Preventing Dementia: Key Factors and Lifestyle Choices with Dr. Clionsky

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

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

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It's not going to come from curing it.

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I feel really confident about that.

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It's going to come from preventing it.

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

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

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How do we face the daunting challenges of dementia and

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cognitive decline, both as individuals and as families deeply affected

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

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

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Mitchell Klionsky, a board certified clinical neuropsychologist.

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

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

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

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

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Klionsky has co authored Dementia Prevention.

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

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Emily Klionsky.

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Dr.

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Mitchell, welcome to Seek Go Create.

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

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meet you and your audience, Tim.

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I'm really excited.

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I am excited that you're here too.

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And this is, this is personal for me.

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

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

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

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

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But I want everyone to know he is Dr.

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Mitchell Kleonski.

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All right.

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

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conference or anything like that.

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

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What do you tell people?

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

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

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I said, yeah.

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

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

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

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to process new information.

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We give tests of short term memory.

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

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We also do tests of what are called executive functions.

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

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and adapt them to new circumstances.

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We do measures of intelligence.

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We touch on personality and depression and anxiety.

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

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would expect for someone like them.

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Someone with their background, education, their educational level,

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

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

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

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

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And if it does, we reassure them.

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Things look good.

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You don't have to worry right now.

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

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dementia as you get older.

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Because I'm all about prevention.

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That's really what this is about.

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

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

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

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That's what really gets exciting.

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

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

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Yeah.

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And there's a lot to that.

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

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

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

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we dive into topics and all that.

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

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to have a great conversation.

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

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for me, this is quite personal.

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

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hit this right out of the gate.

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

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In December of 22, our father passed away.

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

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ish, he was diagnosed with dementia.

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it was about March of 2020.

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

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

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

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

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

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I'm 60.

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She's, I think she's 55.

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I hope I got that right.

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She's five years younger than me.

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and so we're looking at that.

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

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

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

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

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

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that is a consideration of ours.

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

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

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

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Number one, there's a high.

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

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for neurodegenerative diseases, brain diseases as you age, but

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they're also somewhat diverse.

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There's Parkinson's disease.

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

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terms of its underlying cause as we currently conceptualize it.

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

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

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

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

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

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

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Now, you'd rather not have that.

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

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

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

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It doesn't protect you against Parkinson's.

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

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head injuries, alcohol abuse.

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Or vascular factors.

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

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

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

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

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You play it where it lays.

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

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Sometimes you're in the rough.

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You don't want to be in the woods.

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

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but you got to play it where it lays.

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

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

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

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

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

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

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

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This brought up something that was fascinating,

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

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

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

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often some of the physical aspects.

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

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Are we asking the wrong question?

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

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Let's make this personal.

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

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Dr. Mitchell Clionsky: Okay.

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

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risk of dementia by 50 percent or more.

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Now, this is not my data.

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This is much better data that I could ever accumulate.

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

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called the Lancet Commission.

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

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New England Journal of Medicine.

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

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including a couple from the United States.

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

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

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Dementia is due to Parkinson's.

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

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of dementia, not just Alzheimer's.

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And what they discovered was that they had nine factors that

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would reduce the risk by 40%.

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wow, that's pretty impressive.

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

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they'd found three more factors.

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

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

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

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

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

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

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

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I like round numbers because they're more rememberable.

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So I say one out of two.

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

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

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

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eight more that they did not cover.

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

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

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specializes in treating brain diseases.

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

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

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

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impacted by a variety of different medical conditions and therefore falls

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into different medical professions.

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So it involves just not neurology and psychiatry and neuropsychology.

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

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our heart also impacts our brain.

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It involves endocrinology.

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

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It involves pulmonology, breathing and sleep medicine, specifically

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obstructive sleep apnea.

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So you have to read that literature.

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

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

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

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

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So our goal.

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

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

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They're reading what they're reading.

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

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specific area, which is wonderful.

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

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Think about that.

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

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is an incredibly important problem with huge societal costs and personal

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grievance as a result of this illness.

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And yet there isn't a cure.

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a field of Dementiology.

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I want to coin that term.

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So here it is.

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

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Dementia, Dementiology and Dementiologists.

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We need specialists who look at all of this.

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

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

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

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

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

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

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

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talking a lot of gibberish out there.

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

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things that actually had solid evidence.

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

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

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

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now, here's what this is about.

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This is what it means.

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Here's what this is about.

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Here's how you go about finding it out.

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

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

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

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

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

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half of the people who are worried.

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

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what are your risk factors?

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What's your individual profile?

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

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

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

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and where you're near target.

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Just need a little nudge.

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

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

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

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other people to do is it's out there.

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

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What your dementia risk is simply by filling out a questionnaire

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and discovering along the way.

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

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

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Got to talk to my doctor about running that test.

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

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

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Right.

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

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

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are looking for a quick answer.

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

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

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Number one, if we're in a situation.

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

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

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

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

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

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Diagram here.

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

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between all of these.

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

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

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

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this and the world will be greater.

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And it wasn't quite that simple.

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factors involved with that were obesity and general health and

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all those things like that.

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

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

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

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

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

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

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Dr. Mitchell Clionsky: You're right.

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And most of the quick fixes usually involve.

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

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

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

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

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

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All that stuff is probably from a prevention perspective, the

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best diet that you could eat.

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

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variance in terms of prediction.

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

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Best normal diet.

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It is clearly better than a horrible diet.

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

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

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than just a good solid varied diet.

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

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this now because I'm eating healthy.

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

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How could I be at risk?

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

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

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You're drinking more alcohol than is healthy.

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

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asleep for a variety of reasons.

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

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

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

Tim Winders: 00:20:44

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

Tim Winders: 00:20:50

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

Tim Winders: 00:20:54

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

Tim Winders: 00:21:03

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

Tim Winders: 00:21:07

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

Tim Winders: 00:21:12

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

Tim Winders: 00:21:18

So let's take the case of exercise.

Tim Winders: 00:21:22

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

Tim Winders: 00:21:27

I call it the 10 by 3 formula.

Tim Winders: 00:21:30

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

Tim Winders: 00:21:36

And here's why it works.

Tim Winders: 00:21:37

it's not the optimal.

Tim Winders: 00:21:39

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

Tim Winders: 00:21:41

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

Tim Winders: 00:21:46

for this or exercise for that?

Tim Winders: 00:21:48

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

Tim Winders: 00:21:51

Those are not the people I see.

Tim Winders: 00:21:52

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

Tim Winders: 00:21:56

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

Tim Winders: 00:21:58

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

Tim Winders: 00:22:02

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

Tim Winders: 00:22:04

Are you on the exercise bicycle?

Tim Winders: 00:22:06

How long, how often?

Tim Winders: 00:22:08

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

Tim Winders: 00:22:14

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

Tim Winders: 00:22:21

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

Tim Winders: 00:22:30

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

Tim Winders: 00:22:33

You never need special equipment.

Tim Winders: 00:22:35

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

Tim Winders: 00:22:39

You don't have to be in a class.

Tim Winders: 00:22:40

You don't have to join a gym.

Tim Winders: 00:22:42

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

Tim Winders: 00:22:47

they can get to pretty easily.

Tim Winders: 00:22:49

It adds up.

Tim Winders: 00:22:51

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

Tim Winders: 00:22:55

That's 210 minutes a week.

Tim Winders: 00:22:57

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

Tim Winders: 00:23:03

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

Tim Winders: 00:23:08

risk of cardiovascular disease.

Tim Winders: 00:23:10

They all come together at that 150 to 300.

Tim Winders: 00:23:14

Great.

Tim Winders: 00:23:15

Two 10s in the middle.

Tim Winders: 00:23:16

Second thing is if you're moving fast enough.

Tim Winders: 00:23:20

We talk about brisk.

Tim Winders: 00:23:21

What is brisk?

Tim Winders: 00:23:22

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

Tim Winders: 00:23:29

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

Tim Winders: 00:23:32

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

Tim Winders: 00:23:37

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

Tim Winders: 00:23:41

That's pretty cool.

Tim Winders: 00:23:43

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

Tim Winders: 00:23:45

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

Tim Winders: 00:23:48

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

Tim Winders: 00:23:50

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

Tim Winders: 00:23:54

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

Tim Winders: 00:23:58

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

Tim Winders: 00:24:04

I know that I can't.

Tim Winders: 00:24:06

Over exercise in the sense.

Tim Winders: 00:24:07

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

Tim Winders: 00:24:09

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

Tim Winders: 00:24:15

Then go from that up to an hour a day.

Tim Winders: 00:24:17

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

Tim Winders: 00:24:20

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

Tim Winders: 00:24:24

literature and how it translates.

Tim Winders: 00:24:27

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

Tim Winders: 00:24:33

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

Tim Winders: 00:24:37

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

Tim Winders: 00:24:42

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

Tim Winders: 00:24:47

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

Tim Winders: 00:24:50

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

Tim Winders: 00:24:55

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

Tim Winders: 00:25:00

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

Tim Winders: 00:25:05

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

Tim Winders: 00:25:11

Almost everything that I read.

Tim Winders: 00:25:13

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

Tim Winders: 00:25:17

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

Tim Winders: 00:25:20

but it's just healthy habits.

Tim Winders: 00:25:22

It's just like good health.

Tim Winders: 00:25:24

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

Tim Winders: 00:25:27

I do want to address that in a little while.

Tim Winders: 00:25:28

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

Tim Winders: 00:25:30

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

Tim Winders: 00:25:33

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

Tim Winders: 00:25:39

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

Tim Winders: 00:25:43

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

Tim Winders: 00:25:48

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

Tim Winders: 00:25:54

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

Tim Winders: 00:26:00

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

Tim Winders: 00:26:06

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

Tim Winders: 00:26:11

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

Tim Winders: 00:26:16

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

Tim Winders: 00:26:20

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

Tim Winders: 00:26:26

from progressing for some years.

Tim Winders: 00:26:29

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

Tim Winders: 00:26:33

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

Tim Winders: 00:26:36

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

Tim Winders: 00:26:39

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

Tim Winders: 00:26:43

They still get worse.

Tim Winders: 00:26:47

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

Tim Winders: 00:26:49

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

Tim Winders: 00:26:52

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

Tim Winders: 00:26:57

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

Tim Winders: 00:27:02

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

Tim Winders: 00:27:06

taught us years ago really were good.

Tim Winders: 00:27:10

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

Tim Winders: 00:27:15

and our health are separated in time,

Tim Winders: 00:27:20

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

Tim Winders: 00:27:22

with one of my patients this morning.

Tim Winders: 00:27:24

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

Tim Winders: 00:27:29

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

Tim Winders: 00:27:33

Nobody would ever be too heavy or too light.

Tim Winders: 00:27:36

If the result was immediate.

Tim Winders: 00:27:39

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

Tim Winders: 00:27:42

because it's an immediate feedback.

Tim Winders: 00:27:45

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

Tim Winders: 00:27:51

You smoke cigarettes in your 20s.

Tim Winders: 00:27:55

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

Tim Winders: 00:28:00

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

Tim Winders: 00:28:04

to you because you smell like smoke.

Tim Winders: 00:28:07

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

Tim Winders: 00:28:10

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

Tim Winders: 00:28:13

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

Tim Winders: 00:28:17

and continue to do end up being a problem.

Tim Winders: 00:28:21

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

Tim Winders: 00:28:27

also to show the data, why it happens.

Tim Winders: 00:28:30

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

Tim Winders: 00:28:35

out how to make that change.

Tim Winders: 00:28:38

Nobody argues with me.

Tim Winders: 00:28:39

If I say, Exercise is good.

Tim Winders: 00:28:42

a gimme.

Tim Winders: 00:28:44

Sure, I know that.

Tim Winders: 00:28:45

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

Tim Winders: 00:28:51

They all know it is.

Tim Winders: 00:28:53

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

Tim Winders: 00:28:57

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

Tim Winders: 00:29:01

That's where it works efficiently.

Tim Winders: 00:29:03

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

Tim Winders: 00:29:06

work, it's going to break on you.

Tim Winders: 00:29:08

It's pretty simple.

Tim Winders: 00:29:09

Same way.

Tim Winders: 00:29:09

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

Tim Winders: 00:29:14

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

Tim Winders: 00:29:18

It's just the way physics works.

Tim Winders: 00:29:21

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

Tim Winders: 00:29:26

out for you very well in the long run.

Tim Winders: 00:29:28

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

Tim Winders: 00:29:32

that they don't know how to do it.

Tim Winders: 00:29:34

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

Tim Winders: 00:29:38

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

Tim Winders: 00:29:43

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

Tim Winders: 00:29:48

problems and then implement them.

Tim Winders: 00:29:52

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

Tim Winders: 00:29:53

They try to analyze why they do this thing.

Tim Winders: 00:29:56

That's a problem.

Tim Winders: 00:29:58

I don't like that very much.

Tim Winders: 00:30:00

I get bored with that.

Tim Winders: 00:30:01

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

Tim Winders: 00:30:06

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

Tim Winders: 00:30:09

do the things you should do.

Tim Winders: 00:30:10

That's going to get you somewhere.

Tim Winders: 00:30:12

The

Tim Winders: 00:30:14

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

Tim Winders: 00:30:15

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

Tim Winders: 00:30:23

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

Tim Winders: 00:30:27

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

Tim Winders: 00:30:32

Do you adjust and tweak along the way?

Tim Winders: 00:30:33

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

Tim Winders: 00:30:38

that's really good.

Tim Winders: 00:30:40

Another great thing I really in the book.

Tim Winders: 00:30:44

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

Tim Winders: 00:30:47

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

Tim Winders: 00:30:52

that early on is there's dementia.

Tim Winders: 00:30:53

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

Tim Winders: 00:30:56

cognitive issues, things like that.

Tim Winders: 00:30:58

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

Tim Winders: 00:31:03

short history of Alzheimer's and dementia.

Tim Winders: 00:31:07

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

Tim Winders: 00:31:10

started coming into our vocabulary.

Tim Winders: 00:31:14

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

Tim Winders: 00:31:16

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

Tim Winders: 00:31:20

really came more into the forefront.

Tim Winders: 00:31:23

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

Tim Winders: 00:31:31

as culture, are we getting better?

Tim Winders: 00:31:33

Is this getting worse?

Tim Winders: 00:31:35

Is it?

Tim Winders: 00:31:36

Epidemic proportions.

Tim Winders: 00:31:38

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

Tim Winders: 00:31:41

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

Tim Winders: 00:31:46

where you see it all over the place.

Tim Winders: 00:31:47

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

Tim Winders: 00:31:53

What does the data tell us?

Tim Winders: 00:31:54

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

Tim Winders: 00:31:59

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

Tim Winders: 00:32:02

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

Tim Winders: 00:32:07

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

Tim Winders: 00:32:12

So I'm a baby boomer.

Tim Winders: 00:32:15

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

Tim Winders: 00:32:23

fueled most Of the big changes in society.

Tim Winders: 00:32:27

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

Tim Winders: 00:32:31

many of the commercials on TV.

Tim Winders: 00:32:33

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

Tim Winders: 00:32:40

age can't run to play tennis anymore.

Tim Winders: 00:32:43

There's this whole bump in population.

Tim Winders: 00:32:47

That's now 65 and older.

Tim Winders: 00:32:50

And we know that the risk of dementia increases.

Tim Winders: 00:32:55

proportionately as we get older.

Tim Winders: 00:32:57

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

Tim Winders: 00:33:00

chance of having dementia.

Tim Winders: 00:33:02

You get to your mid seventies.

Tim Winders: 00:33:04

It doubles.

Tim Winders: 00:33:05

It's now about 20%.

Tim Winders: 00:33:08

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

Tim Winders: 00:33:12

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

Tim Winders: 00:33:17

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

Tim Winders: 00:33:22

that, 60% in your nineties kind of thing.

Tim Winders: 00:33:25

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

Tim Winders: 00:33:30

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

Tim Winders: 00:33:33

I hear this all the time.

Tim Winders: 00:33:34

Yeah.

Tim Winders: 00:33:34

My dad lived to be 92.

Tim Winders: 00:33:36

He was demented for the last two months.

Tim Winders: 00:33:38

that wasn't really dementia.

Tim Winders: 00:33:39

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

Tim Winders: 00:33:43

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

Tim Winders: 00:33:50

causing a whole balance change.

Tim Winders: 00:33:53

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

Tim Winders: 00:33:58

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

Tim Winders: 00:34:03

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

Tim Winders: 00:34:06

Plus they didn't live that long into retirement.

Tim Winders: 00:34:10

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

Tim Winders: 00:34:16

Not so much anymore.

Tim Winders: 00:34:18

Fewer people putting money in.

Tim Winders: 00:34:20

More people living longer.

Tim Winders: 00:34:22

It's the same way with caretaking and dementia.

Tim Winders: 00:34:25

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

Tim Winders: 00:34:32

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

Tim Winders: 00:34:34

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

Tim Winders: 00:34:38

unless we begin preventing dementia.

Tim Winders: 00:34:42

It's not going to come from curing it.

Tim Winders: 00:34:44

I feel really confident about that.

Tim Winders: 00:34:47

It's going to come from preventing it.

Tim Winders: 00:34:49

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

Tim Winders: 00:34:56

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

Tim Winders: 00:35:00

anymore from an individual basis.

Tim Winders: 00:35:03

Cause you still got your families.

Tim Winders: 00:35:04

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

Tim Winders: 00:35:06

My mom had dementia.

Tim Winders: 00:35:08

I've sat in that seat.

Tim Winders: 00:35:09

I understand that.

Tim Winders: 00:35:11

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

Tim Winders: 00:35:15

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

Tim Winders: 00:35:19

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

Tim Winders: 00:35:24

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

Tim Winders: 00:35:30

To who they became when they developed dementia.

Tim Winders: 00:35:34

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

Tim Winders: 00:35:40

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

Tim Winders: 00:35:46

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

Tim Winders: 00:35:50

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

Tim Winders: 00:35:54

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

Tim Winders: 00:36:00

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

Tim Winders: 00:36:06

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

Tim Winders: 00:36:11

were caretakers for a while.

Tim Winders: 00:36:13

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

Tim Winders: 00:36:18

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

Tim Winders: 00:36:23

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

Tim Winders: 00:36:27

facilities, Atlanta metro area.

Tim Winders: 00:36:32

I do not think we are equipped to take care.

Tim Winders: 00:36:39

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

Tim Winders: 00:36:44

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

Tim Winders: 00:36:47

if the numbers grow as aging.

Tim Winders: 00:36:50

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

Tim Winders: 00:36:53

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

Tim Winders: 00:36:58

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

Tim Winders: 00:36:59

I do know that.

Tim Winders: 00:37:01

Caregiving from a other than family perspective is different depending

Tim Winders: 00:37:08

on where you are in this country.

Tim Winders: 00:37:11

California has some interesting models for people who basically

Tim Winders: 00:37:15

have a home and take care of.

Tim Winders: 00:37:18

Elderly people with dementia that they bring into the home.

Tim Winders: 00:37:22

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

Tim Winders: 00:37:25

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

Tim Winders: 00:37:32

continuity of care kinds of communities.

Tim Winders: 00:37:34

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

Tim Winders: 00:37:38

beyond family care.

Tim Winders: 00:37:40

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

Tim Winders: 00:37:43

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

Tim Winders: 00:37:49

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

Tim Winders: 00:37:54

And she knew that as well.

Tim Winders: 00:37:55

She didn't want to do that.

Tim Winders: 00:37:56

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

Tim Winders: 00:37:59

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

Tim Winders: 00:38:02

So that seemed to be a bad idea.

Tim Winders: 00:38:04

And I wanted to remain as her son.

Tim Winders: 00:38:06

I didn't want to be her caregiver.

Tim Winders: 00:38:08

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

Tim Winders: 00:38:13

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

Tim Winders: 00:38:20

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

Tim Winders: 00:38:25

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

Tim Winders: 00:38:31

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

Tim Winders: 00:38:34

bathe her or anything like that?

Tim Winders: 00:38:36

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

Tim Winders: 00:38:40

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

Tim Winders: 00:38:43

They want to provide all that care.

Tim Winders: 00:38:45

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

Tim Winders: 00:38:49

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

Tim Winders: 00:38:53

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

Tim Winders: 00:38:58

demented with the current resources.

Tim Winders: 00:39:01

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

Tim Winders: 00:39:04

to be able to provide the care.

Tim Winders: 00:39:06

Where does that come from?

Tim Winders: 00:39:08

Yeah.

Tim Winders: 00:39:08

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

Tim Winders: 00:39:15

very difficult to keep people around.

Tim Winders: 00:39:17

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

Tim Winders: 00:39:20

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

Tim Winders: 00:39:26

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

Tim Winders: 00:39:31

be an extreme strain and that we're.

Tim Winders: 00:39:35

Probably not equipped to handle it,

Tim Winders: 00:39:38

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

Tim Winders: 00:39:40

I don't think as well as we should.

Tim Winders: 00:39:42

Everyone's still pouring money into pharmaceuticals.

Tim Winders: 00:39:45

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

Tim Winders: 00:39:50

is driven by stock prices.

Tim Winders: 00:39:51

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

Tim Winders: 00:39:58

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

Tim Winders: 00:40:04

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

Tim Winders: 00:40:08

go about their lives and still work.

Tim Winders: 00:40:09

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

Tim Winders: 00:40:13

ability to take care of themselves.

Tim Winders: 00:40:15

And live their own lives.

Tim Winders: 00:40:16

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

Tim Winders: 00:40:22

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

Tim Winders: 00:40:26

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

Tim Winders: 00:40:31

inoculation, but we're not there yet.

Tim Winders: 00:40:34

And we're some distance away right now.

Tim Winders: 00:40:36

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

Tim Winders: 00:40:39

right?

Tim Winders: 00:40:40

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

Tim Winders: 00:40:43

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

Tim Winders: 00:40:48

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

Tim Winders: 00:40:52

and just have you comment.

Tim Winders: 00:40:54

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

Tim Winders: 00:40:57

love to hit as many of these as I can.

Tim Winders: 00:41:00

And some of them are covered in the book.

Tim Winders: 00:41:01

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

Tim Winders: 00:41:04

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

Tim Winders: 00:41:08

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

Tim Winders: 00:41:11

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

Tim Winders: 00:41:13

Or is that on the site?

Tim Winders: 00:41:15

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

Tim Winders: 00:41:18

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

Tim Winders: 00:41:21

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

Tim Winders: 00:41:27

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

Tim Winders: 00:41:31

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

Tim Winders: 00:41:35

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

Tim Winders: 00:41:39

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

Tim Winders: 00:41:42

So it's out there.

Tim Winders: 00:41:43

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

Tim Winders: 00:41:47

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

Tim Winders: 00:41:51

armamentarium to go after this problem.

Tim Winders: 00:41:54

very good.

Tim Winders: 00:41:54

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

Tim Winders: 00:41:57

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

Tim Winders: 00:42:02

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

Tim Winders: 00:42:08

Um, my wife makes fun of me.

Tim Winders: 00:42:09

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

Tim Winders: 00:42:14

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

Tim Winders: 00:42:18

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

Tim Winders: 00:42:22

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

Tim Winders: 00:42:28

in the black hills of South Dakota now.

Tim Winders: 00:42:31

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

Tim Winders: 00:42:36

about how important sleep is.

Tim Winders: 00:42:42

Dr. Mitchell Clionsky: Great question.

Tim Winders: 00:42:42

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

Tim Winders: 00:42:46

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

Tim Winders: 00:42:50

you can get too little sleep.

Tim Winders: 00:42:52

That's a problem.

Tim Winders: 00:42:53

Five hours or less is not enough sleep.

Tim Winders: 00:42:56

Nine hours or more is too much sleep.

Tim Winders: 00:42:59

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

Tim Winders: 00:43:05

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

Tim Winders: 00:43:08

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

Tim Winders: 00:43:13

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

Tim Winders: 00:43:18

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

Tim Winders: 00:43:23

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

Tim Winders: 00:43:28

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

Tim Winders: 00:43:31

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

Tim Winders: 00:43:35

generally, this is the time I go to sleep.

Tim Winders: 00:43:38

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

Tim Winders: 00:43:42

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

Tim Winders: 00:43:46

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

Tim Winders: 00:43:50

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

Tim Winders: 00:43:56

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

Tim Winders: 00:43:59

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

Tim Winders: 00:44:03

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

Tim Winders: 00:44:08

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

Tim Winders: 00:44:15

of the people, the passengers are.

Tim Winders: 00:44:18

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

Tim Winders: 00:44:23

Why is that?

Tim Winders: 00:44:23

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

Tim Winders: 00:44:27

You don't want the pilot to fall asleep.

Tim Winders: 00:44:29

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

Tim Winders: 00:44:35

like you see in the doctor's offices.

Tim Winders: 00:44:36

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

Tim Winders: 00:44:40

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

Tim Winders: 00:44:47

And then we gave it to the flight attendants.

Tim Winders: 00:44:51

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

Tim Winders: 00:44:57

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

Tim Winders: 00:45:01

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

Tim Winders: 00:45:05

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

Tim Winders: 00:45:09

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

Tim Winders: 00:45:13

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

Tim Winders: 00:45:17

So the oxygen question, are we suffocating our brains?

Tim Winders: 00:45:20

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

Tim Winders: 00:45:25

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

Tim Winders: 00:45:30

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

Tim Winders: 00:45:35

an eye on your blood oxygen level.

Tim Winders: 00:45:37

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

Tim Winders: 00:45:40

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

Tim Winders: 00:45:43

But my watch is supposedly measuring my blood oxygen.

Tim Winders: 00:45:48

Like last night I was at 94%.

Tim Winders: 00:45:51

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

Tim Winders: 00:45:54

And also are we suffocating our brains to some extent?

Tim Winders: 00:46:00

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

Tim Winders: 00:46:02

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

Tim Winders: 00:46:10

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

Tim Winders: 00:46:18

or average of five times or more per hour.

Tim Winders: 00:46:23

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

Tim Winders: 00:46:28

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

Tim Winders: 00:46:32

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

Tim Winders: 00:46:36

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

Tim Winders: 00:46:41

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

Tim Winders: 00:46:47

Now, how common is that?

Tim Winders: 00:46:49

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

Tim Winders: 00:46:53

It was just about four months ago.

Tim Winders: 00:46:56

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

Tim Winders: 00:47:02

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

Tim Winders: 00:47:06

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

Tim Winders: 00:47:11

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

Tim Winders: 00:47:14

Heart Study is one of these studies.

Tim Winders: 00:47:17

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

Tim Winders: 00:47:21

these preventive health places all decided to band together and

Tim Winders: 00:47:25

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

Tim Winders: 00:47:32

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

Tim Winders: 00:47:37

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

Tim Winders: 00:47:41

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

Tim Winders: 00:47:44

enough oxygen pulled out of the air.

Tim Winders: 00:47:48

Oxygen is only 20 percent of our air.

Tim Winders: 00:47:50

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

Tim Winders: 00:47:53

So you're not getting enough oxygen pulled out.

Tim Winders: 00:47:55

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

Tim Winders: 00:48:00

And make their way up to our brains.

Tim Winders: 00:48:02

And that's the problem.

Tim Winders: 00:48:04

Not enough air, not enough oxygen.

Tim Winders: 00:48:06

Our brains don't work properly.

Tim Winders: 00:48:09

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

Tim Winders: 00:48:13

Our brains cannot clear out the toxins that accumulate while

Tim Winders: 00:48:19

we're thinking during the day.

Tim Winders: 00:48:21

There's a system.

Tim Winders: 00:48:22

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

Tim Winders: 00:48:27

system that flushes out the byproducts.

Tim Winders: 00:48:31

Okay.

Tim Winders: 00:48:31

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

Tim Winders: 00:48:35

my trash can, cleans off my desk.

Tim Winders: 00:48:38

Our brains have a system like that.

Tim Winders: 00:48:41

It doesn't work in a low oxygen environment.

Tim Winders: 00:48:43

So toxins build up.

Tim Winders: 00:48:45

We don't think well.

Tim Winders: 00:48:46

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

Tim Winders: 00:48:49

during the day, oftentimes grumpy.

Tim Winders: 00:48:52

We could fall asleep at times.

Tim Winders: 00:48:54

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

Tim Winders: 00:49:00

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

Tim Winders: 00:49:05

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

Tim Winders: 00:49:07

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

Tim Winders: 00:49:11

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

Tim Winders: 00:49:14

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

Tim Winders: 00:49:18

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

Tim Winders: 00:49:24

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

Tim Winders: 00:49:29

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

Tim Winders: 00:49:37

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

Tim Winders: 00:49:41

to, uh, the dementia thing.

Tim Winders: 00:49:43

It may be related to cognitive.

Tim Winders: 00:49:45

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

Tim Winders: 00:49:50

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

Tim Winders: 00:49:55

I recognize that they're oftentimes less creative.

Tim Winders: 00:49:59

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

Tim Winders: 00:50:04

the word impaired, but it's not.

Tim Winders: 00:50:06

As healthy as it should be.

Tim Winders: 00:50:09

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

Tim Winders: 00:50:13

I may have missed it, but like just stress.

Tim Winders: 00:50:15

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

Tim Winders: 00:50:18

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

Tim Winders: 00:50:24

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

Tim Winders: 00:50:28

So just capacity wise, does that feed into this?

Tim Winders: 00:50:33

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

Tim Winders: 00:50:37

overstress it or have too much going on?

Tim Winders: 00:50:40

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

Tim Winders: 00:50:44

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

Tim Winders: 00:50:47

our goal was dementia prevention.

Tim Winders: 00:50:49

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

Tim Winders: 00:50:57

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

Tim Winders: 00:51:02

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

Tim Winders: 00:51:08

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

Tim Winders: 00:51:15

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

Tim Winders: 00:51:19

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

Tim Winders: 00:51:24

call depletes it same way with your brain.

Tim Winders: 00:51:27

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

Tim Winders: 00:51:30

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

Tim Winders: 00:51:34

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

Tim Winders: 00:51:38

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

Tim Winders: 00:51:44

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

Tim Winders: 00:51:49

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

Tim Winders: 00:51:55

process, things in their way, obstacles.

Tim Winders: 00:51:58

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

Tim Winders: 00:52:02

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

Tim Winders: 00:52:06

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

Tim Winders: 00:52:11

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

Tim Winders: 00:52:16

the months of the year backwards.

Tim Winders: 00:52:17

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

Tim Winders: 00:52:20

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

Tim Winders: 00:52:25

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

Tim Winders: 00:52:30

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

Tim Winders: 00:52:34

Would be a really important marker for what your abilities

Tim Winders: 00:52:40

are going to be going forward.

Tim Winders: 00:52:43

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

Tim Winders: 00:52:46

part of my career back in the 70s.

Tim Winders: 00:52:48

I used to do stress management for executives.

Tim Winders: 00:52:51

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

Tim Winders: 00:52:55

training, and stress management.

Tim Winders: 00:52:58

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

Tim Winders: 00:53:01

much coping does the person have.

Tim Winders: 00:53:04

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

Tim Winders: 00:53:09

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

Tim Winders: 00:53:13

They're bored.

Tim Winders: 00:53:14

They're unhappy.

Tim Winders: 00:53:14

They don't know what's going on.

Tim Winders: 00:53:16

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

Tim Winders: 00:53:20

ability and those people are breaking down emotionally and physically.

Tim Winders: 00:53:24

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

Tim Winders: 00:53:29

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

Tim Winders: 00:53:32

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

Tim Winders: 00:53:36

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

Tim Winders: 00:53:41

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

Tim Winders: 00:53:45

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

Tim Winders: 00:53:49

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

Tim Winders: 00:53:52

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

Tim Winders: 00:53:56

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

Tim Winders: 00:54:01

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

Tim Winders: 00:54:05

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

Tim Winders: 00:54:08

We need to find ways to relieve that pressure.

Tim Winders: 00:54:12

And what you brought up was fascinating.

Tim Winders: 00:54:14

Just a walk.

Tim Winders: 00:54:15

I would notice when I would swim or even pickleball.

Tim Winders: 00:54:18

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

Tim Winders: 00:54:20

It erases some things that are hanging out there.

Tim Winders: 00:54:23

None of the things are any different.

Tim Winders: 00:54:25

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

Tim Winders: 00:54:30

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

Tim Winders: 00:54:33

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

Tim Winders: 00:54:36

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

Tim Winders: 00:54:40

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

Tim Winders: 00:54:44

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

Tim Winders: 00:54:48

clear the decks is, is a good thing.

Tim Winders: 00:54:52

So I.

Tim Winders: 00:54:53

I appreciate all that feedback and input.

Tim Winders: 00:54:54

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

Tim Winders: 00:54:59

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

Tim Winders: 00:55:02

even used some visual impairment.

Tim Winders: 00:55:05

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

Tim Winders: 00:55:09

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

Tim Winders: 00:55:13

is one reason I'm bringing this up.

Tim Winders: 00:55:15

He had a ringing in his ears.

Tim Winders: 00:55:17

The tinnitus or tinnitus, whatever it's called.

Tim Winders: 00:55:20

I actually have some degree of that.

Tim Winders: 00:55:22

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

Tim Winders: 00:55:23

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

Tim Winders: 00:55:27

I don't know.

Tim Winders: 00:55:28

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

Tim Winders: 00:55:32

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

Tim Winders: 00:55:38

would just increase that noise of the.

Tim Winders: 00:55:41

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

Tim Winders: 00:55:44

It's something internal.

Tim Winders: 00:55:45

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

Tim Winders: 00:55:48

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

Tim Winders: 00:55:53

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

Tim Winders: 00:55:59

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

Tim Winders: 00:56:03

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

Tim Winders: 00:56:08

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

Tim Winders: 00:56:13

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

Tim Winders: 00:56:17

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

Tim Winders: 00:56:23

worse when there's no background noise.

Tim Winders: 00:56:26

people experience it as they're falling asleep.

Tim Winders: 00:56:27

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

Tim Winders: 00:56:31

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

Tim Winders: 00:56:34

better than having no noise at all.

Tim Winders: 00:56:37

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

Tim Winders: 00:56:41

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

Tim Winders: 00:56:49

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

Tim Winders: 00:56:51

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

Tim Winders: 00:56:55

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

Tim Winders: 00:56:57

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

Tim Winders: 00:57:02

keeps them stuck where they are.

Tim Winders: 00:57:05

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

Tim Winders: 00:57:07

if you have a hearing loss.

Tim Winders: 00:57:09

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

Tim Winders: 00:57:13

They're remarkably smaller than they used to be.

Tim Winders: 00:57:16

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

Tim Winders: 00:57:20

even tell they're wearing a hearing aid.

Tim Winders: 00:57:23

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

Tim Winders: 00:57:25

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

Tim Winders: 00:57:29

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

Tim Winders: 00:57:32

And they say, that's right.

Tim Winders: 00:57:33

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

Tim Winders: 00:57:35

I said, what makes you look really old?

Tim Winders: 00:57:38

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

Tim Winders: 00:57:40

They say, what is it exactly?

Tim Winders: 00:57:42

what that really makes you look old said hearing.

Tim Winders: 00:57:46

Is something we don't perceive externally.

Tim Winders: 00:57:49

It's what you're dealing with.

Tim Winders: 00:57:51

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

Tim Winders: 00:57:54

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

Tim Winders: 00:57:58

You're gonna look younger.

Tim Winders: 00:57:58

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

Tim Winders: 00:58:04

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

Tim Winders: 00:58:07

increase people's cognition.

Tim Winders: 00:58:09

in the moment by improving their hearing.

Tim Winders: 00:58:12

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

Tim Winders: 00:58:16

on non verbal tests when they hear.

Tim Winders: 00:58:19

I'm a huge fan of those.

Tim Winders: 00:58:22

It also really makes for better relationships.

Tim Winders: 00:58:26

Yeah, definitely.

Tim Winders: 00:58:27

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

Tim Winders: 00:58:33

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

Tim Winders: 00:58:39

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

Tim Winders: 00:58:44

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

Tim Winders: 00:58:48

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

Tim Winders: 00:58:53

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

Tim Winders: 00:58:57

And we would say, stop leaving the television going.

Tim Winders: 00:59:01

It can't be good for the brain.

Tim Winders: 00:59:06

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

Tim Winders: 00:59:09

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

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because that can't be good for you.

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Any thoughts on that?

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

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

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And these people are my friends.

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

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

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repeating itself every hour or two.

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

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any specific computer generated exercises or games that by themselves

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are known to prevent dementia.

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

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

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

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

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

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And that's not really what the purpose is.

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It's really to make your brain better.

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But your brain is not a muscle.

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

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But we do want people to be interacting.

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

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So if you enjoy playing them, sure.

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

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

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You really want to be interacting with other people.

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

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Or checkers, or mahjong, or percheesy.

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

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pool or sitting around talking.

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

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things to be stuff you have to solve.

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Or you have to think about.

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Not just things that you have to repeat.

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

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connected as we possibly can.

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

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social media, AI, all the things we have.

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

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interaction, communications and things like that is powerful.

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

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

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I got nothing else going on in my life.

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I can come back some other time.

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I'd

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love

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

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this all day long, literally.

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

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Ad nauseum with each other.

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

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We're going to meet these people.

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we don't do anything in this area.

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Let's talk about something

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

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

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

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

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

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My sister had to step in and all that.

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

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leaders of

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organizations and all can have to deal with.

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

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that's a real focus for me.

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Because if you can keep your leadership.

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

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retire because they can't keep up with it.

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

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I definitely think that's doable.

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the

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

Tim Winders: 01:02:56

can't do what I used to do physically.

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I'm in pretty good shape fit.

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

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

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to keep sharp so we could share that.

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

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

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We've mentioned the assessment a few times.

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Let's drive them to that.

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Give them all the info for that.

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

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can they get all of that info?

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

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Real basic.

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

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

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And it's as easy to remember brain doc.

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It talks about, this is what we do.

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We're doctors who deal with the brain.

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It's got a link to our book.

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

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

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they can listen to those as well.

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

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There's a whole bunch of stuff.

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So that's the place.

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

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Yeah, very good.

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

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that you can go to find all that.

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

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

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

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

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I would choose Seek.

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And it's relates to me.

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

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

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got to ask the next question.

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You got to be curious.

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

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

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

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

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So constantly be looking.

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What can I learn today?

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That makes it a great day.

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

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Amen.

Tim Winders: 01:05:22

Dr.

Tim Winders: 01:05:22

Mitchell Kleonski.

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I so appreciate you taking the time.

Tim Winders: 01:05:27

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

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I appreciate you guys.

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

Tim Winders: 01:05:37

using your head to save your brain.

Tim Winders: 01:05:40

So, again, I did a quick read through.

Tim Winders: 01:05:42

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

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

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Excellent book.

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I believe it's a book that.

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Everyone should read just because of the general nature of the

Tim Winders: 01:05:56

health and why we need that.

Tim Winders: 01:05:57

And I just appreciate the conversation.

Tim Winders: 01:06:00

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

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

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impacts probably almost everyone.

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

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things, and I appreciate that.

Tim Winders: 01:06:15

We have new episodes every Monday until next time continue being

Tim Winders: 01:06:19

all that you are created to be.