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How dementia works.
This is a pretty brutal episode, everybody.
This is from November 4th, 2015, but there's some really good information in it.
If you are suffering from dementia or someone in your family is suffering from dementia, you have our deepest empathy because it is tough stuff.
And we hope this episode can bring you a little bit of comfort because knowledge is power and understanding things is what we're all about and that can really help sometimes when you're dealing with something as devastating as dementia.
So how dementia works right here right now.
Welcome to Stuff You Should Know, a production of iHeartRadio.
Hey and welcome to the podcast, I'm Josh Clark with Charles W.
Chuck Bryant in Knowle.
The stint of Knowle continues.
Everybody is like stuff you should Knowle.
No no that's not what we're calling it it's the stint of Knowle.
All right. Stuff you should Knowle.
That's too clever. Yeah.
It's a little cutesy.
Yeah. That's my only aversion to it.
What are you? Are you with Stuff You Should Knoll?
Changing the name of our show?
After eight years? No, just the Knoll stint.
The name of it. Remember, the Summer of Sam?
Oh yeah. Yeah, sure.
Why not? I don't like it.
Alright. Should we come up with a third idea?
Yeah, the stint of Knoll sounds too much like something's wrong with Knoll.
That's why I like it.
It's hilarious. There's nothing wrong with Noel, by god.
And if you think there is, you need to answer to me.
There's something you should know.
See, that's what I'm saying.
It sounds like something that Strickland would have come up with.
Ooo. You know? Man, we haven't been in a flame war with Strickland in a while.
It has been a while.
It's been too long.
It's gotten soft. You just launched one across the bow.
So, um, Chuck... Yes?
Are you familiar with dementia?
Yeah. Sure. Are you running your family?
Doesn't run in the family, but my grandmother who lived to be a hundred had dementia at some point, which, you know, when you live to be a hundred...
that's... I don't know about likely, but it's not surprising.
It's probably pretty likely.
It's, um, it's not, from what I understand, it's not a, um, just a natural consequence of age.
Right. but it's pretty prevalent.
And dementia is actually super misunderstood, it gets confused with Alzheimer's a lot, there's a lot of different kinds of dementia, but dementia is actually it's not a disease, it's a set of symptoms that's brought on by disease.
Yeah, I think that is widely misunderstood but you are totally correct.
A set of symptoms and it is not just your garden variety forgetfulness that comes as you age no because that is age -related that is but totally age -related things called age associated memory impairment and that is a thing I mean that happens to everyone right it's just like you forget your keys more often that kind of stuff sure but when you do forget your keys more often you snap your finger and go I forgot my keys again what is wrong with me yeah that's normal one of the big tells of true dementias when you don't realize that you're forgetting.
So that's when it gets scary.
We said that it's not a natural consequence of age.
One of the things that I turned up in researching this is we're not exactly sure what causes dementia.
We don't even know if some of the telltale signs of dementia are the cause of dementia in some cases or the result of dementia, not entirely certain.
But it is very widespread among the aged population.
In the United States I think 5 .3 million Americans have dementia right now.
And as our population ages, because the baby boomers are starting to get older, I think they're expecting something like 16 million Americans are going to have it by 2050.
16 million is I think about how many people have it around the world right now.
In America alone we're going to have that number in 2050.
And it's very expensive actually.
Uh, how much money?
A lot. You ready for this?
In 2015, we have spent $226 billion on healthcare for dementia alone.
Um, and they're expecting by, I believe, 2050, when we are caring for 16 million, in 2015 dollars, not futuristic, much more inflated, 250, 2050 dollars.
Right. In 2015 dollars, we'll be spending about 1 .2 trillion dollars on dementia if somebody doesn't do something.
Yeah. It's very expensive.
It's also extraordinarily sad as far as diseases or symptoms of diseases, yeah.
Yeah. I also want to recommend our May 2011 episode, a podcast to remember.
Our memory episode ties heavily into this.
So if you haven't listened to that one yet, go listen to that one either before or after.
Or, if you listen to it and forgot, go back and listen to it.
That's right. So, dementia itself is not diagnosed, it's not simply memory loss, it's memory loss along with one of the following, at least one of the following, one or more aphasia, which is if you can't understand or produce language any longer, apraxia, and all these are super sad, if you've ever seen them up close, apraxia, if you cannot make certain movements even though your body physically is healthy, Agnosia, which is you don't recognize objects like the remote control, or your grandkids, stuff like that.
And then executive dysfunction when you have a lot of troubles planning and organizing and reasoning, so that, along with the memory loss, or at least one of these, you could be diagnosed with dementia.
And so like we said, dementia is a set of symptoms, right?
Yes. It's actually brought on by disease and the most common cause of dementia.
I think something like 60 or 70 percent or something like that of dementia cases is brought on by Alzheimer's disease.
I could've sworn we did one on Alzheimer's, but we have not.
Yeah, I don't think we have. I don't know where – We've talked about it enough I think.
It's, yeah, it's popped up plenty of times, but we've never just done a straight up Alzheimer's one.
Alzheimer's brings on dementia through something called neurofibrillary tangles, also known as beta, or I'm sorry, tau protein tangles and beta amyloid plaques.
Yeah, and the plaques are just a protein buildup, a sticky protein buildup.
Yeah, so when your neurons fire and you have a thought, it's an electrochemical process and there is a residual that is left behind.
These residuals can build up in your synapses and cause your synapses to not fire as well.
When your synapses don't fire as well, they start to die off and the neurons that lead from these synapses or lead to these synapses die themselves.
You have neural loss.
Literally, the brain cells in your brain are dying off at a rapid rate.
And when it's caused by beta proteins or beta amyloid plaques and tau proteins in the cells, then what you have is Alzheimer's.
And they aren't sure the cause of Alzheimer's still, genetics they think has a lot to do with it.
And you can live with Alzheimer's for a while, up to a decade.
Although, in this article, Molly says three to five years is more common. It definitely shortens your lifespan.
Like you said, genes are definitely part of the risk factors.
Apolipoprotein E, I think, which is weird. If you have a mutation on this gene, you have a higher risk of Alzheimer's even though the gene just codes for a protein that carries cholesterol through your bloodstream.
It doesn't have anything to do with the Tau protein tangles or anything like that as far As far as I know.
That's weird. Also, if you have a family history of dementia, or of Alzheimer's, you have a higher likelihood.
And if you have Down syndrome, you are at a higher risk of developing Alzheimer's in middle age.
Oh, really? Yeah. Interesting.
So that's - and we will do one on Alzheimer's - but that's how Alzheimer's can cause dementia.
There's also a vascular dementia, which was a case with my grandfather, he had a stroke.
It accounts for about 20 % of dementia cases.
Stroke is when you have a loss of blood supply to the brain or hemorrhage, or a blood clot.
It can be either one big stroke event, which causes a lot of damage, and that's a single infarct dementia or it can be a lot of the accumulation of symptoms because of a lot of little mini strokes you have over the years.
And then the damage just builds up and you finally once that last one that is the straw that breaks the camel's back and you have dementia that happens pretty rapidly after that last stroke you have. Yeah and that is a multi -infarct when it is a bunch of them and little mini strokes are a lot.
Sometimes you have them and don't even realize you've had them.
With my grandfather, he had the big one.
Oh, really? Yeah, we talked about this before and I think something about speech. Yeah, he lost his ability to speak English.
So that would be aphasia.
Yes. He couldn't produce language.
Well, he produced ...
Yes, he could not produce language.
He said things, but it didn't make any sense.
Gotcha. But he had an understanding.
You can see the frustration.
I know how I'm supposed to my grandmother is driving us let's say.
And she doesn't know how to get there.
He does and he can't tell her but he's telling her.
It's just coming out all mixed up.
And that's a hallmark of dementia is there's emotional changes in the person because they're not communicating like they want to say.
People aren't responding like they want the people to and they'll get snippy and then ultimately say withdraw They'll just give up on communicating it all because it's too frustrating or just too sad, you know.
Yeah Which is it's one of the common results of dementia.
It's a Comorbidity now it's a complication.
Yeah, and then and with the single stroke event Or actually or with the multi strokes, it's different for everyone.
There isn't any single, well, this is going to happen because this person had a stroke.
It could be a variety of different things from paralysis on one side of the face or body, bowel and bladder control problems. He didn't have any of those.
He looked totally the same.
Physically, he walked and talked the same, except for the fact that they weren't real words.
That was like the most noticeable thing.
I remember you telling me about your grandfather before.
I don't remember what it was.
It was a long time ago.
We were talking about speech like or Nicky's area or Broca's area.
Yeah. Something like that.
So with Alzheimer's, it first attacks the hippocampus which means that it's going to take away your episodic memory which is your memory of recent events, right?
Yeah. And then it starts to move its way into other areas of the brain where your judgment is affected, your speech patterns are going to be affected, your personality is very much affected and changes.
With Alzheimer's. With Alzheimer's But not as much with the stroke.
Yeah, with vascular dementia, you know, there might be some other things, where like part of the face is sagging, or the patient can't move their arm or something like that.
But yeah, the personality will remain intact, because those regions of the brain aren't affected, like they are in Alzheimer's.
Yes. And then in about 5 to 15 % of dementia cases, it stems from something called Lewy body dementia, which we were just talking about.
They think Robin Williams might have suffered from.
He definitely did. He definitely did.
They found him his autopsy.
I think he was diagnosed with it before he died.
That was one of the reasons why he took his life.
Yeah, because that can cause severe, intense hallucinations.
Yeah. Big time. Did you look those up?
Oh yeah, man. This is scary stuff.
It feels like very, apparently, a typical one is very brightly colored animal or person that you see in great detail for many minutes on a daily basis, like just intense hallucinations.
I'm sure you think you're losing it.
Right, and that's one of the first symptoms of Lewy body dementia.
And it was discovered by Frederic Lewy in 1912 and it has nothing to do with your body.
A Lewy body, there are deposits, again protein deposits, of the alpha -synuclein that appear on the brain.
So don't think of body in terms of your physical body.
And this is also present Lewy bodies in Parkinson's, so as a result, not only are you going to have symptoms similar to Alzheimer's with Lewy body dementia, but also some of the tremors and balance issues of Parkinson's, which is super sad as well.
Is that what Michael J.
Fox has, Parkinson's?
Yeah. Yeah. And that's what the movie Awakenings was about, wasn't it like a group of Parkinson's patients that El Dobo worked on?
Was that Parkinson's?
I can't remember. I think they didn't realize what – they thought they were locked in or something and then they realized their Parkinson's tremors were so acute that they were not even shaking.
They were just completely, their muscles were totally contracted rather than contracting and relaxing again and again.
And Robert Williams. How about that?
Then we have something that used to be, well, it's called now frontotemporal dementia.
It used to be called Pick's disease but now Pick's disease is a specific version.
Which I couldn't really suss out what the difference is, could you?
No. I couldn't either.
As long as it wasn't just me, I'd feel better.
But FTD is really an umbrella term.
It's about five percent of dementia cases and it's going to affect personality and behavior and language.
Like big -time. Big -time and it's where your frontal and temporal lobes are actually atrophying and shrinking.
Right. And the reason why is, you remember with Alzheimer's you have beta amyloid plaques, and tau protein tangles?
With the frontotemporal dementia, you don't have the beta amyloid plaques, you just have the tau protein tangles but it's enough to cause massive neuronal loss.
Yeah, and I think a lot of people at first think they might have Tourette's, because you can yell things out, inappropriate behaviors.
Yeah, like if your grandfather suddenly becomes hyper interested in sex and likes to talk about it in public or exposes himself to people in public, there's a pretty good chance that he has developed frontotemporal dementia.
Or if I did, because it's unusual in that it attacks younger people.
It's going to onset between 40 and 75 years old which distinguishes it from other types of dementia.
Yeah, and if your grandfather used to do that stuff already, then that's not the case.
The key here is that this has come out of the blue.
If somebody is really just completely changed in their personality, they might get into really risky behavior like gambling all of a sudden.
Shoplifting and being like risky investments or like pulling all their money out of the bank.
And with Pick's Disease too, apparently apathy is a big indicator of this.
There's a big personality change and the person is no longer, they have no empathy.
They may have blunted emotions and then they may also be engaging in risky behavior.
So basically your grandpa or grandma has just turned into like the transporter.
Or me. Or you. Well yeah, you're 40 and 75.
You lack empathy? No, no, no, I'm just saying because it affects younger people.
I thought you were saying like they turned into you.
Oh, no, no, no. You have blunted emotions and you gamble.
There's also Huntington's disease.
This is, it seems like much more physical in nature, uncontrollable movements although there are changes in personality but real fidgety herky -jerky.
Your brain loses the ability to control coordination essentially.
Which is I think 50 % chance of inheriting the gene, but you can live with it for up to 20 years.
Yeah, which seems like as far as dementia goes, one of the longer life expectancies.
But again, I would guess this has kind of become clear, the hallmark of dementia is memory loss paired with some other problem like not being able to create speech any longer, recognize speech, or not being able to move, that kind of thing, or not being able to plan.
And like we said, well, we should probably take a break, huh?
Yeah, we got a couple of more types that we'll talk about and then some other good stuff.
Okay. Right after this.
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The last two, actually the last three we're going to talk about, because there are many, many other kinds of dementia, like we could spend hours and hours talking about all the different kinds.
But we have talked about Kreuzfeldt -Jakob disease and I can't remember which one and we say that all the time.
Is there a disease that kills by preventing sleep?
Oh, is that the one?
Which we should've rightly called how prion diseases work.
Yeah, because it is a prion infection.
It's very rare, about 1 out of a million people will be affected in any given year.
Like mad cow disease or kuru.
Yeah, exactly. It's a spongiform disease.
It's so crazy. It is, it's very interesting.
Could be genetic, but I thought we also talked about it in organ transplant.
Did we? I think so because it can occur because of infected tissue that you are implanted with or from an organ.
Yeah, and this is neuronal loss due to like holes literally being eaten into your brain by this disease.
And then you can also get dementia from when you have HIV.
If you are a boxer or say a football player in the NFL, you may have dementia from a traumatic brain injury like a concussion or repeated concussions.
And there are plenty of diseases.
There's also reversible dementia too.
You have a vitamin deficiency.
If you take certain medications, you can develop dementia, but this is reversible.
For the most part, though, age -associated dementia is not reversible.
Like we said, it's kind of tricky to diagnose this stuff because it is normal for people to become more forgetful as you age.
And then, to make it even more confounding if you're a diagnostician, not only do people get more forgetful, there's an intermediate stage between dementia, a dementia diagnosis, and just normal age -related forgetfulness.
And that is called mild cognitive impairment.
So if you can catch this, from what I understand, and we'll talk about treatments and everything later, but if you can catch things like Alzheimer's and other diseases that lead to dementia early, although there's no cure for any of them, you can manage them a lot better and delay, say, death, or the real devastation associated with it by a significant amount of time.
But catching it is the tricky part, and especially if you have dementia, you don't really realize that there's any kind of problem, so you're probably not going to take yourself to the doctor.
No, but what you should do is listen to your loved ones, because they are going to be looking at you a little more closely.
They have more perspective.
Yeah, exactly. That's what we're looking for.
So don't get offended if a loved one says, let's go get you checked out.
Because you can do something if you catch it early on.
Unless you're very wealthy and it's your no good nephew that you've never trusted anyway, you know?
Very true. Then maybe bring a lawyer in on it.
See what's up. So, if you do go get checked out, from the second you walk in the door, your doctor's going to be eyeballing you, and looking for any signs, just from their trained eye, from how you walk to the way you answer questions, to how they interact with you.
They're going to have to know your history because they need to have some context to compare it to.
Right like were you always a compulsive gambler?
It's like new behavior.
Yeah, and it helps to bring you know if If you're older may be bringing your grown son or daughter with you right or whoever has a lot of bad back sure sure although your spouse you never know Maybe trying to get rid of you.
Oh, yeah like that.
No good nephew. Yeah exactly I'm just kidding of course Although I'm sure that happens then there are a couple of tests that they usually do in conjunction with one another The mini -mental state examination, the MMSE, just a lot of basic questions there for mental tasks.
But they're coded, the tasks are.
Yeah, and they're scored individually.
And when you say, question 3, this person got an 8 on, you can go over and be like, yeah, dementia.
It's actually pretty effective, actually.
It is. And, there's another test that ties into the MMSE that they both indicate one another, which apparently they're both really good at indicating dementia.
But, there's another test called the clock drawing test. Did you look this thing up?
Yeah, I thought it was pretty fascinating.
It really is. Yeah, it seems really, like, why would someone tell someone to draw a clock at a certain time of the day?
Yeah, usually they say, draw a clock, showing that it's 10 after 11.
Yeah. And it makes a lot of sense in a lot of ways because it draws on all these different kinds or different regions of the brain, different skills, right?
So like, first of all, you have to remember what a clock is and what it signifies.
That's a big one. What it looks like.
A clock isn't made of like squiggly lines or anything like that.
You have to remember how a clock is laid out, the order that the numbers go in, that it It doesn't keep going after 12 to 13, 14, 15.
And then, once you've got all this, you have to show the hands showing that it's 10 after 11.
So the hands won't be pointing at 10 and 11, it should be, the longer hand should be pointing at the two, and the shorter hand should be just past the 11, right?
That's right. This requires a tremendous amount of brain power, even though it's very simple and straightforward, and you can tell a lot about a person's mental faculties just by having them draw this.
Yeah, the four specific things it requires are verbal understanding, memory, spatially coded knowledge, and constructive skills.
And if any of those are off in conjunction with the MMSE, then they're going to have a pretty good idea of where you fall on the dementia scale.
If you don't have the constructive skills to pay the bills, you may have dementia.
That's right. And they actually...
I looked at one study about the clock drawing test. Basically, I think it was just a more recent like, hey, let's go in and really look at this thing again.
right and it checks out yeah they stood behind and said yeah it's actually a really good indicator yeah like it really holds up and they i think they developed it in the 60s but it didn't take off until the 80s and then they started to look at it it's like a very 60s thing it does you know but it's something you can do anywhere and now they're starting to gather these um different clocks that people with different types of dementia are drawing and basically compiling them into a database so you know what to look for even more like oh somebody draws a clock that has like a 13, 14, 15 on it, they
may have this type of dementia.
Or this one looks like Salvador Dali drew it.
Right. Then they might have this kind of dementia.
Yeah. Or they might just be super talented.
Right. You never know.
All right. Should we take another break?
Why not? Is it time?
Sure. All right. We'll be back after this talk about treatment and some of the other pitfalls of dementia.
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So Chuck we've kind of um, I think it almost goes without saying like the problems associated with dementia, like you lose your ability to reason in a lot of cases.
You lose your ability to move and take care of yourself, you lose your memories, you have trouble forming new memories, you have trouble recognizing people.
But living life is extremely difficult.
But there's also other complications that you may or may not think of.
Let's say you're an elderly person and you have a battery of medications that you need to take for unrelated heart disease.
Do you think you're going to remember to take those medications?
Probably not. Even if you have a timer set or some sort of calendar or something like that, you may have trouble even remembering that you have a calendar that you need to go check out to see what's on there, let alone to take the medication that's indicated that's on that calendar.
Yeah, that's a big problem.
Nutrition itself is a big problem.
Either you forget to eat altogether, or you think you've already eaten, or you physically have deteriorated so that you can't control the muscles to chew and swallow and you could choke.
Right. That's a real danger.
So when people die from Alzheimer's it sounds kind of strange if you think about it, it's like well, no they forgot They lost their memory or whatever.
Right. No, the brain is actually being slowly destroyed.
Yeah Periodically and eventually it's gonna reach the parts of the brain where like you can't swallow any longer Then you die from that kind of thing You also can lose your sense of hunger Like you just aren't hungry anymore.
Yeah kind of tough to eat especially when you're not thinking or remembering that you should eat Um, when you're just not hungry ever.
Yeah. It's a tough one.
Uh, hygiene, uh, reduced hygiene is a big one.
Um, a lot of times in severe dementia cases, you either are unable to bathe and dress yourself and brush your teeth, or you forget to.
Uh, it just falls by the wayside.
Um, I know that was the case with my grandmother.
She needed, you know, she needed to be bathed by my dad and his wife.
Yeah, because she lost interest in it, or because she just couldn't do it anymore?
Yeah. I think both.
That's another indicator.
You said that when you go in for a diagnosis the doctor's gonna be watching you and just kind of sizing you up.
One of the things you'll look for is whether you look disheveled.
That's a big one. And especially if your son or daughter is saying like, this is really bizarre behavior because Mom always dressed to the nines.
Now she just wears this dirty old bathrobe all the time and doesn't ever want to take a shower.
That's usually an indicator of dementia.
Yeah, it's not like she just gave up and doesn't care anymore.
It's part of the symptoms taking hold.
Although, another problem with dementia and one of the confounding factors, is that depression can be a byproduct or comorbidity of dementia, because you recognize that your life is changing in ways that you're not happy about, you can't communicate anymore, you forget stuff all the time, You can become depressed.
So, then, that could lead to you giving up on taking showers and dressing as well.
Yeah, and not only depressed, but agitated and aggressive, riddled with anxiety, a lot of your emotional well -being and emotional health will be slipping away from you.
Yeah, and, again, this can be a direct result of chemical changes in your brain due to dementia, dementia.
Or, this is the result of you recognizing these changes and just becoming upset about them.
We talked about communication and the hallucinations.
You're going to have trouble sleeping as well in a lot of cases.
And then personal safety.
A lot of people die every day because of accidents that happen as a result of dementia.
Right. People who shouldn't be driving get into cars.
There's a push that's going on now.
I think in the last year or so, as part of the Council on Aging, the United States Council on Aging, there's a new initiative called the Dementia Friendly America Initiative.
It's basically saying, look, we've got about 1 in 8 people over 65 in the US have dementia.
We're about to have way more than that in the next couple decades.
We need to be prepared for this kind of thing.
So, let's start training America how to recognize the signs of dementia and then how to react to it in a friendly and helpful manner so that people who are wandering around with dementia don't withdraw $80 ,000 from their bank account and walk around with it in their pockets outside.
Yeah, and how do you do that?
You get some money from the government as a grant to go out and hire people to literally Apparently go to businesses and go to restaurants and talk to waiters and waitresses or should I just say, waitrons.
Go to banks and talk to tellers.
Go anywhere where there's interaction with another human grocery store check out people and literally train them on like you said how to recognize it and how to kindly deal with these people.
Right, exactly. Apparently one of the things you teach people in service industries is not take it personally, That if somebody is behaving erratically or they are using incorrect words and they are of a certain age, the chances are, they probably have dementia and there are ways of dealing with it.
Apparently responding to it in a soft, friendly manner tends to get results from the dementia patient.
Especially if you are … You mean not being an aggressive jerk?
Right, exactly. Just being nice will frequently get good results.
And yeah, it is a pretty neat initiative.
And necessary. Yeah.
But I'm stricken by the idea that people are planning out this far ahead for this kind of thing.
It's exceptional. It is.
It's scary, but awesome.
So if you do have a family member, one thing that's important to remember, there's something called the caregiver burden that my dad and his wife definitely experience.
It is really, really tough on you, on your family, and it can actually take a physical toll.
They have some stats here.
If your risk of death as a woman, if your husband has dementia increases 28 percent in the first year after they're diagnosed and only 22 percent for a husband whose wife is diagnosed.
It's still a pretty significant increase.
Oh sure. Just from the dementia diagnosis.
What they recommend in this article is to take care of yourself first because they found Understand that if you are not going into this with the right attitude and you are upset or have anxiety, you're just going to do more harm anyway.
So get yourself right.
Take care of yourself and go into it in the right frame of mind and you'll actually be able to help better.
Yeah, and this caregiver burden or caregiver burnout is a very real thing physically, too.
Like you have low energy, you have low productivity, you become snippy, resentful, angry, and it's You can end up basically mistreating your own parent or spouse because you're so upset with this horrific disease.
One of the hallmarks of dementia is that there's no two days that are alike, and when you're dealing with a dementia patient, what worked yesterday isn't going to necessarily work today.
Well, if you can no longer predict what your life is going to be like from day to day and When you're spending, I saw this one study, that found an average of 22 hours a week of unpaid care by spouses, wives, daughters, that kind of thing.
You can very easily get stressed out, and the main thing you have to do is ask for respite care.
You can't do it by yourself.
You have to have other family members, members of your church, your community, come and give you a break so you can go do other stuff for a while.
And, I mean, you could totally see how you could just very easily evolve a really unhealthy dynamic if you're just trying to do it yourself because you lose perspective.
This becomes your norm even though it's totally abnormal.
And boy, you talk about a really sad way to damage what previously was a good relationship with a parent or something is devastating.
So, there are drugs that they use to help stave off dementia, mainly right now they are cholinesterase inhibitors and they suppress cholinesterase which is an enzyme that breaks down acetylacetyl?
Acetylcholine, which we've talked about before.
That's what helps transmit messages between neurons.
So that'll help. Yeah, because if you're not communicating as much as you were before, at least the communication that is going on can stick around longer.
Exactly. You know? It seems primitive as far as like brain drugs go, but it makes sense, you know?
Yeah, and there's another one.
Are they still using this?
I believe so. Memantine.
Uh huh. And it inhibits glutamate, which we talked about before, which causes neuron death when overstimulated.
Yeah. I can't remember where we talked about that one either.
I just remembered, glutamate from the umami episode.
Yeah, it was definitely in that one.
And then there's also stuff you can...
So these drugs will help some.
That's for non -vascular dementia.
Right. With vascular dementia, you're going to want to take blood thinners, anticoagulants, yes, to keep more strokes from coming along and making the whole thing worse.
And then with Lewy body disease, to deal with things like hallucinations and stuff, you'll probably also be given anti -psychotics as well.
And one thing that they're starting to realize more and more It's very difficult to really figure out what kind of dementia people have just from – what's the scan?
David Bonilla M .R .I.?
David Bonilla M .R .I.
scan. And you can really go back and accurately identify types of dementia from autopsies, right?
David Bonilla Right.
David Bonilla And so from more and more autopsies, they're finding that there's a lot of what's called mixed dementia, where you have Alzheimer's and vascular dementia or where you have Alzheimer's and Lewy body disease.
And so it can be really tough to suss out all the different kinds of dementia a person might have but if you can do that, then you can put them on a drug regimen that could really kind of help more than just treating the Alzheimer's letting the Lewy body go unrecognized and rampant.
They're unchecked. There's also preventative stuff you can do too.
Oh yeah? Yeah. Like what?
Crossword puzzles. Yeah.
I told you. Emily's grandmother Mary is 95, and very sharp, and she does word puzzles all the live long day.
And is it Soroku? Yeah, she does she does all kinds of word puzzles.
Yeah. Things that I have never even heard of.
Supposedly, that helps stave it off.
Oh yeah. Apparently, this one's great.
But alcohol, moderate alcohol consumption which is two a day for men or one a day for women has a protective effect.
It staves off dementia.
They're not sure why.
They're not sure what kind of alcohol is the best. They just know that for some reason alcohol has a protective effect.
Probably up to that two drinks and then it's probably bad after that.
Yes. Then it becomes very bad after that.
So you want to just moderate them out.
Right. In all things, people.
Moderation. Moderation.
And then there are some things that you can do.
Here's the thing, there's a debate on whether or not you're tricking your loved one by doing things like giving them an appliance that doesn't work so they can pretend that they're ironing or something.
Because they used to love to take care of their laundry themselves.
So here, let me remove the cord from this iron.
Is that tricking someone?
Is it not? A lot of people think, no, that's what you should do because it makes them feel like they're being useful.
They're not going to get hurt with a hot iron.
So it's all good. Other people say no. That means they're not hanging on to that last bit of reality they may have. I think it's fine.
I think it's fine, too.
And, there's actually, there's an entire village set up in, I think like just outside of Amsterdam.
Yeah, this is awesome.
It's called Hoejwij, right?
Yeah. Hoejwij? How would you say that?
I have no idea because Dutch is the weirdest language on Earth.
We'll say that, okay?
Okay. it's a what's called a dementia village, basically, where everyone who lives in this village, I think 150 people, all have dementia, and they live in group houses.
Well, there are caretakers that live there too.
Okay, yes, you're right.
And they live in the group houses with them.
And a lot of the people realize that this is their nurse or just think it's a good friend of theirs.
They don't really remember when they became friends.
Like a cool roommate.
Yeah, exactly. The houses they live in have different themes according to how the people lived, depending on whether they were blue collar, whether their memories go back to the 70s.
This whole place is basically set up so that it's a very non -threatening, safe place for these people to just kind of live and move about within.
Sure, safely? Yeah, safely.
And so they can go to the grocery store, they can go to the movies, they can go ride a bike.
And everyone, the people at the movie theater, know that the people there have dementia.
So like, they're real movie theater workers and real waiters in the restaurant.
Especially trained.
Exactly. So it's a less clinical setting than, say, a nursing home, and a lot of people say, this is awesome because it's as close to real, normal life that they were used to as they were going to get.
Yeah, exactly. Uh..
then of course there's other people that poopoo and say no you're tricking these people.
But you can say, hey, okay, here's the big difference with this place.
If this dementia patient gets lost in Manhattan and they run across a city worker who's collecting garbage, that city worker may do absolutely nothing to help them.
Yeah. In Hojve village, that city worker is specially trained to get that person back to their house or alert their caretaker that this person is having a crisis or something like that?
It's what we're trying to train people to do in the future.
Yes. They've just isolated to a community.
Yeah, so there's, I mean, when you break it down to that distinction, I don't really see anything wrong with it, especially when you are protecting the patients themselves.
It's not like you're doing it to experiment on them...
No, no, no. ...you know, or because they'll produce gold in their urine or something like that, you know?
Like, this is strictly for their protection, but also allowing them to live a free life outside of a clinical setting.
I don't see much wrong with that.
I do get what the bioethicists are saying like, yes, you're robbing someone of their dignity by lying to them or by deluding them or playing into their fantasies, strictly speaking, yes.
In the real practical world, I think this is great.
If I'm at that point, then play into my fantasies.
Exactly. Please. It is 1984 all the time.
In fact one of the people that worked there said that the people that do criticize it is a very good point, he's like, they don't understand what we're doing here, these aren't actors, they're like real employees of these places, they're just helping out.
And so Hodge Vay village, I hope I'm saying that right because I'm really putting myself out there.
Oh I'm sure you're not.
So, it's become this kind of ideal standard of care, but it's also really expensive.
So, in a country where there's a lot of socialized medicine, it could do pretty well, like in the Netherlands or in Canada.
Yeah, when they take care of people, even though they don't have money.
Right, exactly. Absolutely.
There's one called, in Canada, it's called Pentanguishini Ontario.
They have one. It's a little smaller than the one in Amsterdam.
They're also building one in Miami as well.
So it is starting to take hold.
People do believe in it.
And apparently the patient's families are very happy with this kind of thing too.
Well, and hopefully with the initiative of, what's it called?
Dementia friendly America.
DFA. .org. Yeah, hopefully with those efforts, more and more people will, because it's coming.
Oh yeah, it's coming.
A lot more folks are going to be out there that we need to take care of.
Yeah. We don't know how to cure dementia, we just know it's coming.
I'm going to be one of them.
You think so? Sure, at some point, if I make it that long.
but you know not everybody gets to mention no matter how long you live I don't know I got a feeling yeah it does run in my family a little bit yeah and I and I have the my father's family genes more than my mother's I got I feel like yeah so if I had my mother's genes they all died from heart attacks and strokes okay in heart disease but young not a lot of Yeah, pretty young.
So if you make it past 65, you beat the heart stuff.
Than the Bryant genes kick in.
Then you got the dementia.
Well we're all going down one way or another, right?
I may live to be 100.
You know? Yeah. Oh yeah!
I wonder Chuck, if like our specific...
Like us. You and me, specifically, cramming all this information in every week is actually beneficial or if we're just setting ourselves up for massive cases of dementia because we're just pushing stuff in and getting it out pushing in new stuff and getting it out yeah like are we are we abusing our brains are we exercising it I question that sometimes I bet someone out there I bet there's a neurologist who has a good gut instinct answer to that let us know I want to know good news or bad okay neurologists there's gonna be a subject line that just says neurologist guys you're screwed yeah I have bad
news, if you want to know more about dementia you can type that word into your favorite search engine it will bring up tons of information and great resources you can also type it into the search bar at house stiff works and it'll bring up a great article since I said search bar it's time for listener mail.
I'm gonna call this one Hecky Krasnoe lives, okay, although I don't think he is with us hey guys only just started recently listening to the show.
It's been a fantastic way to pass time and learn something interesting.
I'm a home taught high schooler, so every time I listen to an episode of your show I get a history or science credit.
How about that? That is pretty great.
But as great as that is, that's not why I'm emailing.
I actually have a fun fact for you guys from your Play -Doh episode in which you mentioned Captain Kangaroo.
Well, my great -grandfather worked on that show.
He produced the songs for it as well as several Christmas carols including Frosty the snowman and his biggest claim to fame Rudolph the red -nosed reindeer that is awesome I've always thought it was very funny that a Jewish guy was responsible for the popularity of Christmas carols my family all still Jewish Watches the claymation Rudolph movie every year because of that sure own little taste of that irony Yeah, I don't want to tell you what to do some sure you have a lot of episodes on your plate already But I'm just saying Hecky Krasnoe was a pretty interesting person There might just be enough
material for an episode on him up to you.
Nice. Thanks for helping with my schoolwork That is from Aiden in Maryland Awesome.
Thank you very much Aiden And when I say Hecky Krasnoe lives, I mean lives on sure like Viva La Hecke.
Yeah If you want to tell us about someone interesting in your family, we love that kind of stuff Also, if you're caring for a dementia patient, we want to hear the highs and the lows of that.
Just kind of bring it on home for us, will you?
You can send us an email to StuffPodcast .com.
And as always, join us at our home on the web, stuffyoushouldknow .com.
Stuff you should know is a production of I Heart Radio.
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