Dr. Mitchell Clionsky: It's going to become a massive problem in

the next 10 to 20 years unless we begin preventing dementia.

It's not going to come from curing it.

I feel really confident about that.

It's going to come from preventing it.

If we could get rid of or avoid even 40 percent of the cases of

future dimensions, it would be a manageable problem on a societal basis

How do we face the daunting challenges of dementia and

cognitive decline, both as individuals and as families deeply affected

by these conditions today on seek, go create the leadership journey.

We have a deeply personal and enlightening conversation lined up with Dr.

Mitchell Klionsky, a board certified clinical neuropsychologist.

As someone who has witnessed the impact of dementia within my own family, losing

my father to this illness 18 months ago, along with its presence with both of his

parents and most of his siblings, I am particularly eager to gather his insights.

With over 45 years of experience in more than 30, 000 patients treated, Dr.

Klionsky has co authored Dementia Prevention.

Using your head to save your brain with his wife, Dr.

Emily Klionsky.

Dr.

Mitchell, welcome to Seek Go Create.

Dr. Mitchell Clionsky: Thank you for giving me a chance to

meet you and your audience, Tim.

I'm really excited.

I am excited that you're here too.

And this is, this is personal for me.

Let me just go ahead and say, as we get started here, but, let me start with one

of my icebreaker questions, and then we'll just go ahead and dive into the deep end.

I think you gave me permission to call you Mitch earlier.

So I'm going to call you Mitch, if that's okay.

But I want everyone to know he is Dr.

Mitchell Kleonski.

All right.

So Mitch, let's just say we're out and about somewhere and not at a medical

conference or anything like that.

And you bump into someone and you get chit chatting and someone ask you what you do.

What do you tell people?

Dr. Mitchell Clionsky: I tell people that I measure how they think,

and that usually stops them, and they look at me and say, really?

I said, yeah.

What I do as a neuropsychologist is we give people a variety of

different kinds of tests and measures that look at how well you're doing.

You pay attention in different ways, how well you're able

to process new information.

We give tests of short term memory.

That's oftentimes the biggest question that people come in with, at least.

We also do tests of what are called executive functions.

So planning, Judgment, the ability to think in larger ways and to take things

and adapt them to new circumstances.

We do measures of intelligence.

We touch on personality and depression and anxiety.

And then we take all those scores and compare those scores with what we

would expect for someone like them.

Someone with their background, education, their educational level,

their age, And even their background reading level, we have a test that

we can give them that helps us to nail what they should be able to do.

And then we take their real scores, compare them against their

theoretical scores, and we see if everything lines up the way it should.

And if it does, we reassure them.

Things look good.

You don't have to worry right now.

Here's some things you can do to increase your chances of avoiding

dementia as you get older.

Because I'm all about prevention.

That's really what this is about.

And if they're not lining up, we can Use that same information to help

discover what's going on that's causing those problems and what can be done

to either stop them from getting worse or potentially improve them.

That's what really gets exciting.

We can say, here's some ways that you can get better.

So that's what I, that's the nutshell of what I tell people.

Yeah.

And there's a lot to that.

when someone starts off with we, people with the way they think, this

being more of a longer form interview podcast, I think people listening in

would be, they consider themselves, Maybe deeper thinkers and the way

we dive into topics and all that.

So I think that's fascinating on so many levels and we're going

to have a great conversation.

And as I said, when we started this also, this isn't generic

for me, this is quite personal.

and I was actually texting with my sister, I'll just go ahead and

hit this right out of the gate.

And we'll go ahead and address it because I think it might lead and guide us.

In December of 22, our father passed away.

He was 84 at the time and at about at the age of 80.

ish, he was diagnosed with dementia.

it was about March of 2020.

That'll give you a point of when that occurred.

Now, we have gone back and I've gone through some conversations that I've had

with him and I, we were recognizing some cognitive decline, years before that.

so that's one, one thing that's going on and it obviously impacts my, I

have a sibling, my sister and it's something that we discuss quite a bit.

I'm 60.

She's, I think she's 55.

I hope I got that right.

She's five years younger than me.

and so we're looking at that.

Both my father's parents, his dad passed away with Parkinson's, his

mother had Alzheimer's dementia and he has five siblings and three of

them have some degree of Alzheimer's, cognitive decline, whatever, they're

all in their late 70s, 80s, but still.

It's, I would be, I would probably be lying if I didn't say it's something

that is a consideration of ours.

so so my first big question would be, how concerned should my sister and I be

that we are now dealing with some type of genetic situation with cognitive decline?

Dr. Mitchell Clionsky: We've told me a couple important things.

Number one, there's a high.

At least on one side of your family, possibly both in terms of risk

for neurodegenerative diseases, brain diseases as you age, but

they're also somewhat diverse.

There's Parkinson's disease.

There's Alzheimer's disease, which is really different in

terms of its underlying cause as we currently conceptualize it.

There's probably some vascular dementia factors because those are really common.

That wouldn't be surprised if those are in there as well.

And you have a good reason to be concerned, but not panicked.

And the reason is that even in the most genetically predetermined ways, unless

it's very early onset, we're talking about people in their 50s who are

developing dementia, the actual genetic contribution is probably about 5%.

Now, you'd rather not have that.

You'd rather have them say, well, we did some genetic testing and you're

in the protected range and you can be less concerned, but even there you

couldn't be because those are only genetic risks for Alzheimer's disease.

It doesn't protect you against Parkinson's.

It doesn't protect you against, dementia is due to repeated

head injuries, alcohol abuse.

Or vascular factors.

So while you might say, wow, that's all great from my brain's perspective.

If you've also got a strong family history of diabetes or high

blood pressure or untreated sleep apnea, you may have other risks.

The important thing to understand is it's like golf, the game of golf.

You play it where it lays.

Sometimes you're lucky and you're on the fairway.

Sometimes you're in the rough.

You don't want to be in the woods.

If you can avoid it, you definitely don't want to be in the water hazard,

but you got to play it where it lays.

So the real issue from my perspective, because I hear this question all the

time, it's a legit question, but we can't undo our genetic contribution.

And we know that even for people with very strong genetic contributions,

lifestyle, health factors approaches to this can make a big difference.

In their ultimate outcome, so I would reassure you that well, you know

that it's not the best news It's not damning news either It just means

that you're going to also want to pay really close attention to what you do.

This brought up something that was fascinating,

especially with you saying that you actually study how people think.

I read a book not long ago called The Art of Thinking Clearly, and I recognize

that many times we have dogmas, mindsets, et cetera, that are as damaging as

often some of the physical aspects.

So So here's the question I've got for you.

Are we asking the wrong question?

if you were to talk to my sister and I, what questions would, should we be asking?

Let's make this personal.

And then I've got some bigger questions I want to ask.

Dr. Mitchell Clionsky: Okay.

We know that there are significant numbers of factors that will reduce your

risk of dementia by 50 percent or more.

Now, this is not my data.

This is much better data that I could ever accumulate.

back in 2017, there was a very large commission in Great Britain

called the Lancet Commission.

It was commissioned by the Lancet, which is their version of the

New England Journal of Medicine.

And they put together a blue ribbon panel of experts, about 27 of them,

including a couple from the United States.

And they looked at all of the various factors that had proven evidence

of reducing your risk of getting Alzheimer's disease, vascular dementias.

Dementia is due to Parkinson's.

There's a whole bunch of different kinds of things under the category

of dementia, not just Alzheimer's.

And what they discovered was that they had nine factors that

would reduce the risk by 40%.

wow, that's pretty impressive.

Three years later in 2020, they published a follow up because

they'd found three more factors.

including hearing loss, which they didn't really know about three years before.

And they said, this bumps it up a little bit.

Now we're looking at probably about 42 percent or so.

A couple of years after that, here in the United States, a similar group took

data from the United States Health And retirement survey applied the Lancet

Commission 12 factors, and they discovered that we could reduce the risk by 60%.

So now you got 40 percent on one end, 60 percent on the other.

I like round numbers because they're more rememberable.

So I say one out of two.

But it doesn't stop there because when we wrote the book on dementia prevention,

using your head to save your brain, we then realized there were more factors.

We've got 20 factors, including the 12 from the Lancet commission, but adding

eight more that they did not cover.

And we found these factors, not by just making them up.

We being my wife, An internal medicine doctor and psychiatrist who

specializes in treating brain diseases.

Her name is Emily Klionsky and one of her strengths, one of her superpowers It's our

ability to take information and synthesize it from a variety of different sources.

One of the things about dementia that's really fascinating is that it's

impacted by a variety of different medical conditions and therefore falls

into different medical professions.

So it involves just not neurology and psychiatry and neuropsychology.

It also involves cardiology because a lot of what is involved with

our heart also impacts our brain.

It involves endocrinology.

So the people with diabetes, that's also a huge risk factor for dementia.

It involves pulmonology, breathing and sleep medicine, specifically

obstructive sleep apnea.

So you have to read that literature.

Then you have to look over into areas like exercise, physiology, genetics.

You have to look at a variety of different behavioral types of involvements.

you have to look at some of the details dealing with chemistry of

medications that we're taking and things that we're buying over the counter.

So our goal.

Was to cast this really broad net to read all of this information

because the experts in each of these areas are not reading all of that.

They're reading what they're reading.

It's like being in this certain, they know more and more about a very

specific area, which is wonderful.

If you have that particular problem, but there aren't any dementiologists.

Think about that.

There's no particular field for dementia, despite the fact that this

is an incredibly important problem with huge societal costs and personal

grievance as a result of this illness.

And yet there isn't a cure.

a field of Dementiology.

I want to coin that term.

So here it is.

I'm going to put it out because I'm going to probably go and get a trademark on it.

Dementia, Dementiology and Dementiologists.

We need specialists who look at all of this.

But the important thing was that we came up with all these factors.

We then made sure that they had high levels of scientific Certainty

the reason for that is that there's a lot of clickbait out there.

I'm sure you see it all the time You know eat this don't eat that Do this don't

do that and this one thing or these two things are going to fix your dementia.

That's Nonsense, it doesn't work that way and you really can't eat

your way into dementia prevention either So we got a lot of people

talking a lot of gibberish out there.

We wanted to get rid of the fads You Get rid of all the hyperbole and focus on

things that actually had solid evidence.

So we put together a model that had 20 factors that show how they're all related.

And then our goal was to translate the information that's hard science

Into the communication, like you're sitting, like we're talking right

now, here's what this is about.

This is what it means.

Here's what this is about.

Here's how you go about finding it out.

And that was the whole idea about this project was to take this information,

pull it together and translate it so people could use it because it

doesn't do any good if you don't understand it and can't use it.

So that's where we came about this whole project, but it's great

because we now know that this is a preventable illness for at least

half of the people who are worried.

And the question is, you, your sister, other people out there,

what are your risk factors?

What's your individual profile?

And that's where you go up to our website.

You can take a free dementia prevention checklist, which asks you 25 questions.

And it gives you where you're on target, where you're off target

and where you're near target.

Just need a little nudge.

Just need to lower your blood pressure a little bit or just need to reduce

your hemoglobin A1c and go from being pre diabetic to not being diabetic.

So those are the things I would encourage you and your sister and

other people to do is it's out there.

You can find out right, not right this moment, but in the next hour

What your dementia risk is simply by filling out a questionnaire

and discovering along the way.

Ooh, I actually don't know the answer to that.

I don't know the answer that I got to figure that out.

Got to talk to my doctor about running that test.

That's where I'd encourage you to go because then you're really

working with not just information, but the beginnings of a plan.

Right.

Yeah, one of the things that I noticed about us as we went on this journey

with my father, and I think it's also an issue culturally, is that people

are looking for a quick answer.

what caused it with dad, with his family, they lived near a chemical

plant or they all drank the same water or, we're looking for quick answers.

Number one, if we're in a situation.

And then I also think we're looking for quick fixes when it comes to prevention.

Now, one of the things I don't have it pulled up on my screen right here,

but I've got it pulled up behind this window is within your book, that

diagram that you mentioned with all of those 20, and I showed it to my wife

last night while I was reading this in bed, I said, take a look at this.

Diagram here.

And y'all also, you talked about how there's an interconnectivity

between all of these.

It's not as if take this pill and everything will be better.

And I observed this quite a bit, not to get controversial, back with COVID,

there was this thought, Oh, if we have a vaccine, then it'll solve all

this and the world will be greater.

And it wasn't quite that simple.

factors involved with that were obesity and general health and

all those things like that.

I get, I'll pose this as a question.

I'm making that statement, but it appears as if even myself and I'm aware of it.

I'm looking for simple answers and I'm an engineer by training.

I know this is complex, but it seems like culturally we're not looking for

those 20 factors with that diagram that you and your wife laid out, how.

Can we address that in our culture that is looking for the quick fixes?

Dr. Mitchell Clionsky: You're right.

And most of the quick fixes usually involve.

One of the things that just gets me is I look at, where are the top

selling books on dementia prevention and most of our diet books.

And we know that while eating things like a Mediterranean diet, that's

got a lot of legumes and green leafy vegetables, and not a lot of

beef and more fish and chicken and lean protein and vegetable based.

All that stuff is probably from a prevention perspective, the

best diet that you could eat.

It doesn't account for much of the data, much of the

variance in terms of prediction.

And the other thing is it's not really demonstrably better than the next.

Best normal diet.

It is clearly better than a horrible diet.

A horrible diet filled with lots of fast food and over ultra processed things.

The Mediterranean diet is clearly better than that, but it's not better

than just a good solid varied diet.

But people like to buy cookbooks because they think, I don't have to worry about

this now because I'm eating healthy.

And people look at me all the time and tell me that, but I eat so healthy.

How could I be at risk?

And I say, that's great that you eat healthy.

I encourage you to do that, but you're not exercising.

You're drinking more alcohol than is healthy.

You are taking an over the counter sleep aid because you can't fall

asleep for a variety of reasons.

All of those things you have to factor in as well.

And Oh, what about the fact that you're.

overweight, and that's putting more stress on your blood pressure.

So they don't necessarily like you're the complexity, but I guess the one

saving grace, and we talked about it in the book that it's sort of like

an intertwined ball of knots, and you can't just cut it through the middle.

You can't just clear out the knot with one stroke.

But the cool thing is if you start pulling on some of the threads, some

of the strings, what you find is that makes the other ones easier to approach.

So let's take the case of exercise.

I have a formula for getting people to exercise, which I'll share right now.

I call it the 10 by 3 formula.

You take a 10 minute brisk walk three times a day.

And here's why it works.

it's not the optimal.

I mean, you see this stuff all the time on the internet, what to do to

get this great body if you're 50 and 60 and people say, should I exercise

for this or exercise for that?

Those are all people who are at the high end of exercising.

Those are not the people I see.

I see the people where I ask them, what do you do for exercise?

And they avert their eyes because they don't want to tell me.

Or they tell me things like, I have an exercise bicycle.

And I said, it doesn't tell me anything.

Are you on the exercise bicycle?

How long, how often?

So we're looking for people who are more often not doing enough, enough regularly.

So the reason that the 10 by three formula works is number one, it's hard

to talk yourself out of it's only 10 minutes, so you're never too busy.

You're never too bored to do 10 minutes of exercise.

You never need special equipment.

You don't have to wait for this machine to come in.

You don't have to be in a class.

You don't have to join a gym.

For most people, it's available around where they live or where

they can get to pretty easily.

It adds up.

So the 10 minutes, three times a day is 30 minutes a day.

That's 210 minutes a week.

So what are the major medical society saying 150 to 300 minutes a week is

gonna reduce your risk of dementia, your risk of dying too young, your

risk of cardiovascular disease.

They all come together at that 150 to 300.

Great.

Two 10s in the middle.

Second thing is if you're moving fast enough.

We talk about brisk.

What is brisk?

brisk walking is walking fast enough that your heart rate increases, but not so fast

that you can't talk while you're walking.

So it's a great conversational thing, a social thing to do as well.

If you could do that, you're going to walk about 9 10 miles a week.

That's pretty cool.

And you're going to be able to do it, even if it's hot.

And even if it's cold, I tell people, don't go out.

If it's icy, find something else to do.

Cause I don't want you slipping and falling, but you can do this.

And then you can decide once you're doing that consistently, is that enough

for me now, because it might not be, you might say, I can up my game here.

I know that I can't.

Over exercise in the sense.

Sure, you can go out and try to run a marathon.

I'm not suggesting people do that, but they can go from 30 minutes to 45 minutes.

Then go from that up to an hour a day.

And that's going to give them about 10, 000 steps a day.

And that's really optimal in terms of the dementia prevention

literature and how it translates.

So one, one thing that I noticed as I was reading through that,

and I think that's great info, I was just thinking as you were talking, I

said, yeah, I went out yesterday and I played 90 minutes of pickleball.

And I measured my heart rate at, I got it up to about 150.

sometimes pickleball, you don't do that, but, but I do love, I've

actually gotten to where I love just going out on a long walk.

And to me, that's as much of a mental exercise as it is for physical.

One of the things that, and I hate to, this is going to extremely

sound like I'm oversimplifying, which is what I discussed earlier.

Almost everything that I read.

In your book, I don't say common sense.

That's not the right word because common sense isn't super common,

but it's just healthy habits.

It's just like good health.

If we were talking about, you discuss a lot about sleep.

I do want to address that in a little while.

We'll talk more about sleep and different things like that.

But it's just, if you've got diabetes, if you're obese, if you're overweight,

if you're trying to, isn't this stuff what we should be doing anyway?

Dr. Mitchell Clionsky: Yes you know we talk at the beginning of the book about

how books like this typically make a promise And the promise we make is if

you do these things you will be healthier We can't promise that this will prevent

you from getting dementia Because there are just cases that exist that no matter

what you do, I've got patients like this and man, does it frustrate me because

most of the time I'm thinking that the things I do are going to really make a

difference in my patient's lives and I see some of these people and they've got it.

Especially Alzheimer's type dementia, and they're on current medications,

which for most people, slow down the decline in many cases, stop it

from progressing for some years.

And we've had these pills out for 20, 25 years.

And I know that when they get on them, that's going to be good.

And they're, they've got good habits and they exercise, they

don't drink too much and they don't have major medical problems.

They still get worse.

And that's just the way life is, unfortunately.

And we all know people who never spoke, get lung cancer.

We know people who get cirrhosis of the liver, never had a drop of alcohol

in their life, it's just life, but you're right about the fact that

these have a lot to do, it turns out that a lot of the things our mothers

taught us years ago really were good.

We just thought we could work around them and we didn't, and because our behavior

and our health are separated in time,

this is a really important concept because I was talking about this

with one of my patients this morning.

I said, if every time you ate something, which you really shouldn't

eat, you gained a pound, you would quickly get in control of that.

Nobody would ever be too heavy or too light.

If the result was immediate.

The same way you're not going to leave your hand on a hot stove

because it's an immediate feedback.

The problem with most health behaviors is it seems like there's no consequence.

You smoke cigarettes in your 20s.

Chances are you're not going to experience much in the way except perhaps financial

problems because of your cigarette habit and people don't want to get close

to you because you smell like smoke.

if you hang out with other people I'm not even going to bother with that.

It's only when you get to be in your fifties and sixties and seventies of the

chickens come home to roost that those problems, those things that you started

and continue to do end up being a problem.

So that's why those health habits are really important, both to reinforce, but

also to show the data, why it happens.

And then most importantly, I think help people to then figure

out how to make that change.

Nobody argues with me.

If I say, Exercise is good.

a gimme.

Sure, I know that.

Nobody who is significantly overweight argues that's not a problem.

They all know it is.

They can rationalize it and say, you're just shaming me because No, I'm not.

I'm just telling you your body was built for a certain size.

That's where it works efficiently.

If you're making a carry around a lot more and do a lot more

work, it's going to break on you.

It's pretty simple.

Same way.

If you loaded your car up with bricks and tried to drive it long

distances, it's going to break down faster than the car that is lighter.

It's just the way physics works.

So you can do that and that's your choice, but it's not going to work

out for you very well in the long run.

So a lot of those things, it's that the people don't know, it's

that they don't know how to do it.

And that's why the last part of the book is all about using what I learned

as a psychologist and a therapist very early in my career to help

people to recognize areas of change to figure out how do we think those

problems and then implement them.

Because it's, we see people all the time.

They try to analyze why they do this thing.

That's a problem.

I don't like that very much.

I get bored with that.

We can sit around all day wondering why you're doing the things you shouldn't do.

I'd really rather put our effort into helping you to

do the things you should do.

That's going to get you somewhere.

The

about that, as I was reading through that section of the

book, it was basically what I do with leaders and leadership teams.

Establish the problem, develop a plan, and then you stick to the

strategic plan and move forward to have some degree of impact.

Do you adjust and tweak along the way?

I like the golf analogy you use, you play it where it lays, uh, that type thing.

that's really good.

Another great thing I really in the book.

I think there's so many, I think there's terminologies that people

struggle with, like they call everything Alzheimer's when, it's a big, I learned

that early on is there's dementia.

And then there's the categories that are underneath that there's

cognitive issues, things like that.

But one of the things I wanted to ask about here is you gave a great, it was a

short history of Alzheimer's and dementia.

And I think we're at A little over a hundred years ago is when it

started coming into our vocabulary.

And then you mentioned, I think in the seventies or eighties, there

was, a wealthy businessman that his wife was suffering some things and it

really came more into the forefront.

and I know this is you and your wife, Emily's it's your life as society,

as culture, are we getting better?

Is this getting worse?

Is it?

Epidemic proportions.

when you've just gone through what we've done the last three, four, five

years, it seems as if it's everywhere, you look around and you've got

where you see it all over the place.

And so in your mind, you go, this is everywhere.

What does the data tell us?

And how are we doing, as a society with this?

Dr. Mitchell Clionsky: data tells us it's increasing.

And the reason it's increasing is not that dementia has become more virulent.

It's that we're getting older as a society.

So I'm a baby boomer.

And because of that, I've been in this wonderful bump in the population that has

fueled most Of the big changes in society.

It's our rock and roll music that you're still hearing on so

many of the commercials on TV.

It's our, we're fueling the pickleball revolution, because a lot of people my

age can't run to play tennis anymore.

There's this whole bump in population.

That's now 65 and older.

And we know that the risk of dementia increases.

proportionately as we get older.

If you're in your mid sixties, you have about a 10 percent

chance of having dementia.

You get to your mid seventies.

It doubles.

It's now about 20%.

You make it to your mid eighties, it's now about 40% Now.

It levels off after that, largely due to the fact that other things are killing

people, so the healthiest people are now surviving, and so you don't really get

that, 60% in your nineties kind of thing.

There's a lot of people who, once they make it there, don't succumb to dementia.

They, until the very, very end of their lives.

I hear this all the time.

Yeah.

My dad lived to be 92.

He was demented for the last two months.

that wasn't really dementia.

That was just a breakdown in his systems at that point showed up in

terms of his confusion, but it's this growing, Older population that's

causing a whole balance change.

it used to be that there were enough new people, enough young people earning money

that those who put in their money to the social security system were pretty short.

There was enough new money coming in to pay for them in retirement.

Plus they didn't live that long into retirement.

You retired maybe at 65 and a lot of you'd be dead by your early to mid seventies.

Not so much anymore.

Fewer people putting money in.

More people living longer.

It's the same way with caretaking and dementia.

And so we're seeing this increase that is going to be a real problem.

It's not that it isn't a real problem now.

It's going to become a massive problem in the next 10 to 20 years

unless we begin preventing dementia.

It's not going to come from curing it.

I feel really confident about that.

It's going to come from preventing it.

If we could get rid of or avoid even 40 percent of the cases of future dimensions,

it would be a manageable problem on a societal basis, wouldn't be manageable

anymore from an individual basis.

Cause you still got your families.

And by the way, I'm in the same club as you.

My mom had dementia.

I've sat in that seat.

I understand that.

I tell my patients that, which most of the time really helps because I

tell them this is something where no matter how much knowledge you have,

no matter what you're doing for your job, that is a very powerless feeling

to see your parent change from who they were when they raised you.

To who they became when they developed dementia.

And it's a, it shakes you to your core as you well know.

So again, it's aging and we got to do something now that's going to show

up five years later, 10 years later, that's going to make a difference.

and I think another reason for the call to action, and this is

a topic that was very challenging for us as we were going through it.

Uh, my sister and my mother attempted to be a caretaker for a while, but

until it got to where she couldn't, And then my sister and her family

were caretakers for a while.

And then we had to look at facilities and we had some means.

So we were able to look at some facilities that were not the low end or anything like

that, definitely probably not the highest end, but they would have been respectable

facilities, Atlanta metro area.

I do not think we are equipped to take care.

of the current population that's dealing with these cognitive issues.

And I definitely know that we're not prepared to do it

if the numbers grow as aging.

Do you want to say anything about that or have a comment about that

without getting way off into the weeds on the care issue related to it?

Dr. Mitchell Clionsky: I think you're right.

I do know that.

Caregiving from a other than family perspective is different depending

on where you are in this country.

California has some interesting models for people who basically

have a home and take care of.

Elderly people with dementia that they bring into the home.

I know that in Europe, there are some other models.

I don't think we have the best model in terms of, assisted living or continue

continuity of care kinds of communities.

I think it's for many people, a godsend.

beyond family care.

When my mother developed dementia, it was pretty clear both my brother and I,

because we're the only siblings, that neither of us were prepared, given where

we were with our lives and our careers, to have our mother live with either of us.

And she knew that as well.

She didn't want to do that.

We just all decided she had enough with it at that point.

We decided that one of us would kill the other person at some point.

So that seemed to be a bad idea.

And I wanted to remain as her son.

I didn't want to be her caregiver.

I wanted to be able to go over to the assisted living place close by where I

lived and take her out, take her to my house for dinner, for family gatherings,

take her out for drives, take her to the restaurant, take her places on trips.

do things that were really positive But didn't require me to have to

worry about was she up in the middle of the night And did I have to

bathe her or anything like that?

So I think it's and for some families that's not a problem for them.

They approach it very differently They want mom or dad to live with them.

They want to provide all that care.

That's wonderful There's different ways of going about this But I think that

getting back to your original point, we're really going to stress the fabric

of society if we continue to have more and more people getting older and getting

demented with the current resources.

Because it's not just, you, it's also the people you have to hire

to be able to provide the care.

Where does that come from?

Yeah.

And almost every facility we interact with was short staffed, constant churn,

very difficult to keep people around.

And I felt for him, being a business guy, leadership guy, I kept looking at

it going, this business model is just unsustainable as far as employees.

And a lot of this was, tail end of COVID it was, I could just see that it could

be an extreme strain and that we're.

Probably not equipped to handle it,

Dr. Mitchell Clionsky: We're also not looking at it.

I don't think as well as we should.

Everyone's still pouring money into pharmaceuticals.

And that's where, a lot of the, it's driven by the finances

is driven by stock prices.

It's driven by, A lot of things, which are at a distance from actual care

for this condition, this disease, it's not like other diseases.

there's people who have other diseases, who still live at home and

go about their lives and still work.

In many cases, this is a disease that robs that person of their

ability to take care of themselves.

And live their own lives.

They require care and no matter what, unless we find something, I, I hope

that we're going to see something maybe in genetic, recoding like CRISPR

technology or perhaps something that is in fact a, a prevention through an

inoculation, but we're not there yet.

And we're some distance away right now.

We really have to work on the other parts of this.

right?

One of the things I'd love to do here, I'm trying to watch my time.

Cause I know that I could probably talk to you for hours about this.

I would love to hit what I would consider to be rapid fire topics

and just have you comment.

And I know that there may be a lot of data and things behind all this, but I'd

love to hit as many of these as I can.

And some of them are covered in the book.

And then one of the things we're going to hit really hard as

we wrap up is for people to go and do, I think y'all call it.

The most, the test and drive them to your site.

Or is that what they do face to face with you guys?

Or is that on the site?

Dr. Mitchell Clionsky: Okay, so the most is not deployable at this point.

It was only for physicians and it's not currently available.

We're going to be rolling it out again as an early test that doctors can use

and possibly a version of it that you can give for mom or dad in your home,

but that's at least Till the end of this is the summer of the most for me.

Last year was the summer for first talking about this book and things.

This summer, we're going to get that up and running again.

So it's out there.

It's, but the prevention checklist is where I'm really hoping people

are going to pay attention because that's going to really give them the

armamentarium to go after this problem.

very good.

We'll hit that again at the end and remind people where they can go.

So there's one thing that's been extremely.

in my forefront for some time now, and that is my sleep health.

Um, my wife makes fun of me.

I've got this Apple watch and I've got this app that tells me my blood

oxygen level and how many hours of deep sleep and all this type stuff.

I also noticed this is interesting for people that travel like we do in RVs.

Altitude impacts it and whether I'm in the desert or higher humidity, we're

in the black hills of South Dakota now.

So I know you cover it extensively in the book, but say a few things

about how important sleep is.

Dr. Mitchell Clionsky: Great question.

There's sleep, which has to do with continuity.

Which has to do with the amount of sleep that you're getting,

you can get too little sleep.

That's a problem.

Five hours or less is not enough sleep.

Nine hours or more is too much sleep.

You want to be in that six to eight, nine hour range.

The continuity is important, not only because it's important to go

through the different sleep stages, but your awakening during the night.

Maybe due to other problems that are we're also going to look at and

the third part is the consistency of when you sleep Can be real important

There's a real nice study that looked at that and they found that If people

went to bed and got up at all kinds of different hours That oftentimes that

increased their risk whereas you don't have to be rigid about it But having

generally, this is the time I go to sleep.

And this is the time I wake up can be a real advantage for you.

Now, the issue about why is sleep better at different places may have

to do with the amount of oxygen, because when you're up in the

mountains, you may be a mile high and your oxygen saturation is lowering.

And so while you're waking up is because you're not breathing while

you're sleeping, you're waking up because you're gasping for air.

You can see the same phenomenon when you fly transatlantic or transpacific.

They have the, the atmospheres set at about 8, 000 feet back where all

of the people, the passengers are.

They have it set at a lower level up in the cockpit.

Why is that?

it's okay if you fall asleep because you're not getting enough oxygen.

You don't want the pilot to fall asleep.

So one time Emily and I flew to Europe and she brought along little pulse oximeters

like you see in the doctor's offices.

These were her pulse oximeters and we put them on people's fingers sitting

next to us in the plane and watched their oxygen saturation decline.

And then we gave it to the flight attendants.

And they were incredibly amazed at how their oxygen levels went down.

Now, the transatlantic trans pacific flights are the plum flights.

So they're the ones that the older flight attendants get.

So they're taking these long flights at the highest altitude.

And they're also more likely to have a problem with that drop in oxygen.

So there's a lot there between sleep and oxygen.

So the oxygen question, are we suffocating our brains?

Are some of us suffocating our brains because we're not getting enough oxygen?

I w real quick, I wasn't really aware of the blood oxygen.

COVID because when I first got COVID, someone said, I just need to keep

an eye on your blood oxygen level.

So we got one of those finger pulsometers and I would watch it.

I think it got down to 88, which I was like going, okay, I need to watch this.

But my watch is supposedly measuring my blood oxygen.

Like last night I was at 94%.

I don't sleep well if it gets much slower than that.

And also are we suffocating our brains to some extent?

Dr. Mitchell Clionsky: the issue is something called obstructive sleep

apnea osa obstructive sleep apnea is a condition whereby While we're sleeping

we either stop breathing Or our oxygen level drops by four percent A total of,

or average of five times or more per hour.

So you find this out by taking a home sleep study usually, which is painless and

easy to do, and you can do it in your own bed and it's going to tell you over the

course of the night, how many times did you stop breathing for 10 seconds and how

many times did your oxygen level drop by 4 percent and then you average that with

the number of hours that you slept, if it's five or more, you've got sleep apnea.

Now, how common is that?

there's some really cool data that's come out since we published the book.

It was just about four months ago.

This is data that came out on normal people, 6, 000 quote normal people.

I put that was always in quotes because none of us is really normal.

People from the general population, people go into studies that look

at how people are doing over the course of years, the Framingham

Heart Study is one of these studies.

The Mayo Clinic does different studies, a bunch of different places.

these preventive health places all decided to band together and

give everyone in their 6, 000 new cohort an overnight sleep study.

People 58 and older, half of them had sleep apnea.

Most of them had no clue that they had sleep apnea.

And yet if you're not getting enough air down your lungs, you're not getting

enough oxygen pulled out of the air.

Oxygen is only 20 percent of our air.

The rest of it's nitrogen, some other things.

So you're not getting enough oxygen pulled out.

The oxygen molecules then can't hook onto the red blood cells.

And make their way up to our brains.

And that's the problem.

Not enough air, not enough oxygen.

Our brains don't work properly.

We don't think well while we're sleeping.

Our brains cannot clear out the toxins that accumulate while

we're thinking during the day.

There's a system.

Another thing only discovered in the past couple of years called the glymphatic

system that flushes out the byproducts.

Okay.

I tell people it's like the night cleaning crew comes in, empties

my trash can, cleans off my desk.

Our brains have a system like that.

It doesn't work in a low oxygen environment.

So toxins build up.

We don't think well.

It's a whole variety of other things, but we tend to be Tired

during the day, oftentimes grumpy.

We could fall asleep at times.

We don't want to occasionally, even while driving a car and watching TV.

If you're that person who's waking up like this, because you're watching it while

you're sitting down and you're dozing off.

So there's a lot of reasons why we need to pay attention to that.

So there's something related to that, that I've had a theory on.

I don't know exactly how to prove this with people that I work with.

And typically they're entrepreneurs, leaders, CEOs, things like that.

and and it's related to what you just said, but maybe it's a cousin of it, and

that is this thing of capacity or the amount of stress and what we could handle.

Uh, within our brain and with your study, this may be related

to, uh, the dementia thing.

It may be related to cognitive.

But one thing I've observed is if I'm working with a leader and they are under a

lot of what we would call stress, there's a lot going on, a lot coming at them.

I recognize that they're oftentimes less creative.

They decision making sometimes is a little bit, I hate to use

the word impaired, but it's not.

As healthy as it should be.

And so I didn't see a lot of it in the book.

I may have missed it, but like just stress.

one of the things we know, if we go back 30 years, you and I are old enough

to remember this, we had a few hundred stimuli coming at us on a daily basis.

Now we've got thousands of stuff coming at us.

So just capacity wise, does that feed into this?

can we just use up our brain and all of a sudden it starts shutting down on us or

overstress it or have too much going on?

just take whatever you want to from that rant and go with it.

Dr. Mitchell Clionsky: Yeah, we didn't cover this very much in the book because

our goal was dementia prevention.

And so what you're asking, I think, is a question of bandwidth.

How many things can we do at once and divide our resources?

It's like setting up your Wi Fi in your house, and you have a certain

number of nodes to your Wi Fi, and you have to divide how much gets what.

And the more you add and the more people you have sitting in the other room

downloading movies or playing games or listening to music or being on a zoom

call depletes it same way with your brain.

And they say, can you walk, chew gum at the same time?

actually, it turns out that one of the ways we should be testing for

dementia, and I've not done this research yet, but I know what it's based

on is we should have cognitive tests that we give when someone's sitting.

And then while they're walking briskly, because at that point, they have to

divide their resources to be able to handle the balance and avoidance of

process, things in their way, obstacles.

And we know that their oxygen level also declines as they're

walking for most people, unless you're really in great shape.

And then we would see the difference, the decline in their capacity to

process information, whether it's things like, counting backwards, reciting

the months of the year backwards.

I thought of all kinds of different tests we might give them.

I don't right now have the capacity, the bandwidth to do this study, but

boy, I would love someone to do it because I think the contrast between

how you think while you're sitting and how you think when you're under stress.

Would be a really important marker for what your abilities

are going to be going forward.

years ago, I used to do a lot of work in stress management way in the early

part of my career back in the 70s.

I used to do stress management for executives.

Actually used to do workshops for them on communication, assertiveness,

training, and stress management.

And there was all this dynamic between how much stress and how

much coping does the person have.

Because if you have no stress, but a lot of coping capacity, that's not good.

That's what I see in people who retire and don't have a plan for retirement.

They're bored.

They're unhappy.

They don't know what's going on.

Then you have the opposite where they've got a ton of stress and not much coping

ability and those people are breaking down emotionally and physically.

Physically, because they're just juggling too many balls.

And where you really want this is somewhere in the middle where you

have enough stress that it keeps life interesting and challenging and growth

producing, but enough coping ability that you revel in that, that you like

to do that, that you grow from it as opposed to being overwhelmed by it.

So that's really the, the great balancing act in this.

I've always, one of the things that I speak about when I do

coaching is I, and if I'm wrong on this, please correct me as I say, sometimes

we've got almost like a pressure cooker going on here within our brain.

And that one of the things we need to do is identify, the, People that know

the old pressure cooker, it starts, you it starts making the noises.

We need to find ways to relieve that pressure.

And what you brought up was fascinating.

Just a walk.

I would notice when I would swim or even pickleball.

It's it's just a clearing, it's like an eraser.

It erases some things that are hanging out there.

None of the things are any different.

When I come back to them, but it just releases, it just releases

some of that pressure so that I can look at it with a fresher look.

I think, I've got a deep spiritual thought.

I think oftentimes prayer for those that meditate different things, I

just quiet time, just being still and quiet is something that I really

promote with a lot of my clients, just find some space to where you can

clear the decks is, is a good thing.

So I.

I appreciate all that feedback and input.

All right, the next kind of bigger topic you mentioned in the book,

and I'll let people go check this out, hearing impairment, and you

even used some visual impairment.

And we do believe that my father had some hearing issues that he was

not wanting to get diagnosed, didn't want, and here's the reason why, this

is one reason I'm bringing this up.

He had a ringing in his ears.

The tinnitus or tinnitus, whatever it's called.

I actually have some degree of that.

I've spoken to a number of people my age.

That's, I think that might be more common than uncommon.

I don't know.

I've done a little bit of research on it, but he didn't want to have his

hearing tested and to have anything that would magnify it, because he thought it

would just increase that noise of the.

The ringing, it's obviously not a ringing in the ears.

It's something internal.

So I guess if you want to say anything about hearing, even though it's covered

in the book, but specifically the tinnitus or the tinnitus, however it's

pronounced any thoughts or comments or data on that, as it relates to this topic.

Dr. Mitchell Clionsky: Tinnitus is really common and it, it can be from a number

of sources, both injuries, some people after auto accidents, some people through

exposure to loud noises, some people who we don't even know why they just developed

this quote ringing in the ears, but it's usually at a certain decibel level or

a shushing kind of sound or something that can be really distracting, but it's

worse when there's no background noise.

people experience it as they're falling asleep.

a lot of folks find that having white noise in the background

or a TV in the other room or something like that is actually

better than having no noise at all.

There's some work that is done with hearing aids.

Paradoxically, they're able to actually improve the tinnitus by the hearing aids.

But a lot of times it just doesn't make a difference.

It's a shame that your dad was at a point.

I see this all the time when people decide what it's going to be before

they ever try it out, which I try to talk them out of because it

keeps them stuck where they are.

But the worst that could happen is you get your hearing tested.

if you have a hearing loss.

These days, hearing aids are remarkably cheaper than they used to be.

They're remarkably smaller than they used to be.

Oftentimes, unless you're really staring in someone's ear, you can't

even tell they're wearing a hearing aid.

Because it used to be that people would say to me, Oh, I want to

do that, it's going to make, and it was usually a vanity issue.

And I'd say, you don't want to look old.

And they say, that's right.

I don't want anyone to think I'm old.

I said, what makes you look really old?

They say, what said, what makes you look really old?

They say, what is it exactly?

what that really makes you look old said hearing.

Is something we don't perceive externally.

It's what you're dealing with.

So if you're answering the question, we're not going to know that you're not

hearing until you know, if you're wearing hearing aids, we're not gonna see them.

You're gonna look younger.

Actually, because of that, they said, Oh, then I get them to go get a hearing test.

And because we know that not only is it a cause, but we can

increase people's cognition.

in the moment by improving their hearing.

if I test people without and with their hearing aids, they do better even

on non verbal tests when they hear.

I'm a huge fan of those.

It also really makes for better relationships.

Yeah, definitely.

we sometimes will refer to this brain that we've got in our head as maybe a muscle.

I don't think that's the correct term, but sometimes I do wonder if

there is this, if you don't use it, you might lose it atrophy type thing.

And one of the things we would go back and forth, I recall with my mom,

they would have a, They would have a certain news channel on most of the

time and I don't care which one it is, by the way, I'm not prone to it.

And we would say, stop leaving the television going.

It can't be good for the brain.

So is there any accuracy in that statement or did we just want them

to turn off the Fox, CNN, MSN, again, I don't care which one it is channel

because that can't be good for you.

Any thoughts on that?

Dr. Mitchell Clionsky: It's usually a default position.

It's usually this fills the time, makes me feel like interacting in some ways.

And these people are my friends.

now, therefore, I can feel comfortable just sitting here all day looking at this

and having this go on in the background even though the same story is usually

repeating itself every hour or two.

It's really important to use the brain even though there aren't

any specific computer generated exercises or games that by themselves

are known to prevent dementia.

what we find is with most, and this is a field that's really in flux, because

there are some newer information that suggests maybe sub games for some

people may do something, but the rule has generally been, and the reason

I have not put in a therapist in my office to do brain games with people, is

that usually people who practice brain games get better at doing brain games.

And that's not really what the purpose is.

It's really to make your brain better.

But your brain is not a muscle.

It doesn't work by the same kind of rules that your biceps do, for example.

But we do want people to be interacting.

And they say, what if I play these games on my computer?

So if you enjoy playing them, sure.

But that's not where you want to be limited.

You certainly don't want to be in front of the TV all day.

You really want to be interacting with other people.

I don't care if you're playing cards.

Or checkers, or mahjong, or percheesy.

I don't care whether you're going to the senior center and playing

pool or sitting around talking.

It really doesn't matter, but I want an interpersonal element and I want

things to be stuff you have to solve.

Or you have to think about.

Not just things that you have to repeat.

So I'm trying to get people as active and interpersonally

connected as we possibly can.

Which is odd in a culture where people are interacting some with the

social media, AI, all the things we have.

But I don't think it's showing our age that just some of that personal

interaction, communications and things like that is powerful.

Mitch, is there anything I should have asked that I may have missed?

Dr. Mitchell Clionsky: Oh, there's tons we could talk about.

I got nothing else going on in my life.

I can come back some other time.

I'd

love

Dr. Mitchell Clionsky: there's a lot of, I can talk about

this all day long, literally.

And that's why Emily and I get along so well, because we can both talk about it.

Ad nauseum with each other.

And I say to her, look, we're going out.

We're going to meet these people.

we don't do anything in this area.

Let's talk about something

Yeah, maybe we could do another one where we really focus on

leaders and leaders of organizations and what to happen as this starts

to, I don't know, creep in or to be mindful of it and things like that.

I didn't even get into the situation that we identified with my dad with what

he was doing with the financial aspect of things before it was identified.

My sister had to step in and all that.

there's so many things to this that spill over that.

leaders of

organizations and all can have to deal with.

Dr. Mitchell Clionsky: I definitely want to do that with you because

that's a real focus for me.

Because if you can keep your leadership.

Thinking better and working longer in that position rather than having to

retire because they can't keep up with it.

That's going to be a real advantage to that organization.

I definitely think that's doable.

the

powerful thing again, I just hit 60 and I'm recognizing, you know what, I

can't do what I used to do physically.

I'm in pretty good shape fit.

Um, and mentally I just don't try to put as much in here as I used to for

capacity, but boy, we've got some wisdom and experiences that we need

to keep sharp so we could share that.

And so anyway, All right, Mitch, this is our call to action.

What does someone need to do that has just listened to all of this?

We've mentioned the assessment a few times.

Let's drive them to that.

Give them all the info for that.

And maybe if they need to connect with you and get the book, where

can they get all of that info?

Dr. Mitchell Clionsky: B R A I N D O C dot com.

Real basic.

We picked up this website, this, name 30 years ago.

I got it when it was available and I've kept it all this time.

And it's as easy to remember brain doc.

It talks about, this is what we do.

We're doctors who deal with the brain.

It's got a link to our book.

It's got a link to our checklist that you can get.

There's a bunch of other, not as good podcasts on there, but

they can listen to those as well.

There's a couple articles, that we've written or been written about us.

There's a whole bunch of stuff.

So that's the place.

And also there's a way of connecting, my, there's an email connection there as well.

Yeah, very good.

We'll make sure we include all those notes down below and, the, places

that you can go to find all that.

Mitch, we are seek go create those three words and, they mean a lot to

us, but Those three words, if I were to allow you to choose one that just meant

more than the other two at this time, which word would you choose and why?

Dr. Mitchell Clionsky: They're all tough because they're all great.

I would choose Seek.

And it's relates to me.

It's something I used to tell my postdoctoral residents.

And at one point I had three of them and I said to them, you

got to ask the next question.

You got to be curious.

I can't teach you to be curious, but if you're someone who seeks, if you're

someone who is curious about how people tick or how you tick, if you're

curious about what makes things work or not work, just answer questions, and

you'll You're going to go a long way.

So constantly be looking.

What can I learn today?

That makes it a great day.

If you learn something new, that's a success.

Amen.

Dr.

Mitchell Kleonski.

I so appreciate you taking the time.

I appreciate, and make sure you share this with your wife, Emily.

I appreciate you guys.

Putting the book together, dementia prevention, and I love the subtitle

using your head to save your brain.

So, again, I did a quick read through.

I'm actually going to go back and do a deeper read through it.

I, in the last few days, I read it quickly just to get the gist of it.

Excellent book.

I believe it's a book that.

Everyone should read just because of the general nature of the

health and why we need that.

And I just appreciate the conversation.

I appreciate you listening in on this sort of a personal conversation

that I've had for you, the listener, but I believe it's something that

impacts probably almost everyone.

So you've been able to listen in on me, ask some personal

things, and I appreciate that.

We have new episodes every Monday until next time continue being

all that you are created to be.