Episode 65 - Dementia Prevention Using Your Head To Save Your Brain Book By Dr. Mitchell Clionsky and Dr. Emily Clionsky

Hi, this podcast is brought to you today by Caregiver Relief, the site dedicated to helping seniors remain in their homes as they age, with a special focus on dementia care.

I’m Diane Carbo, your host, a registered nurse deeply involved in dementia care and advocacy. And today, I am thrilled to delve into a topic that touches so many lives, dementia prevention. I’m introducing a new critical resource, a book titled Dementia Prevention Using Your Head to Save Your Brain.

And we are joined by the esteemed authors today, Dr. Mitchell Clionsky and Dr. Emily Clionsky. Dr. Mitchell Clionsky is a renowned neuropsychologist with more than 30 years of clinical experience. His extensive background includes roles such as Baseline Assessment Program Contractor for the NFL Concussion Settlement Program.

And the Associate Clinical Professor of Psychiatry at Tufts University School of Medicine. He has also served as a concussion consultant with the University of Massachusetts Sport Program, and holds long standing memberships in various prestigious psychological and neuropsychological associations.

Dr. Emily Clionsky brings a unique perspective combining internal medicine, psychiatry, and neurology to specialize in dementia and cognitive impairment. Certified by the American Board of Psychiatry and Neurology, she holds both licenses in both Massachusetts and Connecticut. She also served as the assistant medical director at Marlboro County Hospice, highlighting her experience in a hospice setting. Together, their interdisciplinary approach enriches the book with both clinical insights and practical advice, making complex medical knowledge accessible and applicable for preventing dementia.

The synergy between their fields not only enhances the credibility of the content, but also ensures that the strategies they propose are ground in robust scientific evidence and real world medical practice. Let’s welcome Dr. Mitchell and Dr. Emily Clionsky to the show. Thank you both for being here.

Dr. Mitchell, could you start by explaining what a neuropsychologist does and how it relates to dementia care? This is a great question because it is a complex kind of thing, but we boil it down basically into testing how people think. Okay. Great. So we give various kinds of tests of attention and processing speed and memory, particularly short term or recent memory, as well as problem solving and abstract thinking.

We look at how people communicate, and we also touch on their emotional states. And then we take the scores from these tests and compare the person’s score with how we think they should be able to perform them for their age and their background. So that’s the comparison. Are you within the normal range for what you should be able to do?

And if not, where are you not hitting the right marks? What can we do to make an accurate diagnosis? And most important, how can we use that information to guide treatment and support interventions? I’ve worked with neuropsychologists because I’m a rehab nurse for years and I’d like to know from you, for either one of you, or for both of you, was there a particular personal experience or particular case that motivated you to focus on this topic?

For me, it was something that I was very fortunate to have run across in my graduate training, which goes back to the early 1970s. So back then, there really wasn’t much in the way of neuropsychology, but it was fascinating that we could use measures to figure out how people’s brains worked. And this was before things like MRI scans.

So back then, the questions we were asked was, did this person have a stroke? Where did it happen? Because they couldn’t tell otherwise except by doing sensory examinations and looking to see if the person was weak on one side or had a numbness or they lost their language abilities. But we would oftentimes be asked the kinds of questions that now are answered much more accurately by physicians using various forms of scanning.

Now we’ve moved much more from the, where did it happen to the question of what can we do about it? Awesome. My answer is a little bit different than Mitch’s as you might suspect Diane. Yes, I would. And I, not that I want to discount Dr. Mitchell’s side of it, but your side is going to be different because of your perspective in internal medicine and neurology and psychology.

Dr. Emily I’m laughing because first of all, I’m impressed with your credentials because I have a hard time because most internal medicine docs don’t understand dementia. And they don’t know how to help their patients. I have horror stories I could share. I love that you two, I see you two as the dynamic duo.

And you really have come together in such a way that makes things easy for people to understand. So tell me about your motivation to focus on this. I’m going to spread mine out a little bit, but I share your love of patients. But mine started when I was about 15 and a half years old because I was a nurse’s aide at that age.

Oh, God bless you. At Holy Spirit Hospital in Camp Hill, Pennsylvania. And Dolores Tittler, who was an LPM, was my teacher. And I’m now 72, so I’m remembering how long ago this was and how important this one was to me. And one of the first patients I ever was responsible for washing and feeding and bathing and toileting was a very demented 84 year old woman in 403 bed four.

And it was my first day of having a unit where there were four patients to care for. And I was completely incompetent. And Mrs. Tittler took me out into the hallway at about quarter of 11 that morning, after she surveyed what work I had not managed to get done, and she looked at me and she said, Emily, I am so disappointed in you.

And I swear at that moment, and you would appreciate this as a nurse, that spark of conscience was born in me that then carried through. So when I had some training experiences, particularly in my clerkships at Jefferson Medical College, I ran into good internal medicine doctors, and I will never forget seeing a 32 year old woman who was demented laying in a bed.

And the internist who was taking care of her. I was shocked. It’s the first time I’d ever seen anything like that. And I said, what’s wrong with her? He said she has an iron deficiency and a vitamin B12 deficiency. And I just gone through physiology. I thought I knew a lot of stuff. I looked at him, I said, I had no idea that something like that could cause dementia.

He said, absolutely. He said, don’t forget it. It can happen to somebody as young as you. Because at that point I was actually older. Then the patient who is laying in the bed and it shocked me. So eventually I became very committed to the notion that we do a lousy job basically of taking care of dementia patients because we don’t do everything that is reversible. We need to really look at everything that is fixable and then figure out how to deal with what is not reversible. And that’s how I really embarked on my career with dementia. Your higher power or the universe put you two together and for a reason, and it’s just amazing. I’m impressed with the way you now.

I’m going to ask you two both of you, who do you see as your primary audience for your book and how do you think it’s going to help them? We would like our audience to be pretty much everybody because most people think about dementia prevention as being what you start doing when you’re 55 or 60 or 65 years old, and suddenly you see a problem looming ahead of you and some of your friends or older siblings are starting to have problems.

That’s later than we would like. We do tell people it’s never too late to start. In fact, we use the same kind of interventions for people in their 90s. Ideally though, they would start far earlier than that. They would start in their twenties because there are things then, and as Emily will tell you about that if you do something really early, it multiplies.

It’s you know what they tell you about saving money. If you start putting money aside in your twenties, by the time you go to retire, you have a whole lot more than if you start thinking about it in your fifties. So we hope that there’s a very diverse audience. ‘cause this affects everybody.

And certainly if there’s dementia in a family, it would be important for the younger members of that family to get their hands on this book because they’re in the ideal position where they can really start these interventions very early in life. And it’s never too early. It includes everything is from making sure you get as much education as you possibly can, avoiding head trauma. And if you’re really, young, we’ve got eighth graders, 50 percent of eighth graders have already experimented with drugs in the United States, according to the most recent surveys that have been conducted avoid drugs, avoid alcohol, avoid tobacco, avoid the poisons that are going to literally kill your brain cells.

That’s, Emily, the very first thing I get asked when my clients contact me is about their family member with dementia is, am I going to get this? And I too, I did candy striping at Homestead Hospital in Pittsburgh, Pennsylvania when I was a young girl. And I can remember dealing with elderly people all my life.

My grandmother lived to be 98 and she developed dementia in her 90s. And all of my great aunts, I call them my little aunts because they were all little short little ladies, like under five feet. They all developed a form of dementia later in their lives. But it was like in the 90s and not before. I started doing research and it was hard when I was a young person.

But I wanted to raise my children to eat healthy and exercise and do things my grandmother used to work out to Jack LaLanne every day. And I know people that are listening to this don’t even know who he is. I know. Isn’t that amazing? And she always walked and she always, she was very social.

They did card clubs and those types of things. And when I was growing up, Sundays was, Family dinner at Grandma Smith’s house. I’m Diane Smith. I was born that Diane Smith. And we, my aunt and uncle on the other side would bring their two daughters and we would play cards and do all kinds of things.

And we did that well into the 90s. So you’re right, people, you have to start right away. It’s never too late to start. I want to learn what you found with some of the biggest challenges you faced in gathering the information in your book. I think the biggest challenge, but by the way, as I was listening to you talk about what your family used to do, they actually were starting a dementia prevention program. You just didn’t realize it. You were emphasizing social connectedness. You were doing things that were mentally challenging and there’s nothing more challenging than families playing Scrabble or for cheesy or some other vicious game with each other, because the rules are out the window and somebody sits down and steals a piece.

You’re talking about moving all the time, exercising, which is incredibly important. So you were doing a lot of really good things. You just didn’t label it dementia prevention. It was just fun and part of the family life. I label everything dementia prevention. I tell my clients do something with your non dominant hand, do something new and different every day.

And if you’re really good at something, do something that you’re really bad at to increase those neural synapses. But yeah I encourage people to play games. It’s really important. My grandmother could actually look at a stack of numbers, four or five numbers in addition, and she could add them up like that.

And I was so impressed, I learned with an abacus. So I’m on my fingers all the time. And it’s, I’m like, I’m counting with my fingers. I’m actually working on numbers, doing, working with numbers now cause my vocabulary and my words are good, but I have to make myself do things that I’m uncomfortable with.

So you wondered about what it was that was the biggest challenge. One of the things that I found challenging was that we really needed to look at a very wide range of medical disciplines in order to get the information we need. And one of the reasons why there is no specific field of dementia is that sort of the stepchild of a bunch of other disciplines.

The neurologists do dementia, but they also do seizures and strokes and head injuries. and multiple sclerosis and a whole bunch of other things, but some do some dementia too. If you talk to psychiatrists, unlike Emily, most of them just do anxiety disorders, depression, bipolar disorder, schizophrenia.

They’re not really paying attention to dementia. Gerontologists just do an age range, like pediatricians. So they’re not, they’re focused because there’s a lot of older people with dementia, but that’s not their only focus. You have people who are doing cardiology, which has a huge impact on what we find with brain function, because anything you do that’s good for your heart, it’s going to be good for your brain.

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And yet they don’t really pay attention to the dementia literature at all. I include my friend, the cardiologist who I didn’t know anything really said to people for sleep studies because sleep apnea is important. And the sleep medicine people focus on that, but they’re not paying attention to its effect on their brains.

So we view ourselves as the gatherers. We’d go out and gather all of the well established, peer reviewed, solid kind of science, and then pull it together into a model. And then, because this is all language that most people, sometimes even the experts, don’t understand, We had to translate it into language that people could understand and use.

And that was the next step of the challenge, gathering the vetting of the information, the organizing of it, but then the translation, because we wanted people to really use this information. When I’m listening to you, I think of Chris Hemsworth. He is an actor that he found that he’s carrying two, the genes from his grandfather presently has dementia and during a research a study for PBS or one of those stations, he’s doing a series on the human capacity and they did a blood test for him and he found he’s carrying both genes.

So he’s prone to developing dementia. And I was really impressed with his response because he’s taking time away from acting and he’s doing research and doing, trying to incorporate dementia prevention strategies into his life. So you need to send him your book. Yeah. We do need an advocate like that.

Having someone like Hemsworth would be really powerful because we need to bring the message. It’s not the book, it’s the message. And we need to bring the message to a much larger audience than it receives. Right now, everyone pays attention to what new drug is out there. And that’s, in a lot of cases, somewhat locking the door after the barn, after the horse is gone, rather than figuring out how to keep the horse in the barn to begin with.

Could you explain some of the core concepts you discuss in your book regarding brain health? Actually This is the way we try to trade off who’s going to take this one. The primary core concept is that it’s one that you’ve already hit on, which is first of all, start early, do everything that you can possibly do.

And one out of two cases of dementia in the United States is preventable so that’s the incentive. I would probably say, take responsibility for your own health. You really can’t leave it to your doctor to intervene and to do everything that you’re supposed to do because right now the way the medical system is set up in this country is doctors are compensated based on all these goals that they hit.

How many times did they take your blood pressure this year? Did you get your cholesterol check twice? Did you get your mammogram? If you’re a man, did you get your PSA? They’re not really looking at the long term of what it takes to preserve somebody’s brain health. So you individually have got to take responsibility for that.

So you can use the dementia prevention checklist that we have in our book. And complete that and the parts of it that you can’t do by yourself, i. e. order your own blood tests, take that to your doctor and say, okay, I want these tests done because it’s important information for me to figure out if nutritionally and metabolically I’m where I need to be with respect to my home assist team, my methylmalonic acid, my vitamin D, my iron, my oxygen levels at night while I sleep. So there’s a whole lot of things you can do according to the checklist by yourself. But the 1st part is take the 1st step, do the checklist. And what you need to rely on your doctor for take the checklist to them and say this.

I need you to order these tests, so it takes strong advocacy. I love that you have a checklist because people like just checklists and they like to be able to go down the list, especially cause I tell them your limited time with the doctor is 15 minutes. Yes. And it’s not enough time to do anything.

So make use of your time wisely. I’m going to add two more things that need to be addressed by people is if you’re hard of hearing, you’re more likely to develop dementia. Yeah. Yes. That’s what the research says. Yes. And I find it I find it astonishing that people don’t want to wear a hearing aid because it makes them look old.

And I love my hearing aids. Love them. Yes. I don’t understand why, I don’t care. I’ve had people that won’t use a walker in their 80s because it makes them look old. My dad’s twin actually went to a senior center for one day. He wanted to check it out after his wife died so that he would have something to do.

And he says, Now he’s in his 90s and he said, they’re all old people. And they are. Yep. Yep. What are you, Uncle Larry? Come on. And the other thing I think that’s really important that I’d like to touch on is diabetes and the importance of maintaining good blood sugars and stable blood sugars and not abusing your body because they’re saying that dementia or diabetes is the third dementia and it’s very, of course, you’ll know better about that than I do, but you’re absolutely right.

And when you talk about diabetes, you’re really, you’re grabbing a whole great big universe there that all the factors. That feed into to diabetes actually feed into dementia. If we can take a look at diabetes and understand that is essentially an inflammatory condition, just like obesity is an inflammatory condition and high blood pressure produces inflammation in the vasculature, as does bad cholesterol.

We look at that whole complex. We can understand why diabetes is one of the major causes for dementia. In fact, we know from literature that’s been published in the New England Journal of Medicine that even if you have hemoglobin A1c, the way to measure your diabetes numbers over a 90 day period, if you look at that, and if you’re even in the top range of normal, you have a significantly higher risk for dementia than somebody who’s in the lowest quarter range of a hemoglobin A1c.

So I’m not even talking about pre diabetes, I’m talking about normal hemoglobin A1c ranges. So you’re absolutely right, Diane. Yeah, that really concerns me because of the obesity in our country and everybody’s pre diabetic.

Understanding Dementia

Dementia is a complex and multifaceted condition that affects millions of people worldwide. It is a broad term that describes a decline in cognitive function, including memory loss, difficulty with communication, problem-solving, and other thinking abilities. Dementia can be caused by various factors, including Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia. Understanding dementia is crucial for developing effective prevention and treatment strategies.

Alzheimer’s disease is the most common cause of dementia, characterized by the buildup of amyloid plaques and tau tangles in the brain. Vascular dementia results from reduced blood flow to the brain, often due to strokes or other vascular conditions. Lewy body dementia involves abnormal protein deposits called Lewy bodies, which affect brain function. Frontotemporal dementia is caused by the degeneration of the frontal and temporal lobes of the brain, leading to changes in personality, behavior, and language.

Recognizing the symptoms and understanding the underlying causes of dementia can help in early diagnosis and intervention, which are critical for managing the condition effectively.

Dementia Diagnosis and Prevention

Early diagnosis and prevention are critical in managing dementia. The Memory Orientation Screening Test (MOST) is a highly accurate, brief test for dementia that can help identify cognitive impairment. Developed by Dr. Emily Clionsky and Dr. Mitchell Clionsky, the MOST has been used by hundreds of healthcare professionals to detect early signs of cognitive decline. This practical diagnostic tool is invaluable for initiating timely interventions.

Advanced dementia treatment protocols, such as those developed by Dr. Mitchell Clionsky, have shown better outcomes compared to community-based standard care. These protocols often include a combination of medication management, lifestyle modifications, and cognitive therapies tailored to the individual’s needs.

Preventing dementia requires a comprehensive approach that includes lifestyle modifications, such as regular exercise, a healthy diet, and social engagement. By adopting these strategies early, individuals can significantly reduce their risk of developing dementia and maintain cognitive health well into their later years.

Prevention Strategies

Preventing dementia requires a proactive approach that incorporates various strategies. These include:

• Regular exercise: Exercise has been shown to improve cognitive function and reduce the risk of dementia. Engaging in physical activities like walking, swimming, or yoga can enhance brain health by increasing blood flow and reducing inflammation.
• Healthy diet: A balanced diet rich in fruits, vegetables, and omega-3 fatty acids can help support brain health. Foods like leafy greens, berries, nuts, and fish are particularly beneficial for cognitive function.
• Social engagement: Staying socially active and engaged can help build cognitive reserve and reduce the risk of dementia. Participating in social activities, joining clubs, or volunteering can provide mental stimulation and emotional support.
• Cognitive stimulation: Engaging in mentally stimulating activities, such as reading, puzzles, and learning new skills, can help build cognitive reserve. Challenging the brain with new and diverse tasks can strengthen neural connections and improve cognitive resilience.
• Stress management: Chronic stress can contribute to cognitive decline; practicing stress-reducing techniques, such as meditation and yoga, can help mitigate this risk. Finding healthy ways to manage stress is essential for maintaining overall brain health.

Cognitive Health

Cognitive health is essential for overall well-being. Maintaining cognitive function requires a comprehensive approach that includes:

• Regular cognitive assessments: Regular cognitive assessments, such as the Memory Orientation Screening Test (MOST), can help identify cognitive impairment early. Early detection allows for timely interventions that can slow the progression of cognitive decline.
• Cognitive training: Engaging in cognitive training programs can help build cognitive reserve and improve cognitive function. These programs often include exercises designed to enhance memory, attention, and problem-solving skills.
• Lifestyle modifications: Making lifestyle modifications, such as regular exercise and a healthy diet, can help support cognitive health. Incorporating physical activity and nutritious foods into daily routines can have a significant impact on brain function.
• Sleep and relaxation: Getting adequate sleep and practicing relaxation techniques can help support cognitive function. Quality sleep is crucial for memory consolidation and overall brain health, while relaxation techniques like mindfulness and meditation can reduce stress and improve mental clarity.

Emotional and Mental Well-being

Emotional and mental well-being are critical for overall health. Managing stress, anxiety, and depression can help support cognitive health and reduce the risk of dementia. Strategies for promoting emotional and mental well-being include:

• Mindfulness and meditation: Practicing mindfulness and meditation can help reduce stress and anxiety. These techniques promote relaxation and mental clarity, which are beneficial for cognitive health.
• Social support: Building and maintaining social connections can help support emotional and mental well-being. Strong social networks provide emotional support, reduce feelings of isolation, and offer opportunities for cognitive engagement.
• Cognitive-behavioral therapy: Engaging in cognitive-behavioral therapy can help manage stress, anxiety, and depression. This therapeutic approach helps individuals develop coping strategies and positive thinking patterns.
• Self-care: Prioritizing self-care activities, such as exercise, reading, and relaxation, can help support emotional and mental well-being. Taking time for oneself and engaging in enjoyable activities can reduce stress and enhance overall quality of life.

By incorporating these strategies into daily life, individuals can support their cognitive health and reduce the risk of dementia, leading to a healthier and more fulfilling life.

FAQ: Dementia Prevention Using Your Head to Save Your Brain Book by Dr. Mitchell Clionsky and Dr. Emily Clionsky

Who are Dr. Mitchell Clionsky and Dr. Emily Clionsky?

Dr. Mitchell Clionsky, Ph.D., is a clinical neuropsychologist and an expert in dementia prevention, cognitive impairment, and memory disorders. Dr. Emily Clionsky, M.D., is a highly experienced physician specializing in psychiatry and internal medicine with a focus on dementia treatment and prevention.

What is the focus of the book "Using Your Head to Save Your Brain"?

The book focuses on practical diagnostic and treatment approaches to dementia prevention, early detection, and cognitive stabilization. It aims to provide readers with actionable strategies to maintain cognitive health and prevent memory loss.

What is the Memory Orientation Screening Test?

The Memory Orientation Screening Test is a paper-based, highly accurate tool developed by the Clionskys to assess cognitive status and screen for mild cognitive impairment and early dementia. It is practical for both clinical and community-based standard care settings.

What is the Advanced Dementia Treatment Protocol?

The Advanced Dementia Treatment Protocol is an evidence-based framework developed by Drs. Clionsky to address memory disorders, cognitive impairment, and other dementias. It integrates practical diagnostics with cognitive stabilization techniques.

What are Dr. Mitchell Clionsky’s qualifications?

Dr. Mitchell Clionsky completed his psychiatry residency at UPMC Mercy Hospital and has served as Assistant Medical Director at Dartmouth Hitchcock. He maintains an active clinical schedule and has worked on the development of tools like the Accident Concussion Scale for cognitive assessment.

What are Dr. Emily Clionsky’s qualifications?

Dr. Emily Clionsky completed her residency in internal medicine at Jefferson Medical College and psychiatry at UPMC. She is also experienced in translating bench-level research into practical dementia treatment and prevention applications.

How does the book address dementia prevention?

The book highlights methods to prevent Alzheimer’s disease and other dementias through:

• Early diagnosis using tools like the Memory Orientation Screening Test.
• Lifestyle changes for cognitive stabilization.
• Insights from bench-level research applied in real-world scenarios.

What are the professional backgrounds of the authors?

• Dr. Mitchell Clionsky: A clinical neuropsychologist with expertise in dementia prevention and testing, founder of Clionsky Neuro Systems, and former Assistant Medical Director at Dartmouth Hitchcock.
• Dr. Emily Clionsky: An expert in psychiatry and internal medicine who has applied her knowledge in military and medical applications, rural healthcare in Marlboro County Hospice, and private practice.

How is this book different from other resources on dementia?

The Clionskys’ book stands out for its practical diagnostic tools, focus on statistically demonstrated treatment approaches, and integration of insights from bench-level research into community-based care.

How do the Clionskys integrate their clinical experience into their book?

Drawing from their active clinical schedules, work in institutions like Dartmouth Hitchcock, and contributions to international conferences, the Clionskys offer real-world applications of dementia prevention and treatment strategies.

Can this book help patients with mild cognitive impairment?

Yes, the book provides insights into the early detection and treatment of mild cognitive impairment, helping patients stabilize and potentially improve their cognitive status.

What kind of research supports the book's recommendations?

The recommendations are based on both clinical neuropsychology research and practical diagnostic applications, as well as advancements in areas like the computer industry and military applications.

Are the tools in the book widely used in the medical community?

Yes, tools like the Memory Orientation Screening Test and the Clionskys’ treatment protocols are used in medical settings, including rural healthcare, private practice, and hospice care.

What are some notable institutions and locations associated with the authors?

• Massachusetts: The Clionskys’ private practice.
• Dartmouth Hitchcock: Assistant Medical Director role.
• Rural South Carolina: Marlboro County Hospice.
• Jefferson Medical College: Internal medicine residency.
• UPMC Mercy Hospital: Psychiatry residency.

Who would benefit most from reading this book?

Patients, caregivers, and medical professionals interested in dementia prevention, memory disorders, and cognitive stabilization will find this book invaluable.

How do the Clionskys’ backgrounds in psychiatry and neuropsychology complement each other?

Dr. Emily Clionsky’s expertise in psychiatry and internal medicine complements Dr. Mitchell Clionsky’s neuropsychological focus, allowing them to provide a multidisciplinary approach to dementia prevention and treatment.

What role does the book play in addressing Alzheimer’s disease?

The book provides strategies to delay the onset of Alzheimer’s disease, improve early detection, and manage cognitive decline through lifestyle changes, cognitive stabilization, and practical diagnostic tools.

What is the significance of the Clionskys’ work in military and medical applications?

Their work in military and medical applications, such as developing tools for concussion and cognitive impairment assessment, has informed their approach to dementia prevention and treatment in civilian populations.

The Brain Doc is the Clionsky website

Clionsky Neuro Systems (CNS)

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