Peter J. Whitehouse and Daniel R. George, American Dementia: Brain Health in an Unhealthy Society

Dementia is a growing epidemic that affects individuals and families around the world.

Despite the billions of dollars funneled into biomedical research, we still don't have a cure for Alzheimer's. In fact, it's becoming increasingly clear that Alzheimer's is not one disease, but rather a syndrome caused by many different age-related processes.

We need to take action now if we want to protect our brains and prevent dementia from becoming an even bigger problem. This means making lifestyle changes like exercising more, eating better, and reducing stress. It also means supporting research that looks at the complex causes of dementia and finding new ways to treat it.
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Bio:

Peter J. Whitehouse
MD, Ph.D., is a professor of neurology at Case Western Reserve University and a professor of medicine at the University of Toronto. He is co-founder of Intergenerational Schools, a network of unique public, multi-age community schools in Cleveland, Ohio. LinkedIn: https://www.linkedin.com/in/peter-whitehouse-156b432/

Daniel R. George
Ph.D., M.Sc, is a medical anthropologist and an associate professor in the Department of Humanities and the Department of Public Health Sciences at Penn State College of Medicine. LinkedIn: https://www.linkedin.com/in/dgeorge2844/

You can find their book "American Dementia: Brain Health in an Unhealthy Society" on Amazon: https://www.amazon.com/American-Dementia-Health-Unhealthy-Society/dp/1421440474

Transcript

[0:01:25]
Hanh Brown: Hi, I'm Hanh Brown, the host of the 'Boomer Living' broadcast. On the show, industry leaders share information, inspiration, and advice for those who care for seniors. Our expert panel is discussing healthcare, dementia, caregiving, technology for seniors, affordable senior living, and options for financial security, all of which address the social determinants of health. And thank you so much for participating in today's conversation.

[0:01:53]
Hanh Brown: Check out CareString, our recently launched platform where we match seniors to caregivers and guide businesses and their employees through the caregiving journey. So, please check out CareString. Now, for those in the audience, we'd love to hear from you. We're all learning together as we navigate the latter part of life. So please comment or ask questions - we want to learn from your personal aging journey. And thank you so much for tuning in. 

[0:02:13]
Hanh Brown: So, today's topic is 'American Dementia: Brain Health in an Unhealthy Society.' Dementia is a growing epidemic that affects individuals and families around the world. 

[0:02:28]
Hanh Brown: Despite the billions of dollars funnelled into biomedical research, we still don't have a cure for Alzheimer's. In fact, it's becoming increasingly clear that Alzheimer's is not one disease, but rather a syndrome caused by many different age-related processes. We need to take action now. 

[0:02:56]
Hanh Brown: If we want to protect our brains and prevent dementia from becoming an even bigger problem, this means making lifestyle changes like exercising, eating better, reducing stress. It also means supporting research that looks at complex causes of dementia and finding new ways to treat it. So today, my guests are Dr. Peter J. and Dr. Daniel R.

[0:03:16]
Hanh Brown: Dr. Peter J. is a professor of neurology at Case Western Reserve University and a professor of medicine at the University of Toronto. He is also the co-founder of the Intergenerational Schools, a network of unique public community schools in Cleveland, Ohio.

[0:03:36]
Hanh Brown: Dr. Daniel R. is a medical anthropologist and an associate professor in the Department of Humanities and Department of Public Health Sciences at Pennsylvania State College of Medicine.

[0:03:50]
Hanh Brown: So, Dr. Peter J. and Dr. Daniel R., welcome to the show. 

Peter J: "Thanks for having us, Hanh."

Daniel R: "Yes, thank you very much for the invitation."

[0:04:08]
Hanh Brown: Thank you so much. So, aside from your professional life, please share with us something personal about yourself. Go ahead, Dr. Peter.

[0:04:08]
Peter J: Oh, I'm a grandfather of four which ties into my work on intergenerational schools and learning. I'm also a photographer, a nature lover, and a camper. How about you, Dr. Daniel?

[0:04:21]
Daniel R: Yes, and I appreciate the invite. One fun fact about me: I'm in a Beatles cover band in Hershey, Pennsylvania, so I'm a big fan of the Beatles and a big fan of music, both personally and in dementia care, which I think we'll maybe circle back to at some point. But I'm a medical anthropologist by training, and I've been a caregiver in my family for a great aunt who had dementia. So I really appreciate your interest in your personal experiences and those shared by people

 in your audience and your listenership. I'm looking forward to talking today about this very complex issue that you've already outlined. 

[0:05:11]
Hanh Brown: Thank you, thank you so much. Well, dementia is a debilitating disease that robs people of their memories and impairs their ability to think and reason. So, let's talk about the 'American Dementia: Brain Health in an Unhealthy Society.' So back to Peter, how would you define Alzheimer's disease and how does it relate to dementia?

[0:05:24]
Peter J: First, I really appreciate the adoption of this guide. You captured the fact that it's complex. It's not the story we hear in the mainstream media from groups like the Alzheimer's Association. It's not something that's going to be tackled with a single, or even a cocktail of drugs. So that's what it's not. So, dementia is the more general term and Alzheimer's is a label we give. It's an unfortunate label that has a negative connotation for anybody at any age who has challenges with thinking. It can be memory or it can be attention, it can be language. And that can be caused by a number of different things, all the way from brain infections to strokes to aging itself, to a degree. To say there are age-related changes which, when they get exaggerated, these are pathological features that we see.


[0:06:18]
Peter J: Under the microscope, the so-called "seed hallmarks" and neurofibrillary tangles, we then think they play a role in affecting cognition. Alzheimer's used to be considered a single disease, which Dr. Alzheimer, who it's named for, characterized by looking at the microscope and seeing these plaques and tangles. We now know it's a change.

[0:06:38]
Peter J: We moved all under that one category of dementia, but now we know Alzheimer's is heterogeneous, it has lots of different things, it's better considered a syndrome, a set of conditions rather than a single disease.

[0:06:52]
Hanh Brown: Yeah, so do you have any thoughts on that, Dr. Daniel?

[0:06:56]
Daniel R: Yes, I think the least common form of Alzheimer's disease is just plaques and tangles, right. As Peter said, you so often see mixed dementias with Alzheimer's present. To elaborate on Peter's point, what that means is that you see features of vascular disease, small strokes in the brain that often co-occur with plaques and tangles. There are other abnormal proteins, TDP-43, Lewy Body Disease and other things that frequently co-occur with the plaques and tangles.

[0:07:16]
Daniel R: Yes, we're dealing with something that's plural, not a singular disease, even though that's the way we often talk about Alzheimer's. One of the big things that Peter and I are going to push today and in our book is just trying to be honest and tell the truth about the nature of the challenge that we're facing.

[0:07:36]
Daniel R: The proposition of curing a plural syndrome is much different than curing a singular disease. As Peter has already juxtaposed, you won't hear that from the pharmaceutical industry, you won't hear that from the Alzheimer's Association. But I think we really need to be truthful about the nature of this challenge.

[0:08:06]
Hanh Brown: Thank you, thank you for your insights. So, what can we do as a society to create a more supportive environment for those with dementia?

[0:08:24]
Peter J: That is exactly the right question. We can do things for ourselves, but the most important question is, what can we do as a society? This topic has huge ramifications for society in many other ways. What I mean by that is, if we had a society that supported public health, education, clean water and clean air, and got toxins like lead out of our water supply, it's going to be good for our individual health and for our collective health. 

[0:09:13]
Peter J: In a world facing the climate crisis and social injustice, dementia can be a lever for thinking differently that will make changes to society at large.

[0:09:26]
Hanh Brown: What's your take, Daniel?

[0:09:28]
Daniel R: Think about how different that is from the normal story we hear about Alzheimer's disease, which is that if we just unleash markets and fund research, there will be a cure produced over time or preventive measures, like brain fitness games and supplements. But what we're really trying to anchor in the book is a message that active investments we made in the mid-twentieth century have been effective for many people over time. 

[0:10:21]
Daniel R: Public health and public policy moves to get lead out of gasoline, to get healthcare to more people, to lower smoking rates, these are the things that we know affect brain

 health over decades for many, many millions of people.

[0:10:38]
Hanh Brown: That is a loaded question, with some absolute answers you can provide. So, what can we do as a society to ensure that everyone has access to brain-healthy foods and exercises?

[0:10:54]
Peter J: The unit to focus on mostly is the community. We know that your health, and your brain health, is determined by your zip code. You may live in a neighborhood that is a so-called food desert, you can't get healthy foods. You may live in a place where you'd like to go outside and walk, but it's dangerous because the community is not safe.

[0:11:33]
Peter J: Modern human beings somehow think we're above nature, but the climate crisis and other things are telling us no, we've got to learn to live with nature. I think being out in nature is fundamentally very healthy for human beings and communities. There's an age-friendly community movement going on. I say we're all at risk for dementia, we're all aging, so let's focus on making friendlier, brain-healthier communities.

[0:12:12]
Daniel R: We tend in this culture to responsibilize individuals for their own brain health, it's your job to prevent dementia and to keep your brain healthy. But in our book, we have a chapter, for instance, on the "Fight for Fifteen," which is a movement to get a living wage for people in the fast-food industry. 

[0:12:31]
Daniel R: The sad truth is that if you are working poor in this country, or even middle class, it's very hard to live a life that's healthy and good for your brain. People just don't have time, people are stressed out. It's hard to eat a healthy diet like the Mediterranean and low sodium diets which are beneficial for the brain but are very expensive and time-consuming if you don't have a whole lot of money or time.

[0:12:57]
Daniel R: People with working class jobs tend to have more physical hazards in their jobs, more risk of head injuries, and exposures to chemicals and pesticides. So, when we talk about brain health, it has to be at the level of public health, we can't just leave it to the individual.

[0:13:18]
Hanh Brown: We need to make better decisions for ourselves, even though the dominant story that we're told isn't always accurate.

[0:13:23]
Hanh Brown: So true. The causes of Alzheimer's are still not fully understood.

[0:13:29]
Hanh Brown: It can be a combination of genetics and lifestyle factors. Let's talk about the scientific problems with our understanding of Alzheimer's disease.

[0:13:38]
Hanh Brown: So, Dr. Peter, what are the biggest challenges in understanding and treating Alzheimer's? If I put on my medical hat for a moment and focus on that side?

[0:13:52]
Peter J: The biggest challenge, I think, is, as you mentioned, genes and environment. But doctors are so focused on genetics, and there are clues from the genetics about Alzheimer's disease. We can talk about those more if you want. On the other hand, that focus on genes, which then produce proteins, gives opportunities to develop drugs or leads us into this pathway of thinking. We call it reductionism.

[0:14:25]
Peter J: We reduce things to small pathways and therefore small molecules. People will make a profit from this. Doctors, for example, talk about personalized medicine, as if somehow it's your genes that determine your whole health and we just have to understand your genetic map in order to make therapies for you. We believe that personalized medicine comes from understanding who you are as a person, which is your narrative, and the community you live in.

[0:14:58]
Peter J: The problem in medicine, in general, is we have separated medical schools, and for that matter, nursing schools and social work schools, all of whom are important in the care we receive from public health. Doctors have to realize that it's not just about them and their patient in their practice, but it's about you, your community, and your public health responsibilities.

[0:15:26]
Hanh Brown: Very true. I think we all tend to stay within our department or silo, but in a case like this, it's a whole-body issue. It's about the individual, society, and policymakers. It's a huge paradigm shift and I appreciate your work and this conversation that we're having to explain that drive. 

[0:15:47]
Hanh Brown: And it's my desire to bring awareness to this very complex disease. So, thank you.

[0:15:56]
Hanh Brown: Yeah, now, I know we talked about this, but why do we still know so little about Alzheimer's? I know there's a lot of progress, but there's a long way to go. Can you explain that?

[0:16:12]
Daniel R: Yes, it's a paradox. The more we know about Alzheimer's, the less we know. As we've already talked about a bit, what emerges from studying this condition is that it's heterogeneous, it's multifactorial. There's no simple story about what Alzheimer's disease is. It can't be reduced, as Peter said, to one simple mechanism or disease. That really complicates the proposition of developing a single molecule or vaccine or drug therapy to intercede in one pathway.

[0:16:52]
Daniel R: We have a 100% failure rate on our anti-amyloid drugs, for instance, or just anti-Alzheimer's drugs in general. This model that we've set up with markets and pharmaceutical companies attacking one target has only interceded in one pathway of a diffuse syndrome. So, it's unsurprising that these drugs, including the most recent controversial

 drug, have failed. The brain is mysterious. We don't exactly know how the brain functions, how it works, so trying to study dysfunction is complicated.

[0:17:45]
Hanh Brown: Very true, very true. I want to take a moment to thank Pan for joining and providing your thoughts and questions. Now, Dr. Peter and Dr. Daniel, is it possible that our current understanding of Alzheimer's is wrong?

[0:18:05]
Peter J: I think it depends on who you ask. We don't have all the answers, and as Daniel said, life is a mystery. Part of our hubris, the prideful nature of medicine, is that we can fix anything. You just have to give us enough money. That's a large problem of our understanding. The idea that markets will solve everything, you just have to throw enough money at it, and we will be able to do anything in the world. We're learning the limitations of that.

[0:18:42]
Peter J: I wouldn't want what we're saying to sound nihilistic because the irony of this is yes, it's more complicated than the Alzheimer's Association or Us Against Alzheimer's try to claim. But the answers are actually quite simple in the sense that we're talking about creating healthier communities, we're talking about listening to your grandmother, you know, everything in moderation. We're talking about...

[0:19:10]
Peter J: Health, healthy eating, and thinking about this, if we were to empower a society where we allowed that to be available to more people, more equitably, and we didn't have a bunch of billionaires ruining the planet, then launching themselves in rockets to get off the planet because they've screwed things up, that might be a step forward.

[0:19:30]
Peter J: The language we use to discuss these issues is important.

[0:19:31]
Peter J: If we didn't have to think about equity and we had these opportunities, we would be happier. COVID is telling us what we value in life, it shouldn't be consumerism, it's all about family and community. That's why we keep saying the stakes for this are high and complicated.

[0:19:51]
Peter J: But in some sense, the answers are not only simple, but the answers to a lot of things like health rely on a healthier society.

[0:19:58]
Hanh Brown: Yeah, I hear you. I think often we might say genetics, something that we may not have as many choices for. I personally don't know what others might say, but we do have the power to take ownership of our future.

[0:20:18]
Hanh Brown: Now, sure like you said, "Inequities, your zip code, where you live and so forth, I get that, but even with that, we still have choices every day, and those choices will determine the quality of life where you are and where you are heading to so".

[0:20:34]
Hanh Brown: COVID has been a great revealer of everything that we already know, but it's exponentially uncovered and I hope, that it will also uncover that you are empowered to be more proactive about your health and that your health is not confined within the room of your doctor's office or a hospital. Your health is based on everyday choices that you make.

[0:21:02]
Peter J: Yeah, you know, I think, though, I was just on a meeting of the international group called "Re-imagining Dementia" let me just put a plug-in for empowerment, as you said, but empowerment based on using the human imagination, perhaps our biggest attribute as a species, to see where we want to go. If we can see it in our minds and feel it in our hearts then we can go there and that's what we need to do.

[0:21:28]
Daniel R: If I can add to that, you brought up COVID, Hanh, which I think is a great parallel with Alzheimer's because it held a mirror up to the structural problems in our society. 

[0:21:46]
Daniel R: All of these public health cuts that have been made over decades as we moved towards a more privatized model of healthcare. We've tended to cut our public health infrastructure and programming, and the consequences of those cuts were made clear during the COVID pandemic.

[0:22:06]
Daniel R: Also, if you look at nursing homes, we haven't talked much about the care side yet, but nursing homes were decimated in the United States. Over a third of the deaths from COVID have been in nursing homes and that's because in large part we warehouse our elders in these institutions, which is a relatively new phenomenon.

[0:22:28]
Daniel R: But we also have widespread private ownership of a lot of these nursing homes and there's minimal pay for workers there, and there was minimal PPE, protective gear, at the onset of the pandemic, so a lot of the structural problems haven

't been resolved but they allowed COVID to spread rapidly through nursing homes.

[0:22:48]
Daniel R: Our society at large was hit hard and of course I'll mention in closing, the people who were most affected by COVID, it was essential workers, people on the front lines who have to work for a wage and we just didn't have the capacity to support those people or even offer healthcare to everybody, or get testing and resources to those who needed it.

[0:23:09]
Daniel R: Again, COVID is a mirror that highlights the reality of our structural problems and the social determinants of health that are present in both Alzheimer's and COVID cases.

[0:23:21]
Hanh Brown: I echo that. Thank you so much, Danny.

[0:23:24]
Hanh Brown: I want to acknowledge Carpenter Singh.

[0:23:27]
Peter J: Yeah, so Carpenter Singh is making a very good point here about an unhealthy society and what defines an unhealthy society. 

[0:23:43]
Peter J: On a positive note, the Lancet Commission came out with a report a year ago on dementia prevention, intervention, and care, and they found in their analysis of all the data that about forty percent of dementia risk is modifiable.

[0:24:00]
Peter J: If we minimize diabetes, lower head injuries, reduce smoking rates and air pollution, help people maintain a healthy level of exercise, avoid excessive alcohol, treat things like hearing impairment, maintain frequent social contact, and encourage lifelong education, both formal and informal, all of these inputs will positively affect our brain health. 

[0:24:40]
Peter J: But again, how do we structure a healthier society that maximizes or optimizes these outcomes for the most amount of people?

[0:25:00]
Peter J: People often say, "We need to support democracy". Let's introduce into this equation the fact that we need a vibrant democracy and we need to resist the idea that money has bought politics. I'd love to conduct a study that demonstrates people who are active and engaged in local, state, and national politics tend to have better brain health because it's about a sense of purpose.

[0:25:40]
Peter J: It's about a sense of belonging, which is a very important but intangible and hard-to-measure concept. It's those things that I think are ultimately what brain health is all about. The idea that you are engaged, arguably with other people, in the democratic process is, in my opinion, the ultimate brain health intervention. The more we do that, the more we learn and engage, and that's why we started these intergenerational schools.

[0:26:13]
Peter J: Our mission statement is lifelong learning but also spirited citizenship. That's the idea behind how we change society and make it healthier.

[0:26:21]
Hanh Brown: I love it. Now, let's delve into a common question. Do you think we'll ever find a cure for Alzheimer's? What do you think, Peter?

[0:26:33]
Peter J: This question seems loaded because it's about hope. Are we supposed to say no? But fundamentally, we are saying no, and we need to look for hope in other places.

[0:26:47]
Peter J: Change the question: instead of a single cure, let's talk about multiple solutions. People who advocate for Alzheimer's treatments think they hold the answer, but then we have these drugs, infusions, pills, potential brain transplants, electrodes in the brain.

[0:27:28]
Peter J: It's too complicated, the brain is too complicated, aging is too complicated, our individual stories are too complicated for one magic solution. No, we're not going to find a cure for a single Alzheimer's disease. We're going to find a way to improve brain health by changing our society. That's going to be a whole lot more exciting.

[0:27:48]
Daniel R: I think the hope message around a cure is a very effective fundraising strategy, and it's helpful psychologically for people to think there could be a treatment for dementia that reversed the condition. 

[0:28:36]
Daniel R: But that's in the realm of science fiction right now, not a scientific reality. What is a reality are the things that we're talking about: how we collectively engineer healthier societies that encourage prevention from womb to tomb. 

[0:28:50]
Daniel R: In Japan, for instance, they have universal insurance for long-term care. People are guaranteed as a right of citizenship to have it. We could fix our own system, we could bring arts into nursing homes, and skilled care units, fund artists to do those things that we know are beneficial to quality of life, and good for brain health for people who are institutionalized. 

[0:29:32]
Daniel R: So, Peter and I would rather frame our story of hope around different solutions, different ways of problem-solving around a very complex issue that we're all dealing with.

[0:29:54]
Hanh Brown: I want to acknowledge your points and echo that I agree. Thank you. 

[0:30:00]
Hanh Brown: Let's talk about the decline of dementia rates. Do you have any theories as to why dementia rates appear to be declining in the United States and other western countries? Who wants to go first?

[0:30:15]
Daniel R: I hope for us this is the hopeful part of our story.

[0:30:19]
Daniel R: The downward trend in dementia rates that you're referring to has been observed since the nineteen eighties not just in the United States, but in Canada and four Western European countries. And we've seen a thirteen percent reduction in dementia, remember that's the umbrella category that Peter mentioned before, but a sixteen percent reduction in Alzheimer's disease risk.

[0:30:39]
Daniel R: Specifically, when researchers have pooled the data from these countries two really important patterns emerge: one, we've done a better job of treating vascular health and vascular disease in those countries and two, we've increased four more years of education for people who have aged.

[0:30:59]
Daniel R: In those countries over the last fifty or so years now, those things don't exist in a vacuum, right, we have to look at what changes were engineered in the mid twentieth century after the Great Depression and after the world wars and those traumas. We really had a reengineering of society around what people might call social duty.

[0:31:19]
Daniel R: Marking a shift towards Keynesian capitalism, a more managerial style of capitalism that redistributed funds within the culture.

[0:31:26]
Daniel R: To fund social safety nets that created welfare states.

[0:31:33]
Daniel R: That put limits on capital flows between countries, and with that led to, when we think about those two patterns I mentioned earlier, vascular disease and better education, the countries put infrastructure in place.

[0:31:49]
Daniel R: That improved those areas, for instance, national healthcare systems cropped up in the countries that are seeing reductions in dementia rates. In the United States, we have Medicare and Medicaid. What's good for the heart is good for the head, as people say, vascular health improved in these countries and that appears to have benefited brain health.

[0:32:09]
Daniel R: In the United States alone, we've seen a reduction from forty-four percent of the country that smoked in the nineteen sixties to today, about fourteen percent of the country that smokes, and those patterns are observed in other countries too. Again, better vascular health, better brain health. And then I'll just mention two last things. We had the G.I. bill.

[0:32:29]
Daniel R: Right after World War Two, which gave access to higher education to tens of millions more Americans. Through cognitive reserve, this somewhat mysterious process, we know that if you get more formal education, it has a buffering effect on age-related pathologies. So the more people that get more education in these countries.

[0:32:49]
Daniel R: Seem to be protected from dementia to a greater extent. And the last thing I'll mention is on the de-leading of gasoline, which happened in the nineteen Seventies under the Clean Air Act by the EPA, and that reduced blood lead levels in the United States by eighty percent from the nineteen Seventies to the nineteen nineties.

[0:33:09]
Daniel R: Again, lead is a neurotoxin, it also increases risk for heart disease. So, when we start to bundle these public health and public policy interventions together, it's clear that they've had an effect in improving vascular health for people who are now in their golden years and in building cognitive reserve through education. So that's probably why we're seeing those somewhat anomalous reductions.

[0:33:36]
Hanh Brown: What do you think, Dr. Peter?

[0:33:40]
Peter J: I think this is a most articulate young man.

[0:33:44]
Peter J: And really, as that all was said, I was trying to figure out what I can add to it.

[0:33:50]
Peter J: I'm going to do it in a strange way. I'm gonna say, "Look, what's happened in the time that we have abandoned some of these efforts is the climate crisis and why I keep bringing that up is because it actually is the greatest threat to the quality of life of people with dementia. It's the greatest threat to the quality of life of all of us, but if we don't attend to".

[0:34:12]
Peter J: To our community and our world's attitudes towards floods and preventing things that don't kill people, people with dementia as well as children will come back to that intergenerational theme, as you said, are very vulnerable to heat waves, droughts, and floods.

[0:34:33]
Peter J: We have lost something and we know we've lost something which is why there are so many people who are stressed and feeling adrift in the world, alienated.

[0:34:43]
Peter J: Again, if we address this issue of dementia, don't compartmentalize. This is the dementia problem over here and this is the Alzheimer's, Parkinson's, this is the main crisis. We love to put things into categories and then try to solve the problem.

[0:35:04]
Peter J: It's not the way we're going to solve the problems by far.

[0:35:08]
Peter J: I echo that. Okay, so here's another loaded one, do you think the dementia rate will continue to decline in the future?

[0:35:18]
Daniel R: Well, there are some discouraging trends, unfortunately. I talked a few moments ago about the changes that were made in the mid-twentieth century as a response to the traumas of that period.

[0:35:37]
Daniel R: But we also had similar changes happen in the nineteen seventies in response to the crisis of that era, which was stagflation and the oil shocks. The solution was to liberate markets, right, it's often called neoliberalism or hyper capitalism or market fundamentalism, unleashing markets to try to solve problems and stimulate the economy, which led to the reverse of what happened earlier in the twentieth century.

[0:35:58]
Daniel R: Unleashing capital mobility, cutting regulation in the industry.

[0:36:06]
Daniel R: The decreased taxation of the wealthy has badly impacted the funding of the social safety nets that we had in the United States, which other countries still have. These changes have manifested in really troubling ways and I'll just speak to a few of them. One, we've had a resurgence in vascular disease. The improvements that we've seen over the twentieth century are now being reversed. According to the CDC, six in ten Americans live with at least one chronic disease affecting vascular health. This is going to undoubtedly affect brain health for the country.

[0:36:41]
Daniel R: We're dealing with another lead crisis, this time it's not from gasoline like it was in the seventies, it's in our water. Failure to modernize our water mains and making decisions in places like Flint, for the sake of cutting taxes and saving money, has led to lead being in the water in almost every major city in this country. In Cleveland, where I'm from and where Peter lives, the lead levels are actually higher than in Flint.

[0:37:17]
Daniel R: Lead is a neurotoxin, as I mentioned. This is a catastrophe for brain health. Also, while the G.I. Bill, Pell grants, and the expansion of state universities in the twentieth century increased access to formal education for many people and helped build that cognitive reserve, we're now seeing a reduction in higher education enrollment largely because people are getting priced out of it.

[0:37:57]
Daniel R: As part of the seventies, we bundled up people's debt and Wall Street underwrote all of it, and now it costs upwards of fifty thousand dollars or more per year to go to college. We're seeing men not enrolling in colleges anymore, which is troubling. So the people that are studying these trends are now looking at some of these other patterns more recently and saying where that is really troubling for where we're going with brain health in future decades.

[0:38:22]
Hanh Brown: I appreciate what you're saying, but I'm not very excited about it.

[0:38:28]
Peter J: It's such a downer. Why is anyone at risk of dementia likely to go down in any group? How about these people that have these mansions in Miami?

[0:38:41]
Peter J: The wealthy mansions in Miami are about to be flooded. They can catch infections just like the rest of us do. The point is what can we do together and when will the wealthy wake up to the fact that they are not happy and they are not going to be able to stay healthy? So I think the answer to your loaded question is, unless we make a change, dementia rates are not going to keep going down.

[0:39:21]
Hanh Brown: I'm good at asking loaded questions for our first conversation.

[0:39:26]
Peter J: We appreciate it.

[0:39:27]
Daniel R: Having loaded answers is just as true.

[0:39:32]
Hanh Brown: What hope does intergenerational schooling provide for loved ones with dementia?

[0:40:29]
Peter J: I believe we've emphasized that education and learning is an important part of brain health. It's not narrow-focused video games or brain fitness, but social engagement in ways that imply a commitment to helping everybody in the community learn.

[0:40:54]
Peter J: As we were talking about a minute ago, we tend to compartmentalize things. We bring elders on a regular basis into a relationship with elementary school kids in Cleveland, where the Intergenerational School

 was founded in 2000 by my wife and me. The relationship is the key: it's not that the seniors sit in little chairs and learn their alphabet all over again, it's that the kids go to the long-term care facilities for conversation, for relationship, for storytelling.

[0:41:57]
Peter J: People with dementia who participate in these programs have some of my patients because even if you can't remember what you had for breakfast, you can still tell the kids about the role you played in World War II or what role you played politically in saving the Nature Center that our children go to at school from a corrupt politician. This idea of spirited citizenship, of passing activism across the generations, is what it's all about. 

[0:42:52]
Peter J: We can reinvent forms of learning that take us out of the boxes and the classrooms in the way we have been thinking about education in our society today.

Corrected Transcript:

[0:43:06]
Hanh Brown: Daniel and Peter, I am enamored with the book "American Dementia: Brain Health in an Unhealthy Society". I really appreciated the discussion around intergenerational relationships, which I've experienced myself. I live in Shaker, and my daughters went to the same high school, so we have had an intergenerational relationship which we like to think has kept us both going longer.

[0:43:25]
Hanh Brown: It has kept us both going longer, recently.

[0:43:29]
Daniel R: It's also about spreading the message that intergenerational learning is really important. Anyone who had the good fortune of having grandparents in their lives knows how valuable these relationships across generations are. From a personal level, there is nothing more beautiful than grandparents seeing the world through the eyes of a toddler or a five or ten-year-old. There's something very innocent, pure, and hopeful about that.

[0:44:05]
Daniel R: On a personal level, as my mom's ability to speak and think has significantly declined, there are only one or two things that she keeps coming back to in her memory. One of them is sitting around at the dinner table, eating together, with all of her twenty-eight grandchildren.

[0:44:32]
Daniel R: My mom has ten kids and we have ten kids, so she has twenty-eight grandchildren. Her memory is mostly gone, but there are a few things that keep coming back, like us all coming together to sit down and eat, to put a meal together.

[0:44:46]
Daniel R: She always says, "Okay, let's do this again." Her mind keeps coming back and replaying that memory. But there are many people missing from that dinner table she talks about. 

[0:44:54]
Daniel R: The intergenerational memory of your kids and grandkids coming together, the relationships, the conversations, the food... you're not going to find AI or machine learning to replace all that, much less find a cure for dementia. So, I echo it.

[0:45:17]
Peter J: Right, and that meal that you're describing is so much more effective than any drug you could think of. 

[0:45:37]
Peter J: You often see that interventions or activities that stimulate people's senses like eating, like music, like the arts, like intergenerational relationships, like gardening, exposure to nature... those things connect to something quintessentially human. When we take the time to be in the moment with people who may have cognitive challenges, we're meeting them on a very human level and validating something critically important to what it means to be a human being in this world.

[0:46:14]
Peter J: Alongside the concept of pharmaceuticals, I'd like to promote a somewhat tongue-in-cheek concept, but it gets at this idea of getting back to something very profound and foundational about what it means to be human and giving that to people.

[0:46:38]
Peter J: I just had a medical student who published a paper where he developed personalized playlists for nursing home residents based on their music preferences from their youth. He brought their family caregivers to listen to that music with them. People come to life with music; they dance, they move... music is often a deeper language for us. When you see a real metamorphosis, even if it doesn't last beyond the activity itself, it's often far more powerful than anything in the drug pipeline.

[0:47:14]
Hanh Brown: Thank you so much. Okay, I want to move to the intersection of

 climate change and population aging. What are your thoughts on this, and do you think population aging is exacerbating this problem?

[0:47:30]
Peter J: Sure, when I was born in 1949, there were about three billion people on the planet. Now, there are almost eight billion people, and there are a lot more older people like myself. This is due to the successes of public health that have allowed us to live longer.

[0:47:56]
Peter J: By just the numbers, yes, we have a problem with the carrying capacity of the planet. This is often called the "great acceleration", because with that population growth, we've seen more carbon dioxide emissions and rising temperatures.

[0:48:17]
Peter J: We have to recognize that we, the baby boomers, are part of the generation that has contributed to this. The question is, do we return to the roots of the Sixties when we were fighting the Vietnam war and concerned about the environment, or do we pass on our legacy to the next generation?

[0:48:50]
Peter J: Right now, I think it's time for our generation to become more activist. I urge everyone to look at "The Third Act", Bill McKibben's new organization for adults over the age of sixty. We're working on disinvestment in fossil fuels. This is a time in my life for our generation to work together with movements like the Sunrise Movement and Extinction Rebellion, the younger groups.

Corrected Transcript:

[0:49:11]
Peter J: To make a change in the world. The other thing I said before is so important as it's in our own self-interest. Quite frankly, as we age, we're going to be the people that are vulnerable to the changes we're going to see. We need to move away as quickly as we can to handle ourselves.

[0:49:29]
Peter J: When there's a climate change or weather crises, I think it's an issue of solidarity between the elders and the youngsters. We are at phases of our life when we're more dependent on other people for various reasons.

[0:49:47]
Peter J: So, we need this declaration of interdependence across the generations and not keep focusing on what Americans focus too much on individual rights, individual autonomy, and independence. We've never been independent in the sense that I'm using it here. We need to recognize and celebrate our interdependence.

[0:50:11]
Peter J: Across the ages, I think that is really a key part of it.

[0:50:17]
Hanh Brown: What's your take on this, Daniel?

[0:50:20]
Daniel R: Yeah, I think to go back to COVID-19 for a second, I think the hope at the outset of COVID-19 was that crises are often the great drivers of change. We hoped that this crisis would inspire some fundamental changes to the way things are structured.

[0:50:41]
Daniel R: Sadly, that hasn't happened. I think that the system that we're in is very resistant to change. As long as the money is flowing for people, the system isn't going to change. Climate change presents another potential crisis that we could leverage into changes if we can think collectively again and think about collective goals that we want to pursue.

[0:51:06]
Daniel R: Pertaining to brain health, I just want to take a moment to think about what that could look like if we did act collectively again as we did in the mid-twentieth century. We've talked for decades about universal healthcare. When you think about vascular health and the fact that we have eighty million under-insured people in this country right now, those are folks who aren't getting care for diabetes, high cholesterol, hypertension—all the things that are going to affect brain health.

[0:51:26]
Daniel R: If we could find a way to extend healthcare to more and more people, that would be very beneficial to brain health. I think we've talked in recent years about universal higher education—offering free tuition to go to universities like we do in many European countries and like we did in this country in the mid-twentieth century.

[0:51:46]
Daniel R: Offering free vocational training to adults or adult learning opportunities—if we could collectively invest in those sorts of things, now you're talking about scaling brain health and cognitive reserve at a level that would really make a difference.

[0:52:15]
Daniel R: I already mentioned the lead crisis. If we could find a way to invest in overhauling that infrastructure, that would produce manifold benefits for brain health. And the last bit I'll talk about: with the New Deal, they funded artists to build murals and beautiful Art Deco buildings. You could imagine a scenario where in a time of crisis, we could fund artists, music therapists, gardeners to go into nursing homes to provide that frontline social care that we're talking about.

[0:52:58]
Daniel R: We could make investments like Japan did in providing universal long-term care insurance for everybody. There are things that we could do if the

 crisis level reaches a peak, which I think it's inevitably headed towards.

[0:53:09]
Peter J: I'd like to add something to that. Looking backwards, I think we're beginning to realize that some of the indigenous people in the world have healthier attitudes towards nature than we do. There's this often-used expression of thinking about making a decision with seven generations in mind. Actually, I sometimes say it's now we have to think about seventy generations in line because we don't just have to think about our grandkids but also their grandchildren.

[0:53:57]
Peter J: We have to rethink intergenerational relationships and how we think about basic concepts like time. We have a responsibility not only for ourselves but for our parents, grandparents, and many generations to come.

[0:54:21]
Hanh Brown: Thank you, Peter. Daniel, where can our audience find your book?

[0:54:40]
Daniel R: I believe it is on Amazon and we also have a website that people can go to: AmericanDementia.com. We have a Facebook group that has been active since our first book, "The Myth of Alzheimer's". So, people can just search Facebook for "The Myth of Alzheimer's", join our group, and engage in a conversation about these issues.

[0:55:19]
Hanh Brown: I also want to acknowledge our listeners and thank you for joining and adding so much to this conversation. We're all learning about dementia and sharing our knowledge, but without you and your journey with your loved ones, this wouldn't be possible.

[0:56:19]
Hanh Brown: In the coming weeks, we'll be exploring a range of topics relating to aging and retirement. First, we'll take a look at the unique challenges facing baby boomers as they enter their later years. We'll also discuss the role of multigenerational wealth in retirement planning and how real estate investing can be used to secure a comfortable retirement.

[0:56:39]
Hanh Brown: And finally, we'll talk about the importance of finding purpose in the later years and how to advocate for your health and wellness as you age. So, whether you're approaching retirement age yourself or caring for an aging loved one, these topics will provide valuable insight into the aging process.

[0:57:10]
Hanh Brown: Thank you so much for joining today's conversation and have a great day. Thank you, Peter and Daniel.

[0:57:34]
Hanh Brown: Thank you for listening to another episode of "The Boomer Living" broadcast. I know you have a lot of options when it comes to podcasts and I'm grateful that you've chosen this one. Please share this podcast with your friends and family, write a review on iTunes, Spotify, and Google Play. It helps others discover the show.

[0:57:55]
Hanh Brown: We want to help seniors have a great experience as they age. Thanks for tuning in until next time.