MD: Just wanted to add that I really appreciate your, podcasts. I saw the one by Sue Ryan, which was fantastic. She did an amazing job and the one by Dr. Curtis, who also did an amazing job in a completely different area, and I totally endorse basically everything that they said and am very grateful for them.

Good. Thanks for being with us today, Dr. Leslie.

Thank you so much for having me.

[00:23:36] Speaker 2: This is Mike Roth. Listeners, I'm thrilled to share with you this podcast, which is my passion project, to bring knowledge, inspiration, and things you need to know about The Villages and the people living here. Be sure to hit the follow button to get the newest episode each week, or you can hit the purple supporter box.

Even a small donation of three to $10 a month makes a big difference. You can cancel your subscription at any time. Your support means the world to us. Stay curious, stay inspired, and keep those headphones on.

[00:24:16] Rita: Remember, our next episode will be released next Friday at 9:00 AM Should you wanna become a major supporter of the show or have questions, please contact us at mike@rothvoice.com. This is a shout out for supporters, Tweet Coleman, Ed Williams, Duane Roemmich, and Dr. Craig Curtis at K 2 in The Villages. We will be hearing more from Dr. Curtis with short Alzheimer's tips each week. If you know someone who should be on the show, contact us at mike@rothvoice.com. The way our show grows is with your help. Text your friends about this show if you enjoyed listening or just tell your friends about the show. We thank everyone for listening.

The content of the show is copyrighted by Roth Voice 2025, all rights reserved. 

I.

Here are the books Dr. Lesley would like to recommend to caregivers of a person living with dementia:

• Travelers to Unimaginable Lands: Stories of Dementia, the Caregiver, and the Human Brain by Dasha Kiper
• The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer's Disease, Other Dementias, and Memory Loss by Peter V. Rabins and Nancy L. Mace
• A Caregiver's Guide to Alzheimer's Disease: 300 Tips for Making Lif