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 brains.

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. 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, 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.

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. And a lot of people don't want to they don't want to address the issue because they don't want to get diagnosed with dementia or diabetes when, in fact, if they would treat it and take steps that to get that A1C down, they'd be much better off.

Absolutely. I'm going to ask you both during your research, did you come across any findings that surprised you or changed the way you think about dementia prevention? We've been talking and working on this for so long before we started researching the book that we had worked through. A lot of those things was like, Oh, we already knew this.

We already knew this. We've been collecting these articles. We'd be collecting these studies. Now we have to do the hard work of sitting down and writing it all up, but it'd been part of our ongoing practice, I think, but maybe you looking at the I've been looking at everything from bench level research.

Through to field research since 2004. Oh, wow. So we were the biggest challenge for us was not finding the data. It was synthesizing the data and putting it into a form that was comprehensible by, the average person walking around the country. One of the funny things was that there's a lot of.

Parts of Emily's practice that she had already been doing, and we would laugh about it because, oh, here's the article that proves that what you've been doing for the last four years is actually good, or last 10 years. Time and time. Let's save that because we use it in the book. And we did. Yeah, so that was really what we were working ahead of the pack.

Because it takes a long time for research, as to be conducted, to be large enough, to be important, then to be published. So a lot of times, if you're really paying attention, you're working ahead of where the research is at that moment. Remember that patient I told you about, the 32 year old woman who had a B12 deficiency and an iron deficiency?

Believe it or not when I really started to take a look at the metabolic bench level research, of all the things that can cause dementia, that was literally my starting point. What are all the kinds of things that can cause cognitive loss in a human being? And there it was, there was the B 12 deficiency that is best tested for as methylmalonic acid levels that are elevated.

There was the iron deficiency. There was the Hyperhomocysteinemia. So that internist at Lankenau hospital. Outside of Philadelphia knew his business , and it was really, truly the beginning. Actually, coming back to you. I was thinking a little more about the question. There is something that I think is really important, which is the importance of the F word in dementia.

Now everyone's got, I got your attention now. Oh, got stories about that for you, . Yeah. So the F word is floss. Oh, floss. Flossing. Turns out that gingivitis and other diseases of the gums, which are really common as we age, there allows for the buildup of inflammatory infections that can cross the blood brain barrier.

and can cause problems with our brain functioning. So preventive dentistry, regular checkups, daily brushing and flossing turns out to be one of those things that we can tell people to do that they don't think about on their own and don't necessarily see the connection. But it's really important. What's really sad is once you get Medicare, you don't have coverage for dental.

And seniors are on fixed incomes, a lot of them, so they don't get their dental care. And if you're in any hospital now, anywhere in the country, or nursing home, oral care is probably the most neglected of the care. Because people are too busy or too distracted with too many other things to get back to the basics of good nursing care.

And that's one of my pet peeves, you got to do oral care and people just, it's the most neglected. So I've never heard the F word as flossing, so I appreciate that. Because that's something I'm going to make sure that I promote too, is flossing. Because I wasn't aware of, I knew dental health was very important because what's good for the heart is good for the brain.

And you want to take care of your teeth just for heart health as well. Yeah. And I tell you what made the difference for me, cause I was always in a lazy kind of battle about this with my dental hygienist is she turned me onto these little dental picks are made of plastic and they are a lot easier to manage.

Now, when I try to use floss. I'm actually can get my one arm up in the air and the other down below and things are getting on the mirror and it's a mess. Yes. And I got these dental picks and suddenly it's oh, this is easy. It's like a toothpick. I just stick this between Exactly. I use them as well.

I do I do too, because I can't do floss and it's just, I have to be a contortionist to do it, so I too do the pick and dentistry is one of those places where you don't want to have deep pockets. And everybody says to the world, you want to have deep pockets. Cause it means. In that little world.

You want to have the smallest pockets possible because those are the gaps between your teeth and your gums. And so I was really pleased the last time I was back. Cause I've been using these little sticks now for about the last year and each time my gaps get smaller, my pockets get lighter. And I'm very happy.

That's good. That's good. I've been doing it for decades, so I'm way ahead of you on that.

Now I'm going to ask can you share with me a couple of preventive strategies that are particularly effective according to your research? Exercise. Tough, nobody argues about the benefit of exercise. I never got anyone saying, Oh, no, that's not good for you. 99 percent of the people that they don't argue with you about the benefit is how to get them to exercise. So we have a simple formula, which I'll share with you. It's called the 10 by three formula. Here's how it works. You take a 10 minute walk three times a day.

And the reason this works. Is because it's hard to ignore. It's hard to talk yourself out of it's not going to hurt you It's so short that you won't get too bored And you can do it in almost any kind of weather and because of that and the fact that you are doing, it's going to add up and so those 10 minute walks three times a day give you 210 minutes a week of exercise. And if you're walking briskly defined as getting your heart rate up but not so fast that you can't also talk while you're walking.

That's the sweet spot. You're going to be walking nine to 10 miles a week, which is perfect for most people. And it really makes a big difference. And it can be squeezed into almost anybody's busy lifestyle. So that's the one intervention that I almost always try to do with people because, when you ask them, how much do you exercise?

How do you exercise? They'll give me answers like, first of all, avert their eyes because they're embarrassed. Then they'll say I've got an exercise bicycle. And I said, that doesn't tell me anything. Just tells me what you have. Are you using it? Not really. So this is a way of getting people back in.

I too recommend that my clients that they exercise, even if it's 3, 10 minute sessions, it's easy to do and just getting out in nature, taking the, if you can just get out in nature for 1 of those 10 minutes, it can really improve your attitude.

It could really make you feel better about the day and what's going on in your life. So I do encourage that as well. Now, what type of mental exercises do you recommend to keep the brain healthy? Writing a book, doing podcasts. Oh, you mean for other people. Oh, Seven days a week. So we're doing plenty of metal whatever is challenging and Interactive works best, the literature on brain games is pretty disappointing most of it shows that if you do brain games you get better at doing brain games I don't have a problem with people doing them.

I view it as recreation you're really wanting to increase your brain ability. One of the studies that I recently read suggested that if you combine some form of brain problem solving with exercise, you actually get a better effect than either of the two separately. I don't know if that's true.

It's only been one study hasn't been replicated, right? But I think it's a nice model so that, if you're walking and talking with people and maybe trying to solve problems or think about creative ideas, I think that's a great way to start. And if you can be on a board of directors or volunteer in an organization or solve a, work on a project with other people, all of that stuff, we had a friend who used to do Habitat for Humanity and he loved the fact that he would it wasn't very good with his hands.

He was in finance, but he liked the fact that it got him out with other people. We got to solve spatial problems and he, hammered a few nails in the process. And I think it was a really great way for him to keep his brain active. I'm doing a series on caregiver robots because we have a shortage of caregivers or direct care workers in the country, right?

In fact, for every senior there used to be seven caregivers and now there's, we're down to four, and with a growing tsunami, it's gonna get worse. And I'm seeing computerized programs for the, for socialization for seniors. Have you seen anything like that or seen any read any research on it at all?

I'm just curious from my perspective. I actually think it's a really cool idea. They're doing it in Japan and getting good results from it. Somebody said but it's just a robot. What defined is? If you give someone an interactive robot, you become attached to it. You personify the same way we do with our dog.

Where we anthropomorphize him, we attribute to him human qualities. And someone said, but I wouldn't want a robot. I said, really? You wouldn't wanna C3 po or an RD two. And they stopped and said maybe one of those I would. I said, exactly. Is that because it would have all of those characteristics of humanity That you interact with and it would be your friend.

It would be something you could turn to When you're just wanting to talk or you're getting some feedback. So i'm actually I agree. I've I actually promote my clients getting baby dolls when the dementia progresses. But pets are really important in people's lives. And a lot of elderly can't have a pet, but they can have a pet robot.

And the dogs and cats are incredible to make them feel loved and comforted, as well as feel like they have something to interact with all day long. I think that's really important because one of the things most of our seniors tell you, it's time to take your pills. Yes. Yes. Yes. Exactly.

Drink water. Yes. Yes. Those things that we would love to have someone nudge them about. Yeah. Could do. And wouldn't mind that the person is telling them the same story every 10 minutes. But dementia prevention, I tell people, take care of a pet or, I actually walk dogs for friends, and I dog sit so that I can keep people, I can keep my socialization up because when I'm doing what I'm doing, it's doing research, it's talking, it's while I am meeting people, I'm dealing every day with people in pain.

And, needing advocacy in some way for their family members. So I take a break from my stress levels. That's a big one too that can contributes to dementia is stress. And I think that we need to do things that help us decrease our stress in our lives. I'm going to ask you now, are there any medical interventions that you believe are promising for the prevention of cognitive decline? Other than the ones that we've already put in the book with respect to really The evidence supports getting the methylmalonic acid down the home assist team down, controlling your lipid levels, reversing the lack of oxygen while you sleep at night by treating your sleep apnea.

Other than that, there's still no magic single bullet out there that is promising to do any better job than the medications that have been out there for the last 20 years already. And they're disappointing. We oftentimes end up doing better by having people stop taking some things. So for example, stopping some of the sleep medications that people buy over the counter saves them.

It improves their thinking. Yeah. Sometimes people are basically just taking buying vitamins that they don't need, which then pass through their body and are excreted out. They're not doing a darn thing. Cause they don't have a deficiency in that particular vitamin level. So that's important. I guess the other thing is we warn people off the over the counter supplements for brain function.

Yep, I do too advertised on tv. Yes Garbage. Yep. They don't work. Don't spend the money. Yep. I agree. I agree. And worse than they give you a sense that this is all you have to do in order to maintain your brain and that's where there's a real downside if people just wanted to spend their money and they did all the other things anyway. It wouldn't be such a big deal.

But we see people all the time. They say You don't have to worry about me with dementia because I eat a good diet. We said, that's wonderful that you eat a good diet. It's not enough. They say I take this over the counter thing. We say, that's great. If you want to, you're wasting your money, but it's not enough.

These will not help you in a way that you need them to help you. You need to focus on other things. And that's the important message I think is pay attention to the other factors. Now, I'm going to ask you a question. I work with a lot of caregivers and I'd like to know what advice do you have for caregivers who are taking care of somebody who is at risk or already experiencing a minor cognitive decline?

That's a tall question because my real spontaneous answer is the first person you need to take care of is yourself. I agree. And we know that the death rate is higher in the caregivers than it is in the patients with dementia. Exactly. In fact, when I started my site 20 years ago, I had aging home health care.

50 percent of the family caregivers were becoming seriously ill or dying before the patient because of chronic stress. It's now up to 63%. Wow. And it's going to be 100 percent very soon. I'm sure of it, only because we're, we've moved to a Medicare model that has cost sharing. I was just at the nursing home the other day trying to place a client for skilled care and the people ahead of me, I heard somebody sob and I thought somebody died and I learned that they were told it was going to be 250 copay for their 84 year old grandmother to stay in the rehab center and get the care she needed and the family was like lost.

How are they going to be able to afford that? But that's what's happening. And Medicare now has gone to a cost sharing program platform, so we are going to be struggling and I just read an article yesterday where they're doing hospital at home programs and they're putting all this equipment in the homes and they're expecting the family caregiver to do the work of professional nurses.

Yes. Exactly. Which is insane. Yes. Yes. Absolutely insane. Because the family caregiver is not trained. It's simply something as simple as knowing how to turn somebody. Yes. You and I understand skin. Yes. I don't. The first thing we ever learned was skin. Yes. Those simple things that are so innate in us.

The poor human being who's caring for this demented person just doesn't understand. And I've seen the effect of the best of intentions. It doesn't make up for the lack of care that these people need, and it just creates additional wear and tear on the caregiver because when they go to try and lift and try and turn, they're stressing those shoulder muscles.

They're throwing their backs out there, falling themselves. So you land up with two wounded people instead of one. I share your concern. I really, truly do. I do. I feel, I worry about my caregivers. And as you, when you started our podcast, you were saying you were a nurse's aide. And you had four patients you had to take care of.

God bless us if that was real in the real world now. Our aides are handling eight to twelve patients in a shift. Thank you. We handled our maximum back then. This was in 1967. We were only allowed to handle six and eight if they were all doing their own self baths. Yeah. So we were primarily doing beds and sticking food trays in front of them and giving them foot rubs and back runs at three o'clock in the afternoon.

What a dream that would be today. Can you imagine nurse or nurses ain't even having the chance to give a foot rub to a patient today? People would think we were crazy saying something like that. I actually, I was talking to a group of student nurses the other day and I said, when I became a nurse, I was 20 and that was in 1974.

And I just turned 71. But in those days, we used to take a cart. With warm water that we had lotion put in so that the lotion would be warmed up. God forbid we put cold on anybody. Oh my god, yes. And we used to do hour of sleep HS care. And you start at the back of the hall and you would bathe everybody's back and give them a massage and do their feet and you check their bottom and make sure their pillows.

Yes. Now I can literally tell you I have been into rooms now where an aide has a towel and one part they put shaving cream. I literally watched this shaving cream on one side, kept the other side dry. They're cleaning a person off, drying them off and then putting double diapers on them because they don't want to have to change them out during the night. Oh, dear God. So this is the kind of things that we're dealing with in care in with trained so called trained professionals, but we've pushed it way too far. But I do, I think one of the things, and I do, I really promote stress management. I have a course on they're called the Stress Buster that I really encourage.

And I think that one of the things that people need to do is start every day with an attitude of gratitude. What can you be grateful for when you're overwhelmed and it does, trust me, caregiving gets overwhelming and you, you've got to keep that attitude of gratitude. Being healthy, but they also eat so poorly because I agree with you completely done.

And I think that stress busting is really critical and that you put together a program for that already. Yeah, it's important. It's very important caregivers also I think need to not be martyrs. Following up on what you said about save yourself first, they need to be able to ask for help. Yes, in a reasonable way, straightforward way.

I need help here. What can you do to help me out? I can take a shift. Can you do some errands? I need to run. Can you call somebody for me? Can you do something to take a load off me? And they also need a little bit of assertiveness training to be able to say no. Would you also go and so over here?

I'm sorry. I'm not, I can't do that. That's not possible. I'm really full out with this particular thing I'm doing. So I'd love to, but I can't. I'm creating this, I've created this concept that I'm going to be rolling out in the next few months is called care team partners. And I'm with the lack of with Medicare with its changes and rationing care so badly.

And then we have a shortage of direct care workers. We need to create a sense of volunteerism in our communities to help the family caregiver with practical assistance, not hands on care so much, but how about helping somebody get to the doctors or bringing a meal for them? Or do they need laundry done?

Can I help do laundry while you're doing something else? So I'm calling it faith and caregiving because I want to start promoting it to churches and see if we can get. Because our growing senior community, it's necessary to have some support with the biggest problem with most family caregivers is number one, they feel like they're failing if they ask for help.

And we have to really encourage them. Hey, we're here. We are here to help you because so many of them are drowning in so many things they're doing, they're, giving up their jobs. They're going into debt. They're being judged by uninvolved siblings and other family members.

It's very challenging. And that's why I thought your book was really good because it actually promotes, dementia prevention in a realistic way. And anybody who reads it will understand, I have to do, take care of myself first. Because who's going to take care of me when something happens?

Because that's a big one. Very much so I'm going to ask you now for somebody looking into implementing advice from your book, what is the first steps they should take? Pull out the dementia checklist, the dementia prevention checklist, which you failed to mention is free and downloadable on our website.

So you don't even have to get the book to start the process. You can go up to brain doc.com. And for the listeners out there, I will have this on the webpage as well, a link to the book and a link to their website, brain doc.com. And there you can take your dementia prevention checklist, which will give you all of those 20, there's 25 questions, some of which you'll be able to answer right away.

Do you smoke cigarettes some of which you will not be able to answer right away because you probably don't know what your LDL level is. Yeah, you probably don't know or if you've ever had tested what your homocysteine level is So you will be able to download it Take it to your doctor. Get some tests run.

If you need them, look at what we haven't talked about, which is the likelihood that you've got sleep apnea true for 50 percent of everybody over the age of 58, in terms of the most recent research. It's amazing. One out of two people age 60 and above have obstructive sleep apnea. And so all those important things.

And that's a starting point. And finally, one last question for you before you've been so gracious with your time and I really appreciate it. What is the one key takeaway you hope every reader gets from using your say, using your head to save your brain? Stop being a dementia worrier, become a prevention warrior.

Oh, I love that. I love that. Yeah. Good job there guys. I like that one. Oh, and speaking of good job, you're doing a great job. Thank you for all the time and the effort that you put into creating these programs that makes so much sense for people who really need to help the guidance and support. Thank you so much.

And I'm excited to be able to promote your book and I hope people will buy it and start implementing the strategy so that they can have a longer, healthier and quality of life. Thanks guys. I appreciate you. I want to say to my family caregivers out there, remember, you are the most important part of the caregiving equation.

Without you, it all falls apart. So please, practice self care every day because you are worth it.

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