Parenting UP! Caregiving adventures with comedian J Smiles

You Can Prevent Dementia? A Conversation with Dr. Mitch

• J Smiles • Season 4 • Episode 18

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Ever wondered how a professional caregiver navigates all of the emotional and psychological strains while maintaining a balance? Join me as I connect with Dr. Mitch, an esteemed neuropsychologist and fellow caregiver. In this episode, we shed light on the critical role of neuropsychologists in diagnosing and treating brain disorders. We also delve into the emotional roller-coaster of caring for a loved one with Alzheimer's, and how humor and community support can become lifelines.

Dr. Mitch opens up about his dual journey as a neuropsychologist and a son watching his mother grapple with dementia, offering an insider's perspective on the distinctions between clinical psychology and neuropsychology. We discuss the ironies and challenges he faced in his professional and personal life, while highlighting insights from his illuminating book, "Dementia Prevention: Using Your Head to Save Your Brain". This discussion aims to demystify the topic of dementia, providing practical strategies for prevention and a fresh outlook on cognitive health.

Our conversation takes a deeper dive into the signs of dementia and the complexities of normal aging. For those passionate about brain health, this episode offers a blend of heartfelt stories, professional advice, and a touch of humor to help navigate the challenging landscape of aging and dementia. Tune in to discover how small, consistent changes can make a big difference in maintaining cognitive health and preventing dementia.

#CaregivingJourney
#Neuropsychology
#DementiaAwareness
#AlzheimersCare
#BrainHealth
#CaregiverSupport
#ClinicalPsychology
#HumorInCaregiving
#EndAlz
#PreventDementia

"Alzheimer's is heavy but we ain't gotta be!"
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Speaker 1:

First time I went to a psychologist it was because I couldn't get out of the bed. In law school I literally did not care about bathing or eating or paying my bills, answering the phone, taking out the trash. My maternal grandmother was deceased and I didn't understand why the world was still turning, why the television was still going on with programming while the mail was still being delivered. And I didn't care, because the biggest thing to me was OMG, other people that I love can and will die, so what is the point in continuing? I wasn't suicidal, but I also had zero desire of making further connections with life form. Yep, it was that deep. And I was an adult. I wasn't eight or 12. I had two degrees, I'd worked in corporate America, lived in three other nations on two continents and I was in law school and all the way falling apart. It's my first time working with a psychologist. My first time working with a neuropsychologist was when my mother was standing in the kitchen making a sandwich and urine was running down her leg and she didn't know it. She kept making the sandwich, did not know that there was pee puddling in her sneaker. What the hell? That's when I found out that neuropsychologists are the ones who really figure out what in the world is going on with the brain and can tell other doctors hey, go in this direction. They are the doctors that tell the surgeons and the neurologists which direction to investigate if a person's brain isn't working well. How cool is that? I mean, it's cool to know about it. You just don't want to need one of them. Yeah, think about if you're the expert where that has been your life's work and then, 15 and 20 years into being that expert, you're the expert where knowing how people's brain work is what you do and people are coming to you from all over the country. And then it's your mom, but she won't listen Because to her you're just that five-year-old little boy playing with trucks. Yeah, come on. Come on, come on in and listen and watch. Listen on Apple and watch on YouTube. Come on, patreon, let's do it. Woo Woo.

Speaker 1:

Parenting up Caregiving Adventures with Comedienne Day Smiles is the intense journey of unexpectedly being fully responsible for my mama. For over a decade, I've been chipping away at the unknown, advocating for her and pushing Alzheimer's awareness on anyone and anything with a heartbeat. Spoiler alert. I started comedy because this shit is so heavy, so be ready for the jokes Caregiver newbies, ogs and village members just willing to prop up a caregiver. You are in the right place. Hi, this is Zeddy. I hope you enjoy my daughter's podcast. Is that okay? You can prevent dementia. A conversation with Dr Mitch.

Speaker 1:

This episode's supporter shout out is Chloe's Glammy from Instagramout. Is Chloe's Glammy from Instagram. Hey, chloe's Glammy. And I quote I love Zeddy like. I know her Exclamation point. That warms my heart.

Speaker 1:

I lost my mom, had to move back to Georgia in the home I meant to gift to her. I started watching you with Zetty in the midst of my grief. You brought me unexplainable joy the smiley face emoji and the praying hands emoji ty meaning thank you. And also little known fact is growing up betty's closest, closest, closest friends called her ty for theelma Yvette. So that is super extra wide. You were selected Chloe's Glammy as today's supporter shout-out yes, absolutely, and everyone else remember give a review on Apple Podcasts podcast. Youtube comment if you want. Ig comment if you want, and you too can be today's supporter. Shout out one of them days. You know what I mean. Our parenting up community is growing so fast I can't put out an episode as fast as we're growing. So text PODCAST to 404-737-1449 for updates, exclusives and suggestions on topics. While you're at it, share an episode with a caregiver you love. Review on Apple Podcasts and follow us on social media. Subscribe to our YouTube page.

Speaker 2:

It really helps parenting of family.

Speaker 1:

Listen, I know you probably like, yeah, yeah, yeah, jay, here you go again saying that you went and found somebody special. Well, it's true, Okay, that's why I don't give you a podcast every single day, cause it takes my team time to find special people. And we did it yet again. This time this is a guest who actually is a specialist in figuring out whose brain might not be working that well, and he's a caregiver. Yep, yep, go ahead and be excited. I'm going to call him Dr Mitch. I don't know what he's going to make the rest of y'all call him, but welcome, dr Mitch. How you doing, jay? I'm happy to be here. I'm doing great. It's so good to see you. Thank you, thank you so much. So your fancy schooling, as my grandfather would have said, is in neuropsychology. You have a PhD in that, correct?

Speaker 2:

PhD in clinical psychology and then advanced training in neuropsychology. So it's a little different twist on it, because in clinical psychology we mostly deal with emotions and thoughts, basically how a lot of people get along with each other. So when I was just doing a lot of clinical psychology, I'd go to parties and I'd tell them I'm a clinical psychologist and I get two reactions Either they'd want to tell me all their problems or they'd run for the hills because they were sure I was reading their mind. So then I started doing a lot more work with how people thought, how they paid attention, how they remembered, how they were able to solve problems, which is how the brain works. It's called clinical neuropsychology. So then when I go to parties they'd say what do you do? I'd say I'm a neuropsychologist. They'd look at me and say, hmm, and that was fine. So it's a lot better being a neuropsychologist for at least that reason, if nothing else.

Speaker 1:

Yeah, at parties.

Speaker 2:

People say, huh, that sounds really important. It's a whole lot more fun doing what I do because it gives me the chance to really understand how people's brains work.

Speaker 1:

I tell you what I know people like you help save my mom's life. Now, for better or for worse, that was fun. I hate that I needed a person like you, but it's fun that she's still alive. I'll tell you that, Dr Mitch. I'll tell you that. So you wrote a book and what I think is cool about the book okay, dementia prevention that sounds pretty standard and classic, but what I love is your tagline using your head to save your brain.

Speaker 1:

Now we're going to get deeper into it later on in our conversation, Letting us know kind of what's going to be in here, Like if you do your homework and you think smart, you might be able to prevent some of this stuff, which is that this is just a nice idea to even think we might have some control, because right now, most people going around in the world believe that dementia and Alzheimer's is just a big old boogie monster and we can't do anything about it. So just the tagline saying, hey, use your head, save your brain. I'm like you know what, Sign me up for this book, because the fact that I might have a freaking chance in the world to do something is exciting. What I want to talk about before we even get into that, because we are a community of family caregivers is who were your caregiver for, or who have you cared for, and what was their ailment?

Speaker 2:

So the irony is that the ailment was dementia and the person who came down with it was my mom, when she began to show signs of confusion and forgetfulness, and there were significant changes in her behavior that were entirely unlike the woman who raised me and my brother along with my dad, but she was.

Speaker 2:

You know, moms do most of the heavy lifting in raising children in my experience, and there was a very important relationship that both of us had with my mom. And so here I was in midlife dealing with all these other people who were having problems with their thinking, testing them, advising them and their families, talking about how we could help them. And here my own mother came down with this, and so I spent my 50th birthday in a basically a psychiatric unit where my mom had been taken because she had lost really all touch with reality at that moment and thought that there were people in the trees, thought that somebody was going to come up and whisk her off and become her 12th husband Now her only husband, my dad had died about six years before that, so there's no way in the world this could possibly have been her 12th husband, but that was what was going on in her brain at that time.

Speaker 1:

Hold on, Doc. You're saying your 50th birthday.

Speaker 2:

Yep time.

Speaker 1:

Hold on, doc. You're saying your 50th birthday, yep, now wait. Okay. So you know I'm a comedian and we're having people around here pissed off because during COVID they didn't get a chance to go have a seafood dinner on their 50th birthday and they just had to stay home and maybe order hamburgers from Uber Eats or something. But here you are experiencing your 50th birthday with your mom in a psych ward or some mental health facility and you don't even know what in the world is happening. At that point you didn't know what it was. Huh, I did.

Speaker 2:

I did. You know, as with most people, you at first attribute the changes that are sort of episodic they happen and they go back to normal as being due to stress, and in fact they usually start under stress. So you see people who are perfectly okay, it seems, in the routine environment, but things change. They go on vacation, they can't figure things out as well, or there's a big change due to health and they don't adapt.

Speaker 2:

One of the real unveiling circumstances for many of the people I see is the death of a spouse. Because even if they were the one who was the caregiver for that spouse, having to care for that spouse gave them the structure, gave them the routine that oftentimes allowed them to keep it together. So when their spouse dies, everyone says, well, he or she's different than they were, but you know they're grieving and so oftentimes I see people for the first time about six months after widowhood and at that point people are saying you know, this isn't the way it should be. She hasn't or he hasn't bounced back to normal. And that's where we see that that's been holding them together in the past.

Speaker 1:

So you knew your mom, you knew it was a form of dementia and not some other type of psychosis or something.

Speaker 2:

Very much so, yeah, and it was pretty clear to me. I could not convince her, however, to get the kind of help that I thought she needed at that point. Now, the saying is that a prophet there's no prophet in his own land that you have to be from some distant place and help, you know, preferentially, carry a briefcase with you in order to be viewed as an expert. So parents, my family, I have to remind them. I say you know, people actually pay me to come and get my advice. Why aren't you taking it for free? But they don't, because I was the kid that they remember for being five Right. So my mom wasn't about to listen to that, she just poo-pooed it. It wasn't until things really went off the rails that we realized we needed to do something quickly in order to make, to keep her safe and to provide her with the care that she needed her safe and to provide her with the care that she needed.

Speaker 1:

What do you what prior to her having to be admitted? What did you see that let you know? Hey, this looks like dementia or Alzheimer's or anything that lets you know. This is not a normal gradual aging process. Mom needs significant help.

Speaker 2:

She used to be very organized and be able to manage bunches of things at once, and now she couldn't do that anymore. I remember one Thanksgiving dinner where we were all set to sit down and she said well, I think it's time to start the turkey. We said, you know, I hadn't smelled it. I thought the other smells maybe were covering it. But we haven't started the turkey. Well, no, no, it won't take long. We said mom, you've made turkey, you know, hundreds of times because we had it several times a year.

Speaker 2:

She always knew how to time those kinds of things and to organize them. She once came up to visit me from Pennsylvania. I live in Massachusetts and I had taken the entire day off of work. I was set to meet her at this particular place for breakfast and she never showed up and I tried to get a hold of her. This was before the days of cell phones, so getting a hold of her was a bit more of a problem. I think we may have had flip phones back then, but all I can tell you is she ended up deciding, on the way up from Pennsylvania, to stop at Mohegan Sun and spend the day playing slots. It just didn't connect with her that I'd gone to this extent to be with her that day and she thought nothing about it. It wasn't like it was malevolent, it was that it just didn't connect.

Speaker 1:

Okay, the turkey would have sent chills up my spine. That takes the longest. That takes the longest to cook of the whole thing and the basic. First of all, no one in my family has ever let me be in charge of the whole thing and the base thing, okay. So, first of all, no one in my family has ever let me be in charge of the turkey. I am the turkey. They're like Jay, you are the turkey, you just come in and you laugh and create the jokes. They let me put ice in the cups. That's about all I get to do, but that had to be startling. And then, yeah, the Mohegan Sun.

Speaker 1:

I've lived in Massachusetts before and you have to decide to get off at that exit because it's pretty windy. And then you know you got to park and you got to make it. This. It is a concerted effort to stay in there too. You know it's it's not easy to get up in that place. So you're right. Were there other family members who believed you too? Or did everybody think that you were a little bit, a little dramatic?

Speaker 2:

No, my brother understood One of the best things, and I hope for your caregivers in your audience that they and their siblings, if they're in that position, see things eye to eye, because it's really so much easier when you both agree, or the five of you agree, and you recognize what the problem is. I've seen so many families where that's not the case, and usually the people who are farthest away have the least appreciation for what's going on. They're also oftentimes held in the highest regard by the person who's experiencing the dementia. So there's this horrible kind of irony where the people doing the most get the least credit and the people doing the least are thought to be just wonderful. You know you should talk by my, your brother in Los Angeles. He doesn't think there's a problem. You know you haven't talked with him except briefly for the last three months. Of course he doesn't think there's a problem. Tell you what I'm going to send you out there to spend a week with him.

Speaker 1:

We'll talk then, yeah with them, we'll talk then. Yeah, I hear of that all too often and it causes a rift between the siblings, like if the rift already existed. Then it just continues to create a larger wedge between. Because it's like, hey, how dare you like call or come back home trying to tell me what to do when you haven't been here, but the one who's living further away is emboldened by this empowerment that the parent is giving you know. But hey, but mom or dad called and asked me to get involved with the finances or ordering X, y and Z supplies. You know, so it does. It can get tricky. It can get tricky really, really fast. So what caused you to write?

Speaker 2:

Go ahead.

Speaker 2:

One of the things that's really good about what I do professionally, though, is that when you test somebody in a standardized environment, you bring them into a neuropsychological office.

Speaker 2:

You administer very standard tests, things like I'm going to read you these 12 grocery items, write them down, and then, when you take the paper away, you see what they can remember from the list, and maybe you have them repeat the list a couple of times and see 10 minutes later how much they can hold on to, or you tell them some standardized stories and see what they can remember standardized stories and see what they can remember. When you give them those kinds of objective tests, that really, in many cases, reveals the problems that they're having, and it's an opportunity for a number of the family members to look at the problem together. You don't always get the person who's been tested to agree that that's what's going on, because sometimes they have a lot of excuses. You know well, I wasn't thinking it was a bad day for me. The sun was in my eyes that kind of, you know, excuses the dog ate my homework, right but it does give everybody else at least a chance to say wow, I see what you're talking about now.

Speaker 1:

When would you suggest a person request a neuropsychological exam?

Speaker 2:

Ideally, we would have family doctors doing brief cognitive examinations every year every six months, depending on what the person's like, beginning at about age 65. Okay, and they would be able to get a track record. The other thing that would be great, and something that my wife and partner, emily, and I, are working on, is taking a five-minute dementia test that we developed and has been used by hundreds of doctors, and developing a form of it that could be used by family members to test mom or dad or their partner's cognition at home, using something that we know reflects what we see in a testing laboratory, because that's where we developed it. We have a database of thousands and thousands of people and we have their scores on this test called the MOST, the Memory Orientation Screening Test, and five minutes, and we actually had it in an app that was used by doctors where they could give the test. It would spit out a whole treatment plan based on the score, the test, redistributing it and coming up with a version of it that hopefully people will decide is worthwhile getting and giving to mom or dad so that they can go to the doctor and say look, I'm concerned. Could you please get the background tests, the MRI scan the blood tests, the things that we need to look at, and then maybe we send them to neuropsychologists.

Speaker 2:

Problem with us is there's not enough of us and therefore the waiting lists tend to be too long. Oftentimes I hear horror stories about people waiting six to ten months to get somebody in to be tested. Now, in my practice, we figured that out. We get people in within three weeks because we became efficient years and years and years ago and figured out how to do this in a much different way. Everyone else is like little cobblers working on shoes in their workshop. We have a mass supply kind of thing where we move people through, get really great results, but we figured out how to do it much more economically. Get really great results. But we figured out how to do it much more economically Because I see about 700 to 1,000 dementia patients every year.

Speaker 1:

What yes, yeah, that's unheard of.

Speaker 2:

It is unheard of.

Speaker 1:

It did take. I think it took about eight weeks for my mom to get her neuropsychological test and that was the first step. She was about 62 years old and that was the first step in her journey to the diagnosis of Alzheimer's, and it took forever. I thought I was going to implode and it took forever. I thought I was going to implode.

Speaker 2:

It feels like forever, but in actuality, based on what I know about the country, that today is pretty much average, maybe even a little faster. So it's a problem, and because of that, oftentimes we don't get the good starting data that allows us to then decide how do we begin to treat this now, and that's really important. How do you start early? How do you get the person diagnosed? How do you rule out the things that are the great imitators? Because you have those.

Speaker 2:

Somebody looks like they have dementia, but they're really depressed that's a big one. Someone looks like they have dementia, but they're really depressed that's a big one. Someone looks like they have dementia, but it's because their vitamin B12 levels are next to zero. They have dementia, but really what's going on is that they are experiencing an infection or they're having some other medical problem, or they're having some other medical problem. There's a variety of things that we go through that we then advise doctors to order to try to make sure we have the right diagnosis and then starting the patient on treatment and lifestyle changes, because there's a lot of lifestyle and general health problems that are very important. Even if you have already a diagnosis of dementia, you can do a great job of slowing it down or stopping it in its tracks if you deal with it early on. So I have a lot of patients who are the same five years later as when they walked in my doors because of treatment and because of lifestyle change. I love it.

Speaker 1:

Let's get into of lifestyle change. I love it. Let's get into that right now. I love that segue. So the book Dementia Prevention Using your Head to Save your Brain. You co-authored it with your wife, who's a medical doctor. What is her area of expertise?

Speaker 2:

Taking care of me is number one Believe me, that's a full-time job?

Speaker 2:

If that's the case, she has an MD, a PhD, an MRSD. See, because I suffer from AWD acquired wife deafness. So it's hard for her. I feel for her. As they say in the South bless her heart, bless her heart. No, she's actually done a couple of things.

Speaker 2:

First of all, emily went to medical school at the age of 42. Okay, she had a whole career before that in sales and in high-end business kinds of things. She went to Jefferson Medical School in Philadelphia at age 42. They only accept two people who are older than the average students atypical students in their entire class. So she's sitting there with 21-year-olds 22-year-olds in her first year medicals class. She then did a residency in internal medicine a couple of years doing that. She then went down to the poorest county in North Carolina bordering the poorest county in South Carolina to be a public health service doctor for four years. So she took care of really poor people down there, many of them with multiple medical problems, huge numbers of diabetes cases, high blood pressure, strokes, you name it. She saw it down there. She then decided that what she really wanted to do was to be a psychiatrist. So she went to Dartmouth-Hitchcock Medical School up in New Hampshire, got a second residency and became board certified in psychiatry and neurology.

Speaker 2:

Now we weren't together at that point. Now we weren't together at that point Long story we had been high school sweethearts, separated 35 years, got back together and discovered not only were we, incredibly, still in love with each other after all that time, but we were both interested in dementia. So we have this marriage of love and professional interest. It's a weird thing, but I'm grateful every day for it because it makes things so interesting. She's the smartest person I know, so I stole a lot of stuff from her.

Speaker 1:

Listen, Dr Kleonski, you buried the lead. You should have started with this.

Speaker 2:

No, no, it comes out better at the end, I think.

Speaker 1:

I don't know, buddy.

Speaker 2:

You buried the lead guy.

Speaker 1:

That's good.

Speaker 1:

That's good, that's good, that's good. That is what you call rich with a lot of texture, with a lot of texture one. So I want to put I don't want to give too much away about the books. I want to make sure that individuals get a reason to go and purchase and dog-eared and highlight. What I really appreciate is you give the average person hope, a reason to dig in and say, if I make these changes, if I get this information, I can, I got a shot at controlling my own destiny when it comes to dementia.

Speaker 1:

I wanted to ask you just to give us your Fifty, you know your forty thousand. Look on the things about prevention. You list life factors. Obviously, some things are, you know DNA and it's not much we can do about that. What may be your biological factors? But you talk quite a bit about health and diet and exercise and lifestyle factors and you list dementia risk factors and give us just a an overview of how you came up with those dementia risk factors and which ones you really believe of the dementia risk factors, like if you couldn't do but wanted to really try to tackle right away, what would you think they should be.

Speaker 2:

Let me start with a number. The number is one out of two. That's the number of cases of dementia that are preventable.

Speaker 1:

That's a good number. It's not a chance.

Speaker 2:

It's actually a probability of 50%. Where does that come from? It's not our data. It comes from two particular sources. The first is a large-scale analysis done by a group called the Lancet Commission. So this is from the Lancet Journal, sort of like the New England Journal of Medicine for Britain.

Speaker 2:

27 different specialists analyzed all of the data regarding preventable factors for Alzheimer's disease, vascular dementia, dementias due to head injury, dementias due to Parkinson's all of the different dementias. They did this and published back in 2017, and they had nine factors that would reduce the risk of dementia by 40%. Three years later, in 2020, they published a follow-up. They identified three more risk factors, one of them, surprisingly, being hearing loss, and they recalculated that they now had increased it to about 43%. Three years after that I'm sorry, two years after that, 2022, here in the United States, they took the same factors, applied them these 12 factors at this point to a study called the United States Health and Retirement Survey. They found that 60% of cases were preventable. So on one hand, we have 40. On the other hand, we have 60.

Speaker 2:

Not my numbers. I feel really comfortable saying that one out of two cases can be prevented. Now, we looked at those, but we added to that another eight factors, we've got 20 in our model. So, at a minimum, we believe that one out of two factors one out of two people, excuse me can avoid becoming demented. So it's a really preventable kind of thing that people don't recognize because, just like you were saying earlier, they have this nihilistic view that, oh my goodness, I'm going to heck in a handbasket. It's like the fickle finger of fate pointing. And that's what you're dealing with Nothing you can do. And so I have a very optimistic word, a very optimistic message, which is no, even if you have those factors, even if genetically you're predisposed, you can still markedly change the likelihood for you.

Speaker 2:

Now, it's not everyone, and I'm very much aware, because we see those patients as well as the patients who don't get worse, and we throw everything we have at them and they're doing everything right. They still get worse. Don't know what to do for those people yet, but for most people we can do a lot. What are a couple of things everyone can do? Most people, we could do a lot. What are a couple of things everyone can do? Number one move.

Speaker 1:

Get up and walk. So I got a really simple formula for exercise and, dr Mitch, you don't mean, I got to move from Atlanta to Los Angeles Only if you walk.

Speaker 2:

But if you're driving, nah, that won't help. So if I can get people to take just a 10-minute walk and that's what I always say to them can you do a 10-minute walk? Well, yeah, they say. I say so. What's good about this is you don't need equipment, you don't have to belong to a gym. You're not going to hurt yourself doing this. You're not likely to get lost if you walk 10 minutes, just five minutes out and back. You can do it even in hot weather or cold weather or rainy weather, because you're not going to melt. I want you to do that. Well, I can do that, but I want you to do it three times a day. And the reason is if you could do that three times a day, every day, you're not walking 210 minutes a week.

Speaker 2:

All the major medical societies are telling us that the sweet spot is 150 to 300 minutes. So you're right there in the middle. Now, if you can get up to the point where you're walking briskly brisk, as defined, as your heart rate goes up, but you can still talk while you're walking you're going to cover 9 to 10 miles a week. This will make a difference in your cardiovascular health, in your heart, in your diabetes, in your risk of stroke and in your brain. That's number one. I would suggest to everyone. It's rarely not doable. For those people who say my balance is that poor, I say then consider a stationary recumbent bike. So you're sitting back, your legs are up here, you got a nice TV in front of you and you're watching your favorite show or series. Because now you can stream anything. You do that 30 minutes a day. You're going to make a difference in your longevity as well.

Speaker 1:

Question Dr Mitch, does it matter if there's a person who says, hey, you know what, I'd rather knock out my 30 minutes all at one time, Do you care?

Speaker 2:

Not if you're doing it and can keep up with it. But if you're the person who does 30 minutes and then takes three days off because you hurt your knee, then I tell them it's like being a bank robber. You go and you rob a bank, you get $100,000 from the bank, but they arrest you Now you don't get any of their money back, but you spend the next five years in jail. You're not making $20,000 a year. You might as well be flipping burgers, because you're going to do better than that. So don't overdo it. Then end up in your bed. That's not a good idea. Do it in gradual ways. Don't try to eat the hamburger or, these cases, the tofu burger all in one bite. Do it in nipples. That's number one.

Speaker 2:

The other thing I would suggest that they do is, if you really want a comprehensive look at this and I'm not spoiling the book in any way we're giving away for free at our website a 25-question dementia prevention checklist that you can take for free. You can download it or fill it out online and it will show you where you are on target, where you're off target and where you're near target. So essentially creates for you an opportunity to see for yourself. What could you change? What would be the best place to start? And that goes up our website, which is called Braindoc B-R-A-I-N-D-O-C Braindoccom. It's right there. You just click on it. And I said you could download it, fill it out, because there's some things you'll need to get some lab work done or check your doctor's records for, because you probably don't know some of the answers to some of those questions. But that's okay because you can fill it out and then take it again see what scores you get. So that's a great place for people to start.

Speaker 1:

That is so amazing. How long do you think it would take the average person to complete the list from your website, if?

Speaker 2:

they have some of the lab data, know what their blood pressure is, know what some of their vitamin D level is, know what their homocysteine and methylmalonic acid levels are, things like that. It would take them five minutes, but most people don't, so they'd have to go back either into a portal to their online medical record, and even there there are some tests that the doctors unfortunately do not routinely order, but which are very important for how your brain is using vitamins like B12 and B9. So that's why, for some people, downloading it first, getting a hit list for what they need to find out, and then actually filling it out online, is a better approach.

Speaker 1:

Are these the? Will your primary care physician, your family doctor, be able to run all these tests, or do you need to go to a specialist?

Speaker 2:

Nope, they're regular internal medicine tests. They're just the kind of see. So Emily's background in internal medicine was here's what, in the golden age of internal medicine, we used to do, and the reason we did this is because these are important, first for cardiovascular health, but because almost everything that affects your heart affects your brain. That's what makes them important for brain health. So people with atrial fibrillation, elevated and irregular heart rates they're at higher risk for stroke. They're also at higher risk for vascular dementia. Things like that cholesterol levels are really important for people in terms of their brain health. You may not know what those things are. Your doctor can certainly order them and they should.

Speaker 1:

Yes, Two things that stood out to me about the think that I want to say that I don't think we'll give anything away. Um, I think you you did. Uh, I liked the way you described what normal aging looks like, so I would appreciate if you would share a little bit your language, your medical vernacular, like, hey, yeah, yeah, your parents, grandparents, uncles and aunties yes, there's a certain amount of forgetfulness or a slowdown in energy level or maybe even a change in personality that may occur as they're aging. So A, b and C is to be. Parenting up is in vicious denial, and it's so. We might take a little too long. The me's of the world, the J smiles of the world, saying ah, you know, the mom was just in a bad mood or she's pissed off with the pastor, that's why she ain't go to church today, because he made her mad last Sunday, and we will not look ourselves in the mirror and say something is wrong with my mama. So if you could share in your own words a little bit, I think that could be helpful.

Speaker 2:

I wish you were an easy answer. It's not. Denial is a really normal response for us who are seeing changes and I can tell you from my own experience that was the case. Who wants to start to worry about this really big problem if there's nothing at that time we thought you could do about it? Who wants to say I may have to rearrange some important parts of my life, I may have to go to battle with my mom about whether or not she needs help? Why would nobody in their right mind would do that? So it's much easier to say oh, you know, that's why she didn't go to church or that's why she did this thing. It's just stress. I'm sure she'll be better at some point. So that's real normal. And the fact is there isn't a real clear demarcation between that and what is normal.

Speaker 2:

Generally normal cognitive aging from a neuropsychological perspective is that the person's scores on tests of memory and processing speed and problem solving begin to slowly decline in their 60s and 70s and 80s, so that what's called normal being normative. Like other people, your age becomes lower and lower. You know, if you're 50 and you can only remember eight out of 50 items on a story, that's a problem. If you're 85, that may actually be normal. We have a group that we call super-agers. Those people are the lucky ones or the ones that have taken care of themselves, and at age 85, they still think like 55-year-olds. For most of us, however, we lose a half a step while we're racing. There's a couple miles per hour off our fastball that we don't have anymore. That's perfectly normal and doesn't interfere with everyday life. So that's why I wish there were a greater demarcation these days.

Speaker 2:

What you're going to see is a whole push from the Alzheimer's community to start doing blood testing to look at levels of protein in the blood from something called beta amyloid and something called TAU, t-a-u, which can be precursors of Alzheimer's disease. These are getting more and more commonly used. They're more reflective of what we see on advanced imaging and more of what we see if we were to do an autopsy. But there's some problems with this. You can get people with fairly high levels of these proteins who have completely normal cognition and will never get dementia. You also can see people who don't have high levels of this, but this is only true for Alzheimer's dementia. If you've got vascular dementia, which is just as common, you're not going to have elevated tau and beta amyloid. If you have dementia due to Parkinson's disease, your tau and amyloid are probably going to be normal, so you're going to miss a whole lot of people.

Speaker 2:

So, really, the diagnosis is made by some objective testing, some observation and trying to peel away the things that are not dementia. More importantly, though, if you start at whatever age I'm talking, even 20s or 30s and start implementing some of the lifestyle changes and you avoid excessive alcohol and you don't smoke cigarettes and you don't go on Valium, librium, lorazepam, benzodiazepines anti-anxiety pills for long periods of time, you do a lot of different things. As we lay out in the book. A lot of the blood testing is inconsequential, in my opinion, because you're going to avoid a lot of those risks, and I'd rather have people playing forward from where they are rather than doing nothing and worrying about what might happen.

Speaker 1:

Amazing.

Speaker 2:

It's common sense in many ways. It's just not very commonly seen. You know, the whole idea of this book was we're going to take all of this information that's already out there, but it's in about 10 different disciplines. We're going to organize it because most of the people in those disciplines are only reading their own stuff. The cardiologists are just reading cardiology, the neurologists are reading neurology, the sleep medicine, people only paying attention to sleep medicine. So we're going to pull this all together, yes, and then we're going to translate it so that people without MDs and PhDs actually understand it. That was the really important thing, because if you don't understand it, you can't use it and you end up looking for a little pill that you can buy on TV that supposedly helps keep your brain going. It doesn't work.

Speaker 1:

And guess what, doc? Those are all the people with the stinking dementia, all the people who don't understand. We're the ones with dementia, and or we're the caregivers, who also don't want to get it, because the family members, the family caregivers we are so close to this thing, we see the horrors of the disease, are living with this other anxiety of will it happen to me and, if it does, who will take care of me? Like in my instance, I don't have any children. I'm looking around like, oh man, not only do I not want the disease, I don't even know who to tell what I would want done. Yes, I do have a gaggle of God kids, but what you don't know.

Speaker 1:

So, in any case, thank you so much for the book. Thank you so much for the book. I am so grateful and I cannot wait to promote it more and more and more, because you all knocked it out of the park on giving clear directives to individuals who are not medically based on hey, there's hope, there is something you can do to grab dementia and Alzheimer's dementia by the neck and say, hey, before you get me, I am going to fortify myself. And who doesn't want to get the upper hand on disease period, end of story. And so thank you to you and your wife for putting in the hard work and rolling up your sleeves to go outside of your disciplines and gather all this information.

Speaker 1:

This conversation has been so refreshing and so rewarding. I can't wait to get the feedback from the Parenting Up community on what they find most useful to them, because you know, we're all we are as individuals. Different parts will resonate with each person, so I can't wait to see what they say. Different parts will resonate with each person, so I can't wait to see what they say. Once again, tell everyone where first, where can they find the book? And give us the name of your website again, where they can go and get the checklist examination.

Speaker 2:

But the book is in a bunch of places. It's in paperback and hardcover. It's also in audiobooks. You can download it within a minute of this and download it. I did not read it, thank goodness. It is read by an extremely great actor and her name is Nan McNamara. She makes it even more interesting than I think it reads.

Speaker 2:

So if you're interested in audiobooks, that's a great place. You can get it downloaded on Apple on your Apple iPad. You can get it on Kindle. You can get it through Amazon. You can get it at Johns Hopkins Press there's our publisher, so it's and bunches of bookstoresores, so there's a lot of places to get it and I hope people do or it's also in a bunch of libraries. So if you can't afford it, borrow it. I'm fine with that. This is really much more important than a book. This is a mission. So the more people who know about this and hopefully, if if you read it, you'll like it, you'll review it or you'll turn it on to somebody else and say let's read this as a book club or let's discuss this, because the more people we have doing this, the more important the statement's going to be and the more lives we will influence. Our website is wwwbraindoccom. Wwwbraindoccom.

Speaker 1:

Fantastic. Last thing, dr Mitch, I end every episode with a segment we call the Snuggle-Ups, and what the Snuggle-Up is is my version of saying, hey, this is a very hard thing for family caregivers, but if you go ahead and lean into it, it will make your journey easier. Like, stop fighting it and go ahead and do this. I typically give snuggle ups that are related to that particular episode, but what I like to do is ask each guest what is a snuggle up that you would like to suggest as it relates to caregiving dementia, alzheimer's, brain health, something that you would share, to the parenting of community. Like, hey, you know what, if you go ahead and just lean into this, your journey will be easier, something you've experienced as a caregiver or in your expertise as a neuropsychologist.

Speaker 2:

A couple of thoughts. One is that it really helps if you can laugh during caregiving, even if it's a little at the expense of the person you're caring for, because it's really a human experience and it helps at times to laugh rather than cry. The other thing is, if you take the message of dementia prevention seriously, what you will do to honor the spirit of your loved one, the parent, is to save your children from having to do this job for you.

Speaker 1:

That's powerful, that is super powerful. And of course, we stand on humor here and levity. I think you mentioned something about humor with having to buy the pens on a road trip. What was that about?

Speaker 2:

You remember that for our pre-call? Yeah, so my brother and I were. My mom went into assisted living up here where I live and it was a tough transition for her, but my brother came up from Pennsylvania with her. This was after he had to crawl under the door of the bathroom because she had locked herself in the restaurant on the way up, so it was a thrill-packed adventure already. So at that point she doesn't have good control over her bladder or her bowels. So we're in the pharmacy buying the large economy size of Depends my brother and I and we walk up to the counter and there's this young, 16, 17 year old woman behind the counter with throwing on top of the counter like three different things of economy size depends. And so I look at her and I said I know what you're thinking. My brother and I are taking a trip. We don't want to stop. She cracked. She cracked up.

Speaker 1:

Yeah, that's a good one.

Speaker 2:

It's better to laugh.

Speaker 1:

It's better to laugh. It's better to laugh. Thank you so much for joining us for this conversation. You are welcome anytime. I look forward to the next time we're able to chat and I'm going to do my own dementia list and tell you what my test score is so you can tell me what in the hell I need to do.

Speaker 2:

You now have your own personal neuropsychologist. Take advantage.

Speaker 1:

Thank you. Thank you so much Because I actually just asked my primary care for one, so maybe I'll just talk to you. Thank you so much. It's been a pleasure. Take care, let's snuggle up.

Speaker 1:

Number one Move 30 minutes a day. That doesn't mean turning over in the bed, doesn't mean moving your thumb up and down your cell phone or scrunching up your fingers on the keys to your laptop. It means moving your legs and your arms at the same time. Now Doc asked us for, let's say, 30 minutes. He even suggested just three sets of 10. I'm going to even break it down. Let's say six sets of five. Y'all know five is my favorite number. I'll give you six sets of five.

Speaker 1:

You can walk up and down the steps if you work in an office building, if you have steps in your apartment building, in your house, or you can walk around the block one time, or just walk down one side of the street of a block If walking 30 minutes a day, no matter how you cut it up, can prevent you from getting dementia. You're a family caregiver. You know how ugly it is is. You know what it can give to the family that's around you having to care for you and watch you shrivel up into somebody that's unrecognizable in 30 minutes, that's not even a whole freaking program. If you add it like that's not even a whole freaking program. If you add it Like that's not even a whole television program. If you add in commercials and bathroom breaks, you had like 33 minutes. Come on, don't be a buster, don't be a loser. Move to 30 minutes. Yeah, every day. Don't take no damn days off. None, none.

Speaker 1:

Number two know your personal numbers, your blood pressure Standard, at least in the Western Hemisphere, north America, the United States. They say for a blood pressure 120 over 80. They say for a blood pressure 120 over 80. Well, that isn't really for everybody. So talk to your doctor and find out for your height, your weight, your age, what is it? I have one of my very good friends. Her blood pressure is normally much lower than that. It's like 110 over 65. And that is her normal blood pressure. So find out what your standard numbers are your blood pressure, your cholesterol and your glucose levels. What are they? Write them, damn things down, put them in your cell phone. This is not for your LO, this is for you, the caregiver how you gonna care for somebody if your ass is falling apart. Okay, that is very, very important.

Speaker 1:

And then Doc has said on his website there is a free test that will tell you all of the dementia risk factors. Go take the damn test. It's free. It is going to tell you where you land in the thing. Now, whether or not you do something about it, that's on you. But at least know you should at least know it's like going to get an eye exam. If you pick up a book and all of the letters blur into a line, then you probably go to the eye doctor. That's the same with this dementia test. If you take this test and know that your brain is wonky and starting to do weird stuff, I am hoping that you would do something about it.

Speaker 1:

Statistics are saying that one in two people that would get dementia can avoid it. Hell, we are the parenting up community, the global community that is leading the way of family caregivers. We are going to be the one out of every two. That's about to be us. That's going to be us. We going to be the one out of the two that does not get a dementia. We about to prevent it. So I feel sorry for the people. So look, anybody. You know that's not a part of the Parenting Up community. You better go get them. You better tag them and tell them to start listening and start watching, whether they want to, whether they are they. If they are ear hustlers, then we got the Apple podcast. If they are ear hustlers, then we got the apple podcast. If they are voyeurs, then we have youtube. And if they really down with knowing all all the juicy bits and pieces, then we got patreon. Baby, we listen. Ain't no reason in losing when we got the playbook.

Speaker 1:

Come on Number three what scares you the most about aging? I want you to sit with that question for a second. Let it marinate all down in your bones, in your cells. What scares you the most about aging? If you need to write it down, talk with your mentors, your best friend, walk around talking to a tree, figure out what it is that scares you the most about aging and then make a plan to address it. And don't say something that's a cop-out, like dying. That's way too simple, that's way too easy.

Speaker 1:

Again, this is the parenting of community. We don't do no lazy shit like that. Like what is it really Okay, is it? You may not be able to walk, you may lose your vision. You may lose your sight. You may lose your sight For some people, if they lose their libido, they're like you know what I don't really like the idea that I might not be as sexually aroused as I get older.

Speaker 1:

All right, clearly, with dementia might lose my memory, might lose my mind, might not know who the hell I am or where I am, but know what is driving you as your greatest fear. Write that down and have a plan of attack. Let me know what it is. Y'all know, listen, there are so many ways you can reach me through Patreon, through IG, through my website, through newsletter, through the text what are some of the things that scare you the most? We will then attack that as new topics, we in this together. Alzheimer's is heavy, but we ain't got to be All right. Yo, what's up y'all? I'm over here just mixing and scratching up stuff and reminding y'all.

Speaker 1:

Patreon is open. It is open and ready for you, you, for you, you, you, you and your mama too. We are loading up things, all things Zetty, all things podcast, all things caregiving behind the scenes, extra stuff. J Smiles comedy is dropping with her own little collection within the J Smile Studio Patreon. Very, very soon, it'll be less than a month, but you want to go on and get in there because there's exclusives. That's kind of time sensitive to whoever is in there first. We've already had live broadcasts for people who are already in. Uh, I'll be honest, because of you know, branding matters. So there's some stuff that I just can't say and do on the world wide web, that I can do in the patreon pantry. So if you want to see and know and hear and experience more of what's happening between my ears, come to the J Smile studio, my Patreon pantry.