RE-RELEASE: DR. MITCH CLIONSKY - Dementia Prevention: Using Your Head to Save Your Brain

This episode originally released on March 11, 2024. While Don and I are taking a much needed break, we wanted to share one of our most popular and valuable episodes in case you missed it. And if you already heard it, it couldn't hurt to listen again because the episode is filled with powerful informstion for keeping your brain as healthy as you possibly can! Have a happy and healthy 2026...and thank you all for listening!

 Don and I both agree that this episode ranks as one of our favorites to date. Our amazing guest, Dr. Mitchell Clionsky is a board certified neuropsychologist with more than 30 years of clinical experience and has treated more than 20,000 patients with cognitive problems. Dr. Clionsky understands the toll of memory disorders as both a caring professional and as the son of his mother Muriel, who died in 2008 from dementia. 

Dr. Clionsky holds staff privileges on four hospitals and in addition to dementia, he evaluates ADHD, concussions, and a variety of neurological conditions. From years of patient data, Dr. Clionsky and his wife/partner Emily Clionsky, MD have developed the Memory Orientation Screening Test or MOST, a highly valid measure that provides a single, numerical score that reflects cognitive status and change over time. MOST helps identify -cognitive problems- earlier in the deterioration process so health professionals can intervene and help their patients live better lives.

Now Dr. Clionsky and his wife, Emily, have taken what they do in their consulting room and have written a new book, Dementia Prevention: Using Your Head to Save Your Brain. It's an exciting, fun to read, motivating, and potentially life changing read that is the culmination of 45 years of extensive clinical evaluation and treatment. Scientifically detailed and vetted by Johns Hopkins University doctors and content experts, it is translated into terms that almost everyone will understand.

8 out of 10 people over 55 say that Alzheimer’s disease and other dementias are a major concern. Well now there is something that can be done. Dementia is not inevitable, but for 1 out of 2 people it is preventable. And we are so excited to share all about this fascinating breakthrough. Enjoy!!

Connect with Dr. Clionsky here.

Chapters

• 0:00 Opening, Weather, And Catching Up
• 1:57 Docuseries Update And Support
• 3:12 Introducing Dr. Mitchell Clionsky
• 4:43 Hopeful Science: Function Over Fear
• 9:10 Medications That Slow Decline
• 12:20 Genes Vs Lifestyle: What Matters
• 15:20 What Really Helps: Exercise And Sleep
• 18:52 Hidden Risks: Smoking, Alcohol, OTC Meds
• 22:05 Anticholinergic Burden And Safer Choices
• 25:19 Checklists, Testing, And Roadmaps
• 28:21 When To Test And What It Means
• 31:15 Sleep Apnea, CPAP, And Brain Oxygen
• 35:04 System Gaps: Where Are The Dementiologists?
• 39:25 Screening, Baselines, And Medicare Barriers
• 43:31 The Book’s Origin Story And Mission
• 47:15 Practical Takeaways And Closing

Transcript

SPEAKER_00: 0:00

When the world has got shut down.

SPEAKER_01: 0:03

Alzheimer's sucks. It's an equal opportunity disease that chips away at everything we hold dear. And to date, there's no cure. So until there is, we continue to fight with the most powerful tool in our arsenal. Love. This is Love Conquers Alls, a real and really positive podcast that takes a deep dive into everything Alzheimer's, the good, the bad, and everything in between. And now, here are your hosts, Susie Singer Carter and me, Don Priest.

SPEAKER_00: 0:39

Hi everybody, I'm Susie Singer-Carter.

SPEAKER_01: 0:42

And I'm Don Priest, and this is Love Conquers All. Hello, Susan.

SPEAKER_00: 0:47

Donald, good morning.

SPEAKER_01: 0:48

Good morning. How are you today? It is gloomy and it's raining. Yeah.

SPEAKER_00: 0:52

It's rainy. We're having a we're having some kind of um, what is it? What do they call it?

SPEAKER_01: 0:57

I think it's called a storm. No. Yeah, it's called a uh it's an atmospheric river. I guess they got bored with rain. I guess in the same rain they got bored. Yeah.

SPEAKER_00: 1:13

Because it's I don't know what the difference between this is from last year rain, like, but somehow it's a river.

SPEAKER_01: 1:20

But it depends, you know, here in LA it's really weird because you know, it we we have like within 10 miles from here, they have 12 inches of rain and we have a half an inch. So we're in Los Angeles, listeners.

SPEAKER_00: 1:32

So if you don't know, we're uh we're in Los Angeles where you know any weather is is just it's it's incredulous. Yeah, yeah.

SPEAKER_01: 1:43

It's you know, the the the streets turn into uh a war zone and uh people don't know what to do, and uh they you know, so it's it's always a good time.

SPEAKER_00: 1:52

We get cranky, we don't like it. Anywho, but so yeah, everything's good. We're fit we're uh on a little update on no country for old people. We're very close to finishing um our docuseries, and um so so that's that's uh an incredible uh achievement for us right now. We've been working on this over the past like every day for almost two years, year and a half. And it's um so we're very very excited about getting to this point, and um we'll have some news as to where we you may be seeing it soon, and um you know we're still doing the tweaks and the polishes, but that's that's kind of the fun part now to make it pretty pretty and sound pretty and um and all those things. So uh we do we could we will accept more any support, financial support, if you know tax-deductible donations are always welcome. You know, there's always there's always some something that will come up and sneak up on us, you know, like uh a licensing fee for a song that that is somehow outrageously high. But in any case, we this will this will get out. But let's talk about what's going on today.

SPEAKER_01: 3:12

Today is very exciting. We have a very exciting guest.

SPEAKER_00: 3:16

A great guest today that's really um resonates deeply with me. So I know it's gonna be resonate, but he he will resonate very deeply with our audience. So why don't you give him a proper introduction, Don, and then we'll get to it.

SPEAKER_01: 3:31

I will be very proper. Dr. Mitchell Kleonsky is a board-certified neuropsychologist with more than 30 years of clinical experience and has treated more than 20,000 patients with cognitive problems. Dr. Kleonsky understands the toll of memory disorders as both a caring professional and as the son of his mother Muriel, who died in 2008 from dementia. From years of patient data, Dr. Kleonsky and his wife partner Emily Kleonsky MD have taken what they do in their consulting room and have written a new book, Dementia Prevention, Using Your Head to Save Your Brain. It's an exciting, fun-to-read, motivating, and potentially life-changing read that is the culmination of 45 years of extensive clinical evaluation and treatment. Eight out of ten people over 55 say that Alzheimer's disease and other dementias are a major concern. Well, now there is something that can be done. Dementia is not inevitable, but for one out of two people, it is preventable. And we're so excited to find out more about this fascinating breakthrough. So without further ado, let's say hello to Dr. Mitchell Kalyansky. Hello, Doctor.

SPEAKER_02: 4:39

Hello, Don and Susie. Glad to be here today.

SPEAKER_00: 4:42

You know, it's interesting because you, you know, let's we'll get into the dementia and Alzheimer's, but all of your other, you know, uh focuses, like, you know, um all just every kind of brain cognitive issue is so fascinating to me because you know it it it really affects everything in real relationship-wise and and your your quality of life. Like I but anyway, that's a whole nother story, but it's just incredible the kind of the kind of um work that you've been doing. So really impressed, obviously, and um so impressed with this comp with this conversation that we're gonna have because my mom had Alzheimer's for 16 years, which is a very, very, very long, long journey, right? Sure is and uh you know I I looked for somebody like you all the whole time, looking for somebody who could give me some insight in the window into this. And there isn't a lot of although there's a lot of research out there, there's there's very little that is um um relatable or resonates. It doesn't, you know, all of it is very sort of you know hypothetical, and you hear the same sort of things all the time, like exercise your brain, or how do you deal with somebody with Alzheimer's? And and you know, yes, uh that I learned very well eventually, but but the whole what is going on in the brain, right? And we don't it's very hard to understand. And then part two of my of of of my questions for you is like how does someone like us, you, me, people that have dealt have had it in their family, how do we live without living in fear? Because I live in fear all the time. If I forget anything, I feel like that's it, I'm done, I have it.

SPEAKER_02: 6:38

I'm on the fast train to dementia.

unknown: 6:40

Yeah.

SPEAKER_02: 6:41

Yeah. And that's part of the reason why I bring, I believe, a very optimistic kind of message. But it's a message that's based on sound scientific research. You know, we have been over the course of the years, and we meaning my wife, who's a brilliant physician, Emily, and who has taught me a lot about the medicine part of this that you don't get in clinical neuropsychology school as a PhD. And what we find is that if we can start off by finding correctable aspects of our health, fixing those, things that very often doctors have not even looked at. So we want to turn over every stone that's a reasonable stone. Don't want to go off on weird fads, but to turn over the reasonable kinds of physical things, dealing with diabetes, high blood pressure, uh, some of the things that we're taking that are over-the-counter medications, uh, alcohol, and how much is a healthy or not quite so unhealthy amount of alcohol to consume. What we know about smoking, what we know about sleep, and particularly sleep disorder breathing, where people are having sleep apnea, where they're not getting enough oxygen to the brain. So we can look at all of those and do some of the lab tests that we recommend in our book. What we find is that we can begin to set a foundation for building a better house above it, where we get those things solidly in place. And then we look at lifestyle as a way of improving cognition. For people who already are having problems with their memory, documentable kinds of diagnosable kinds of problems, then there are medications which have actually been out since the mid-1990s, which can slow down or stop the progression of decline from a functional point of view. Now, that means that underneath the surface, if we looked inside your brain, we would say, well, there's still those things that are brain cells that are dying. There's still, you know, tangles and plaques and things going on. But frankly, I don't care so much about what my brain looks like. I really care about how it works. And I think most people do as well, because that's really what it translates into. And we may not be able to do such a good job of changing how the underlying structure is working, but we can do a lot about function.

SPEAKER_00: 9:06

Is that are those are those drugs still, are they still like um uh nemenda and aerocept? Are those still the hallmark drugs for slowing it down?

SPEAKER_02: 9:16

They really are. There's two others very much like arocept. It's now called doneepazil because it's generic. But there's a second one called rivastigmine, and a third one called galantamine, all of which work to support the levels of a chemical in our brain called acetylcholine. Acetylcholine is important for making memories, for translating, transferring information from one brain cell to another. And while we can't put in more acetylcholine, we can make the existing acetylcholine work better. And that's really the key for those medications. It's also the reason why those medications don't improve memory, but they help to prevent it from getting worse. We also know that oftentimes combined with the other existing medication called mementine, what used to be called memenda, in combination they work even better than either one by itself. So we're bringing all different forces to bear when we're treating someone, because this is a major contest against dementia, and we want to use every single tool we have, including activity, including social engagement, including fixing hearing loss, which by the way, can cause decline in cognition. So it's a very important kind of thing. You know, but let me stop. Wait, when people ask me, what's the one thing I should do? What's the one thing I should eat? What's the one tip you give me? The answer is there isn't one, and that's the whole point. It's a combination. It's figuring out how these things work together, and so it's grasping the entirety of it. And that's what we try to do in the book, is bring in all these different ideas and then translate them into language that most everybody can understand. Because if you can't understand it, you can't use it.

SPEAKER_00: 11:09

It's true.

SPEAKER_01: 11:10

It's yeah, is there a way to determine whether it's genetic or behavioral or a combination thereof? And is it different for if it's genetic than if it's just behavioral as far as prevention?

SPEAKER_02: 11:21

For most people, the genetics of it are about 5%. We make a big deal about the genetics vectors, genetic testing that you can do. I don't advise it because it doesn't change a dart thing about how you're going to prevent dementia. If it did, I would recommend it, but it's sort of like just another nail in the coffin, so to speak, in people's view of what dementia is about. There are a couple genetic lines that are indicative of early, very early onset dementia, like people in their 50s. But by the time you are born into one of those families, and there are not too many of them, you know what it is because you don't have any grandparents. Everyone's died in their early 50s. Other than that, though, most of the genetics just sort of lean you a little more in that direction. Most of dementia, however, is not caused genetically. It's caused by a series of medical conditions we have and lifestyle factors. And in some cases, things that have happened to us that we can change. You know, we got dropped on our head when we were a year old. Not going back and changing that. We had a traumatic early life that predisposes us to having problems dealing more with stress, so we end up chronically depressed. Hard to fix that. There's a lot of, you know, we grew up in an area where there's a lot of pollution. Maybe you can't do anything about that. Or we ate some lead paint off the windowsill when we were young. But we're focused on what we can do now, whether you're in your twenties, your fifties, or even your 70s and 80s, because it's never too early to start. And you can make changes that are positive no matter where you are, no matter how old you are. So it's it's very important to start, as we say, play it where it lays. It's like golf. You know, sometimes you're on the fairway and sometimes you're in the woods. But either way, you've got to decide which shot you're gonna take.

SPEAKER_00: 13:24

Right. So I I have a question. I was thinking while you were talking about, you know, it it in your book you say it's not inevitable. Like dementia is not inevitable, and that one out of two people it's preventable. And and is that correct? Am I saying that correctly? Okay, so if it's not so, but do you think that there's some sort of built-in uh, you know, science for our that our bodies just you know that dementia is maybe like a way to ease you out of life. I don't know. I'm just I I'm trying to wrap my head around it if there's some biological reason that because I remember my mother, and she said this to me when her before my stepdad died, she said, Oh, I don't want to, I don't want to know when he dies because he's my best friend. And I and he was 12 years older than my mom, and I maintained that that part of having her Alzheimer's, because she was a very happy, happy Alzheimer's patient, you know. She she it was that she didn't have to remember all the time that he that he was not around. And I don't know if that's real or not, but I felt like it was like oh in some ways it was, you know, a double-edged sword.

SPEAKER_02: 14:30

Well, for one thing, you're certainly lucky that in spite of her dementia, your mother had a good personality. That's not always the case. No, that's true. And in some cases, people are very different emotionally than they were throughout their lives. Occasionally they become very nice. And when the families bring them in, they say, don't be fooled. This woman, they tell me stories, or this man they'll tell me stories. But at this point in their life, they're very friendly, they're very convivial, uh, they're gentle even. In other cases, you get people who never would utter a bad word about anyone, and now they swear up a storm and they're mean, and it's just a change caused by the neurological condition. To your point about is this uh sort of the way things should be, I don't know anyone who would choose to get dementia rather than living thinking well throughout their life and then just drop dead. As I say, I'd like to wake up dead one morning when I'm about a hundred. And uh that would be okay. I think it's really the fact that we're living longer. Because age is the biggest risk factor. When people they say, oh, well, you we should eat like we did in 1900, I said, that's wonderful, but most people died in their 50s. Right. Uh there was something recently that came across the internet where they did a study, they found out that dementia was really rare in ancient Greece and ancient Rome. It's like, people only lived to be 25 back then. This is not a disease of the youth, this is a disease of the aged. And now people are living to be 80, 85, even longer. You want to be healthy in your mind as well as your body throughout that time. So it's uh it's a matter of getting older.

SPEAKER_00: 16:17

It is, it is. So when you say, so what are I know you you you what are some of the things that are the hallmark of of you know of things that we should avoid? You know, we I've heard sugar, you know, anything that's inflammatory, um, you know, you hear things like we'll keep your mind exercised, doing puzzles, this and that. I mean, I'm an avid dancer, so I I always feel like dancing is gonna keep me as young as I can be because it's you know, you're always learning something new, and and you can only concentrate on that. So, or you know, and learning and music, things like that. What what is your thoughts on that?

SPEAKER_02: 16:58

So let's dispel most of the what you eat concepts because they contribute very little. Now, if you have a horrible diet, that's not going to be good for you. Never was good for you. You don't need another reason to have a healthier diet. But everyone's talking about the Mediterranean diet, the mind diet, which is a combination of the Mediterranean and another anti-inflammatory diet. It's always good, but it contributes so little to the difference that don't kill yourself trying to avoid eating butter because you're going to eat olive oil instead, or saying, oh my goodness, I can't have a steak because I got to have just chicken or fish. It won't make enough of a difference for the effort. As for the brain games, nice concept. It would be nice if our brains were muscles, we could exercise them. We can in fact create new pathways. And dancing is one of the best things that you can do because it combines mental activity, new concepts, new sequences, along with balance, which is really important from a false prevention, if nothing else, as well as the exercise component. Because it really is important to move every day. And if I can get my patients up and moving and walking and dancing, I'm always going to have a better outcome emotionally and cognitively than if they're spending their time sitting on the couch watching old westerns or the life channel on TV.

SPEAKER_00: 18:29

Right.

SPEAKER_02: 18:31

If you're going to look at a couple factors that are pretty universal, number one, exercise is going to be one of them. Number two, getting regular sleep is really important because our brain does important things for our body while it's turned down. I won't say off, but turned down while we sleep. One of the things that we've discovered a couple years ago is a whole new system in our body we didn't even know we had, because it's so microscopic. It's called the glymphatic system. The glymphatic system is in our brain. It has one function really, which is to flush out the toxins that accumulate while we're thinking during the day. So we have byproducts, waste products that build up, it's like the papers on my desk or in my trash can. Well, while we're sleeping, there's that cleaning crew supposed to come in and empty the trash cans and clean off the counters. That's the gymphatic system. It flushes out those toxins. Well, it doesn't happen if you're not getting enough sleep. It doesn't happen if you're not getting enough oxygen to your brain while you're sleeping, and there may even be some evidence that if you sleep irregular hours, that you're not as well off as if you have a more regular kind of sleep pattern. So sleep is important. You don't want to smoke cigarettes. No matter what you think your cancer risk is. It's not, it's very poor bad for your vascular system and for the nerves that are around the blood vessels that go to your brain. So there isn't a safe level of smoking. I have people who say, Well, I only smoke four cigarettes a day. And I say, Yeah, but when you're doing that, you're changing how much oxygen there is in your system and you're spiking your blood pressure, increasing your risk of stroke. Do you really want to do that for those four cigarettes a day, or can you figure out a different way of dealing with your at usually psychological rather than biological smoking habit? There's also some things that we buy at the pharmacy that we think are safe because they don't require a prescription. One of them being over-the-counter sleep aids that contain diphenhydramine, otherwise known as Benadryl. It's all those things with the PM at the end of those. Guess what? Remember the acetylcholine I was talking about a couple minutes ago? How we want to keep those levels up, that's why people get medications? Well, these over-the-counter things actually depress acetylcholine levels. So you can have problems thinking because of what you're taking to fall asleep.

SPEAKER_00: 21:13

Wow. So it is that all so Benadryl, you said Benadryl, right?

SPEAKER_02: 21:17

Yes.

SPEAKER_00: 21:18

So that's so that's you that's you know, an antihistamine, right? Yes. So same thing. So if you're taking antihistamines because you have allergies, that can create yes or no.

SPEAKER_02: 21:31

It's mostly the combination of things. It's really what we call the anticholinergic burden. So there's a calculator that you can use. It's online. It's called the anti-cholinergic burden calculator. We actually have a link to it in our book and on our website. Because if you put in the medications that you're taking or the things you're taking off label or non-prescription, it'll tell you what your risk is. Because these things do build up. And so it may not be that the Zertec that you're taking because of your seasonal allergies is such a big thing, but if you're also taking something so that it tightens your bladder while you're sleeping, that adds to it. If you happen to be on a heart medication that's anticholinergic, that adds to it. Some antidepressants add to it. So there's a variety of things that in combination, not a single thing, but in combination can be a problem.

SPEAKER_00: 22:26

Wow, Mitch, that's that's fascinating because you know you're ticking off a lot of boxes that people as you age, those are the kinds of you know, drugs that you're given. I know my mom was on an antidepressant for a long time, and then you know, uh heart medication and and diuretics, all those things that that probably contributed to the her loss of cognitive function.

SPEAKER_02: 22:50

Some may be. There's a lot of antidepressants that are not anticholinergic, and that's fine. I mean, really, I don't want anyone to stop taking anything.

SPEAKER_00: 22:58

No, but you need to just do your homework and talk to your doctor.

SPEAKER_02: 23:03

Right. Do not just the same way with the the little mothers, mothers' little helpers, the benzodiazepines, the valliums, libriums, atavans, xanaxes that sometimes are given out like candy. Actually, if you're taking a benzodiazepine on a regular basis for more than nine months, uh sorry, ninety days, excuse me, 90 days, which isn't a long time, three months, that can increase your risk of dementia. But don't stop cold turkey. That's the important thing. Talk to your doctor about a safe way to decrease your dependence on it.

SPEAKER_00: 23:40

That's interesting too, because our mother's generation took a lot of valiums and at right? That was part of like everybody took them. You know, and when my mom had uh uh migraines and there was a lot of you know those kinds of um medications that you just mentioned that were given to her because you know there was now they have incredible drugs like Ropax and things like that that you know you don't they're not they're not opioids, right? They're they work on a different kind of science and because I suffer with migraines and you know I I can't imagine that generation wasn't like my mom, she was like it just basically you were just dulling it for until it went away, you know. So um I I I can see why yeah, you really have to do your homework, and I think what you you're providing in your book is amazing, like the the link just to just to plug in your the drugs that you're taking. I mean, how easy is that to do to find out if it's a risky drug? I mean, that's so it's so easy and so important. Oh my god, I love you.

SPEAKER_02: 24:45

Thank you. Happy to be live. What do you think? In our book and uh on our website, which is called braindoc.com, is we have a dementia prevention checklist that you can fill out either online or you can download the PDF that'll give you an idea of where your behaviors and your health are either on target or off-target, or whether they're near target. Just you need a little nudge to get onto an on-target behavior. So it gives you sort of a roadmap. And one of the things we're working on right now is developing this into a colorized model so that people can not only fill it out, but it'll get a report at the end of it. It's not there yet, but it'll be there probably at the same time that, or maybe maybe after your uh documentary comes out, because it's a work in progress. But uh it's it's something which is definitely uh uh in the works right now, and I think it's going to be great because it'll give people the chance to say, here's where I'm doing okay, here's where I can focus on change. Because change is really the essence of adaptation, change is what life is all about, and for so many people they get stuck, usually in midlife.

SPEAKER_00: 26:10

Yeah, no, absolutely. I mean, I really I think it's incredible, and I think, you know, w what you first of all, your whole your whole framing of this is so awesome because it's so it's understandable, it it doesn't feel daunting, it doesn't, and I'm I am so resistant to the pie in the sky. Like I get people obviously because I've been doing I've been in this Alzheimer's community for a very long time, and I don't know if if you know we did a a short film based on my mom, the day in the life, you know, my mom and the girl, and I really wanted to destigmatize and and show the reality of it. Like you were mentioning, you know, people some I was lucky that my mom's you know was stayed, had a great personality, but she certainly showed some very odd things, like in my film, like out of nowhere, I was suddenly a whore and I should go back out on the street corner. And then when I told her later that she said that, oh, I would never say that. You need to look me up, right? You know, and so because she had a great sense of humor, but that you know, it it it was scary to her that those things were coming out of her mouth, because that wasn't who she was. But you know, and I knew that, but it was hard to hear. But but anyway, you frame it in such a uh a very um uh relatable way. It's very easy, like you said, exactly what you're saying, how you describe your book. It's very easy to relate to, it's it's it's you know, in every person language, and it really is comforting because I've been scared to death of like and Don is my partner, you know, and we I if I forget a word, I am certain I have Alzheimer's. Certain.

SPEAKER_01: 27:47

I was just gonna ask that. What what at for for those of us who are despite being wildly young, um continuously we just can't come up with that word, we can't think of a name, the people that we know it like the back of our hand. At what point do you say, because it's like I don't want to take an Alzheimer's test. I don't really want to know, because it's like, what do I do about it at that point? But at what point do you say, no, maybe you should, or no, let's just keep the preventative things happening so even if you're heading that way, you're doing the right thing.

SPEAKER_02: 28:20

If the test will motivate you to do more or better in your prevention strategies, then taking the test may be helpful because it'll say, well, you're starting to slip a little bit, redouble your efforts. On the other hand, I remember years ago reading the book, I'm dancing as fast as I can. I don't know if you ever read that book, but the intro to it is a joke. And it's about a couple that meets at a resort at the Catskills, and this woman and man are dancing, and he says to her, I'm only gonna be here for the weekend. And her response is, I'm dancing as fast as I can. So if you're doing everything that you're supposed to be doing, taking the test only is going to really tell you, should am I losing it enough that a medication being added to this might help? Other than that, that's really the the reason for doing the testing is to try to establish a level of cognition because we compare test scores with how the person should do based on their age and their education, their occupational background, and their reading level. So that's everyone's their own control, so to speak, their own comparison. The everyday kinds of things. Why did I walk into this room? Where did I leave my coffee cup? What was that thing I was about to tell you that I've now gotten distracted and forgotten? Are tickets that maybe tickets into evaluation, but they certainly don't tell the tale or make the diagnosis because there's such a huge overlap between normal cognition, everyday errors, senior moments, and something that's concerning that you can't use those as a way of gauging anything. I will tell people, look, if you they come in for that reason, and I see them clinically, I'll say, my hope is everything is great. I'll be able to reassure you that you're doing wonderfully, and point out a couple dementia prevention tips. But if they're not, if things don't line up as they should, this is a wonderful time, as a wake-up call, to figure out what do I need to do? Do I need to take some medicine? Do I need to change my habits? What do I need to watch out for? And we we start from there. So it's actually very reassuring when they come in and I can talk with them about okay, here's where you are. Let's see. It's wonderful to be able to say, you know, let's do an experiment. Uh, here's something controversial. Let's cut out that marijuana gummy that you're taking every night to go to sleep. Because, you know, back in the day, marijuana used to be 4% THC. But today it's like 18 to 30% THC. And when you were 20, you had a much younger brain than you're now having at age 70 or 75. Let's see what your thinking is like if you don't do this for a while. Because the jury, in my opinion, is still out on marijuana.

SPEAKER_00: 31:25

Yes.

SPEAKER_02: 31:26

And we'll figure it out 10 years from now, but for some people, that's going to be 10 years longer than they'd want it to be. So if you're going to use it socially, recreationally once in a while, probably not a big deal. But if you're using it every day, as a lot of retired people start getting high at about one o'clock, at the same time that they have to be having a cocktail because you know it's five o'clock someplace.

SPEAKER_00: 31:50

Yes.

SPEAKER_02: 31:50

That's not such a great idea for your brain on a regular basis. And sometimes you discover by not doing that for a while, you look back and say, Wow, I'm not having those moments any longer.

SPEAKER_00: 32:05

Right. Right. That's a that's incredible.

SPEAKER_01: 32:10

I have uh I do have sleep apnea, and and I I've had a difficult time uh doing all the things, the CPAPs, the APAPs, all those good things that I just I'm not very compliant with them. So I feel and it and it's gotten a little better as the years have gone, actually, since I've had it earlier. But I'm I'm always I always do feel tired, you know, they're watching TV and all of a sudden I'm just sleeping. If you do have that, do things like, oh, I'll take a 30-minute nap in the middle of the day. Do those things help, or you need that straight through solid block of sleep?

SPEAKER_02: 32:45

So this is the great question because I'm a huge believer in CPAP. Having used one myself every night for the last 18 years, I can tell you from all of the literature out there that the best thing I could do for you would be to help you learn how to get comfortable using your CPAP so that your brain will become five years younger. Because you've got to get that much more oxygen. Because even if you have mild sleep apnea, there's at least five times every hour that you either stop breathing or your oxygen drops by four percent. Now, if you're comfortable with Susie putting a pillow over your face five times every hour while you're sleeping.

SPEAKER_01: 33:30

Oh, we're not in the same room.

SPEAKER_02: 33:32

Doing so bad that it drives her away, probably.

SPEAKER_01: 33:35

We're not married. We're just we're not.

SPEAKER_02: 33:40

I thought that okay, somebody else is doing it you're sleeping with. That's what's equivalent to.

SPEAKER_01: 33:47

Yes, myself out of this case. Yeah.

SPEAKER_02: 33:51

But but seriously, that's the key. I mean, there are other techniques, there are dental devices which are somewhat helpful.

SPEAKER_01: 33:59

I've tried those.

SPEAKER_02: 34:00

They're not really as efficient. There's a new technique called Inspire, which they're touting on TV. It looks really easy, but it's not. It's only for moderate to severe sleep apnea. It's a surgical procedure. It only works in half of the case. Really? I didn't know what the price tag was. Yeah.

SPEAKER_01: 34:19

Oh, yeah.

SPEAKER_02: 34:20

It's only it only reduces sleep apnea by 50%. So if you have moderate to severe sleep apnea, you're going to end up with still mild sleep apnea. CPAP, similar kinds of devices, will get it down to the I have an APAP now, but yeah.

SPEAKER_01: 34:36

Yeah. Okay, so I should try again.

SPEAKER_00: 34:38

You've got it for CPAP.

SPEAKER_01: 34:40

Well, I have I have I've tried the CPAP. CPAP, I couldn't do it all. APAP I've got now, which is easier, is I don't know if it's 100% as effective, but it would be better than not doing the same thing.

SPEAKER_02: 34:50

So this is a automate, it's uh basically automatic, it adjusts to your pressures, which is perfect. Yeah. In fact, the ones that are set for particular pressures, we're talking serious stuff here, but we'll talk about this later if you like. But basically, you've got to find something with your doctor that works for you, and then you have to get your head wrapped around it. See, the thing for most men, particularly, is they don't feel that they will be sexy enough if they have a CPAP machine. If this were not audio, you could see that I'm just as sexy as I need to be.

SPEAKER_01: 35:27

Oh my god.

SPEAKER_00: 35:29

He is. Oh no.

SPEAKER_01: 35:33

Almost too sexy. Almost too sexy.

SPEAKER_02: 35:37

The key is, and I tell this to my patients, unless you're into doing it something kinky, the time you put on your CPAP is after you have sex. At that point, who cares? Right. Exactly.

SPEAKER_01: 35:54

Right, that's right. Exactly.

SPEAKER_00: 35:55

I love the way you think. I love it. Can I can I say to you this? So doing this documentary, like one of the things that that is so apparent in our healthcare system is that, you know, there are so few geriatricians anymore, and and the geriatricians that we that are even there don't really have a good handle on dementia and Alzheimer's. And so, you know, so you can imagine doctors that aren't geriatricians, your regular GPs, you know, it there really is ageism and ableism in within our healthcare system. So, you know, they're they're not getting, you know, I think as we grow older, unless you go to somebody like you, who's an expert, who really understands, you know, this whole the whole journey of of dementia and and and brain health, you're really at the mercy of people that don't understand it as well, right? And so there becomes sort of this pat answer, or they put you off to somebody else, sometimes a psychologist, sometimes, you know, because there just aren't enough experts. What, you know, how how can we fix that? It's so important because like you said, we're living longer, and it's like sending a baby to, you know, a heart specialist when they need to go to a pediatrician, right?

SPEAKER_02: 37:17

Wow, you have said a ton right there, and I agree with you entirely. In fact, you know, one of the things I've just a couple days ago, I was about to write a blog for my Psychology Today blog called Where Are the Dementiologists? There are none. Here's what's really interesting about this, and you touch on this, is that dementia is sort of a stepchild of a bunch of other disciplines. There's neurologists who do dementia work, but they also will treat seizure disorders, strokes, multiple sclerosis, a whole bunch of other things. There's psychiatrists who will treat dementia, but usually they're more interested in anxiety, depression, bipolar disorder. There's psychologists, even neuropsychologists like me, but we can't write prescriptions and we can't order many of the tests. I spend most of my professional life holding the hands of physicians to get them to write orders that I want them to write so that we can get this patient on medication or get a test that we need. GPs do all kinds of stuff. They're the quarterbacks, the internal medicine doctors. They're the quarterbacks of the team, but they don't have the time to get specialized. We also know the cardiology, endocrinology, exercise physiology, pulmonology, sleep medicine, man, you name it, there's all these other areas, all of which impact dementia, but there aren't any dementiologists. What we really need is a subspecialty that's trained, fellowship trained. In other words, you get your internal medicine degree and then you go on for additional training that involves geriatrics as well as all the neurology and other aspects of dementia so that you can intervene in these very or consult really with the other providers. So that's exactly what we need.

SPEAKER_00: 39:16

Oh, it's so so important because you know you you have someone with dementia or Alzheimer's, advanced Alzheimer's, but they're still, like my mom, I just used my mom as an example, but I've heard the stories, you know, now for a year and a half, really, really interviewing a lot of people, and they and every and most people experience the same thing is that you know, you you your loved one is sent to an emergency hospital, they don't even realize that they have Alzheimer's, so it's like, oh, they're non responsive. No, they have advanced Alzheimer's, they're there, just talk to them. You know, they will have they will respond with a shake of the head or a smile or whatever. They may have lost their ability to speak, but they're there. They don't understand, so they feel so they they attribute it to something else as opposed to that it feels. Being dementia, so they started you know trying to fix it with other things, and I saw it in my mom's records, her medical records, you know, and and that it was like I can't now it's off the top of my head I can't remember the the the medical term for it, but it was like the reason why she was non-responsive was for something else, and it was like had nothing to do with that. Because I could walk in and go, Mama, how you feeling? And she'd look light up, you know, and I could get her to laugh, and she'd laugh, you know, and and it just takes time, it takes patience, you know, and to and if you understand that, and if it was even if there was, you know, a requirement to look and know does this person over 70 at least have dementia? Let's know that right away off the bat, so that we treat them responsibly.

SPEAKER_02: 40:46

The whole question of testing people with a brief instrument starting at a certain point in time makes a lot of sense. Just to get a baseline, and even though it's a rather crude measure, one of the reasons we developed the memory orientation screening test was we wanted to get something that was quick, that was better than the existing tests in terms of its accuracy, and that we could get doctors to use on an iPad so it would deliver an actual report to them based on the five minutes of testing that they did, and then it could become a part of the patient's medical record.

SPEAKER_00: 41:26

I love it.

SPEAKER_02: 41:28

It's a great idea, but we ran into some practical realities, one of which being that Medicare will not reimburse doctors for doing this. They used to when we first started the test, and then they kept cutting down the reimbursement. Finally, they cut it out entirely. So now you have to have a doctor who wants to do more. And they're they're slammed, they're just absolutely slammed. That's why the appointments get shorter and the number of problems you can address gets fewer.

SPEAKER_00: 41:57

That's right, that's right. How can we change that? Okay, I know this is out of your book, not for part of your book, but it it's so infuriating because you have all this great information, right? So the what what happens is it becomes a responsibility for all of us. And yet if we aren't working together with our team, with our health team, it's sort of, you know, we're we're gonna hit a wall when when it's beyond our expertise. So when we end up in a hospital or if we end up in long-term care, people need to understand how to actually work, you know, be a team for someone with dementia. Because it it, you know, like you and it's when so many people have it, why is it not a specialty? And you're and it I guess it's follow the money again, right?

SPEAKER_02: 42:44

Probably. And also that we've got so many specialties now. I think that that's we don't have enough doctors. That's the other thing. So we're dealing with shortages in a lot of areas. I think that this should be part of every medical school education. Uh at one point, uh Emily and I were talking about starting a dementia prevention foundation with the goal of putting a book into the hands of every one of the 80 some thousand medical students there are in the United States, just as a starting point, saying, here, here's something, because it's the same knowledge you would get from reading the medical journals. They're all all the references are in there to the medical journals. It's just that we've taken that and now translated it so that it's but the doctors can go back, or anyone who's reading it can go back to the original articles and say, okay, let me try to read this in medicalese and look at the statistical analysis and look at the sample size and all these things that we do in research. But that would be a starting point. It would also be a starting point. One of the other ideas we've been toying with is taking our test and setting it up so it can be done at home by a loved one. So if you wanted to sit down with your mom, let's say, early on, give her a five-minute test that would give you something you could take to the doctor and say, Let's act on this. Let's get the blood test she needs, let's get this. Let's not just write it off as being sort of normal because you know she's kind of old.

SPEAKER_00: 44:13

Mild cognitive impairment. That was like the first diagnosis my mom got was mild cognitive impairment. You know, and my mom was so, you know, she was very quick-witted and she could wit her way out of anything, right? You know, so and um, you know, Joia de V for days, and so you know, it was like doctors didn't really take it seriously, you know. They would forget that she even had and I knew because I knew her so well.

SPEAKER_01: 44:38

I knew you saw her behaviors change, not just what she couldn't remember. You just saw her behavior change.

SPEAKER_00: 44:44

But if she couldn't remember, she would figure out a way to make it work, you know, and so like you know, down to the point of like, do you you know, do you remember this person? Of course I do. You are so beautiful to me, right?

SPEAKER_02: 44:58

Everyone becomes a honey or a darling or uh or a song.

SPEAKER_00: 45:03

My mom sang a song to everybody because that was her, that's what she that was her tool. So, you know, it it could be worse, you know, it could be worse.

SPEAKER_01: 45:12

It was it was very uh yeah, what was your aha moment we for you and Emily to say we gotta write a book? We gotta take everything we've we've aggregated to this point and and why a book as opposed to just a website, or what what was the the the process?

SPEAKER_02: 45:28

Great question. It was sort of accidental in a way. Uh there was a conference. Both both of us need continuing medical or psychological education credits every year in order to keep our licenses. So we're living in Western Massachusetts. There was a Harvard conference down in Boston on social media and book writing, nonfiction book writing for medical professionals. And so I said to Emily, look, this sounds like fun. We can go down there, we'll get our credits, we'll stay in the hotel we enjoy the most in Boston, and we'll just do this. This is light, this is easy, we'll just go and have fun. So we go down there and we walk in, the usual Harvard conference, there's like three, four hundred people sitting in a ballroom, and we look at the whole list of things that are going to teach us how to write an elevator pitch. They're going to teach us how to do this and that and the other thing. Meanwhile, my wife, who by the way, went to medical school at age 43, having a history. Rockstar.

unknown: 46:31

Rockstar.

SPEAKER_02: 46:31

I know, she's amazing. So she previously had been in sales and in other areas, high-tech sales, like selling early computer systems back when they morphed from uh from typewriters and those kinds of things. Anyway, so Emily's a lot smarter than the average person. I'm sitting there, like I am, trying to learn about this stuff. Meanwhile, she's scoping out the room where all the book editors and agents are congregating. And we go back to the room and we do the elevator pitch, and she's now selling it within about the first hour and a half of the conference. So she pulls me over there, and we meet this guy who is the acquisitions editor for Johns Hopkins Press. And she scoped it out, realized we want an academic press because we want something that's grounded in the science. There's enough books out there on Eat This, Do That. They don't work, but they sell a lot of books. And she said, we don't want to do that. If we sell books, that's great, but we really want to do something we can be proud of that's scientifically based. And so she went up and developed this pitch, and I was standing there with her. She gives this 90-second pitch to this guy who's now breathless on the other side. By the way, Johns Hopkins also publishes the book that's the best book for caregivers of someone with dementia called The 36-Hour Day. If you haven't read that book and you're caring for someone with dementia, it's like a godsend, it's a guide. Anyway, so the guy on the other end of this says to her, Wow, that would be perfect when we come out with the eighth edition. Now, this is Dow back in 2019, pre-COVID. So he says, We're going to be coming out with this in like 2022, but this would be a perfect companion. He says, you know, if I had a contract with me, I would have you sign it now. So I look at him and I said, I've got a fax machine. I call this bluff. Turns out he didn't have a contract. Turns out we had to go through all this vetting by these different scientific committees and experts to do it. But that was the start of it. It came up purely as let's try this. And then the question is, how does a husband and wife, how do a husband and wife write a book together when they've never done something like this? It's a marital stress test.

SPEAKER_00: 48:52

I would survive.

SPEAKER_02: 48:54

I I would it's very good for growing new relationship credits and figuring out how to do a very sophisticated dance with each other. I would it's it's not for the timid.

SPEAKER_00: 49:06

No, no. Don and I are best friends forever. We're best friends since I'm 19 years old. And he's been through my whole life with me. I've gone through two divorces, and we've worked really well together. We we barely ever have a TIFF. But this, I mean, it is it, and I can say that we and we get along so well, but it working together is is really hard.

SPEAKER_01: 49:30

It is.

SPEAKER_00: 49:30

It's really hard. It put it can, you know.

SPEAKER_01: 49:32

When it's not just, yeah, when it's not just this. You know, there's other relationships involved because it's a dance. And yeah, and you gotta learn all new steps constantly.

SPEAKER_00: 49:43

Oh yeah. I I think every I want this is what I want. I want everybody to have this book. Everybody needs to have this book. Like it you need to have, I would I'm I it's a Bible. You have to have this book.

SPEAKER_02: 49:59

Say it's the people, tell them where to get it. Yeah.

SPEAKER_00: 50:02

Oh, we're gonna tell them that we're gonna have it on the uh where we get it on Amazon, right?

SPEAKER_02: 50:06

You can get it on Amazon, yes, you can.

SPEAKER_00: 50:08

Yeah, but we're gonna we're gonna have it in the show notes, people will have it, and then we'll also put it up on when we edit this, we'll have it up on on this on the screen as well. But you guys, this is Love Conquers Alls, right? This is our podcast, this is what we do. We, you know, and through this loving relationship of Mitch and Emily, who came together and and sat and almost, you know, really put their their marriage to the test and wrote this incredible book that is so easy to assimilate and to do. And it's so it so resonates with me because trust me when I tell you, having been in this this community for so long, how many people have approached me with this and that and cranial and you know, and this diet and this drug and so and so, and I just go and nothing has resonated with me as much as your book. And I think it's just practical and and and smart, and it's it's it's all we have today is your book. I really mean that.

SPEAKER_02: 51:09

I really appreciate what you're saying. And and actually Don was asking about audible is it on Audible? If it is, it's narrated by an actress out in LA who, if you haven't met her, she's sorry, wait, hold on.

SPEAKER_01: 51:22

Wait, we have to edit that.

SPEAKER_00: 51:24

It's a podcast. People know Yeah, that's okay.

SPEAKER_01: 51:27

We if we fact we probably won't even edit it.

SPEAKER_02: 51:29

Leave it in, it's wonderful. I'm assuming is that a real dog or is that just your your telephone? There's two of them.

SPEAKER_00: 51:37

There's two dogs.

SPEAKER_02: 51:39

Actually, pet owners is an anti-dementia thing. I don't know if you knew that, but pet owners, especially dog and cat owners, I don't know about iguana owners, but pet and cat dog and cat owners, actually, that's a positive thing for your cognitive health as well as your emotional health. So you're doing a good job by having a dog.

SPEAKER_00: 52:02

Excellent, excellent. And now that I know it's on Audible, you guys, now there's no excuses because Audible is my life. I I have read, I say read, but because I I can multitask like no other. So I love Audible more than anything. I how man how many books do I listen to, Dawn? Like every I just go.

SPEAKER_01: 52:22

About four a day.

SPEAKER_00: 52:23

Yeah, I love them so no, no, no, no. I but I do, I love them so much because you can get, you know, you're driving, you can hear it, and it's like it's so much better. And I'm very audible, you know, I'm I'm auditory, so it really sticks. It sticks very well. So yay. So Audible, Amazon, you guys get it. It's gonna be this is this is a game changer. I really believe that.

SPEAKER_02: 52:48

Well, thank you.

SPEAKER_00: 52:49

Yeah. Oh no, Sirius, thank you. Thank you for putting so much time and thought into this and and being so you're so reasonable. You know, you're just very reasonable, and I just I get I get such a good feeling about it. Um, is there anything that you wanted to say that we didn't say that we might have missed that you feel is important?

SPEAKER_02: 53:08

You know, we covered a lot of really, really good things. I guess you know, to sort of put things in a nutshell, again, the fact that so much of dementia is preventable gives us hope. The fact that it's something that we can analyze in terms of our own lives and develop a roadmap toward improving, I think is very important. And I can't overemphasize the importance of adapting to life as life changes and as we change. That's sort of the key. You know, we we grow up and changing and growing is an important part. So many people get stuck in midlife. I'm really hoping to help them to push beyond that and to make you know the last 20 years of their life maybe the most enjoyable, the most positive aspects that they can. If we can do that, we'll have accomplished a lot.

SPEAKER_00: 54:04

That's beautiful. That is a beautiful thing. Yep. I agree. Thank you. Wow. Well, thank you so much. And and and tell Emily we thank her as well. And and that she is a rock star, and I love it. Gotta love a woman that goes up and just pitches it, just goes, got it. I know how to get this done. Watch out, folks. I love that. So um maybe we can we'll talk to her one day with you again. You come back with your next yeah, I would love it. Um because yeah, I mean, we we like we say, that's why we call love conquers alls. We just really believe that, you know, it takes a lot of love and it sounds like you know, it because it does. It takes a lot of heart to put your to put a lot of time into something like this because I'm gearying up this ending.

SPEAKER_01: 54:56

I'll tell you what, I know she's setting me up here. I'm setting them up for this. Watch how this works. Watch how this works.

SPEAKER_00: 55:01

So why, John? Why do I say that?

SPEAKER_01: 55:04

Well, you say that, you know why? Because love is powerful, love is contagious, and love conquers alls. And we do thank Dr. Mitch Kleinsky today. What a what a wonderful show and what a wonderful thing you're doing. Uh, if you like what you heard today, please like us, follow us, subscribe, do all those things you can. And definitely we will put up the the the book and all the links and everything to your website. And uh again, we thank everyone for listening or watching today. And uh we will definitely see you next time. Bye bye.

SPEAKER_00: 55:36

Take care.