Growing Older: Understanding Cognitive Decline in Seniors
September 24, 2024 | Episode 25
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Lindsey Gordon, Dr. Lee, Marcus Thorpe
Marcus Thorpe 00:13
We are getting older. Our parents are starting to age, and Father Time is undefeated. But understanding cognitive decline doesn't have to be a scary topic. It can be something you can take, you can learn from, and you can manage. Welcome to the Wellness Conversation an OhioHealth Podcast. I'm Marcus Thorpe.
Lindsey Gordon 00:30
And I'm Lindsay Gordon. We have a great guest to lead us through this very challenging discussion. It's Dr Daniel Lee, a neuropsychiatrist with OhioHealth neuroscience. Dr Lee, it's great to see you. Thank you so much for being here.
Dr. Lee 00:30
It's a pleasure to be with you.
Lindsey Gordon 00:30
Talk us through how you came to be a neuropsychiatrist, what motivated you to lead in this space. And it's important work that's underway, right?
Dr. Lee 00:55
Yeah, I certainly think so. I think when we think about these big life decisions, especially with vocation or career. I think there's two kinds of organizing principles for myself. I think the one is, does it make me excited? Am I curious about it? And the second is, do I find it fulfilling? For the first, I've always been someone who loves human stories, narratives. I was always a big reader, and I loved the exercise of taking someone else's perspective, of putting myself in the shoes of like a historical figure or a novel's protagonist or antagonist. And I think that sort of exercise kind of lends itself to asking questions about like, what makes us feel the way we do, or think the way we do, or interact with others the way we do and organize ourselves in communities, and how those relationships get formed and sometimes fall apart. And then that brings up questions like, how are the mind and the brain alike? Where do they converge, and how do they diverge? And I think that's what led me to Neuropsychiatry. It kind of straddles that little divide, that perspective between brain and mind, about cognition and behavior, in terms of what I find fulfilling about it. You know, there's a lot of ways in which you can find meaning through service. For me, I think what's interesting about dementia and aging is you’re kind of grappling with very human experiences. In some ways, dementia is accelerated aging, and as folks kind of think about that last phase of life, it's gives you this unique perspective in how they're interacting with their family and thinking about these questions about legacy and about their children, and earning their trust to be able to hear about that and be a part of their story. A little bit, I just find really fulfilling.
Marcus Thorpe 02:57
It's really interesting. It's such a beautiful way of thinking about the work you do too, right? Not just the work of figuring out what's wrong or what's going on, but also embracing that human and that story and that journey and the things that go along with that, too. I think that's an important part of your work, to really be able to connect to it too, right?
Dr. Lee 03:17
Yeah, I think so, and especially in this field, where, you know, we don't have a silver bullet, we don't have a magical cure, and sometimes it's just kind of sitting with that experience of change, and sometimes all I can do is lend a listening ear. But you know, those kind of moments, I think, can be powerful. They certainly touch me a lot.
Marcus Thorpe 03:40
I think the one thing that I've spent a little time with you since you came here to OhioHealth, pretty recently, too. Of the number one question that I think I hear others say to you, or that I think people have in their mind, is really just understanding terminology when it comes to dementia, cognitive decline, Alzheimer's, maybe we just start there and talk a little bit about how people can understand those terms that get thrown out a lot, but maybe they think they all mean the same thing, but they don't.
Dr. Lee 04:11
We've certainly not made it easy for others and for even ourselves. These are terms that docs get confused about a lot as well. Let's start with dementia. It's a term that carries a lot of freight. It means a lot of different things to a lot of different people, and we haven't done a good job as a society about, you know, being clear about what it means simplistically, all it means is there are some cognitive changes, meaning, memory, thinking, language, visual skills, to the point where it's starting to affect your day to day. So driving, managing your bills, dressing, bathing yourself, that's all it means. So you can have technically a dementia from strokes or brain tumors or different metabolic deficiencies, like, if your vitamin B 12 levels are low, but then you can have a dementia due to, you know, progressive neurodegenerative causes. And what I mean by that is, these are illnesses where parts of the brain start to die and get damaged, and Alzheimer's is the most common type of that. So you can have dementia due to Alzheimer's, among other things, like Lewy Body, Parkinson's, Frontotemporal dementia. So the terms are very closely related, but they're distinct.
Lindsey Gordon 05:34
A lot of our listeners. We have listeners from every phase of life, but there might be someone listening today who is caring for an aging parent or parents, and they're starting to learn this terminology, or maybe they're starting to notice things in their parents where something's not right. What are the types of conversations that need to be had when talking about diagnosing or getting on a path to diagnose one of these and and managing it. Because, like you said, there's no silver bullet, right? So it's about managing it.
Dr. Lee 06:09
Exactly right. I'm no expert when it comes to this, you know, I'm a son of of a mom and dad, and you know, I'm seeing them age two. I can speak for our experiences, but there's no one size fits all right. I think these conversations need to be approached from the perspective of, you know, love and wanting to be supportive, and that relationship is different each time. And I think folks are going to approach their mom and dad or their loved ones in a way that, you know, they think that they will receive. I think the key thing, as you kind of mentioned, is, you know, early detection and early diagnosis. You know, we all occasionally, as we age, will, you know, forget the title of a book or a movie or that actor who was that person in that movie? That's normal. And there can be changes in processing speed or occasionally with multitasking, those are all normal. But if we're seeing things like forgetting recent events or conversations repeating themselves, getting lost and these issues kind of consistently cohere to form a picture that things are slowly changing in a steady fashion. It's important to again, the mindset of love and support kind of talk to mom and dad about, hey, maybe it's time we get to see a specialist or talk to our primary care doctor and talk about next steps, because it is about education. It's not about getting you on a chemotherapy regimen. It's about, hey, this is what's going on. This is what we're up against. It might be slow. There's a journey, and we need to marshal our resources, whether it's support from family, friends, a social worker, a doc, we want to monitor, keep you safe, keep you supported.
Marcus Thorpe 08:06
Do you see a lot of families that come to you, and do you ever think to yourself, or often think to yourself, Boy, I wish I would have seen this person five years ago, maybe 10 years ago. Is that I think we all drag our feet a lot, even just going to see our regular primary care physician, but when it comes to the specialty side of it, do you see people that you wish you would have seen five or 10 years earlier?
Dr. Lee 08:29
Every day. And there's so much more we can do in terms of, you know, getting that team together and leveraging support and even medications nowadays, the earlier you start, the better you can have a chance to slow things down and maybe slow things down so that you don't experience those most advanced stages. Maybe we could have talked about getting you in a different living arrangement, whatever the case may be, a little bit earlier so we're not kind of scrambling and emergently trying to find something that fits. And then, you know, think about those 5 or 10, years where family members knew something was wrong but didn't know what it was, and maybe were told it was something else, or relationships were deteriorating because they didn't have a clear explanation. You know, I wish I could turn back time and had have those conversations and, you know, let people know that, hey, this isn't something they're doing on purpose. This isn't something they're doing because they're not trying. But this is an illness, just like any other, like a like a heart illness or a lung illness every day that happens.
Lindsey Gordon 09:43
Where are we at with managing the onset of symptoms or the progression of the disease? Are you hopeful for the future with the research that's underway, and you mentioned some medications to help manage it as well?
Dr. Lee 09:56
I am hopeful. I think the last year or two has seen the advent of a good first step towards something new. In terms of medications, there are basically three kind of categories we think of. None of them are magic bullets, as I've said, but they can have modest effects in slowing things down. So the first medication we typically talk about is a medication that boosts a signal in the brain that can help brain cells communicate better. It basically facilitates efficiency of transmission, and it can help with attention and memory. So medications that fall in this category are like Donepezil, also known as Aricept. There's a few others as well, and these medications, again, have very, very modest effects. There's a second called memantine, or namemenda. It works slightly differently. What it does is it blocks a signal that we think is neuroprotective, so it's protecting brain cells from damage. So these two medications work slightly differently, but again, have modest effects in slowing things down. These medications have both been out since the 90s, so it's been quite a dry spell when it comes to R and D with medications in this field. But again, in the last year or two, we've seen the introduction of two FDA approved products that clear a protein called amyloid. Amyloid is one of two we think, neurotoxic proteins or particles that are deposited in the brain and Alzheimer's disease. And what these medications do is they quite effectively clear this protein away. Again. It's not a cure. Alzheimer's is more than just amyloid, but it does seem to slow things down by about 30% over a year and a half again, the earlier you give it, the better. And you know, there are some safety risks that we have to monitor around these medications, but for folks who are just noticing the earliest signs, this means buying time and buying time with family, friends, experiences and new memories.
Lindsey Gordon 12:04
Speaking of those family and friends, I know every patient benefits from having a support team of loved ones, and I feel like in this, in the work that you do, you have your patient, but then you also are tasked with working directly with their family to make sure they're in that space where they're supported and their symptoms are not putting them in danger or harm's way. Does it feel like for every patient, you kind of have multiple patients, in a way?
Dr. Lee 12:35
I require as a matter of course, whenever it's possible to have family members present for every visit. Can't do this alone. I have a team as well. They also need to show up with their team as well. And it's about making sure that the caregivers are educated about what to watch out for, how to help, how to even reframe conversations, you know, the way we're talking right now, where we're kind of reasoning or using logic. You know, sometimes that's not the best way to talk to these loved ones anymore. So we talk about different communication strategies, about being more validating and supporting. And that, again, that education doesn't just come from me, it comes from my nurse, our social worker, speech and occupational therapist, physical therapist, we work as a team to kind of make sure everyone's all on the same page.
Marcus Thorpe 13:31
Dr Lee, I think about you and the work that you're doing and how passionate you are about it, and then I think about some of the other disciplines within even neuroscience, like multiple sclerosis or or stroke and even cancer patients, where we've seen these huge leap forwards with medications and treatments and success and all of those things. And yet, kind of in the dementia Alzheimer's space, it's been a lot slower, and we haven't seen those tremendous gains from just a clinical perspective. Is that frustrating as a physician to know that we're not leaps and bounds forward from where we were maybe 5, 10, 15 years ago, where maybe these other disciplines are seeing such great success, that's got to be a little frustrating for you and for families, right?
Dr. Lee 14:20
It is frustrating, but it's, you know, part of the motivation to work in this field. These diseases are very complex. They're very heterogeneous. In some ways, the complexity here outstrips that what of what we see in cancer. So as we learn more about the biology, we just learn more and more about how this disease is more than just these proteins like amyloid or tau, and involves other aspects, like inflammation and metabolism, how cells use energy, genetics. But that also gives me hope. Hope that you know, if we use cancer or heart disease as kind of our North Star, we can work towards a future where you know, just as we do with cancer patients, when patients get chemotherapy, you'll notice they not just getting one drug. They're often getting a cocktail of several drugs. And if we think about these different aspects of a disease like Alzheimer's, as complex as it is, you know, maybe at one point in the illness we are giving something that clears amyloid. Maybe we're getting something that clears tau, that deals with genetics, that deals with how these brain cells communicate with each other, and maybe some of these treatments can be given even before someone has symptoms. There's studies where people with so called preclinical Alzheimer's disease who have these markers but don't yet have symptoms, maybe we can delay or even prevent the onset of symptoms. You know, that's the future we're all hoping for.
Marcus Thorpe 16:01
I love that there's that potential, hope and whenever we do have a breakthrough within this space, how monumental it's going to be right for so many folks as we start to age. And it's going to be really neat to see whenever we do have that, that big breakthrough, it's going to be great.
Lindsey Gordon 16:16
I'm sure everyone listening has experienced at some point in their lives someone who has either been a support person for or maybe in their own family unit has seen what dementia and Alzheimer's can do. You mentioned some of the ways to manage it or prolong the onset. What are some of those ways that we could keep our minds sharp? How can we keep it at bay for as long as possible?
Dr. Lee 16:39
I like to tell everyone that how you live, arguably does more than any pill or infusion I can give you, at least in the year 2024 there's three kind of basic pillars that I encourage everyone to think about, including myself. One is watching what you eat. Two is being physically active, and third is being socially active. And when we talk about diet, specifically, you know, there's a lot of diets you can read up about, and you know, you'll go online and see benefits to each one. The one that has the most evidence that's been researched most extensively is what every doc will tell you, the Mediterranean diet. That's the one that you know seems to have the most evidence and delaying onset of cognitive symptoms or slowing down progression of disease. And you know, that's kind of common sense. Stuff like vegetables are good for you. You know, fish and chicken is good for you. Nuts, making sure you're watching how much red meat and sweets you're in taking. And then the second is to be physically active, to get that heart rate up, to move, to walk, to jog, swim, bike, and to sort of set goals for yourself so that you want to in graded fashion, make sure that you're doing this on a routine and regular basis. And then there's a lot of profound evidence that loneliness actually increases the velocity of decline and can facilitate the onset of symptoms a little bit earlier as well. So we want to think about being socially engaged, having that community. I have patients that have Alzheimer's disease, and they seem to decline very, very slowly, this very small subset of the patient population all seem to have a few things in common. They watch what they eat, they exercise a lot, but they have something that gives them meaning, whether that's community or vocation or volunteering or church, all of these things, you know, just play a huge part in kind of doing more to slow things down. And you know, it gives one a sense of agency that, you know, I don't have to wait for my next doctor's appointment to get a new medication or pill. I can do something every day to help myself.
Marcus Thorpe 19:02
I think because people don't necessarily want to eat better, eat right, or maybe do the exercise and do the hard work. Sometimes they'll turn to they'll see the commercials for over the counter, things to help with your cognitive what's your take? Kind of level set folks on what you think of some of those over the counter, things that are promising to clear the brain fog and make sure that you're you know there from a cognitive advancement stage. How do you look at those kind of things, especially when there's promises to try to keep you in good shape?
Dr. Lee 19:34
There's no shortcuts to healthy living, certainly some sort of supplements or dietary things that you see online or on your shelves at the pharmacy, they will purport to help with memory or cognition. You'll note that they don't say that they help with Alzheimer's disease or Parkinson's disease. They're not allowed to say that, and that's because at the highest levels of clinical study they have in past muster. That being said, a lot of them make theoretic sense, or maybe they help in a petri dish or an animal model, or in studies where there's fewer patients. And what I say is, some of these are safe, and we can try them, and I have no qualms about, you know, making sure that they're viewed as supplements, just as the name suggests. They're no substitute for living right and being active and watching what you eat, but they can be an add on and a bonus, and for some folks, it really does make a difference, or at least it seems to. And I want to be open minded and work with patients and work on their kind of values and priorities. So I think it makes sense for some people. But again, it's no substitute for the hard work of living healthy.
Lindsey Gordon 20:57
I think the loneliness piece is something that's we're starting to hear more about. We hear headlines now about research that shows loneliness, you know, has negative health effects, and some countries have, you know, even created leadership roles to combat loneliness. I remember my grandfather one time we were trying to get him to download a mobile app for banking, and he said, why would I want to do banking on my phone? I want to go and talk to the banker. You know, this is how I get out. I walk down to the square, and I see my banker, and I know how he's doing and how his kids are doing. And why would I want to do it through my phone? And I think about that all the time, how, you know, the phones isolate us in a way, right? Have you seen that the loneliness factor accelerate in recent years with the rise of, you know, even post pandemic, right, where we got used to doing so many things, virtually.
Dr. Lee 21:52
Absolutely. This is something I'm hearing from almost all of my patients who have lived through 2019 to, you know, 2022 unfortunately, a lot of those services and in person, things had to go away, and we've kind of become increasingly reliant on online or virtual platforms, and that sort of isolation and loneliness is sometimes temporally associated with these symptoms really emerging and declining quickly. You know, I just think about, we could be doing this podcast right now on Zoom or teams. I just wouldn't have that immediacy. I wouldn't feel as energized and alive while I'm, you know, looking at you, making eye contact, and reading your body posture and all of those things are important to be stimulated, active, engaged, living in the present. So absolutely, yeah.
Marcus Thorpe 22:47
I feel like we could do two hours on this topic. I mean, there's so much ground to cover, and we are limited by how much time we have for this podcast. But is there a final take home that you really want people to think about when it comes to, you know, cognitive decline and dementia and those kind of things, is there, is there a big point that you wish you could just get across to folks as they tune in and tune out of this?
Dr. Lee 23:16
If I had to choose one, I would kind of circle back to how we started this conversation when we talked about, you know, cognitive aging is something that you know can scare us, like I kind of said cognitive aging or dementia. You know, these are part of the aging process. In some ways they're a little more accelerated or dramatic, but we all are faced with the prospect of changing. You know, there's a lot of evidence that cognitively, we start to decline in our early to mid 30s. I'm sorry to say.
Marcus Thorpe 23:54
I'm way past that.
Dr. Lee 23:56
So this is inevitable. This is part and parcel of the human condition. Again, like I said, this is something that unites us. So I love, you know, meeting different patients and their families from different walks of life, and you know, finding that, you know, these questions are the ones that Vex us the most. But I think the key is to slowly get on that journey towards acceptance that most folks when they aged gracefully, it's about this process of accepting change. You know, the important things in life remain important, right? Like family, friends, spiritual life, vocation, those things always give you meaning. Those are the priorities. Those are the things that you want to, you know, celebrate and really hold on to, because those things, too may change over time. That's the one sort of inevitability about life. So I want to encourage folks listening to, you know, kind of if they can change their perspective. On what it means to change in age. It doesn't necessarily mean the end of all good things. It's a different phase of life, and it might mean different opportunities and different perspectives, and certainly a lot of wisdom and experience gained along the way. Well,
Marcus Thorpe 25:16
this has been awesome, I think, really informative, really that that kind of podcast, that no matter what age and stage you are, this is something you should be listening to, that you should be sharing with other people so that they can hear it and understand. So we really appreciate the time. Dr Lee, it's been really eye opening, I think, in a lot of different ways. So thank you.
Dr. Lee 25:37
It's been a pleasure.
Lindsey Gordon 25:39
So this is the part in the part in the podcast, too, where we like to have a little fun. And we thought we could ask a couple quick questions here.
Marcus Thorpe 25:47
Yeah, let's talk about what you do to keep your brain sharp, right? It's one of those things where I think you you're constantly telling people how they should be living their lives. What do you do to try to stay sharp?
Dr. Lee 25:57
Oh, there's a lot more I could be doing. I'm no model patient. This may feel like sort of a overly sentimental answer, but I think about my relationship with my wife, you know, she keeps me curious. She asks me questions that challenge my intuitions. She makes me learn. She makes me notice that flower or tree that I didn't notice. It teaches me about it, or some, you know, book that she read that you know, really touched her. And I think that kind of keeps me young, keeps me interested, keeps my interests broadened. So I'd have to say that that's the biggest thing in my life.
Marcus Thorpe 26:48
That's a good one.
Lindsey Gordon 26:49
And lastly, what do you two like to do socially together? Do you have a favorite activity?
Dr. Lee 26:53
Yeah, well, I like to spend every possible second I can when I'm not at work with her. So we like going to farmers markets, walking in parks. We like to read together. Our favorite thing is to, you know, just have no plans, find a neighborhood to just walk around in, stop at a bookstore, get some coffee, explore things. That's our favorite way to spend a Saturday.
Marcus Thorpe 27:17
You're in the right community for that. There's lots going on here in central Ohio. So we know that you you find plenty to do, and we sure are appreciative of your work here at OhioHealth. So thank you so much for joining us.
Dr. Lee 27:28
It's my pleasure again.
Lindsey Gordon 27:29
And thank you at home for joining us for this episode of the Wellness Conversation an OhioHealth podcast. Before we wrap up, we invite you to follow us on all our major social channels, to stay up to date on new episodes and other health and wellness topics. And if you're looking for more information on OhioHealth services and locations, be sure to visit ohiohealth.com.
Marcus Thorpe 27:49
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