[SPEAKER_00]: Mrs.

Aging Ford, a podcast from Mayo Clinic about the science behind healthy aging and longevity.

[SPEAKER_00]: Each episode, we explore new ways to take care of our long-term health, the health of our loved ones and our community, so it can all live longer and better.

[SPEAKER_00]: I'm Dr.

Christina Chen, a geriatrician and internist at Mayo Clinic at Rochester, Minnesota, and this episode we are talking about Alzheimer's disease.

[SPEAKER_00]: We have known about this condition in over a hundred and twenty years.

[SPEAKER_00]: We have made a lot of advancement, but there is still no cure.

[SPEAKER_00]: Here in the US, we also have an increasingly aging population with Alzheimer's being one of the top causes of death in that group.

[SPEAKER_00]: So where are we now in terms of treatment options and our understanding of the disease?

[SPEAKER_00]: And what does the future of Alzheimer's look like?

[SPEAKER_00]: Today, we welcome Dr.

Jonathan Graff Radford, the vice chair of the Department of Neurology and Chair of the Division of Behavioral Neurology at Mayo Clinic in Rochester, Minnesota.

[SPEAKER_00]: He is very active in multiple research initiatives in Nelson, Mr.

Mencha, advancing the science and understanding of the disease process.

[SPEAKER_00]: And he has probably published the most peer review articles I have ever seen in my life from one person alone over four hundred, I think, which is truly impressive and just [SPEAKER_00]: Such an expert in the field of dementia, so really an honor to have you here with us today, Dr.

Graff referred.

[SPEAKER_02]: Well, thanks for the invitation.

[SPEAKER_02]: It's really a team effort.

[SPEAKER_02]: We have a great behavioral neurology division that's very active academically, so it's a fun team to work with.

[SPEAKER_00]: All right, so Alzheimer's disease, let's start with the big picture.

[SPEAKER_00]: Where are we in terms of our understanding of it?

[SPEAKER_00]: And how sophisticated are the current disease treatments right now?

[SPEAKER_02]: Yeah, we do have an aging population.

[SPEAKER_02]: And so right now, the Alzheimer's Association estimates there's about six point nine million Americans living with Alzheimer's disease.

[SPEAKER_02]: And that number without a more potent intervention is expected to double every twenty years if we don't do something about it.

[SPEAKER_02]: And worldwide, you're looking at about fifty five million people with dementia.

[SPEAKER_02]: So really is a public health crisis and something we need to think of societal interventions as well as medical breakthroughs to tackle.

[SPEAKER_02]: So it's a very highly prevalent disease and it's rare that you meet people who don't have a family member or friend who's experienced that process.

[SPEAKER_00]: How do you explain Alzheimer's disease to people and how does it differ from other types of dimensions?

[SPEAKER_02]: That's a common question with patients and their families.

[SPEAKER_02]: They often want to know what's the difference between dementia and Alzheimer's disease?

[SPEAKER_02]: Are they the same things?

[SPEAKER_02]: And so taking a step back dementia is really an umbrella term we use to refer to when someone has memory and thinking problems and they're not able to perform daily activities independently.

[SPEAKER_02]: So what we mean by that are no longer able to cook by themselves, no longer able to drive or manage a checkbook.

[SPEAKER_02]: And Alzheimer's disease is the most common cause of dementia.

[SPEAKER_02]: And so when we think of Alzheimer's disease, it's a very specific type of dementia.

[SPEAKER_02]: So biologic process really characterized by the deposition of two proteins in the brain, amylate and tau.

[SPEAKER_02]: And the process actually starts about twenty years before the first symptoms turns.

[SPEAKER_02]: And so those proteins get deposited.

[SPEAKER_02]: That leads to brain cell death.

[SPEAKER_02]: And that eventually leads to brain shrinkage.

[SPEAKER_02]: And it really starts shrinking in the memory center of the brain.

[SPEAKER_02]: We call that the hippocampus.

[SPEAKER_02]: And that's why people's initial symptoms are often memory based.

[SPEAKER_02]: So they may forget appointments or misplaced their keys frequently.

[SPEAKER_02]: And those are some of the subtle early changes because of the part of the brain that's targeted.

[SPEAKER_00]: I bet you get this question very commonly.

[SPEAKER_00]: How do we distinguish normal, aging memory loss?

[SPEAKER_00]: Because gosh, I can't remember what I had for breakfast this morning.

[SPEAKER_00]: How do we distinguish that from something pathologic?

[SPEAKER_02]: with normal aging.

[SPEAKER_02]: There are cognitive changes.

[SPEAKER_02]: So people might perform tasks a bit slower than they used to.

[SPEAKER_02]: They may have more difficulty coming up with people's names.

[SPEAKER_02]: That's all normal.

[SPEAKER_02]: But when someone starts to have a consistent memory problem.

[SPEAKER_02]: So they're forgetting if not just one appointment, but multiple appointments or they're repeating themselves frequently, even in the same conversation.

[SPEAKER_02]: That's when we start to say, maybe there's something going on here.

[SPEAKER_02]: It's worth getting evaluated to make sure it's not something more than normal.

[SPEAKER_00]: Do we know more about the risk factors?

[SPEAKER_00]: Can you talk us through some of those?

[SPEAKER_02]: So I think it's important first to distinguish the risk factors for Alzheimer's disease and dementia in general.

[SPEAKER_02]: So age is the most important risk factor for Alzheimer's disease.

[SPEAKER_02]: Most people with Alzheimer's disease are over age sixty five.

[SPEAKER_02]: And the risk continuously goes up with age.

[SPEAKER_02]: Sex is also a risk factor.

[SPEAKER_02]: So it turns out females are much more likely to develop Alzheimer's disease than males.

[SPEAKER_02]: And then there's a genetic component.

[SPEAKER_02]: So people who have a first degree relative apparent sibling with Alzheimer's disease are at elevated risk of developing it.

[SPEAKER_02]: So those are the key risk factors.

[SPEAKER_02]: But when we think about dementia in general, there are other risk factors that should be discussed as they're modifiable, meaning we can do something about it.

[SPEAKER_02]: And we think about it through the whole lifespan.

[SPEAKER_02]: So even things such as how much education you have, that can be a risk factor.

[SPEAKER_02]: So people with lower education are at increased risk of dementia.

[SPEAKER_02]: And then the big one that we should be thinking about even in middle age are vascular risk factors.

[SPEAKER_02]: So what are we talking about there?

[SPEAKER_02]: Those are things like high blood pressure, high cholesterol, diabetes, smoking, obesity, and physical inactivity.

[SPEAKER_02]: And all of those things each independently increase your risk of dementia.

[SPEAKER_02]: And then there's some novel ones that have recently been looked at that [SPEAKER_02]: took the field by surprise.

[SPEAKER_02]: So hearing loss is a new one that we were surprised to learn about is a risk factor for dementia pollution as well as head injuries.

[SPEAKER_02]: You may have heard of these football players and other combat sports individuals getting cognitive issues and it's now been established that repeated head injuries and new risk factor for dementia.

[SPEAKER_00]: So what I'm hearing is that there's proactive things we can do as long as we're aware of it to reduce those risk factors for example, protect our head against trauma and getting our hearing tested early if we're noticing hearing loss.

[SPEAKER_00]: That's really good to know.

[SPEAKER_02]: And just to give a more tangible example, there was always this idea that maybe you could let people's blood pressure run a little high when they're older.

[SPEAKER_02]: But there was a study done a few years ago called Sprint Mind, where they addressed this.

[SPEAKER_02]: So they looked at blood pressure of two different targets.

[SPEAKER_02]: So the top number is called the systolic blood pressure.

[SPEAKER_02]: And one group was randomized to have a top blood pressure of a hundred and forty, which is not considered very high.

[SPEAKER_02]: The other group had aggressive control of their blood pressure, and their goal was one-twenty.

[SPEAKER_02]: And they looked at not only their cardiovascular outcomes, but also their cognitive outcomes, and it turns out the group that had aggressive blood pressure management had a twenty percent lower risk of developing mild cognitive impairment, which is the precursor to dementia.

[SPEAKER_02]: And these are people who had high blood pressure were over age sixty five and were treated progressively.

[SPEAKER_02]: So that's just one example where you can do something about your risk of future cognitive impairment with addressing one simple risk factor.

[SPEAKER_00]: You mentioned those are gender difference.

[SPEAKER_00]: There's a genetic influence.

[SPEAKER_00]: Any other specific populations that are at higher risk?

[SPEAKER_02]: African Americans have a higher risk of dementia, as well as Hispanic Americans.

[SPEAKER_02]: People are actively investigating why they're these group differences, but Vascular risk factors seem to be one potential cause.

[SPEAKER_02]: The other one that is really interesting is social isolation.

[SPEAKER_02]: So it turns out that people who don't have a lot of networks of individuals they interact with on a daily fashion and up having a higher risk of dementia.

[SPEAKER_02]: Why that is?

[SPEAKER_02]: Maybe it's the stimulation that people get, but that seems to be a consistent additional factor.

[SPEAKER_02]: We mentioned that females have a greater risk of Alzheimer's disease than males.

[SPEAKER_02]: Part of that is females live longer, and so they end up living long enough to get Alzheimer's disease.

[SPEAKER_02]: But it's more than just lifespan.

[SPEAKER_02]: There seem to be independent risk factors.

[SPEAKER_02]: And one of the things they found is that females who have early olforectomy, so they get their ovaries removed before age thirty five, that can be a risk factor for developing dementia earlier.

[SPEAKER_02]: And so there may be some hormonal reasons.

[SPEAKER_00]: As far as the hormonal influences for women going through a pair of menopause or who've had early surgical and just menopause, does adding early hormone therapy prevent dementia?

[SPEAKER_02]: That's a million dollar question.

[SPEAKER_02]: That's an active area of research.

[SPEAKER_02]: Is there a right window to give hormonal therapy sort of a Goldilocks time where you could reduce the risk of dementia?

[SPEAKER_02]: And it seems like there's probably not a one size fits all approach.

[SPEAKER_02]: And that's where doing more precision medicine, individualized studies will help us.

[SPEAKER_02]: So the jury still out, but it is an active area of investigation.

[SPEAKER_00]: So are there any other environmental or occupational risk factors you mentioned air pollution earlier?

[SPEAKER_02]: There's been some really interesting epidemiologic studies looking at this in areas where the air quality is particularly poor, tend to have a higher risk of dementia.

[SPEAKER_02]: So that is a societal intervention.

[SPEAKER_02]: We can think about what's the level of air quality we need to obtain to lower the risk for all of the people living in that area.

[SPEAKER_00]: So we mentioned the early symptoms as the short-term memory loss repetition.

[SPEAKER_00]: How does that then progress?

[SPEAKER_02]: So when we think about the stages of Alzheimer's disease, the first stage we think about is this stage we call mild cognitive impairment.

[SPEAKER_02]: That's where someone has the beginning of a memory and thinking problem, but they're still able to do all of their activities of daily living independently.

[SPEAKER_02]: So they're not getting lost driving.

[SPEAKER_02]: They're still able to balance the checkbook.

[SPEAKER_02]: They're still able to go to the grocery store by themselves and obtain all the items that were on their list.

[SPEAKER_02]: Then the next stage after mild cognitive impairment is mild dementia due to Alzheimer's disease.

[SPEAKER_02]: And that's where some of the more complex activities of daily living start to become more difficult.

[SPEAKER_02]: So they may have more difficulty following a multi-step recipe.

[SPEAKER_02]: They may start getting lost while driving in unfamiliar areas.

[SPEAKER_02]: But the basic activities of daily living remain intact.

[SPEAKER_02]: What we mean by that is they're still able to eat independently.

[SPEAKER_02]: They're still able to bathe independently.

[SPEAKER_02]: After that, we think about moderate Alzheimer's dementia.

[SPEAKER_02]: That's where there's more loss of those activities of daily living, meaning you need more assistance.

[SPEAKER_02]: You're less likely to be safe to be left alone.

[SPEAKER_02]: You might leave the stove on, things like that.

[SPEAKER_02]: So you need someone around more often.

[SPEAKER_02]: And then finally, we think of severe Alzheimer's dementia.

[SPEAKER_02]: That's where some of those basic activities of daily living, like eating independently as well as bathing without assistance, start breaking down.

[SPEAKER_02]: On average, from diagnosis, people live about eight to twelve years.

[SPEAKER_02]: And everyone has a different path.

[SPEAKER_02]: So there's no one path for an individual.

[SPEAKER_00]: I see.

[SPEAKER_00]: It's a long eight to twelve years because you are supporting people through those stages of functional decline.

[SPEAKER_00]: What do we know about young onset Alzheimer's disease?

[SPEAKER_00]: How young are we talking about?

[SPEAKER_00]: And how is it different from late onset?

[SPEAKER_02]: We see a lot of young onset Alzheimer's disease at Mayo Clinic and the definition is when you have your first symptom before age sixty five.

[SPEAKER_02]: And it's particularly important because it turns out because Alzheimer's is so common, you're looking at about a quarter million Americans with young onset Alzheimer's disease.

[SPEAKER_02]: And important to have it on your radar, because it presents differently than typical late onset Alzheimer's disease.

[SPEAKER_02]: When you present at a younger age, you can have eight typical presentations.

[SPEAKER_02]: Instead of memory problems, you might have visual spatial problems where you're getting an accident frequently.

[SPEAKER_02]: You're reaching for items and missing them.

[SPEAKER_02]: You may have language problems where you're having trouble coming up with the right word.

[SPEAKER_02]: You're mispronouncing words.

[SPEAKER_02]: And that's overrepresented in this young onset population.

[SPEAKER_02]: There are some rare genes associated with Alzheimer's disease where families tend to get the disease in their thirties, forties in early fifties.

[SPEAKER_02]: But those genes are very rare and not the cause of dementia and most people with young onset Alzheimer's.

[SPEAKER_00]: And just to follow up question there as far as the genetic influences, if there is a strong family history of Alzheimer's dementia, should people get tested for that genetic profile?

[SPEAKER_02]: If someone has the diagnosis and they're younger, they may want to get tested because there are some specific clinical trials targeting people with specific genetic conditions, but it's a really individualized decision whether they want to be part of a clinical trial and know if they have the gene [SPEAKER_00]: Good to know.

[SPEAKER_00]: So let's move on to some of the treatments now.

[SPEAKER_00]: Take us through how Alzheimer's treatments have changed through the years.

[SPEAKER_02]: Our treatments that have been available for a long time are symptomatic treatments, which were modestly effective.

[SPEAKER_02]: So these are medications called colonestry inhibitors, which can boost a neurotransmitter and the brain called acetalcoline.

[SPEAKER_02]: And that's important for making new memories.

[SPEAKER_02]: For many years, that was the standard treatment for Alzheimer's disease, but it didn't stop the disease slow it down.

[SPEAKER_02]: It just masked the memory symptom a bit.

[SPEAKER_02]: There was another medication approved a few years after the colon history is called Mamanteen, which similarly at a more advanced stage of the disease, more moderate Alzheimer's disease masked some of the symptoms.

[SPEAKER_02]: But then we went through a twenty year gap with no new medications approved despite multiple trials.

[SPEAKER_02]: And it was quite frustrating for patients, their families as well as the field.

[SPEAKER_02]: But fortunately, we had a couple of breakthroughs in the last couple of years with a new class of medications getting [SPEAKER_02]: if they approval.

[SPEAKER_02]: And these are called anti-amilate antibodies.

[SPEAKER_02]: And so they are targeting the amilate protein, which is one of the hallmark proteins causing the disease that we mentioned earlier.

[SPEAKER_02]: And these drugs can bind to and remove it from the brain.

[SPEAKER_02]: And in the clinical trials, they slowed down the progression of the disease by about thirty percent.

[SPEAKER_02]: So while we're excited that we have these new drugs, they're not home runs.

[SPEAKER_02]: They modestly slow the progression.

[SPEAKER_02]: And so you can think about it on an annualized basis that they give you back three to four months of preserved cognition per year.

[SPEAKER_02]: But people who took them continue to decline.

[SPEAKER_02]: So they are not curative.

[SPEAKER_02]: And they're only for people with the earliest stages of the disease.

[SPEAKER_02]: So these are people who have mild cognitive impairment or mild dementia.

[SPEAKER_02]: When they tested them later with the more moderate dementia patients, these classed drugs don't work.

[SPEAKER_02]: And that makes sense because Amoid is a very early part of the disease process.

[SPEAKER_02]: And so when you target it later, other aspects of the disease have already taken hold.

[SPEAKER_02]: So it's only a subset of people who are eligible for these drugs.

[SPEAKER_02]: And even amongst those, you're looking for people that would have lower risk of side effects.

[SPEAKER_00]: And these drugs are specifically for Alzheimer's dementia.

[SPEAKER_00]: It's not for any other types of dementia.

[SPEAKER_02]: Correct.

[SPEAKER_02]: And that's why people who are being considered for these drugs need to undergo a pretty extensive evaluation to confirm they have Alzheimer's as the cause of their dementia.

[SPEAKER_02]: So they're going to get [SPEAKER_02]: what we call biomarker testing, where we're testing to see if there's amulet in the brain before we'd consider administering these drugs.

[SPEAKER_02]: And many times people think they have Alzheimer's disease, but when they get that detailed evaluation, it turns out there's another form of dementia, another cause that's driving it.

[SPEAKER_00]: Can you tell us a little bit about the biomarker testing?

[SPEAKER_02]: So for many years, the gold standard biomarker to measure Alzheimer's pathology in the brain was a pet scan.

[SPEAKER_02]: This is an amulet pet scan, which basically lets you visualize whether or not there's amulet in the brain.

[SPEAKER_02]: That's very accurate, but it's expensive, and it can be time consuming to get for people.

[SPEAKER_02]: The other biomarker that's almost as good as a pet scan is the routine procedure and neurology measuring amulet in spinal fluid.

[SPEAKER_02]: So people would get a lumbar puncture where you get a needle, stuck in your back, you pull out some of the spinal fluid, and you can measure the amulet and tau protein in the spinal fluid to get an accurate sense if Alzheimer's disease is present.

[SPEAKER_02]: And that's also a very good study.

[SPEAKER_02]: You can do a lot of them, but it is a little invasive.

[SPEAKER_02]: And there's been a really exciting development in the last year that now we have good blood tests, which are approaching the accuracy of spinal fluid and even pet scans.

[SPEAKER_02]: We have one at Mayo Clinic, and that can accurately determine whether there's emulate protein in the brain or Alzheimer's pathology in the brain.

[SPEAKER_02]: It's not a perfect test, but it does a very good job at screening folks.

[SPEAKER_02]: So we're getting at the point that the biomarkers are more widely available, easier to get done and accessible.

[SPEAKER_00]: And is that only available at Mayo Clinic or are there other institutions that offer this?

[SPEAKER_02]: Lots of institutions are now offering different versions of it.

[SPEAKER_02]: One of the challenges with the blood tests that was not all of them are equally as good.

[SPEAKER_02]: And so you want to make sure you're getting one that's been highly validated against the gold standard and of the highest quality.

[SPEAKER_00]: I was at this health tech conference recently and they had at least three or four companies looking at these advanced AI tools using big data to detect early cognitive changes and it sounds like technologies really kind of advancing in that area of using machine learning or AI to do early detection and he thought somewhere that's going.

[SPEAKER_02]: It's a really exciting area in research.

[SPEAKER_02]: There's a huge effort around this.

[SPEAKER_02]: I've seen a number of studies where they've looked at the medical record and trying to identify patterns and using those patterns that may not be obvious to someone just reading the medical record.

[SPEAKER_02]: to identify someone who's going to develop dementia before they develop it.

[SPEAKER_02]: There's also ways to analyze some of the brain images while someone still has normal memory and thinking and make a strong prediction of when they might develop memory problems based on that data.

[SPEAKER_02]: And then there's also some companies looking at using technology that you already wear like your Apple Watch or your phone and making guesses based on a [SPEAKER_02]: activity level and other factors, how you're interacting with the phone, whether or not you're going to develop dimension in the future.

[SPEAKER_02]: So very exciting time.

[SPEAKER_02]: Lots of effort behind it.

[SPEAKER_02]: And, you know, we look forward to some of this coming to the clinic soon.

[SPEAKER_00]: Speaking of Mayo Clinic, tell us about some of the exciting work that's happening at Mayo right now.

[SPEAKER_02]: Nikki Stricker, who's one of our neuropsychologists, has developed a digital cognitive exam called Mayo Test Strive, which you can do on your phone, on a tablet, or on the computer, and you can do a five minute memory test, and repeat it as many times as you want, and we're using it to monitor people who are getting this anti-immolite therapy to look at their trends over time.

[SPEAKER_02]: Previously, we might have needed to do a pen and paper test, bring people into the office, but that's a tool that's also being used to predict future dementia risk based on how someone performs and a change in their performance over time.

[SPEAKER_02]: The other cool tool that Mayo is working on is a speech.

[SPEAKER_02]: tool.

[SPEAKER_02]: So Hugo both who works in artificial intelligence and the neurology department has developed a tool where he's captured thousands of neurology patients speech and had our speech pathologist annotated from different features.

[SPEAKER_02]: Now you can then have a spontaneous speech sample.

[SPEAKER_02]: and make guesses as to their neurologic diagnosis based on what the speech pathologist said about the prior thousands of people as well.

[SPEAKER_02]: And we're part of an age study called the ahead study.

[SPEAKER_02]: So we're treating people who have amulet in their brain but haven't developed any memory problems it because we talked about how that starts twenty years before symptoms start.

[SPEAKER_02]: And a lot of people think that [SPEAKER_02]: If you can remove it before nerd generation or brain atrophy is said in, you can have a bigger impact than the thirty percent slowing once they become symptomatic.

[SPEAKER_02]: So that's one area that's very exciting, especially for people of family history of Alzheimer's disease, that may prompt them to start getting evaluated if this ahead trials positive.

[SPEAKER_00]: That's really neat to see how much things have advanced nowadays because I truly hope for a day where Alzheimer's does not exist.

[SPEAKER_00]: And I don't know if that's going to be in our lifetime, but we know that the hardest part is after the diagnosis, living with the disease.

[SPEAKER_00]: So what does the future of dementia care look like?

[SPEAKER_00]: Is it going to be a lot more memory care units?

[SPEAKER_00]: Is it going to be a lot more care at home?

[SPEAKER_00]: What do you think it's going to be?

[SPEAKER_02]: We had our Alzheimer's conference in the Netherlands a couple years ago, and they've had a very innovative way of taking care of patients with dementia.

[SPEAKER_02]: They call it a dementia village.

[SPEAKER_00]: Yes, I see them.

[SPEAKER_00]: That's amazing.

[SPEAKER_02]: Yes, it's very cool where they have people living what would otherwise look like a very normal life with parks and hairstyles and movie theaters and the people who are [SPEAKER_02]: at the hair salon or at the movie theater actually the caretakers of the people dementia and they're able to enjoy the outdoor activities, the socialization and you can imagine the better outcomes that might come from that versus being in a building where everything is the same color and the lights are bright.

[SPEAKER_02]: So I think that's something that I'm hoping to see more pop up in the US as a aspirational way to take care of patients with dementia.

[SPEAKER_00]: I think that would be amazing, just build one here because it sounds like the best thing for them.

[SPEAKER_02]: And it's not as expensive as some of the care we're giving because when you're in nature, when you have the socialization, a lot of behaviors that are otherwise problematic that require more, twenty-four-seven supervision go away.

[SPEAKER_00]: Right, even though they have the condition, it doesn't mean that they can't live well.

[SPEAKER_00]: Do you have any resources or advice to give for caregivers and other innovations in that space for the care provider?

[SPEAKER_02]: Yeah, some of those inspirational people I've met are the caregivers of patients with dementia, really innovative, creative, selfless, and it's an incredibly challenging time for them.

[SPEAKER_02]: And so the first thing is to make sure early on that you go get support.

[SPEAKER_02]: I mean, you can learn so much from other people that have walked the path.

[SPEAKER_02]: And so I think getting involved with the Alzheimer's Association in particular, [SPEAKER_02]: They have great support groups, where with your local providers, what support groups they may offer, that can be a big boost.

[SPEAKER_02]: Meeting with a social worker is always valued because there's often community resources that can be used to simplify things for you, identify people who can be with your loved one.

[SPEAKER_02]: her care partner when you're need to go shopping and things like that.

[SPEAKER_02]: So I think making sure you're not taking everything on yourself and identifying what's available in the community and then educating yourself whether it be through books or online resources to know as much as possible.

[SPEAKER_02]: That can be really helpful as challenges come up often people have figured out how to navigate those before speaking of books.

[SPEAKER_00]: I know that you have a book out and Alzheimer's dementia.

[SPEAKER_02]: So with Angela Lundy, we edited a book called Mayo Clinic on Alzheimer's and related dementia.

[SPEAKER_02]: And we tried to make it for caregivers, care partners and families of people with a thing with dementia.

[SPEAKER_02]: But as well as for people who just want to learn more about the topic.

[SPEAKER_02]: And it not only talks about the science and hopefully easy to digest way, but also talks about what we've learned from care partners about how they've managed to take care of people with dementia.

[SPEAKER_00]: Can't wait to read it.

[SPEAKER_00]: For someone who is concerned about their memory or cognitive health right now, what would you advise them to do?

[SPEAKER_00]: What steps can they do right now to really take care of themselves moving forward?

[SPEAKER_02]: Well, the first thing I would say is think about some of those lifestyle interventions to start right away.

[SPEAKER_02]: So that would be things like treating your vascular risk factors, eating a heart healthy diet, the one that has the most data behind it is what's called a Mediterranean diet.

[SPEAKER_02]: That's cooking in olive oil, eating fish twice a week, having a handful of nuts daily, eating more fruits, vegetables and beans and avoiding processed foods, basically.

[SPEAKER_02]: So those are things you could start doing right away.

[SPEAKER_02]: But if you are having frequent lapses in memory, then it probably is worth getting checked out because not everything is due to Alzheimer's disease.

[SPEAKER_02]: And if it is due to Alzheimer's disease, you still want to get checked out early because you may be a candidate for some of these interventions we talked about earlier that could slow it down.

[SPEAKER_02]: But I'll just mention there's some people we see who have memory problems and ends up being from untreated sleep apnea.

[SPEAKER_02]: And we treat their sleep apnea and their mild memory problems improve.

[SPEAKER_02]: Or there's other reversible causes of cognitive changes.

[SPEAKER_02]: So one's called normal pressure hydrocephalus where people get a buildup of spinal fluid on the brain.

[SPEAKER_02]: And we can work with our neurosurgery colleagues to drain that fluid and get them back to functioning normal.

[SPEAKER_02]: So I always say it's probably worth checking because one you want to look for these reversible causes.

[SPEAKER_02]: And two, if you do have it, it's better to know early to get that accurate diagnosis to start making plans.

[SPEAKER_00]: For the younger folks who may be wondering, why should I be concerned about this?

[SPEAKER_00]: I'm in my twenties.

[SPEAKER_00]: How is this going to affect me?

[SPEAKER_00]: Why is it so important for younger adults to be thinking about this?

[SPEAKER_02]: Well, I think younger adults should be thinking about setting their brain up to be healthy over their lifespan.

[SPEAKER_02]: And that really starts with decisions made in midlife or even before that.

[SPEAKER_02]: So we talked about vascular risk factors.

[SPEAKER_02]: High blood pressures becoming more and more common in our country.

[SPEAKER_02]: And so making sure you're getting your blood pressure checked even in your twenties, thirties and forties at a regular interval.

[SPEAKER_02]: And treating it if it is elevated is something that can reduce your future risk of dementia, similar with things like physical inactivity, not smoking.

[SPEAKER_02]: All of these things are lifestyle choices that you're making at that younger age that will pay dividends as you continue to age and reduce your risk of dementia.

[SPEAKER_00]: I find that my patients really identify and value the notion of staying independent.

[SPEAKER_00]: And if your brain doesn't work, eventually your body won't work.

[SPEAKER_00]: And then we really don't want to be living our lives in a state of stability in our later years.

[SPEAKER_02]: Absolutely.

[SPEAKER_00]: We kind of have a tradition on our podcast.

[SPEAKER_00]: We just want to get to know you, the expert, and what does aging forward mean to you?

[SPEAKER_00]: And what do you personally do to stay healthy and keep your brain healthy?

[SPEAKER_02]: So aging forward, I think to me means making choices that promote longevity, cognitive health, [SPEAKER_02]: and mental well-being.

[SPEAKER_02]: And that, for me, is using the Peloton, so I try and get on the Peloton bike every morning for my cardiovascular exercise.

[SPEAKER_02]: Who's your favorite instructor?

[SPEAKER_02]: My favorite instructor is Christine, but I love all of them.

[SPEAKER_02]: And recently I've gotten into strength training because that's important for bone health, important for preventing falls.

[SPEAKER_02]: And so I use a tonal for that and try and get that in twice a week.

[SPEAKER_02]: And then we try and follow a Mediterranean type diet at home.

[SPEAKER_02]: And then of course spending as much time with family as possible.

[SPEAKER_00]: I really appreciate you taking the time to have this conversation with us today.

[SPEAKER_00]: Let's always get to know that we're continuing our efforts to understand this disease better, find ways to be proactive and empower ourselves so that we can take control of it.

[SPEAKER_00]: And I truly hope that one day we do have a cure.

[SPEAKER_00]: And if we don't, at least, understand how we can live better with it.

[SPEAKER_00]: Thank you so much for leading the way.

[SPEAKER_02]: Thanks for having me.

[SPEAKER_00]: So that's all for this episode.

[SPEAKER_00]: Hopefully you're feeling a little bit more informed, inspired and empowered.

[SPEAKER_00]: On the next episode of Agent Ford, resources for taking care of your loved ones at home.

[SPEAKER_01]: If you really look at [SPEAKER_01]: what's really critical to keep people at home.

[SPEAKER_01]: It's actually not the medical care and it's not nursing care.

[SPEAKER_01]: It's personal care.

[SPEAKER_00]: Yeah.

[SPEAKER_01]: It's someone to bathe me, feed me, toilet me, you know, but it's not covered by insurance.

[SPEAKER_00]: If you have a topics suggestion for future episodes, you can leave us a voicemail at five zero seven five three eight six two seven two and we might even feature your voice on the show.

[SPEAKER_00]: For more information on Dr.

Graff Farford's book, Mail Clinic on Alzheimer's, you can check out our show notes below.

[SPEAKER_00]: It comes out later this month.

[SPEAKER_00]: For more aging fort episodes and resources, head to Mayoclinic.org slash aging fort.

[SPEAKER_00]: And if you found this show helpful, please subscribe and make sure to rate and review us on your podcast app.

[SPEAKER_00]: It really helps others find our show.

[SPEAKER_00]: Thanks for listening and until next time, stay curious and stay active.