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Brain Health and Dementia
Dr. Jacob Hall discusses brain health and dementia.
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Learn more about Jacob Hall, MD
Jacob Hall, MD
Dr. Hall completed medical school at the University of Southern California and went on to complete residency and fellowship training at Stanford University. He then served as Clinical Assistant Professor at the Stanford Memory Disorders Center where he taught medical students, residents and fellows. He also contributed to several research projects and clinical trials with a focus on neurodegenerative disorders. He is board certified in neurology and behavioral neurology.Learn more about Jacob Hall, MD
Transcription:
Brain Health and Dementia
Melanie: Welcome to TVH health chat with Temecula Valley Hospital. I'm Melanie Cole. And I invite you to listen as we discuss brain health and dementia. Joining me is Dr. Jacob Hall. He's a neurologist and a member of the medical staff at Temecula Valley Hospital. Dr. Hall, it's a pleasure to have you join us. This is such a great topic, and there are so many questions that people have about our brains and brain health. Is memory loss, a normal part of aging Dr. Hall? Is it something that is inevitable or not?
Dr. Jacob Hall: Well, thanks so much for having me here. I'm excited to talk about this, subject. It's a very common question. So, memory loss is not necessarily inevitable. I think it is inevitable that all of us probably starting somewhere in our twenties will have very gradual, and subtle cognitive decline. And that includes a little bit of memory loss. But we're talking about minimal changes that are not disruptive to our lives and don't affect function so that we probably can't avoid, but memory loss that reaches sort of the threshold of dementia, probably can be avoided to a certain extent.
Melanie: Well, then let's talk about that threshold of dementia. And while you're telling us that, sort of what age people might start to notice the red flags that would signal something is just a little bit off. I'd like for you to tell us the difference between Alzheimer's and dementia because people are like, oh, right away if they experience memory loss, they might think Alzheimer's immediately. So if you would segue Dr. Hall into a discussion or a description of the difference between those two, the umbrella terms and what signals, what red flags we might notice.
Dr. Jacob Hall: Yeah. So we typically, I think about this in terms of three basic umbrella terms. Like, we just talked about there's normal cognitive aging and those sort of mild or minimal symptoms that we discussed. And the next major category is mild cognitive impairment. And mild cognitive impairment basically means that either, the person themselves or their family members are noticing a subtle cognitive change.
And when they undergo cognitive testing, we can see that objectively, there is more memory loss or more cognitive decline than we would expect for their age. Yet those people are still functionally independent. They can do all of their activities of daily living without difficulty. And then the final umbrella term is this concept of dementia.
And that's just says that the cognitive decline has progressed to the point that they're no longer, fully independent with their activities of daily living. So maybe they can no longer pay the bills on their own or take their medications independently. And so those are the big three categories. And then when you think about where Alzheimer's disease fits into this, that gets a little bit more complicated because now the way we think about Alzheimer's disease is the biological changes in the brain that can eventually lead to any of these categories.
So mild cognitive impairment due to Alzheimer's disease, or dementia due to Alzheimer's disease and typically in life where we're just guessing if there's Alzheimer's disease there or not it's hard to know definitively
Melanie: So is this hereditary? That's the first thing I'd like to know about risk factors. As far as you've mentioned that starting in our twenties, there's a little bit of cognitive decline that happens with us. And people accept that, you forget where your glasses are or your keys, whatever it is. Is this hereditary, are there some risk factors that would say yes, this is going to be something that may happen in your family or yes, dementia does happen in your family. Tell us about that.
Dr. Jacob Hall: The genetics of Alzheimer's disease are very complex. There certainly is a genetic component. It has a lot to do with whether you're talking about sort of early onset familial Alzheimer's disease, where Alzheimer's runs very tightly in families often at a young age, in the forties or fifties, sometimes even the thirties, versus this concept of sporadic Alzheimer's disease, which is usually late onset after age 65 or so. And both are genetically, modified but much less so with the late onset sporadic version, which is the vast majority of Alzheimer’s disease that you and I are familiar with. So yes, there's a component of genetics, but, probably equally important are the lifestyle risk factors.
Melanie: Well, then tell us what those are.
Dr. Jacob Hall: The list keeps growing. I think the ones that stand out the most have to do with cardiovascular health and it's often the things that we typically think of when we're thinking about healthy lifestyles for heart disease and stroke and high blood pressure and so forth. So, physical activity, exercise or the lack thereof makes a big difference especially aerobic exercise seems to make a big difference in terms of reducing the risk of cognitive decline. Diet has a big role in that as well. Certain diets have been studied like the Mediterranean diet. People that adhere to that tightly seem to have a much-reduced risk of, cognitive decline and Alzheimer's. And the list goes on from there. Smoking is a risk factor certainly, excessive alcohol use. There's growing evidence that air pollution is a contributor, sleep deprivation or poor-quality sleep can be a contributor. And really the list goes on and on from there.
Melanie: Well, since this segment and this episode is not strictly about dementia or Alzheimer's, I'd like to talk about brain health. Dr. Hall. are there any thing we can do? Are there things that we can do? Behavioral strategies that we can try to optimize our functioning? We used to hear there are brain games or balancing a checkbook, which certainly kids are not doing at all these days or crossword puzzles.
Are there things that we can do that can actually help to exercise our brain muscle?
Dr. Jacob Hall: There certainly are. And I think the evidence that this works is growing and growing. So all of those risk factors I just mentioned, or at least most of them are modifiable. It means there's things we can do to reduce those risk factors. And again, if you think about exercise, without a doubt, one of the most effective things we can do to enhance brain health and therefore reduce the risk of cognitive decline. The dietary measures I talked about, and you mentioned, brain games and crossword puzzles. There is still some evidence that those things are helpful. At a minimum, we say it's important to stay socially active and cognitively active.
And really that's pretty broadly defined. So that just means do what is engaging and stimulating and fun for the person doing it. It doesn't necessarily have to be Sudoku or crossword puzzles just whatever's good for that person. And then, yeah, I mean, not smoking, keeping alcohol to a reasonable level, all of these things, not only work, but work probably, pretty markedly. So, you know may cut the risk of dementia by half or more, over a pretty short period of time and boost cognitive scores on testing. So, you know, a lot of reasons to be motivated, to try to do these things.
Melanie: Well, there certainly is. And another area of interest to many people is the nutritional aspect of it. Are there herbal supplements or vitamins or fish oil or resveratrol? We've heard caffeine, Gingko biloba. I mean, we've heard about all of these things, Dr. Hall. Do any of them have an effect on our brain health?
Dr. Jacob Hall: Well, broadly speaking, I think we can say that nutrition in general makes a big difference. So eating full, complete diets that are well balanced, such as the Mind diet or the Mediterranean diet, as I mentioned, certainly help. When it comes down to breaking these diets into individual elements, what's the particular vitamin, what's the particular supplement that might be helpful the answer is we just don't know. None of them have been proven to help. And as a general recommendation, we tell people not to invest too much or any of their money into these products. It's possible that some of them will work. I think more research is needed, more work is done to get to the bottom of these questions.
But right now we just don't know, which is why we recommend these more holistic lifestyle interventions.
Melanie: So before we wrap up, tell us what's new and exciting in your field. And is there anything else that you think that we missed that you'd like people to know about treatments for dementia once mild cognitive impairment maybe has been diagnosed? What are you doing for patients? And what's exciting in your field?
Dr. Jacob Hall: Yeah. So, as for what we're doing now, when somebody is diagnosed with mild cognitive impairment, I think that mostly serves as, a way to think about the future and plan for the future and perhaps be more motivated to implement some of these lifestyle changes. At the dementia stage, there have been some medications that work, not tremendously well, but they do work and they've been available for many years now.
And as far as what's exciting in the field, right now we don't have any medications that can slow down Alzheimer's disease or slow down dementia. They help with the symptoms, but they don't actually change the disease course and that hopefully will be changing soon. So we've got dozens, if not hundreds of medications that are somewhere along the research pipeline right now with some of them being potentially quite close to being FDA approved.
In particular, there's one that's been in the news quite a bit recently called aducanumab, which was actually submitted for potential FDA approval. We don't know yet if that will happen. I think that's quite up in the air, but regardless it's a positive sign for the field. It shows that we're getting closer to understanding this disease and being able to truly change the course of it and slow it down and keep people functioning independently longer.
Melanie: Well, that certainly is the most important thing. And what a great message. Thank you so much, Dr. Hall for joining us today. And that concludes this episode of TVH Health Chat with Temecula Valley Hospital. You can visit our website@temeculavalleyhospital.com for more information, or to get connected with one of our providers.
Please also remember to subscribe, rate and review this podcast and all the other Temecula Valley Hospital podcasts. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians.
I'm Melanie Cole. Thanks so much for joining us.
Brain Health and Dementia
Melanie: Welcome to TVH health chat with Temecula Valley Hospital. I'm Melanie Cole. And I invite you to listen as we discuss brain health and dementia. Joining me is Dr. Jacob Hall. He's a neurologist and a member of the medical staff at Temecula Valley Hospital. Dr. Hall, it's a pleasure to have you join us. This is such a great topic, and there are so many questions that people have about our brains and brain health. Is memory loss, a normal part of aging Dr. Hall? Is it something that is inevitable or not?
Dr. Jacob Hall: Well, thanks so much for having me here. I'm excited to talk about this, subject. It's a very common question. So, memory loss is not necessarily inevitable. I think it is inevitable that all of us probably starting somewhere in our twenties will have very gradual, and subtle cognitive decline. And that includes a little bit of memory loss. But we're talking about minimal changes that are not disruptive to our lives and don't affect function so that we probably can't avoid, but memory loss that reaches sort of the threshold of dementia, probably can be avoided to a certain extent.
Melanie: Well, then let's talk about that threshold of dementia. And while you're telling us that, sort of what age people might start to notice the red flags that would signal something is just a little bit off. I'd like for you to tell us the difference between Alzheimer's and dementia because people are like, oh, right away if they experience memory loss, they might think Alzheimer's immediately. So if you would segue Dr. Hall into a discussion or a description of the difference between those two, the umbrella terms and what signals, what red flags we might notice.
Dr. Jacob Hall: Yeah. So we typically, I think about this in terms of three basic umbrella terms. Like, we just talked about there's normal cognitive aging and those sort of mild or minimal symptoms that we discussed. And the next major category is mild cognitive impairment. And mild cognitive impairment basically means that either, the person themselves or their family members are noticing a subtle cognitive change.
And when they undergo cognitive testing, we can see that objectively, there is more memory loss or more cognitive decline than we would expect for their age. Yet those people are still functionally independent. They can do all of their activities of daily living without difficulty. And then the final umbrella term is this concept of dementia.
And that's just says that the cognitive decline has progressed to the point that they're no longer, fully independent with their activities of daily living. So maybe they can no longer pay the bills on their own or take their medications independently. And so those are the big three categories. And then when you think about where Alzheimer's disease fits into this, that gets a little bit more complicated because now the way we think about Alzheimer's disease is the biological changes in the brain that can eventually lead to any of these categories.
So mild cognitive impairment due to Alzheimer's disease, or dementia due to Alzheimer's disease and typically in life where we're just guessing if there's Alzheimer's disease there or not it's hard to know definitively
Melanie: So is this hereditary? That's the first thing I'd like to know about risk factors. As far as you've mentioned that starting in our twenties, there's a little bit of cognitive decline that happens with us. And people accept that, you forget where your glasses are or your keys, whatever it is. Is this hereditary, are there some risk factors that would say yes, this is going to be something that may happen in your family or yes, dementia does happen in your family. Tell us about that.
Dr. Jacob Hall: The genetics of Alzheimer's disease are very complex. There certainly is a genetic component. It has a lot to do with whether you're talking about sort of early onset familial Alzheimer's disease, where Alzheimer's runs very tightly in families often at a young age, in the forties or fifties, sometimes even the thirties, versus this concept of sporadic Alzheimer's disease, which is usually late onset after age 65 or so. And both are genetically, modified but much less so with the late onset sporadic version, which is the vast majority of Alzheimer’s disease that you and I are familiar with. So yes, there's a component of genetics, but, probably equally important are the lifestyle risk factors.
Melanie: Well, then tell us what those are.
Dr. Jacob Hall: The list keeps growing. I think the ones that stand out the most have to do with cardiovascular health and it's often the things that we typically think of when we're thinking about healthy lifestyles for heart disease and stroke and high blood pressure and so forth. So, physical activity, exercise or the lack thereof makes a big difference especially aerobic exercise seems to make a big difference in terms of reducing the risk of cognitive decline. Diet has a big role in that as well. Certain diets have been studied like the Mediterranean diet. People that adhere to that tightly seem to have a much-reduced risk of, cognitive decline and Alzheimer's. And the list goes on from there. Smoking is a risk factor certainly, excessive alcohol use. There's growing evidence that air pollution is a contributor, sleep deprivation or poor-quality sleep can be a contributor. And really the list goes on and on from there.
Melanie: Well, since this segment and this episode is not strictly about dementia or Alzheimer's, I'd like to talk about brain health. Dr. Hall. are there any thing we can do? Are there things that we can do? Behavioral strategies that we can try to optimize our functioning? We used to hear there are brain games or balancing a checkbook, which certainly kids are not doing at all these days or crossword puzzles.
Are there things that we can do that can actually help to exercise our brain muscle?
Dr. Jacob Hall: There certainly are. And I think the evidence that this works is growing and growing. So all of those risk factors I just mentioned, or at least most of them are modifiable. It means there's things we can do to reduce those risk factors. And again, if you think about exercise, without a doubt, one of the most effective things we can do to enhance brain health and therefore reduce the risk of cognitive decline. The dietary measures I talked about, and you mentioned, brain games and crossword puzzles. There is still some evidence that those things are helpful. At a minimum, we say it's important to stay socially active and cognitively active.
And really that's pretty broadly defined. So that just means do what is engaging and stimulating and fun for the person doing it. It doesn't necessarily have to be Sudoku or crossword puzzles just whatever's good for that person. And then, yeah, I mean, not smoking, keeping alcohol to a reasonable level, all of these things, not only work, but work probably, pretty markedly. So, you know may cut the risk of dementia by half or more, over a pretty short period of time and boost cognitive scores on testing. So, you know, a lot of reasons to be motivated, to try to do these things.
Melanie: Well, there certainly is. And another area of interest to many people is the nutritional aspect of it. Are there herbal supplements or vitamins or fish oil or resveratrol? We've heard caffeine, Gingko biloba. I mean, we've heard about all of these things, Dr. Hall. Do any of them have an effect on our brain health?
Dr. Jacob Hall: Well, broadly speaking, I think we can say that nutrition in general makes a big difference. So eating full, complete diets that are well balanced, such as the Mind diet or the Mediterranean diet, as I mentioned, certainly help. When it comes down to breaking these diets into individual elements, what's the particular vitamin, what's the particular supplement that might be helpful the answer is we just don't know. None of them have been proven to help. And as a general recommendation, we tell people not to invest too much or any of their money into these products. It's possible that some of them will work. I think more research is needed, more work is done to get to the bottom of these questions.
But right now we just don't know, which is why we recommend these more holistic lifestyle interventions.
Melanie: So before we wrap up, tell us what's new and exciting in your field. And is there anything else that you think that we missed that you'd like people to know about treatments for dementia once mild cognitive impairment maybe has been diagnosed? What are you doing for patients? And what's exciting in your field?
Dr. Jacob Hall: Yeah. So, as for what we're doing now, when somebody is diagnosed with mild cognitive impairment, I think that mostly serves as, a way to think about the future and plan for the future and perhaps be more motivated to implement some of these lifestyle changes. At the dementia stage, there have been some medications that work, not tremendously well, but they do work and they've been available for many years now.
And as far as what's exciting in the field, right now we don't have any medications that can slow down Alzheimer's disease or slow down dementia. They help with the symptoms, but they don't actually change the disease course and that hopefully will be changing soon. So we've got dozens, if not hundreds of medications that are somewhere along the research pipeline right now with some of them being potentially quite close to being FDA approved.
In particular, there's one that's been in the news quite a bit recently called aducanumab, which was actually submitted for potential FDA approval. We don't know yet if that will happen. I think that's quite up in the air, but regardless it's a positive sign for the field. It shows that we're getting closer to understanding this disease and being able to truly change the course of it and slow it down and keep people functioning independently longer.
Melanie: Well, that certainly is the most important thing. And what a great message. Thank you so much, Dr. Hall for joining us today. And that concludes this episode of TVH Health Chat with Temecula Valley Hospital. You can visit our website@temeculavalleyhospital.com for more information, or to get connected with one of our providers.
Please also remember to subscribe, rate and review this podcast and all the other Temecula Valley Hospital podcasts. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians.
I'm Melanie Cole. Thanks so much for joining us.