A Fresh Perspective on Dementia Prevention with Neuropsychologist Dr. Mitch Clionsky
Sep 18, 2023
Marcy Backhus
Have you ever wondered how you can actively prevent dementia? Today, we're taking a deep dive into this topic with our esteemed guest, Dr. Mitch Clionsky, a board-certified Neuropsychologist and author of Dementia Prevention Using your Head to Save Your Brain. Join us as we explore the complex world of cognitive health, where we unravel the differences between Alzheimer's and Dementia, the concept of mild cognitive impairment, and why understanding our cognitive strengths and weaknesses is crucial for prevention.
The conversation continues by illuminating the unseen threads that connect sleep, oxygen, and dementia prevention. Sleep apnea, often overlooked, carries significant risks for our brain health and energy levels. Dr. Klianski sheds light on the fascinating world of telomeres and sleep apnea's role in their shortening over time. The importance of oxygen for preserving your brain health is elucidated, offering a fresh perspective on the science behind dementia prevention.
Finally, we broach the often-avoided topic of change – especially as we age. Dr. Clionsky emphasizes the significance of learning new things and being open to change. We dive into the importance of early detection and intervention in dementia and Alzheimer's prevention, discuss cognitive tests that help measure cognition, and underscore the benefits of regularly assessing physical and cognitive attributes. Get ready for a riveting discussion on the dynamics of cognitive health in aging adults, and join us on this enriching journey.
Have you ever wondered how you can actively prevent dementia? Today, we're taking a deep dive into this topic with our esteemed guest, Dr. Mitch Clionsky, a board-certified Neuropsychologist and author of Dementia Prevention Using your Head to Save Your Brain. Join us as we explore the complex world of cognitive health, where we unravel the differences between Alzheimer's and Dementia, the concept of mild cognitive impairment, and why understanding our cognitive strengths and weaknesses is crucial for prevention.
The conversation continues by illuminating the unseen threads that connect sleep, oxygen, and dementia prevention. Sleep apnea, often overlooked, carries significant risks for our brain health and energy levels. Dr. Klianski sheds light on the fascinating world of telomeres and sleep apnea's role in their shortening over time. The importance of oxygen for preserving your brain health is elucidated, offering a fresh perspective on the science behind dementia prevention.
Finally, we broach the often-avoided topic of change – especially as we age. Dr. Clionsky emphasizes the significance of learning new things and being open to change. We dive into the importance of early detection and intervention in dementia and Alzheimer's prevention, discuss cognitive tests that help measure cognition, and underscore the benefits of regularly assessing physical and cognitive attributes. Get ready for a riveting discussion on the dynamics of cognitive health in aging adults, and join us on this enriching journey.
Speaker 1:
Hello and welcome to the AJ and A Prasissi podcast. My name is Marcy Backes and I am your host. On today's episode we have a great interview with Dr Mitch Klianski. He and his wife, emily, have written a book Dementia Prevention Using your Head to Save your Brain. This has been published by John Hopsk.
Speaker 1:
I can't say that, john Hopsk, I can't do it. Okay, everybody, I'm going to try again. John Hopkins Press and in order to be published by them, it has to have scientific backing. So listen to this great interview. Make sure you get the book. Head to my website, wwwagingafrasissi'spodcastcom. Under the resources page you will have information that links you right to Dr Klianski's website, which is braindoccom, and I will also have a link to the book. On Amazon you can get Audible or the actual book to read. So I'll leave that up to you.
Speaker 1:
I'm not going to tell you anything about what's going on with my life, because right now I am on a cruise heading to Alaska. So enjoy this interview and I will personally be back with you next week. Thanks, everyone. Remember what I always say AG and A for Sissies. All right, everybody, I'm really excited to introduce to you Dr Mitch Klianski. He is a board certified neuropsychologist who has treated more than 20,000 patients with cognitive problems. He and his physician, wife Dr Emily, have written a book Dementia Prevention Using your Head to Save your Brain and I'm very happy to have you here. I know my audience is excited. This is something that we really haven't talked about and it's something that I think everybody I'm 62. I think anybody once they hit 50, honestly starts thinking about this, unless they've had a parent or someone in their life that has had it, and my first. I have a question and if it's too long of an answer, you can shorten it as best you can for us laypeople but is there a difference between Alzheimer and Dementia?
Speaker 2:
So that, first of all, happy to be here, marcy, pleasure to meet you, and yeah, that is. You know, when we go out and do talks in the community, that's almost always the first question if we haven't already addressed it as part of the talk. So, and the issue you talked about in terms of you know, as you started getting into your 50s and 60s, you become more concerned about this. They did a study, research, interview kind of thing a few years ago and they discovered that 80% of people out there, at almost any age, have some concern that they're going to become demented as they get older, that they're going to lose mental abilities, they're going to make it difficult for them to function, take care of themselves and basically to live a full life. So this is a very important topic. It's one that starts when we start to hear people talk about it in their 20s because they're caring for a grandparent.
Speaker 2:
Exactly 40s, because they now have children and they wonder, okay, what's going to go on when I get older? And if they've had a parent or have known someone closely who's had, this comes even more personal Right. Doing this for many years, when my mother developed dementia, back when I was younger than you, back in my early 50s, it brought a whole different level of understanding to this, because now I was seeing what it was like from the caregiver's perspective as well as from the doctor sitting across the table. But getting back to your question, because I wonder to think about Alzheimer's like you might think about Ford or Chevy. Okay, ford and Chevy are brands of automobile. There's also Chrysler, there's also Toyota. So Alzheimer's is a form of dementia. Just the same way, there's Lewy body dementia, there's front of temporal dementia, there's vascular dementia, there's Emily is estimated there may be 400 known causes Wow, many of which are rather unusual and esoteric.
Speaker 1:
So we don't see a lot of those.
Speaker 2:
But just as much as we see people with Alzheimer's disease, we see people who have vascular problems, circulation problems. They're not getting enough blood and oxygen to their brain and therefore they're thinking as deteriorated.
Speaker 1:
Oh, interesting Okay.
Speaker 2:
So there's all kinds of different ways that this could happen. There's certainly normal aging where we consider that you lose a half a step as you get older. You don't quite remember as well in your 80s as you did in your, quite as quickly as you used to. Some things require more work, but by and large you're still really functional, okay. So if you look at dementia as the end point of a declining process, we start with the fact that everybody, as they get older and they're thinking that are normal for age but basically not as good as they used to be when they were younger.
Speaker 2:
Right, we deal with these, we call them senior moments, we adjust to them, we laugh about them sometimes. We in some cases develop workarounds. Well, if that becomes worse in terms of being greater than what is quote normal and it begins to interfere with our functioning, then we have something called mild cognitive impairment. Now MCI for short is before you become so bad that somebody with MCI develops dementia over the following three years. So it really is a wake up call. We try to catch people far before that when they're just worried or thinking about what do I do now that I'm in my 30s, 40s, 50s, et cetera, to plan for not getting demented. I'm older. I say plan for it because I consider this to be an active intervention, not just a matter of hoping and praying and wishing, but rather understanding what your strengths and weaknesses are and then doing things to accentuate your strengths and try to avoid or eliminate your weaknesses.
Speaker 1:
Okay, All right. Well, in this book that you've written, dementia prevention using your head to save your brain how do we do that?
Speaker 2:
Oh, you want the 32nd version.
Speaker 1:
Yeah, the 32nd, what is it? What are a few steps that just listening to this and it's scary just to listen to because you feel like you have zero control You've watched other people go through it who seem like they have zero control and just slide, I think. What can we do?
Speaker 2:
Okay, well, that's a great question. And you don't, notices of dementia can be prevented. Okay, so one out of every two people didn't have to get dementia. And the trick is trying to be the one rather than the two in the one out of two people trying to figure out what to put yourself to stack the odds, stack the deck in your favor. So in our book we present, this is all research based. By the way, it's published by Johns Hopkins Press. So in order to be published by their very research oriented, scientific kind of group, we had to go through a variety of committees where experts in the field would vet the research and vet the writing to see if it was in fact consistent with science. So that was several steps. That don't happen if someone just wants to write their own book published on Amazon, for example. So we've started by spending years really collecting research from a whole variety of different disciplines, because it turns out there isn't one discipline that specializes in dementia.
Speaker 2:
You have neurology, certainly you also psychiatry, and people in neurology do things other than dementia. They do seizure disorders, they do Parkinson's, they do much of things In psychiatry. Dementia is part of what they do, but it's not the majority. They're focused mostly on depression, anxiety. You think that You've got people like me who are neuropsychologists. Our job is to test people's memory and their thinking abilities using objective tests. So we're sort of like the Anthrum Scale for dementia. You step on, you see how much you weigh. Well, we tell you how you do on these various tests that you can give us information. As it turns out, elements of cardiology and how your heart is functioning become very important. Elements of pulmonology, breathing, as well as sleep medicine are really critical. You've got the endocrinologists who deal with diabetes, which is a cause for dementia. You get into the substance abuse issues, because alcohol, alcoholism, particularly over long periods of time, causes increased risk of dementia. We think that perhaps even marijuana could be implicated if it's used long enough, intensely enough.
Speaker 2:
Okay, there's a whole variety of different medical fields, so you have to really look far and wide to pull in all this data. So, fortunately, my partner, my wife, is a very skilled clinician, very skilled physician. She first was an internal medicine doctor and then, when her hips gave out, she couldn't run around after patients in various rooms. She got a second residency in psychiatry up at Dartmouth-Hitchcock and then decided that what she wanted to do as a psychiatrist was to treat people with brain-related problems, so that's what she does now. She's more of a neurologist in many ways, so we share this passion for brain-related conditions. Consequently, she and I are able to look at this whole wide range of medical problems and to pull the literature, the research, together.
Speaker 2:
That's not enough, because if all we did was to say this study says this, so that study says that you would have a very good book for help with people fall asleep Right, yes, they could just read it at a time and they'd be out like a light. So we have to translate it, not dumb it down, but translated into like what our patients tell us, the kind of experiences that bring this to life. Because our goal in someone reading or listening to the book is that they will not only learn, but they're going to also be entertained in the process. So we build a model in this book and while I tell people that dementia prevention is a thing, it is clearly not one thing. Okay, the biggest research study that was done on this identified 12 different things that were all important that could reduce your risk of dementia by at least 40% Another study that we had.
Speaker 2:
A couple of things here. We can make it 60% Amazing, so one out of two. We actually add several to that, one of those being the whole area of sleep disorder, breathing, otherwise known as sleep apnea. So if you or anybody you know sleep apnea, you know that this is caused by not breathing enough times while you're asleep. I'm married. You're stopping breathing, okay. Well, I have sleep apnea, as does Emily. It turns out that 50% of people over age 58 have sleep apnea.
Speaker 1:
Interesting.
Speaker 2:
When you get into your 70s that ratio goes up to about 70%. It is, in fact, in many ways the secret sauce of preserving your brain, because if you stop breathing multiple times while you're sleeping, not enough oxygen can then get out of the air attached to the red blood cells and get up to your brain. So you're a species you don't remember well, you don't have good energy, you oftentimes are up in depressed in very many ways. So treating the sleep apnea hopefully your husband does that is really, really important in preserving your brain as well as many other functions. So people can't see you shook your head.
Speaker 2:
I'll tell you why you know, it's interesting because he says you know the machine and refuse it. Okay, well, you're gonna here's, you're gonna sit down and make a listen to this podcast, because I'm gonna tell you why this is important. And I understand completely, because he's a guy, which means, according to him, he's perfect, correct?
Speaker 2:
He doesn't need anything else, why would I? I've met too many of them, used to be one. Why would I want to sleep with this mask over my face, attached to a hose, to a machine that puts air under pressure and keeps my airway open? I will feel old, I'll feel sick and I won't feel sexy, right? So first rule is you don't use the seat back during sex.
Speaker 1:
Well, yeah, there you go, Unless you're not afterwards, unless you're a little bit kinky.
Speaker 2:
Yeah, you do it afterwards, so you're not going to lose your sex skill. In fact, your wife who's now not listened to you, struggled to breathe and snore may actually stay in the same bed with you and you're going to have more opportunities. So that's number one. Okay, number two here's how I got myself. This was 20 years, 17 years ago, when I started doing this. I started using the seat back. At that time the movie Top Gun came out and I was thinking about Tom Cruise. So he gets into his jet, puts on his helmet right, straps on his oxygen mask and takes off, because he knows he doesn't have his oxygen on. It's going to get up to 30,000 feet, fall asleep, go crashing to earth. So I thought, okay, let me just, silly as this is, pretend to be Tom Cruise. Right, I'll take off at my plane. And suddenly it became okay. And to this day I have been proselytizing, because 50% of the men who end up going for those little blue pills to help them in the bedroom of sleep apnea.
Speaker 2:
Sleep apnea is a leading cause of strokes and heart attacks. Sleep apnea actually is a leading cause of gout, of all things Interesting. And if you treat this problem, you will probably extend your life. There's the very most recent research. I'm talking, august 23.
Speaker 2:
Found that people with sleep apnea have a shortening of the chromosomes in the nucleus, the DNA of their cells. So in all of our cells there are DNA strands made up of chromosomes. At the very end of these are little tiny cats Think about the caps on your shoelace that keep your shoelace from unwrapping. These are called telomeres. As we get older and the cells repeatedly divide over time as we age to create new cells, these chromosomes strands get shorter and shorter and shorter until they can't reproduce and at that point, eventually you die. Well, turns out that if you got sleep apnea and you treat it, your telomeres don't get shorter. If you don't treat it, they get shorter. They just discovered this using blood tests on these very specific groups of people. And they did. They tested them for about a month on sleep apnea and a month off sleep apnea Wow, and they grew blood tests. They drew blood tests so they could pair them. So I really believe that one of the secrets to longevity, as well as good brain health, is oxygen. Who would have thought that?
Speaker 1:
That's what I think.
Speaker 2:
It's important to breathe, yeah, and it's at the basis for diabetes, blood pressure, energy levels, the things that make you want to get out and walk and exercise, the things that make you feel good about yourself and other people. So we're selling oxygen this week. That's our sales pitch.
Speaker 1:
Well, yeah, and I've had a woman, sylvia Adler, on here talking to us about breathing and going along the same lines of how important oxygen is. And then here we find out it's important to so many things, and dementia is one of them.
Speaker 2:
Another one and when you're asleep, you don't know it. That's the sad thing. So many people I see say, oh, I don't think I have this. I said, well, what do you mean? Well, I thought aware of it. I said, well, you're sleeping Right. Well, I guess you're right. I said that's why these days, you can get a one night home sleep test. If you bought this retail, which it can cost about 250 bucks, it'll tell you how many times you experience this and what the treatment might be.
Speaker 1:
Well, I think yeah, because I guess, if they're not sleeping with someone who doesn't hear you gasping for air and sitting up in the middle of the night. You wouldn't know, and it's an important thing to know. So I suggest that highly, people.
Speaker 2:
One of the ways they were able to persuade people to use the CPAP was to have their partner video them while they're sleeping, because when they got to see themselves gasping and struggling and writhing around, it's a pretty demonstrable kind of message that says, wow, I'm doing that, I don't want to do that.
Speaker 1:
No, absolutely. I think that that's a definite good way to do it. Maybe that's what I need to do get the video camera out. Well, it's extremely interesting. I think that everyone should read this book Dementia Prevention Using your Head to Save your Brain. We all need to save our brain. We're living longer, right, and so our risk of dementia increases.
Speaker 2:
That's right.
Speaker 1:
Right and I've always thought to myself I think everybody does If I'm going to live long, I want to live my best life. I don't want to be just hanging on by a string and all of those things, and I think researchers like you are finding out way more things to help us.
Speaker 2:
Because it's becoming a clinician to persuade the people we see. The real impetus for writing the book is. I can only see maybe 800 to 1,000 patients a year.
Speaker 1:
Right.
Speaker 2:
And I don't have that many cycles. I'm not going to be practicing. I'm 72. I'm not practicing for the next 30 years. The question is how to reach more people, because this is a major problem for our society and we need to do something. We have the tools to do something. We can't be praying for a cure because the likelihood is it will not happen. Right Right Prevention can start happening today for everybody.
Speaker 1:
A question just went right through my head. It's going to come back, I know it. Okay, so we've got the book. If somebody is out there and they're concerned about themselves or their thought processes or their feeling, I mean, we all know that there are certain things that we start forgetting. Obviously, you don't have to start forgetting when you're old, as you challenge yourself. There's things I know that can help that. Who is the first stop for somebody who feels like they may have the beginnings of some sort of dementia?
Speaker 2:
Ideally it's your primary care physician. Okay, I say ideally because part of the dilemma we have is that primary care physicians, as much as they care, don't have as much time as they need in seeing somebody. They're limited or they've limited themselves, based on insurance and demands for how long they're going to see you. So you have like 15 minutes and you better not have more than two problems. Also, they don't necessarily have good tools for doing an assessment. They have their own biases. So if you have a doctor who's your age or older, they may do the complaints that you have. Ideally, what they should do is they should give you a brief test in the office and unless you do really really well on that, they should probably be sending you off to see somebody like me, a neuropsychologist who can spend three hours testing you and getting a really good idea of what your strengths and weaknesses are. And, as you'll see in the book, there are a variety of background blood tests that should be looked at. You should do your own self-assessment. In the book we have self-evaluation on the prevention checklist, but you don't have to get the book to get the checklist. You can go to our website, rain doccom. You can download it, to fill it out for yourself, and that'll show you what the ideal levels are and you can find out where your levels are Ideally.
Speaker 2:
We would like you to read or listen to the book, because it then is going to tell you what to do with that knowledge and how to make changes, because one of the hardest things for all of us to do is to change. Somewhere in adulthood, the impetus to change suddenly leaves most of us. Now we're growing up, we're changing all the time, we're taking on new things, we're going to school, we're learning in jobs, we're developing all kinds of new skills and somewhere along the line we decide okay, done. I'm fully baked here. But, as you know, as we get older, there are even greater challenges that we have to adapt to, and usually we don't have any training in these areas and we have to keep curious and open mind.
Speaker 2:
So I tell people about the whole process of worrying about dementia. As we say in the book, do not be a dementia worrier Right, become a prevention worrier. Do something, figure out your risk and then make changes. And we'll show you how. There's three chapters in the book devoted to making change, why it's so difficult and how to break it down to the steps you can take, because I don't want to just have people worried. I want them to do something different.
Speaker 1:
Right, find the change. You know, the one thing that I do think about my audience is it is excuse, older, obviously because of the topic, but if they've already found podcasts, I find that there's hope for you out there, because if you're doing podcasts, that's something that wasn't available, you know, even 10, well, 10 years ago, yeah, but not so much, and so I think that that's a great thing and it shows that you have that ability to make changes and to continue. I'm an odd duck. I love change, is always love change. The more the change, the better for me. But I understand that most people aren't like that. But if you don't change and if you don't learn and if we don't continue to grow, then we get stagnant at any point in our life, and when we're getting older, I think our biggest changes are ahead of us. You kind of touched on that a little bit. I think the bigger things are coming down the pike, and it may be. It may be something is losing your own child, or there's things that you're not expecting. We think things are going to go a certain way and that's not necessarily how they're going to go.
Speaker 1:
I, the thought that had gone through my head is my husband and I both had our physicals this week. I'm 62. He's 67. And he came home from his this morning and he goes did they give you a cognitive test? And I said no. I said they probably gave it to you because you're on socials, on I'm medic excuse me, medicare, and that's part of what they have to do for that. And so he was going through it.
Speaker 1:
I go and you know, and he's kind of poo pooing it and I said you know, craig, you shouldn't, because what if you didn't know where to put the clock, hands on the clock, or what if you didn't?
Speaker 1:
What if one of those things you went? Whoa, I don't know that, all of a sudden I said these are really important tests and they didn't use to do them. And I said I'm glad to hear that the doctor is doing them and making people aware of these things. And little did I know it was going to come into play today within our conversation that, yeah, you were talking about you starting with your, your primary care physician and here are primary care. She's a young gal was doing that and it made me happy because I thought what if I all of a sudden she asked me to draw a circle and put this time on them and put the numbers on the clock and the time, and I couldn't do it. That's not something you do every day, it's not something that you think about, but now, all of a sudden, you're being asked to do it and you can't.
Speaker 2:
That. That's the kind of measure and, when you think about it, we should have been doing it all along. I'm glad that your doctor is doing this, because it would be akin to going in. And the doctor said to you so how's your blood pressure? And you say what do you mean? Don't you want to put a sphignum amometer on my arm Right? You want to put it on your chest and test it? Or how's your weight? Well, I don't know why don't you just step on the scales and get weighed Right? And you still may argue oh, I'm not, I usually got my shoes off. Let me take all my clothes off here, right, and my ring, and my ring Exactly. But we're measuring those things. We should be measuring cognition.
Speaker 1:
Well, and when you think about pediatricians with babies, they measure everything, everything is measured every time they go in and I agree, I think as we get older, those things can, things could should continue to be measured at with such vigorousness as we did when children were babies and they were going up. And as we're going down, they should keep an eye on us as well. I agree, and I'm excited for your book. I'm sorry, go ahead.
Speaker 2:
Thank you. Let's go say there's so much you can do when you catch it early as opposed to catching it late, and the options are so much greater when we get to see the scales tilting in the wrong direction, because we can, in many cases, do some of those things. What should that mean?
Speaker 1:
Well, I agree and I'm excited to get through your book. I'm definitely going to listen to it. I love to listen to books, I like when I'm in the car and I can listen. I I will have this on my website, everybody. I will also have the website brain doccom so you can link to it from my website, and Dr Cleansky has been great in answering some of our beginning questions here on dementia and Alzheimer's and some of the things we have to not look forward to, and hopefully with his help in this great book we can stave some things off, and I appreciate your time today. Thank you so much.
Speaker 2:
It's been my pleasure and have a good back anytime. I'd love to talk more about this.