0:00

But

0:00

inevitably we know that it's

0:06

possibility for all of us now if

0:06

there is a familial history of

0:10

it, we have a higher chance of

0:10

developing it does not mean that

0:13

we're going to get it we just

0:13

are more predisposed to it but

0:17

we have some control over it to

0:17

be able to say, Okay, I'm going

0:22

to try to live the healthiest

0:22

lifestyle I can, with the

0:25

ability to lower my risk.

0:28

Welcome to Now

0:28

or Never Long-Term Care Strategy

0:31

with Kosta Yepifantsev a podcast

0:31

for all those seeking answers

0:35

and solutions in the long term

0:35

care space. This podcast is

0:39

designed to create resources,

0:39

start conversations and bring

0:43

awareness to the industry that

0:43

will inevitably impact all

0:46

Americans. Here's your host

0:46

Kosta Yepifantsev.

0:50

Hey, y'all,

0:50

it's Kosta. today. I'm here with

0:52

my guest. Dr. Jennifer Stelter,

0:52

clinical psychologist, dementia

0:56

expert in John Hopkins press

0:56

author specializing in dementia

1:00

care. Dr. Stelter is a certified

1:00

dementia practitioner, certified

1:05

Alzheimer's disease and dementia

1:05

care trainer recognized by the

1:09

National Council for certified

1:09

dementia practitioners. Today

1:13

we're talking about dementia,

1:13

mental health and how to lower

1:17

the risk of Alzheimer's. Dr.

1:17

Stelter, as a clinical

1:21

psychologist, you've spent the

1:21

majority of your career

1:24

researching, developing and

1:24

experimenting to provide

1:27

innovative solutions and

1:27

treatments in the dementia care

1:30

space. How did you start working

1:30

in this field?

1:34

Absolutely.

1:34

First, thank you for so much for

1:36

having me on, I appreciate it.

1:36

You know, my journey is quite

1:39

different than a lot of

1:39

healthcare providers, or, you

1:42

know, caregivers who move into

1:42

this space. I'm a clinical

1:46

psychologist by trade, as you

1:46

mentioned, and the earlier part

1:49

of my career actually was spent

1:49

strictly in mental health. And

1:52

so I work with a wide variety of

1:52

clients, you know, anywhere from

1:56

folks with me, you know, minor

1:56

depression all the way through

1:59

severe, you know, cognitive and

1:59

psychotic, you know, events and

2:04

things like that. And so, you

2:04

know, when I was in my postdoc,

2:09

actually, I started a project

2:09

with Northwestern here in

2:14

Chicago, Illinois, and the Heinz

2:14

VA, where we were looking at

2:18

helping seniors to live a

2:18

healthier lifestyle. So that was

2:21

kind of my first exposure to the

2:21

senior population. And I just

2:26

absolutely fell in love with

2:26

working with them, spending time

2:30

with them, talking hours with

2:30

them about their, their life

2:35

experiences, and I learned a

2:35

tremendous amount. And so to

2:39

myself, I said, you know, I

2:39

really think I have something

2:41

here in terms of where my

2:41

interest might lie for the rest

2:44

of my career. And so, after my

2:44

postdoc had completed, I

2:48

actually entered into senior

2:48

living, and helped in the

2:52

behavioral health realm. And so

2:52

here in Illinois, a lot of

2:56

individuals who have mental

2:56

health challenges do end up

2:59

seeking services in nursing home

2:59

kinds of settings, because it

3:02

isn't available mental health

3:02

services, you know, to the

3:05

spectrum that it used to be. And

3:05

so that's kind of where I

3:09

started in senior living, and

3:09

then quickly transitioned into

3:12

working in memory care. And so

3:12

you know, in the same realm,

3:17

when I was working with seniors,

3:17

at the Heinz VA, Northwestern, I

3:22

absolutely just fell in love

3:22

with folks living with dementia.

3:25

They're, they have so much fun

3:25

during the day, and they are

3:29

just the sweetest folks. And so

3:29

when I started to kind of embark

3:33

upon that journey, I realized,

3:33

wow, I really can make a

3:36

difference here. And where I

3:36

started to kind of unravel the

3:42

onion was talking to a lot of

3:42

nurses, certified nursing

3:46

assistants, family members, and

3:46

they just struggled with

3:50

understanding what the disease

3:50

was about how it progressed,

3:54

what happens to the person, and

3:54

what can you actually do to

3:57

connect with people living with

3:57

dementia, because many of them

3:59

were struggling with how to do

3:59

this. And also further, I

4:03

learned that there wasn't a lot

4:03

of quality education out there

4:07

for people seeking the need to

4:07

be able to care for people

4:10

living with dementia. And so at

4:10

that point, I said, I can take

4:13

my psychology, experience and

4:13

education and really apply it to

4:19

this world of dementia, and be

4:19

able to really make a

4:23

difference. And, you know, most

4:23

people they enter into this

4:27

industry because they have a

4:27

loved one or someone that they

4:29

were very close with who

4:29

developed the disease. And I

4:32

actually quite the opposite

4:32

actually entered it because of a

4:34

love and passion and a calling

4:34

for it. And then later on

4:37

actually had a grandmother in

4:37

law who developed Alzheimer's

4:40

disease and was able to be a

4:40

good asset to the family. So

4:43

it's kind of a reverse for me,

4:43

and I just really haven't looked

4:47

back ever since.

4:48

Well, let's give our audience some background information for the

4:50

rest of the episode. How does

4:54

dementia affect the brain?

4:56

Yes, so

4:56

when we talk about specifically

4:58

Alzheimer's disease, Um, because

4:58

there are many forms of

5:02

dementia. So with Alzheimer's

5:02

disease being the most common,

5:05

we'll kind of start there. You

5:05

know, there are I like to really

5:09

kind of talk in, in, you know,

5:09

words that anybody can really

5:12

understand, right? So there's

5:12

plaques and tangles that form in

5:16

the brain that are called

5:16

protein deposits, right, they

5:18

can kind of they can glom

5:18

together like a, what I like to

5:22

call like termites on wood,

5:22

right. So, you know, we know

5:26

when termites affect wood, they

5:26

actually eat away the wood until

5:29

it's gone. So the protein

5:29

deposits are actually doing that

5:32

they're eating away that portion

5:32

of the brain work formed. And

5:35

unfortunately, several protein

5:35

deposits kind of form around the

5:38

brain. Now, the reason that

5:38

these Protein Protein deposits

5:43

form are from many different

5:43

factors. Some are lifestyle

5:48

factors, some are genetic

5:48

factors, okay? And when these

5:52

protein deposits form, they

5:52

don't break up. Okay. Now, you

5:57

and I may have protein deposits

5:57

formed in our brain, but

6:00

they're, they break up, right.

6:00

Okay, interesting. And so what's

6:04

happening is they don't, they're

6:04

forming together, and they're

6:06

eating away parts of the brain.

6:06

Now, those parts of the brain

6:10

that are being kind of eaten

6:10

away, are, you know, they how

6:15

has many functional skills for

6:15

us that keep our brain and our

6:18

body going. And when that part

6:18

of the brain is gone, the person

6:22

can no longer use those skills

6:22

are no longer present anymore.

6:26

And so that's like kind of high

6:26

level what's happening with

6:29

Alzheimer's disease. Now, there

6:29

are other forms of dementia that

6:32

we, you know, more commonly know

6:32

about now, because of folks like

6:37

you who are spreading the word.

6:37

Many different kinds of gurus in

6:41

dementia care myself, and so on

6:41

and so forth. Right. So things

6:44

like we've learned more recently

6:44

about frontal temporal dementia,

6:48

right? We've learned about Lewy

6:48

bodies dementia, right? We've

6:52

learned about vascular dementia,

6:52

right? These are all forms of

6:55

dementia. And they affect the

6:55

brain differently. But when we

6:59

talk about Alzheimer's disease

6:59

being the most common, that's

7:01

really what's going on as the

7:01

disease progresses.

7:04

So the other

7:04

forms of dementia and believe it

7:08

or not, I did not know that

7:08

dementia was a symptom of

7:12

Alzheimer's, even though I've

7:12

been in this industry for a

7:15

decade. That is a misconception

7:15

that a lot of people get wrong,

7:20

you know, and so I've been

7:20

educated as well. And I'm glad

7:23

that people that tune in they

7:23

get an opportunity to understand

7:26

the difference. So if

7:26

Alzheimer's is caused by the

7:32

proteins, the built up of the

7:32

plaque, and the tangles, are the

7:37

other forms of dementia, the

7:37

Lewy Body, the vascular

7:40

dementia, are those also caused

7:40

by the same plaque buildups in

7:45

the brain? Or is that is that a

7:45

different? Cause?

7:49

There are different causes related to that. So for example, when you

7:50

talk about, like Lewy bodies,

7:55

dementia, or I'm sorry, like

7:55

vascular dementia, with vascular

7:58

dementia, it's brought on by a

7:58

series of strokes. And so

8:01

depending on where the stroke

8:01

was in the brain, that is going

8:04

to impact those functional

8:04

deficits. Now, if the person has

8:09

multiple strokes that affect

8:09

various areas of the brain, then

8:13

of course, the brain is more

8:13

impacted. Right. Okay. And so

8:17

yeah, it depends. I mean,

8:17

obviously, you know, we can go

8:20

into each one of those. But I

8:20

think that what's important to

8:22

know is that these various forms

8:22

of dementia do impact the brain

8:26

in different ways. And

8:26

unfortunately, it does cause

8:28

what is a loss of mental

8:28

functioning, which is what

8:31

dementia is. And that loss of

8:31

mental functioning can cause

8:35

deficits and orientation,

8:35

memory, language learning

8:39

ability and judgment, right. And

8:39

so depending on which symptoms

8:43

they have, that can equate to

8:43

this form of dementia. And as we

8:48

were saying, you know, dementia

8:48

is just an overarching term that

8:52

it can be shown up in all of

8:52

these various diseases. So when

8:55

folks say something like, my mom

8:55

had Alzheimer's disease, she

8:58

didn't have dementia. That's not

8:58

accurate, right? Because if she

9:01

had Alzheimer's disease, she had

9:01

dementia. Right. But when

9:04

someone has dementia, they may

9:04

not have Alzheimer's disease, it

9:08

might be something else. Yeah.

9:09

So let's

9:09

focus on Alzheimer's. Two

9:11

questions. What are the stages

9:11

of Alzheimer's disease? And at

9:15

what stage? Is it normally

9:15

apparent to the people around

9:19

you?

9:20

Sure,

9:20

absolutely. So for simplicity

9:22

purposes, there's early middle

9:22

and late stages. Okay. Now, for

9:26

any folks who are turning and

9:26

who are tuning in who might be a

9:28

little more clinical, I like to

9:28

use the functional assessment

9:34

stage called the fast

9:34

assessment, and that breaks it

9:36

down into seven stages. And that

9:36

just allows us as clinicians to

9:40

be able to pinpoint a little

9:40

more fine tuned ly where they

9:43

might be in in the progression.

9:43

But for early, middle and late

9:47

stages, where we start to

9:47

actually see some changes where

9:50

other people can notice is

9:50

definitely in the later parts of

9:53

the early stage. Now, early on

9:53

folks who are living with it, do

9:58

notice that there's a difference

9:58

but they may not want to talk

10:01

about it, they may not want to

10:01

admit it, right. But they know

10:06

something's different. Where

10:06

again, where it's picked up on

10:10

with from other people is when

10:10

it's later in that earlier

10:12

stage. And so what loved ones or

10:12

even clinicians might start to

10:18

pick up on is, you know, when

10:18

the person has repeated their

10:20

stories, you know, over and over

10:20

again, and they are saying it as

10:24

if they have never said it

10:24

before, right? It's not apparent

10:28

to them that they're repeating

10:28

it, right. They're losing things

10:32

quite often. So it's not where

10:32

you lose one thing. So people,

10:35

you know, they freak out, like,

10:35

oh, my gosh, I lost my keys

10:37

today, do I have dementia?

10:37

Probably not. Right. But you

10:42

know, if you start to lose

10:42

subsequent amount of things,

10:45

driving to places and not

10:45

knowing how to get home,

10:48

especially places that they've

10:48

driven to quite often, and it's,

10:52

you know, what we call a skill

10:52

of procedural memory, where it's

10:55

almost automatic, you know, how

10:55

to drive to and from, and now

10:58

you struggle with that, right?

10:58

When there's problem solving

11:02

challenges, right, you're not

11:02

able to kind of work through

11:05

some of the day to day things

11:05

that we are normally can. When

11:10

there's challenges around

11:10

compliance of medication, right,

11:13

they're either not taking their

11:13

medications or they're

11:16

overtaking them. Financially,

11:16

there's challenges where we

11:20

start to see that either they're

11:20

not paying bills, or they're

11:22

overpaying bills, right? Or,

11:22

unfortunately, we see quite a

11:26

number of seniors being scammed

11:26

financially, and falling into

11:31

kind of those buckets, right.

11:31

And so when we start to see an

11:35

impact, like I said, on driving

11:35

skills, medication management,

11:38

financial management, you know,

11:38

problem solving organizational

11:42

skills, some short term memory

11:42

deficits, that's where we start

11:46

to say, we need to start to seek

11:46

help.

11:48

And I see a

11:48

lot of people, in my opinion,

11:51

think that this is a very small

11:51

population that are going to

11:55

develop a some form of dementia.

11:55

But individually, how do we come

12:01

to terms with the fact that

12:01

roughly one in five will have

12:06

some kind of cognitive

12:06

impairment in their life?

12:09

Yes. And

12:09

even after age 85 is wanting to

12:13

why. So how do we come to terms

12:13

with this? I think that we have

12:19

to understand, you know, one,

12:19

that we have the ability to

12:26

likely prevent this. Okay.

12:26

Right, by lifestyle changes,

12:31

and, you know, various health

12:31

entities that we have control

12:35

over okay. to, I think it's to

12:35

stay educated, the more educated

12:41

we are on this disease, and, and

12:41

we're willing to talk about it,

12:44

and we're willing to learn more

12:44

about it. I think that can only

12:48

make us more powerful, right. So

12:48

I think that inevitably, we know

12:54

that it's a possibility for all

12:54

of us. Now, if there is familial

12:58

history of it, we have a higher

12:58

chance of developing it does not

13:02

mean that we're going to get it

13:02

we just are more predisposed to

13:06

it. But we have some control

13:06

over it to be able to say, Okay,

13:11

I'm going to try to live the

13:11

healthiest lifestyle I can with

13:15

the ability to lower my risk,

13:15

right?

13:18

Can you

13:18

expand on that healthy

13:21

lifestyle? Like, what do you

13:21

believe are the key tenants? And

13:26

I know most people say diet and

13:26

exercise, but I want you to go a

13:29

little bit deeper than that.

13:29

What are the things that we can

13:33

kind of start right now in terms

13:33

of creating a healthy lifestyle?

13:37

Yeah, so there's a lot of clinical evidence around this. And you

13:39

know, we've a lot of research

13:43

has been spent on trying to find

13:43

a cure for Alzheimer's and other

13:46

forms of dementia. But I know a

13:46

lot of entities are shifting

13:49

towards brain health, right? And

13:49

so if you do see any educational

13:52

forums or discussions or blogs

13:52

around brain health, read it.

13:56

Okay, take the time to read it.

13:56

Right. So where do they

14:01

pinpoint? Right, I will start

14:01

with diet and exercise, but I

14:03

will be more specific, the

14:03

Mediterranean diet has been most

14:07

studied to help with you know,

14:07

lowering the risk for cognitive

14:11

impairment. It also has shown

14:11

some great entities for our

14:15

physical health, as well, as

14:15

well as our mental health. It's

14:18

actually shown to lower

14:18

depression and anxiety in men

14:21

and women. Wow. So the

14:21

Mediterranean diet is a focus a

14:24

lot on like leafy greens, foods

14:24

that are high in omega three

14:28

fatty acids, and if you don't,

14:28

like you know, fish is kind of a

14:31

big one for that. If you don't like that, you can always take supplements, you know, that kind

14:33

of thing. There's a point

14:36

towards you know, nuts and

14:36

lagoons, you know, various kinds

14:39

of beans, you know, things like

14:39

that. Staying away from you

14:43

know, lots of like a high sugar

14:43

diet and whatnot. You can have

14:48

like red meat but you know, in

14:48

moderation, you know, those

14:51

kinds of things. So, I highly

14:51

recommend looking up the

14:55

Mediterranean diet and actually,

14:55

the mind diet and that's it An

15:00

acronym mi n. D, was studied

15:00

extensively by Russia University

15:06

here in Chicago. And so if you

15:06

Google that you'll find some

15:09

clinical evidence wrote.

15:09

Absolutely. So that's diet when

15:14

we talk about exercise. And

15:14

looking at the evidence around

15:18

it, there actually pinpointed

15:18

having about two and a half

15:22

hours a week, at a rigorous,

15:22

like a rigorous rate. That'd be

15:26

like a brisk walk could actually

15:26

lower your risk for developing

15:30

dementia. So two and a half

15:30

hours a week, you break that

15:33

down as maybe 30 minutes a day,

15:33

five days a week, right? Where

15:37

you're walking briskly around

15:37

your neighborhood, right? So it

15:40

doesn't have to be something where you have to go buy an expensive gym membership or

15:42

anything like that, you can

15:45

actually use the resources at

15:45

home to be able to do this. And

15:48

so it can be implemented if

15:48

you're carving out the time to

15:52

do that.

15:53

So one more

15:53

follow up question. Yeah, go

15:56

ahead and finish your thought first,

15:58

I was going to add to that, because there are a number of other

15:59

things that we can do to lower our risk too. And I do want to

16:01

try to spread the word on being

16:06

able to stimulate us

16:06

cognitively. Though, a brain

16:12

games is a really great way to

16:12

do this. And you have to kind of

16:15

pick and choose what your

16:15

favorites are, whether it's to

16:17

duco, whether it's crossword

16:17

puzzles, word searches, right.

16:21

And these are easily accessible

16:21

apps on your phone. Now, I'm

16:25

still old school. And I really

16:25

do encourage folks to still use

16:28

paper and pencil versions of

16:28

these because you're actually

16:31

utilizing other parts of your

16:31

brain that you may not otherwise

16:35

when you're using just the

16:35

phone, like maintain your

16:38

writing skills and things like

16:38

that. Absolutely, it's very

16:41

important, we do that. And

16:41

unfortunately, we're seeing a

16:44

lot of, you know, fine motor

16:44

skills, kind of struggling for

16:50

our younger folks, because

16:50

they're so used to using

16:53

computers and phones and things

16:53

like that. So it would be in our

16:56

best interest to still use paper

16:56

pencil as much as we can. But

17:00

you know, the research is

17:00

actually pinpointed to about

17:05

three times a week, 30 minutes

17:05

at a time, engaging in some form

17:09

of cognitive stimulation. Okay,

17:09

now that can come from those

17:13

games that I mentioned, but can

17:13

also come from things like using

17:16

your baking and cooking skills,

17:16

gardening skills, anything

17:19

tactile in nature, can be really

17:19

beneficial to your cognition.

17:23

The research shows that nothing

17:23

less than that, because if you

17:27

do less than that, you're not

17:27

really benefiting your brain.

17:30

But you don't need more than

17:30

that, right? So that three days

17:33

a week, 30 minutes at a time.

17:33

And if you can't sustain

17:36

attention for 30 minutes, then I

17:36

say break it down to 15 minutes,

17:39

right?

17:39

Because that

17:39

is a problem nowadays. Actually,

17:42

we were just yeah, my wife and I

17:42

were just talking about that

17:44

this morning about ADHD and

17:44

they've actually developed to

17:48

have children. So going a little

17:48

off topic. They've developed a

17:53

video game that is meant to

17:53

address children with ADHD,

17:58

because they can focus on games,

17:58

but typically they it works as a

18:03

detriment. So now there's a game

18:03

that actually is a benefit to

18:07

teach them how to focus more. So

18:07

anyway, that was a tangent. I'm

18:10

sorry. One more follow up

18:10

question. When you said that one

18:14

in two people over the age of

18:14

85, are at risk of developing

18:19

some form of dementia. Do you

18:19

does that correlate to if you

18:25

look back through the statistics

18:25

of Americans that struggle with

18:30

being overweight or obese? And

18:30

that's usually about 48%. does

18:35

that correlate to the sense that

18:35

because half of Americans, you

18:40

know, obviously, put it,

18:40

frankly, are either overweight

18:43

or obese, that that is why one

18:43

in two people when they get to

18:48

the age of 85, and you know,

18:48

closer to the end of life that

18:51

they develop this disability or

18:51

this disease, there's not a

18:55

direct

18:55

correlation.

18:55

obesity is a risk factor for

18:58

developing dementia. Things like

18:58

diabetes as well that make you

19:02

know, type two diabetes that may

19:02

go along with that. But the

19:06

reason that those folks aged 85

19:06

and older may develop it more

19:11

readily is because age is the

19:11

number one risk factor for

19:14

developing Alzheimer's. So just

19:14

as we get older, we are at a

19:18

higher risk. But folks who are

19:18

obese whether they are younger

19:21

than 85 or not, they it is a

19:21

risk factor for developing

19:26

dementia as well. Unfortunately,

19:28

speaking to

19:28

caregivers, specifically, what

19:30

do you think are some

19:30

misconceptions about dementia

19:33

and Alzheimer's disease that

19:33

even the caregivers of those

19:37

living with the symptoms might

19:37

not understand?

19:40

Yes, so I think we hit on a big one earlier, which is, you know,

19:42

dementia is an overarching term,

19:46

many forms of dementia. And so

19:46

we have to just understand that

19:50

right in terms of what might be

19:50

going on with our loved ones. I

19:54

think another one is in the

19:54

earlier stages, this is more

19:58

towards the later part of the

19:58

earliest dangers we start to

20:01

see. And then you know, medium

20:01

moderate, we start to see

20:04

challenges around speech, right?

20:04

Where the person is just really

20:09

trying to find that word. And

20:09

what something's called, like,

20:13

it's almost like that feeling of like the tip of the tongue. Right? It's right there happens

20:15

to me a lot. And worse things

20:20

where it's, I know, right? So

20:20

it's kind of one of those things

20:23

where you start to see that a

20:23

lot. But what caregivers start

20:28

to think is, well, if they can't

20:28

remember these words, that means

20:35

that they really don't know

20:35

what's going on. And that is not

20:38

true. Because although we lose

20:38

the ability to grab those words,

20:46

they can understand meaning for

20:46

a very long time, a lot into the

20:51

later stages of the disease.

20:51

I'll give you an example. I'm

20:54

gonna pull something from my

20:54

desk here, right? This is a pen

20:57

we know is identified as a pen,

20:57

we know that is used to Write

21:00

Right. So they may be thinking

21:00

of what does that call, I need a

21:04

pen, right? But that can't say

21:04

the word pen. And as a

21:08

caregiver, you're like, oh, my

21:08

gosh, how does she not know what

21:11

it's called? Right? So then we

21:11

assume mom is confused, doesn't

21:15

know anything, right? But

21:15

really, if you just show mom the

21:19

pen and say, Were you looking

21:19

for this mom, the pen? Oh, yes,

21:22

that's what I was thinking.

21:22

Right? She will know what this

21:25

does for a very long time and is

21:25

independently able to use it

21:29

without any assistance needed.

21:29

Right. So we have to understand

21:34

that, you know, there are really

21:34

we need to dive into what

21:37

happens during these stages. And

21:37

that may be for another podcast.

21:42

But also, when we get to that

21:42

it's what happens early, but

21:47

what happens later on. Right. So

21:47

I think that's one thing that we

21:50

have to understand is so you

21:50

know, at face value, you know,

21:53

there are yes, some challenges,

21:53

but there are a lot of things

21:58

that they can still do, we

21:58

should focus on what they can

22:02

still do, and reinforce those

22:02

skills as much as possible. So

22:06

they can hold on to them for as

22:06

long as they can. So So I think

22:11

that's that's a big

22:11

mess. I

22:11

agree. And so essentially, just

22:14

to summarize into one complete

22:14

thought, instead of just

22:17

throwing the baby out with the

22:17

bathwater, like, oh, they can't

22:20

remember the name of for pen or

22:20

the word for a pen. You know,

22:24

that's it, it's over. Right?

22:24

Instead, I think you're saying

22:27

reinforce, even the fact that

22:27

they recognize the pen, and they

22:33

can still use the pen, they may

22:33

not remember what it's called,

22:36

or they may need help being

22:36

prompted. But overall, let's not

22:40

just throw in the towel and say,

22:40

Oh, my gosh, you know, I'm I'm

22:43

at stage seven. Right, when

22:43

you're still at stage three.

22:47

Right. Good point. Right. So

22:47

aside from diet and exercise,

22:51

because I know we touched on

22:51

that earlier, are there any

22:54

other effective treatments for

22:54

dementia? And more importantly,

22:58

how do you think that these

22:58

treatments will evolve over the

23:01

next decade?

23:02

Absolutely.

23:02

So we know that there's no known

23:05

medical treatment right now for

23:05

dementia, it's definitely you

23:09

know, when we talk about

23:09

approach to care, it's about

23:12

socialization. And so we talk

23:12

about our health 70% of our

23:19

health is actually made up of

23:19

our social determinants, meaning

23:23

that how we socialize and relate

23:23

to others, our relationships,

23:26

our interpersonal skills, right?

23:26

I mean, as humans, generally

23:30

speaking, we are social

23:30

creatures, right. And I think we

23:33

all learn that during the

23:33

pandemic of how much

23:35

socialization is a key to our

23:35

mental health, right, and our

23:38

cognitive health. And so a lot

23:38

of approaches to care that have

23:42

been developed in this industry

23:42

are around socialization and

23:46

around that ability to be

23:46

stimulated, myself included, I

23:51

developed the dementia

23:51

connection model, over a 10 year

23:54

period, really focusing on how

23:54

our brain works, and how stimuli

23:58

from the outside coming in and

23:58

can impact our brain in positive

24:02

ways. Okay. And you know, so a

24:02

lot of treatments or a lot of

24:06

approaches to care out there are

24:06

around this kind of

24:09

socialization and utilizing the

24:09

skills that are still present,

24:12

to reinforce them in order for

24:12

them to stay as independent for

24:15

as long as possible. Okay. We

24:15

talk about some of the recent

24:19

medications that have come out.

24:19

So there are two sets of

24:23

medications that have been

24:23

involved in this field one is

24:26

neuroleptic medication, which is

24:26

medication that allows for the

24:30

brain to have a little more

24:30

functional ability. As the

24:33

disease is progressing. It does

24:33

not resolve dementia, it's not a

24:37

cure. And actually, it's a bit

24:37

controversial because of the

24:40

side effects to these

24:40

medications. Even Canada

24:44

actually has stopped prescribing

24:44

these kinds of medications

24:48

because the risks have

24:48

outweighed the benefits right

24:51

over time. Then the other set

24:51

are these newer medications that

24:55

just came out. Lucano Ma was the

24:55

lit the most Most recent

25:00

medication that came out, the

25:00

very first version actually was

25:05

a medication where it was IV

25:05

therapy, it was about 45 to 60

25:09

minute infusion that can only be

25:09

done in hospitals or in

25:13

treatment centers. And so for

25:13

some of them who have dementia

25:16

to be able to sit that long and

25:16

to take in this infusion was

25:19

quite cumbersome. And the

25:19

efficacy rate was very low is

25:22

low in like the mid 20

25:22

percentile with lots of side

25:25

effects. The second version

25:25

Lucano mob is the most recent,

25:29

as I mentioned, that come out

25:29

pill form, which is great. The

25:33

controversy here is that it

25:33

still has a lot of side effects

25:37

and efficacy rate is in the

25:37

higher percentile rate of you

25:41

know, it being effective. So the

25:41

challenge is is you know,

25:45

Medicare has been looking at do

25:45

we cover this medication? Do we

25:48

not? If you're thankful for the

25:48

work of the Alzheimer's

25:51

Association, they have verbally

25:51

agreed to cover it? It just has

25:55

not gone into kind of written

25:55

formal agreement, what is

25:58

it meant to

25:58

do? What does the medication

26:00

actually meant to address? Like,

26:00

how does it How does it react

26:02

once it's in your body?

26:05

Yes, the great thing is it's meant to break up those protein deposits.

26:08

And what are the side effects? Yes.

26:11

Lots of

26:11

side effects. So. So the

26:15

highlight Yeah, no, no, no,

26:15

yeah, no, it's okay. So,

26:18

unfortunately, there's been edge

26:18

atheria to the brain, there's

26:23

been, you know, kind of, I want

26:23

to say seizures to the brain.

26:30

There's been looks at you know,

26:30

different kinds of like, you

26:33

know, your typical your dry

26:33

mouth, your diarrhea, that kind

26:35

of stuff. There was in the study

26:35

for Luca anima, there was one

26:43

death that had occurred. So I

26:43

think that there's some delicacy

26:48

around it, obviously. But this

26:48

medication is specific only for

26:53

Alzheimer's disease is not for

26:53

other forms of dementia, it has

26:56

to be started early on to have

26:56

an impact. Because if it's

26:59

breaking up those protein

26:59

deposits, it's not known yet to

27:04

be able to break up all their

27:04

protein deposits in the brain

27:09

that form as a disease

27:09

progresses through moderate late

27:11

stage. So it has to be done started. What

27:13

about like,

27:13

every day, when I turn on the

27:16

TV, I see a commercial for no

27:16

Riva plus, or any other you

27:22

know, vitamin that's supposed to

27:22

increase memory, D, you know,

27:27

decrease the risk of cognitive

27:27

decline? How do you feel about

27:30

those types of vitamins?

27:34

You know,

27:34

I mean, I'm, I'm a bit

27:38

controversial on the whole FDA

27:38

approval thing, because I'm, I'm

27:43

big too. I'm big into

27:43

alternatives. As you can see, I

27:47

use essential oils, I've used

27:47

aromatherapy with a number of

27:51

folks living with dementia, I

27:51

highly encourage, and I teach

27:55

folks about this type of

27:55

stimulation. And so FDA approval

27:59

is not a requirement for me in

27:59

terms of being able to look at

28:02

it for a, you know, a person

28:02

living with dementia, I think we

28:07

have to look at the clinical

28:07

evidence behind it, their

28:11

efficacy rate, you know, I don't

28:11

know specifics around you know,

28:15

what each one has to offer. But

28:15

I always say, number one,

28:19

discuss this type of

28:19

intervention with your

28:22

physician, or if you're already

28:22

working with a neurologist to

28:25

talk with them about the

28:25

benefits of this, because these

28:28

types of supplements are not for

28:28

everybody. And not everyone

28:31

receives the benefit of it. So

28:31

we have to kind of look at short

28:34

term versus long term benefits.

28:34

And also look at what other

28:37

medications you're on to make sure there's no contraindications. So, you know,

28:38

the thing is, is make sure you

28:43

do your research before you take

28:43

anything that you can order

28:46

offline or online, excuse me, or

28:46

that, you know, someone

28:50

recommends to you that maybe not

28:50

not, you know, who's not a

28:52

clinician in the industry. Just

28:52

make sure you do your research

28:56

before consuming

28:56

anything. Are

28:56

you optimistic that in the next

29:00

1020 30 years, we are going to

29:00

be able to find an effective

29:04

medical treatment for

29:04

Alzheimer's and dementia, and

29:09

all and 100% Okay, good. Good.

29:09

So, you know, there are a lot I

29:14

mean, I'm assuming there's a lot

29:14

of people working on this

29:18

because I think it's, it's safe

29:18

to say that this is going to

29:22

become a lot more of a topic of

29:22

conversation because we're

29:26

becoming more of an aging

29:26

society. More people are

29:29

developing this disease, it's

29:29

affecting more and more families

29:32

and, you know, if you really

29:32

can, if you really think about

29:35

it, in my This isn't this is

29:35

just purely my opinion, when

29:40

someone suffers a physical

29:40

disability like a fall, right?

29:43

So they're going to need a lot

29:43

more support with, you know,

29:47

transitioning, you know, in

29:47

terms of like, you know, from

29:50

bed to chair, wheelchair, all

29:50

that stuff, and that could be

29:53

very difficult for a family to

29:53

reconcile with when somebody

29:59

starts Getting you, you know, as

29:59

a son or a daughter or somebody

30:05

from for starts forgetting you

30:05

as a spouse, or a loved one or a

30:09

partner life partner, that's a

30:09

lot harder to reconcile. When

30:15

people disconnect from the life

30:15

that they've spent 40 5060 years

30:21

building. I mean, you can't it's

30:21

hard to rationalize it

30:27

is it is

30:27

and that caregiver, you know,

30:30

and or family member, they

30:30

really will start to go through

30:34

the grieving process, right. And

30:34

so it's an it's unfortunate that

30:37

it's a long bereavement process,

30:37

especially with Alzheimer's

30:40

disease being a longer

30:40

progression, that this person

30:44

will be in kind of this morning

30:44

phase, because they're losing

30:47

the person that they fell in

30:47

love with, or they got to know.

30:51

And it's, it is unfortunate,

30:51

because it's very difficult on

30:55

both ends.

30:58

So we always

30:58

like to end the show with a call

31:01

to action. How can we start

31:01

building communities more

31:05

knowledgeable about and

31:05

accessible to those with

31:10

dementia?

31:11

Yeah, so

31:11

I, for folks who have who follow

31:14

me on my socials and all of that

31:14

out, I always promote, educate

31:17

yourself. Because when we

31:17

educate ourselves, we have more

31:20

knowledge and power to be able

31:20

to understand this disease

31:23

better. If we are helping

31:23

someone who living with

31:25

dementia, we know how to and

31:25

what's available for treatments,

31:28

you know, treatments, approaches

31:28

to care, those kinds of things.

31:31

We are more knowledgeable on how

31:31

the disease is going to

31:34

progress. And then we can better

31:34

connect to that person living

31:37

with dementia. And so staying

31:37

educated is important. And

31:42

there's so much out there now,

31:42

you know, wonderful folks like

31:45

yourself that have podcasts

31:45

around this. There are our

31:48

blogs, you know, there's a new

31:48

show that actually came out that

31:51

deepest note was a part of you

31:51

know, that people can actually

31:54

watch it on TV. There's

31:54

commercials now about getting

32:00

tested earlier. Right. It's

32:00

phenomenal to see a commercial

32:04

about dementia. So I think that

32:04

we're headed in the right

32:07

direction with advocacy work. I

32:07

think the Alzheimer's

32:10

Association amongst many

32:10

healthcare professionals and

32:13

organizations are taking a stand

32:13

to say, Let's educate ourselves.

32:17

Let's have information out

32:17

there. Folks, don't even go to

32:20

my website dementia connection

32:20

institute.org. I've got a

32:23

resource page with podcasts that

32:23

I've been in blogs that I've

32:27

done articles, I've written

32:27

those kinds of things. So

32:30

there's a lot out there. And I

32:30

think that the more that we can

32:32

stay educated and knowledgeable

32:32

about this, we're going to be

32:36

able to recognize symptoms and

32:36

our loved ones or patients,

32:41

whatever it might be. We can

32:41

intervene earlier, which a lot

32:45

of the treatments that are out

32:45

there right now in terms of the

32:47

medications that we've talked

32:47

about, you have to start early

32:50

for it to be effective, right.

32:50

So I think that it's really

32:53

important that we continue to

32:53

just talk about it. Let's let's

32:57

let's not, let's let's kill the

32:57

stigma. And we can do that by

33:02

talking about it. And that's me

33:02

really important.

33:07

Thank you for

33:07

joining us on this episode of

33:09

Now or Never Long-Term Care

33:09

Strategy with Kosta

33:12

Yepifantsev.If you enjoyed

33:12

listening and you wanna hear

33:15

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33:19

Podcasts,leave us a review or

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33:26

Long-Term Care Strategy is a

33:26

Kosta Yepifantsev

33:31

production.Today’s episode was

33:31

written and produced by Morgan

33:33

Franklin. Want to find out more

33:33

about Kosta? Visit us at

33:39

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