Dr. Sanj Kakar: Welcome, everyone to Mayo Clinic Q&A. I'm
Dr. Sanj Kakar. If you've ever misplaced your keys, or had
trouble recalling a neighbor's name, you may wonder is this
typical aging or something worse. When it comes to
Alzheimer's disease and other forms of dementia, what is
actually happening to the brain, and how do you keep it healthy?
A new edition of a Mayo Clinic book aims to answer these
questions and much more. The second edition of Mayo Clinic on
Alzheimer's Disease and Other Dementias, a guide for people
with dementia and those who care for them is now available. Here
to discuss this are co-editors of the book, Mayo Clinic
behavioral neurologist, Dr. Jonathan Graff-Radford and
Alzheimer's disease researcher, Angela Lunde. Thanks so much for
joining us today, and welcome to the program.
Dr. Jonathan Graff-Radford: Thanks so much for having us.
Dr. Sanj Kakar: And congratulations on this book.
Angela Lunde: Thank you.
Dr. Jonathan Graff-Radford: This is a question we get in the
like to sort of talk to you about what's normal in terms of
the aging process and the way our brain sort of develops as we
go through that.
behavioral neurology clinic every day. So, what are the
typical changes the brain undergoes with aging. And like
any part of our body, the brain does change as we age, it
actually very gradually shrinks. And this is associated with a
slowing down of our thinking and occasional misplacing of your
keys or forgetting someone's names. But when these problems
become more regular or start to interfere with our ability to
function in an independent way, that's when we need to be more
concerned.
Dr. Sanj Kakar: And is there a typical age where you see that
happening?
Dr. Jonathan Graff-Radford: Most commonly, we start to see this
in the 70s, and 80s. But we do follow a number of people who
develop these problems at younger ages, and that's
something we specialize at Mayo Clinic as well.
Dr. Sanj Kakar: As you know, many people use the words
dementia and Alzheimer's disease to mean the same thing. Are they
the same thing?
Dr. Jonathan Graff-Radford: They're not the same thing. So, dementia
is a nonspecific term that refers to a change in your
thinking abilities that interferes with your ability to
function independently. So, it may interfere with your ability
to balance a checkbook, prepare a meal, or live by yourself. In
contrast, Alzheimer's disease is a specific disease due to a
buildup of toxic proteins in the brain. That is the most common
form of dementia, but there's other forms of dementia as well.
Dr. Sanj Kakar: Now we see all the time advertisements about
how we can sort of train our brain or make it better as we
get older to prevent this from happening. Any thoughts about
this and decreasing our risk of dementia?
Dr. Jonathan Graff-Radford: This is an exciting area of science
that's really blossomed over the last 10 years. We know a lot
more about the lifestyles that are associated with decreasing
our risk of developing dementia. The ones that have been studied
the best are certain diets. So, a heart healthy diet like a
Mediterranean type diet, which includes eating fish regularly,
eating lots of olive oil, fruits, vegetables and nuts, has
been associated with decreasing your risk of dementia. Also,
cardiovascular exercise, getting your heart rate up while you're
exercising, and they recommend you do about 150 minutes of that
a week. That has also been associated with decreasing your
risk of getting dementia. And just this year, Lancet published
12 lifestyle behaviors that could substantially reduce the
world's dementia factor risk by up to 40% if we adopt them. And
included in that are things like vascular risk factors as well.
Dr. Sanj Kakar: What about these puzzles or ways to stimulate
your brain to stay sharp? Any truth behind that?
Dr. Jonathan Graff-Radford: There's some preliminary evidence that
staying cognitively active and socially engaged is associated
with reducing your risk of developing dementia. There's
actually ongoing studies right now to see if certain cognitive
activities can really reduce your risk. But what we recommend
is that if you enjoy doing them you should do them. But the
science isn't quite there to broadly recommend them for
everyone yet.
Dr. Sanj Kakar: You must be particularly excited about this
second edition of this book. Can you tell us what's new in the
book?
Dr. Jonathan Graff-Radford: The second edition really includes a
lot more personal stories of our patients living with dementia
and their care partners. We learn a lot from people who are
undergoing the journey. And that's something I've learned in
the clinic day in day out taking care of them is that they teach
me as much as I teach them. And so, their stories are really
valuable information for people reading this book about what
it's like. We also include in this book, not only information
on Alzheimer's disease but other forms of dementia as well,
including Lewy body dementia, frontotemporal dementia. And
we've also address young onset Alzheimer's disease, which is
something we see quite a bit in our behavioral neurology clinic.
And that's people who get Alzheimer's under the age 65.
And they have different problems than people who get Alzheimer's
disease when they're older.
Dr. Sanj Kakar: You alluded to obviously different forms of
dementia. And we know, for example, in the sports industry
with head injuries, especially in younger people that can lead
to problems down the road. Is that something that you've also
tackled in this book?
Dr. Jonathan Graff-Radford: Yeah. We do talk about what you've
been reading about it in the news, which is something called
chronic traumatic encephalopathy. And this is a
type of dementia that's due to repeated head injury. We
typically see this in high level athletes like professional
football players and boxers. And so, it's something that's
covered in this book as well.
Dr. Sanj Kakar: Angela, as Dr. Graff-Radford mentioned in this
book, what's new is the personal perspective. Can you tell us
why you felt that was important and some of the highlights that
you've learned that you'd like to share with us today?
Angela Lunde: As Dr. Graff-Radford mentioned, you
know, there's really no better way for us to understand
dementia than from those who are experiencing it firsthand. And I
know in my 20 years of being in this role, you know, my best
mentors and teachers and guides have been persons living with
dementia as well as their care partners. Even when we were
first conceptualizing this book, one of the things that we did
was we brought together persons living with dementia and care
partners and asked them, what do they want in this book, what's
important to them, what do they want to see. So, we really
wanted those that are most impacted to greatly influence
what it was that we decided to put into this book. And you
know, the book includes clear up-to-date information about
healthy aging and about dementia. It really tells you
what's going on in the brain and in clear ways that I think we
can all understand. But you also get to meet an individual that I
know, a great friend named Mike who's living with Lewy body
dementia. You get to meet Rosalie who's a care partner
that I've known now for over a decade. You get to meet a group
of men who call themselves the guy's, and this is a group of
men who meet, and have met now for a couple of years, every
single month in a local cafeteria, or a local cafe up in
the Minneapolis area. And these are the real people behind the
disease. You hear their stories through their own experiences.
And it's these stories, right? It's the stories that help us
feel understood. They validate our own experience. They help
us feel connected and let us know that we are not alone. So,
that was a really important component that we wanted to give
to this book.
Dr. Sanj Kakar: As you said, medicine is an art form. And
we're always learning not only from our patients, but as you
said, their caregivers. And so, with through your research, what
are sort of some of the misconceptions or stigma that
you've learned about and would like to address with this?
Angela Lunde: One of the things that I've done for years now is
when I go out and I talk to groups, I'll ask them the
question, when you hear the word dementia what words or images
come to your mind. And you know, I usually hear things that that
center on the ideas of loss and decline and deficits, getting
old, and much of our view of dementia comes from the media,
the pictures that we see out there, and much of how we
understand dementia comes from the medical model. It comes
from healthcare professionals. And because of that, much of
what we understand about dementia is focused on what's
wrong, what's not working what declines and deficits people
experience. And all of that shapes our perspective and our
view of dementia. You know, and it's actually the job of
healthcare to focus on what's wrong and figure out how they
can help in that way. So, you know, we need that. But the
problem with, you know, the medical way we've come to
understand dementia, the problem with how media sometimes
portrays this disease, is it gives us a very one-sided view.
So, what the book does is it gives us an opportunity to
really explore stigma misconceptions related to
dementia. And a few examples around these misconceptions that
are addressed in the book, the misconception that people can no
longer contribute in meaningful ways because they have dementia,
the misconception that that those with dementia can no
longer need to learn new things, or that everybody with dementia
is all the same. The reality is that every individual with
dementia is unique, they will experience dementia in their own
way. So, the book helps to see beyond the deficits, to see
beyond the disease, and helps uncover the strengths as well as
the people living with these diseases.
Dr. Sanj Kakar: I can just tell the way you're speaking how this
has really touched you and from learning from the patients and
their families. Can you explain how the COVID 19 pandemic may
have affected some of the care patients have received and with
their loved ones in terms of access to care and some of the
misnomers associated with that?
Angela Lunde: Remember, you know, knowing that our best
teachers are those who are living with the disease. And
what I've heard across the globe from people living with dementia
as it relates to the pandemic, is they'll say things like
people now know what we've been going through all along, right?
Because people living with dementia have always felt a loss
of connection. They've lost the ability to do the things that
they've enjoyed. And they've had a sense of isolation. So, in
some regards, I think those living with dementia now feel
better understood. And what it does for us I think, is it
provides an opportunity to have greater empathy. The pandemic,
because it's impacted all of us across the globe, it's also then
provided some benefit to those living with dementia and care
partners, because I think there's more focus on innovative
ways to connect. We now have support groups that are
available virtually which means no matter where people are,
there's no longer issues with regards to accessibility such as
transportation. Health care visits are also now done online
which can be you know, has pros and cons. But for many caring
for somebody with dementia, it can provide a great convenience.
And we know there are definite downsides for all of us,
including those impacted by dementia. Some of the day
programs that they've come to depend on for care partners for
respite and for those living with dementia it's been a
connection for them. There's been a disruption in their daily
routines, as we've heard about the ability for people to visit
loved ones who are in care communities have been profoundly
affected. So, there's lots of things we've learned, I think,
about people impacted by dementia through this. And we do
see both the pros, some of the pros, and of course definitely
the profound ways that this disease has impacted dementia
and those living with it.
Dr. Sanj Kakar: Dr. Graff Radford, what have you noticed
in the clinical arena, how COVID-19 has affected care for
patients with dementia?
Dr. Jonathan Graff-Radford: COVID-19 has really affected all of us,
but particularly those with dementia. And depending on the
level of severity of the dementia, they may not
understand things like social distancing and masking. So, it's
incredibly important that you realize you're doing those
things, because you're protecting your loved ones. It's
important we've heard from our patients to stay connected, as
Angela mentioned. And so, that may mean things like writing
letters regularly to your loved ones with dementia, getting on
the phone with them regularly, or if they're comfortable with
technology, doing video visits. And these are some of the
techniques that our patients have used to stay in touch when
physical contact is not as readily possible.
Dr. Sanj Kakar: What I love about this book is how the both
of you have brought different perspectives together to come
together in a sort of symbiotic way. Angela, I'd like to ask you
first, what's the one message you'd like people to take away
from this book?
Angela Lunde: The book doesn't sugarcoat things. It's an honest
guide full of information about dementia and about healthy
aging. But alongside dementia, the book also shows that new
hope can be cultivated. Mike, who I spoke about earlier, tells
us that even alongside this disease there is a life, and
there is life worth living after a diagnosis. And Rosalie, the
care partner that I mentioned earlier, teaches us that new
strengths can be cultivated as a part of this experience. She
specifically talks about patience, resilience, gratitude,
and even humor. So, that's the one takeaway I hope people get
is we get to see this from the whole perspective.
Dr. Sanj Kakar: Dr. Graff-Radford, your thoughts on
the final takeaway from this book?
Dr. Jonathan Graff-Radford: I would echo Angela's sentiment
that there is hope for our patients living with dementia
and their care partners. Scientists continue to learn
every day about when the disease starts, how it's progressing,
what treatments are on the horizon, and as we mentioned
earlier, there are lifestyles that can reduce your risk of
developing dementia. So, we're optimistic about the future.
Dr. Sanj Kakar: Anything else Angela, Jonathan you'd like to
add?
Angela Lunde: A final thing I would share as well is there's a
fair, there's a good section of this book that's for those
living with the disease to talk about the disease through the
lens of wellness. And there's a good section of this book for
caregivers that talks about wellness as well. So, it's
really a guide on understanding the disease as well as a path to
wellness.
Dr. Sanj Kakar: Our thanks to Jonathan Graff-Radford and
Angela Lunde, co-editors of the second edition of Mayo Clinic's
Book on Alzheimer's Disease and Other dementias. Thank you so
much for joining us today.
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