What Can You Do to Prevent Dementia
James Ellison, MD, MPH discusses whether or not you can prevent or delay the onset of Alzheimers or Dementia and he offers some great advice and lifestyle tips that can help to ward off symptoms and memory issues associated with dementia.
Featuring:
Dr. Ellison’s clinical specialties include the assessment and treatment of neurocognitive disorders and mood disorders in later life. His research interests have addressed cognitive and behavioral aspects of these conditions and he has served as a site Principal Investigator in multiple trials of new medications for the treatment of Alzheimer’s Disease. He is also the Editor in Chief of the Journal of Geriatric Psychiatry and Neurology and the author and/or editor of several books about psychiatry.
Dr. Ellison moved to Delaware in 2015 to become the first Swank Foundation Endowed Chair in Memory Care and Geriatrics. His objective in this role is to enhance the care of older adults with neurocognitive disorders in Delaware by increasing their access to state of the art diagnostic tools, clinical assessment and treatment approaches, caregiver support resources, and research trials. He is privileged to work as a geriatric psychiatrist embedded in an interdisciplinary consultation team that includes geriatricians, social workers, a neurologist, and a nurse practitioner devoted to this shared goal of treating people with mild to severe cognitive difficulties and related emotional and behavioral conditions. His program, the Swank Center for Memory Care and Geriatric Consultation, is Delaware’s only dedicated outpatient program serving this purpose.
Dr. Ellison is the proud father of two college-age young men who share his passion for community service. His partner, Kate, works as McLean Hospital’s fitness director in Belmont, MA. When not working, Dr. Ellison enjoys attending concerts, playing the violin, reading, and looking for time to keep fit
James Ellison, MD
Dr. Ellison was born in Minnesota and raised mostly in California, but higher education opportunities lured him to Boston, where he trained to be a psychiatrist at the Massachusetts General Hospital, Subsequently, he spent several decades working as a general and geriatric psychiatrist in several hospitals in or near Boston. He also received a Master of Public Health degree from the Harvard School of Public Health. Throughout his career, he has developed and led clinical and research programs while also promoting education of the public and of his professional peers. He has worked in diverse settings including emergency psychiatry services, inpatient and outpatient clinical settings, managed care, and private practice. Since 1999, he has focused on mental health issues of older adults.Dr. Ellison’s clinical specialties include the assessment and treatment of neurocognitive disorders and mood disorders in later life. His research interests have addressed cognitive and behavioral aspects of these conditions and he has served as a site Principal Investigator in multiple trials of new medications for the treatment of Alzheimer’s Disease. He is also the Editor in Chief of the Journal of Geriatric Psychiatry and Neurology and the author and/or editor of several books about psychiatry.
Dr. Ellison moved to Delaware in 2015 to become the first Swank Foundation Endowed Chair in Memory Care and Geriatrics. His objective in this role is to enhance the care of older adults with neurocognitive disorders in Delaware by increasing their access to state of the art diagnostic tools, clinical assessment and treatment approaches, caregiver support resources, and research trials. He is privileged to work as a geriatric psychiatrist embedded in an interdisciplinary consultation team that includes geriatricians, social workers, a neurologist, and a nurse practitioner devoted to this shared goal of treating people with mild to severe cognitive difficulties and related emotional and behavioral conditions. His program, the Swank Center for Memory Care and Geriatric Consultation, is Delaware’s only dedicated outpatient program serving this purpose.
Dr. Ellison is the proud father of two college-age young men who share his passion for community service. His partner, Kate, works as McLean Hospital’s fitness director in Belmont, MA. When not working, Dr. Ellison enjoys attending concerts, playing the violin, reading, and looking for time to keep fit
Transcription:
Melanie Cole: Welcome. This is Christiana Care's Podcast series. I'm Melanie Cole and today we're talking about what you can do to delay or prevent cognitive aging. Our speakers in this podcast series represent the Swank Center for Memory Care and Geriatrics. Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults, and their caregivers coping with dementia or other neurocognitive disorders. Joining me is Dr. James Ellison. He's the Swank Foundation endowed Chair in Memory Care and Geriatrics at Christiana Care. Dr. Ellison, it's a pleasure to have you with us today. Let's talk about mild cognitive impairment versus dementia. Is it a precursor for full blown dementia? You've explained in a previous podcast what dementia really is, but what if it's forgetting where you put your keys or just forgetting what you had for breakfast the day before? These mild things, senior moments, some people call them. Is that a precursor for dementia? Tell us a little bit about that.
Dr. Ellison: Well, thank you Melanie. This is a very important point. As we get older, most of us are going to develop some minor changes in cognitive functioning, slower processing, the occasional slip of memory, but mild cognitive impairment or mild neurocognitive disorder is diagnosed when a person requires reminders or other compensatory behaviors in order to function as well as usual, and that's on a more regular basis. If you no longer can keep your appointments without writing them down and checking them multiple times, that might be a warning sign. If you can't drive to places that were once familiar without the GPS, that again might be a reason for concern, but most people are going to be able to tell the difference between a pathological loss of memory and a normal aging process, and your primary care provider can help you with that if you have questions. Now, as far as mild cognitive impairment being a prodrome for dementia, it's true that many people who develop dementia will pass through that phase of mild cognitive impairment, but not everybody with mild cognitive changes will go on to develop dementia. It's estimated that maybe 12% or so per year will progress to dementia for mild cognitive impairment, but others will remain in that stage of mild cognitive impairment sometimes for years.
Host: Well, that certainly does give hope, Dr. Ellison, for people that might be worried about those small memory lapses that they develop. So let's talk about disease management and prevention with lifestyle changes. I'm an exercise physiologist and we've learned over the years about various lifestyle behaviors that can help to prevent or delay the onset. Tell us about some of those. Is diabetes, heart disease, sleep disorders, exercise, nutrition, can any of these help?
Dr. Ellison: Well, you've brought up already the most important one of all, which is activity, physical exercise and activity. And I like to say activity rather than exercise because there's a difference between living an active lifestyle and making a limited time for exercise. These are different processes. An active lifestyle includes such things as a walking sometimes rather than driving everywhere, taking the stairs rather than the elevator on occasion, not parking in the closest parking spot to where you're going and so on. So remaining active is very important and exercise for an older adult should not only be aerobic, but also a resistance training to preserve strength and flexibility and balance training. So I'm sure you know this as an exercise physiologist and you're probably familiar also with the research that has shown that active exercise and activity is one of the best preventions for cognitive decline.
And this has learned from a variety of different kinds of studies. We know that if we ask a group of older adults how much they've exercised and then measured their cognitive functioning, we can find statistical associations between people who've exercised on a more regular basis for years and have higher cognitive functioning, and people who haven't been as active and don't age quite as well cognitively. There are also studies which are intervention trials with animals and with humans that show that an exercise program has very many beneficial effects on metabolism and cognition. For example, exercise lowers blood lipids, increases insulin sensitivity, improves energy metabolism. So there are many ways in which exercise helps physically, but it also has been shown to improve processing speed and executive function. Exercises is very, very important.
You also mentioned some of the diseases that we associate with aging, and now with the advances that have taken place in medical treatment, it's very typical for a person who's older to have accumulated some chronic diseases. High blood pressure is a very common, hyperlipidemia or elevated cholesterol, diabetes is a very common disease, and when a person develops any of these diseases, it can affect the brain and have effects on cognition. So one of the low hanging fruits in prevention of cognitive decline, is to make sure that we do what we can about these chronic illnesses that affect brain health. And for example, in the United States, our recent studies showed that only about half of the people with high blood pressure were adequately controlled. So detecting and treating these medical disorders such as high blood pressure, hyperlipidemia, and diabetes are very important things to do. And we're learning more about how diet can affect aging and cognition.
We've known for a while about the dash diet, the dietary approach to treat hypertension. And the dash diet is a very healthy one that also is beneficial for the brain. A later diet that was developed is the mind diet, which combines elements of the dash diet with some components from the Mediterranean diet that's been around for a long time. And all of these diets emphasize fresh fruits and vegetables, decreased protein from red meat, but more from legumes, and other sources of protein, and plenty of fiber and good healthy fats like olive oil. The benefits of this diet has been shown to preserve cognition longer. Now, there's some interesting studies like the Finish study that we call the Finger study that was published some years ago that showed that a group of older adults who had a multidimensional health program that included socialization, attention to vascular risk factors, dietary counseling, and physical activity, showed improvements or less a decline in cognition compared to a group of adults who didn't have these interventions.
Host: Wow. There's so many factors at play here, Dr. Ellison. It's so comprehensive. So you've mentioned nutrition, you've mentioned physical activity. What about cognitive stimulation? We used to hear back in the day, balance your checkbook. Well, people don't have checkbooks very much anymore. You know, they would say crossword puzzles or Sudoku or one of those kinds of things. Tell us about how cognitive stimulation and I'd like you to include in that you mentioned it, social engagement because I think peers, discussion, going out and doing things can also help. Tell us about that.
Dr. Ellison: Well, cognitive stimulation comes in many forms. Anything in which you actively use your mind, doing puzzles, playing games, having discussions, all of these are very valuable. Lots of people like to do crossword puzzles and Sudoku or to do puzzles online, and the AARP has some puzzles on their website, uh, that are very accessible. There are also websites to which you can subscribe like Lumosity or Brain HQ, which are very well done. The disadvantage about using those kinds of computer games and cognitive websites, is that you can get so caught up in doing puzzles that you isolate yourself or lose the opportunity to do things that are more social. So I'm a big advocate of cognitive stimulation that's more social, playing Scrabble with a friend, doing a puzzle, playing trivia with a group of people. All of those are excellent ways of exercising your mind. Cognitive stimulation is important, but I also say to people that exercise has a better body of evidence supporting it. So if you can make sure that you do your exercise and have time leftover, use that time to stimulate your mind as well and to become involved in a social activity.
Host: One thing that we haven't mentioned that I'd like to make sure we discuss before we conclude today, Dr. Ellison is restorative sleep. People have problems sleeping. It makes it so you can't focus the next day or drowsy driving all of these other complications. Does sleep have an effect on our cognitive function in the long-term?
Dr. Ellison: I'm so glad you mentioned sleep because that's one of the areas where we can intervene and really make a difference in preventing cognitive decline or delaying it, and improving health and quality of life. Sleep is such an important part of good health. There are sleep disorders like sleep apnea in which sleep is actually very disturbed and a person doesn't have restorative sleep, even though they spend enough time in bed. But in my clinical practice, what I see more often is people robbing their sleep time in order to get more done or do things that are more enjoyable to them, and so they don't sleep enough hours. And when you don't sleep enough hours, you don't get all of the benefits of restorative sleep. Part of what happens in sleep is you consolidate the day's memories and you actually benefit during slow wave sleep from a kind of a cleansing process by which the glymphatic system of the brain helps reduce the circulating amyloid in the brain. And so the brain is actually healthier if you have enough sleep.
Host: Well, that's certainly true. I can definitely attest to that. And Dr. Ellison, as we conclude, tell us about your team. You're the Swank Foundation, endowed Chair in Memory Care and Geriatrics at Christiana Care. Tell us about your team at the Swank Center.
Dr. Ellison: Well, at the Swank Center we have an exceptional interdisciplinary team that includes psychiatry, neurology, family medicine, and we have associations with neuropsychology, behavioral health, and general medicine, and other specialists. So we are able to provide primary care providers, and self-referred patients as well, with a comprehensive evaluation and a treatment plan or suggestions that will help them, first of all, determine whether there's a significant cognitive problem. But also help them adopt a healthier lifestyle and a brain healthy lifestyle and improve their quality of life.
Host: Thank you so much Dr. Ellison for coming on and sharing your incredible expertise. I can hear the passion in your voice when you discuss these topics. Thank you again for joining us. And that concludes this episode of Christiana Care's Swank Memory Care Podcast series. For an appointment at the Swank Center for Memory Care and Geriatrics. Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders, please call (302) 320-2620 to schedule an evaluation. And to learn more about programs and services, you can always visit ChristianaCare.org/SwankMemoryCare to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast, and all the other Christiana Care podcasts. I'm Melanie Cole.
Melanie Cole: Welcome. This is Christiana Care's Podcast series. I'm Melanie Cole and today we're talking about what you can do to delay or prevent cognitive aging. Our speakers in this podcast series represent the Swank Center for Memory Care and Geriatrics. Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults, and their caregivers coping with dementia or other neurocognitive disorders. Joining me is Dr. James Ellison. He's the Swank Foundation endowed Chair in Memory Care and Geriatrics at Christiana Care. Dr. Ellison, it's a pleasure to have you with us today. Let's talk about mild cognitive impairment versus dementia. Is it a precursor for full blown dementia? You've explained in a previous podcast what dementia really is, but what if it's forgetting where you put your keys or just forgetting what you had for breakfast the day before? These mild things, senior moments, some people call them. Is that a precursor for dementia? Tell us a little bit about that.
Dr. Ellison: Well, thank you Melanie. This is a very important point. As we get older, most of us are going to develop some minor changes in cognitive functioning, slower processing, the occasional slip of memory, but mild cognitive impairment or mild neurocognitive disorder is diagnosed when a person requires reminders or other compensatory behaviors in order to function as well as usual, and that's on a more regular basis. If you no longer can keep your appointments without writing them down and checking them multiple times, that might be a warning sign. If you can't drive to places that were once familiar without the GPS, that again might be a reason for concern, but most people are going to be able to tell the difference between a pathological loss of memory and a normal aging process, and your primary care provider can help you with that if you have questions. Now, as far as mild cognitive impairment being a prodrome for dementia, it's true that many people who develop dementia will pass through that phase of mild cognitive impairment, but not everybody with mild cognitive changes will go on to develop dementia. It's estimated that maybe 12% or so per year will progress to dementia for mild cognitive impairment, but others will remain in that stage of mild cognitive impairment sometimes for years.
Host: Well, that certainly does give hope, Dr. Ellison, for people that might be worried about those small memory lapses that they develop. So let's talk about disease management and prevention with lifestyle changes. I'm an exercise physiologist and we've learned over the years about various lifestyle behaviors that can help to prevent or delay the onset. Tell us about some of those. Is diabetes, heart disease, sleep disorders, exercise, nutrition, can any of these help?
Dr. Ellison: Well, you've brought up already the most important one of all, which is activity, physical exercise and activity. And I like to say activity rather than exercise because there's a difference between living an active lifestyle and making a limited time for exercise. These are different processes. An active lifestyle includes such things as a walking sometimes rather than driving everywhere, taking the stairs rather than the elevator on occasion, not parking in the closest parking spot to where you're going and so on. So remaining active is very important and exercise for an older adult should not only be aerobic, but also a resistance training to preserve strength and flexibility and balance training. So I'm sure you know this as an exercise physiologist and you're probably familiar also with the research that has shown that active exercise and activity is one of the best preventions for cognitive decline.
And this has learned from a variety of different kinds of studies. We know that if we ask a group of older adults how much they've exercised and then measured their cognitive functioning, we can find statistical associations between people who've exercised on a more regular basis for years and have higher cognitive functioning, and people who haven't been as active and don't age quite as well cognitively. There are also studies which are intervention trials with animals and with humans that show that an exercise program has very many beneficial effects on metabolism and cognition. For example, exercise lowers blood lipids, increases insulin sensitivity, improves energy metabolism. So there are many ways in which exercise helps physically, but it also has been shown to improve processing speed and executive function. Exercises is very, very important.
You also mentioned some of the diseases that we associate with aging, and now with the advances that have taken place in medical treatment, it's very typical for a person who's older to have accumulated some chronic diseases. High blood pressure is a very common, hyperlipidemia or elevated cholesterol, diabetes is a very common disease, and when a person develops any of these diseases, it can affect the brain and have effects on cognition. So one of the low hanging fruits in prevention of cognitive decline, is to make sure that we do what we can about these chronic illnesses that affect brain health. And for example, in the United States, our recent studies showed that only about half of the people with high blood pressure were adequately controlled. So detecting and treating these medical disorders such as high blood pressure, hyperlipidemia, and diabetes are very important things to do. And we're learning more about how diet can affect aging and cognition.
We've known for a while about the dash diet, the dietary approach to treat hypertension. And the dash diet is a very healthy one that also is beneficial for the brain. A later diet that was developed is the mind diet, which combines elements of the dash diet with some components from the Mediterranean diet that's been around for a long time. And all of these diets emphasize fresh fruits and vegetables, decreased protein from red meat, but more from legumes, and other sources of protein, and plenty of fiber and good healthy fats like olive oil. The benefits of this diet has been shown to preserve cognition longer. Now, there's some interesting studies like the Finish study that we call the Finger study that was published some years ago that showed that a group of older adults who had a multidimensional health program that included socialization, attention to vascular risk factors, dietary counseling, and physical activity, showed improvements or less a decline in cognition compared to a group of adults who didn't have these interventions.
Host: Wow. There's so many factors at play here, Dr. Ellison. It's so comprehensive. So you've mentioned nutrition, you've mentioned physical activity. What about cognitive stimulation? We used to hear back in the day, balance your checkbook. Well, people don't have checkbooks very much anymore. You know, they would say crossword puzzles or Sudoku or one of those kinds of things. Tell us about how cognitive stimulation and I'd like you to include in that you mentioned it, social engagement because I think peers, discussion, going out and doing things can also help. Tell us about that.
Dr. Ellison: Well, cognitive stimulation comes in many forms. Anything in which you actively use your mind, doing puzzles, playing games, having discussions, all of these are very valuable. Lots of people like to do crossword puzzles and Sudoku or to do puzzles online, and the AARP has some puzzles on their website, uh, that are very accessible. There are also websites to which you can subscribe like Lumosity or Brain HQ, which are very well done. The disadvantage about using those kinds of computer games and cognitive websites, is that you can get so caught up in doing puzzles that you isolate yourself or lose the opportunity to do things that are more social. So I'm a big advocate of cognitive stimulation that's more social, playing Scrabble with a friend, doing a puzzle, playing trivia with a group of people. All of those are excellent ways of exercising your mind. Cognitive stimulation is important, but I also say to people that exercise has a better body of evidence supporting it. So if you can make sure that you do your exercise and have time leftover, use that time to stimulate your mind as well and to become involved in a social activity.
Host: One thing that we haven't mentioned that I'd like to make sure we discuss before we conclude today, Dr. Ellison is restorative sleep. People have problems sleeping. It makes it so you can't focus the next day or drowsy driving all of these other complications. Does sleep have an effect on our cognitive function in the long-term?
Dr. Ellison: I'm so glad you mentioned sleep because that's one of the areas where we can intervene and really make a difference in preventing cognitive decline or delaying it, and improving health and quality of life. Sleep is such an important part of good health. There are sleep disorders like sleep apnea in which sleep is actually very disturbed and a person doesn't have restorative sleep, even though they spend enough time in bed. But in my clinical practice, what I see more often is people robbing their sleep time in order to get more done or do things that are more enjoyable to them, and so they don't sleep enough hours. And when you don't sleep enough hours, you don't get all of the benefits of restorative sleep. Part of what happens in sleep is you consolidate the day's memories and you actually benefit during slow wave sleep from a kind of a cleansing process by which the glymphatic system of the brain helps reduce the circulating amyloid in the brain. And so the brain is actually healthier if you have enough sleep.
Host: Well, that's certainly true. I can definitely attest to that. And Dr. Ellison, as we conclude, tell us about your team. You're the Swank Foundation, endowed Chair in Memory Care and Geriatrics at Christiana Care. Tell us about your team at the Swank Center.
Dr. Ellison: Well, at the Swank Center we have an exceptional interdisciplinary team that includes psychiatry, neurology, family medicine, and we have associations with neuropsychology, behavioral health, and general medicine, and other specialists. So we are able to provide primary care providers, and self-referred patients as well, with a comprehensive evaluation and a treatment plan or suggestions that will help them, first of all, determine whether there's a significant cognitive problem. But also help them adopt a healthier lifestyle and a brain healthy lifestyle and improve their quality of life.
Host: Thank you so much Dr. Ellison for coming on and sharing your incredible expertise. I can hear the passion in your voice when you discuss these topics. Thank you again for joining us. And that concludes this episode of Christiana Care's Swank Memory Care Podcast series. For an appointment at the Swank Center for Memory Care and Geriatrics. Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders, please call (302) 320-2620 to schedule an evaluation. And to learn more about programs and services, you can always visit ChristianaCare.org/SwankMemoryCare to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast, and all the other Christiana Care podcasts. I'm Melanie Cole.