Episode 413: Understanding Your Brain. How To Prevent Alzheimer’s and Dementia with Dr. Thomas Bird

Episode Summary

Throughout this episode, Dr. Bird talks about the difference between Alzheimer’s and dementia, what changes we can make to prevent them, and recommends healthy habits for people in their 20s to 40s. We also talk about genetic testing, who and when they should get one, causes, red flags, treatments, and more.

Rob Shallenberger: Welcome back to our “Becoming Your Best” podcast listeners! So grateful that you joined us today; this is gonna be a big deal for every listener that’s listening today. Whether Alzheimer’s or dementia has touched you directly in your family, or indirectly, it will touch everyone in some form or fashion. We have with us today one of the world’s leading experts, Dr. Thomas Bird, from the University of Washington, who, if I understand correctly, was with the University of Washington Department of Neurology, and worked in the genetic side of it for more than 35 years; just an amazing man. For those listening, I don’t know if you know this or not, but my mom passed away three years ago, from early-onset Alzheimer’s, and Dr. Bird was instrumental in helping us get some genetic testing done. And to all of our amazement, she was negative for almost every known variant. And that was a relief to us, as the children. But the whole point is that this is a vicious disease that touches a lot of people in the world and it’s also very misunderstood. This is why I’m so grateful that Dr. Bird has taken the time to be with us today; is to help pull back the curtain a little bit on what this all means to us, and give us a little bit more understanding. Again, I don’t know if the numbers are exactly right, I pulled them off the All-Knowing Google; but if it’s correct, it said 55 million people right now, in 2020, have either been diagnosed with, or dealing with, some form of Alzheimer’s or dementia, and by 2030—at least according to that study I read—it said that number could reach up as high as 78 million. So, big deal. Dr. Bird, so grateful that you’re here with us. Anything that you’d like to say about your background before we jump into what’s really important to our listeners, which is the brain health and everything related to that? 

Dr. Thomas Bird: Thank you very much. It’s my pleasure to be here. I’m always delighted to talk about this topic because it’s so important and because it’s been part of my career for actually 40 or 50 years. So, just in terms of my background, I wear two hats. This morning, I have no hat on. But, in fact, I wear two academic hats, and one is a neurologist. I’m a clinically trained neurologist. And the other is, I’m a medical geneticist. So, my interest has always been in genetic diseases of the brain. Maybe we’ll touch on a little later, how that happens to interact with Alzheimer’s disease. But your point is a perfect starting point, and that is how common the disease is. Millions of people have it and the projection is for millions more to develop it. That’s largely because of its relationship to age; it’s perfectly clear that the older the population you’re dealing with, the more common is Alzheimer’s. The numbers are something like, over the age of 85, more than a third of people have dementia. I’m using that term pointedly; the term “dementia.” Notice I just switched from talking about Alzheimer’s disease to mentioning dementia. If your audience comes away with anything this morning, I think the most important thing for them to recognize is the difference between the words “dementia” and “Alzheimer’s disease” that’s very confused in the general population. It is confused in the media. They really are two different terms. Dementia is the larger term. Dementia simply means a serious compromise of cognitive thinking and memory problems. There are dozens and dozens of things that can cause dementia: toxins, poisons, head trauma, all sorts of things. Alzheimer’s disease is a more specific type of dementia. So, it’s one of the causes of dementia. When you read about dementia in the news media, you want to be careful to see are they talking about dementia? Are they talking about Alzheimer’s disease? Do they know what they are talking about? The background of Alzheimer’s is really fascinating. If you just allow me to take a couple of minutes to mention.  

Rob Shallenberger: Take whatever time you need.  

Dr. Thomas Bird: Where did that term come from? Well, what happened was, approximately 110 years ago, a neurology psychiatrist in Germany, by the name of Alois Alzheimer, saw a patient who was actually 50 years old; a woman who met criteria that we would now call dementia; she had loss of cognitive functions, loss of thinking, loss of memory, and it progressed and got worse. He wore lots of different hats. And one of the hats he wore was, he was also a neuropathologist. When that patient died, he was able to obtain her brain at an autopsy and look at her brain under the microscope, and he was amazed at what he found. He found two things that he described and reported, and one of them was a thing called plaques. She had plaques in her brain. You talk about plaque on your teeth; it’s just an accumulation of stuff that shouldn’t be there. So, she had these lumps of plaques in her brain and had thousands and thousands of them. In addition to that, inside her nerve cells, inside her neurons, she had tangled material that shouldn’t be there. So, they were in neurons so he called them neurofibrillary tangles. And he reported that one single person, one single case, and that became so famous that that disease became known as Alzheimer’s disease, and that defines the disease; it’s a person who has progressive dementia. When you look at their brain, they have these plaques and these tangles. The major advances in science in the last 30 years have been to define what those plaques and tangles consist of. And it turns out that the plaques consist of a protein called amyloid. If you follow the media on Alzheimer’s disease, you’ll see a lot of talk about amyloid. And the neurofibrillary tangles are composed of a protein called tau. And when you see, in the last few years, there have been almost monthly reports about attempts to treat Alzheimer’s disease. And the approach they’re taking is trying to get rid of these two proteins in the brain.  

Dr. Thomas Bird: So, a lot of the approaches are called anti-amyloid approaches, and that’s an attempt to remove or prevent the accumulation of these amyloid plaques in the brain. For more than a decade, those approaches were unsuccessful; they were negative studies and people became quite frustrated. But in the last two years, there have actually been two positive studies; there have been two studies that are attempting to remove amyloid from the brain, and they seem to do it, and it has slowed down the progression of the disease, at least statistically; it doesn’t cure the disease, it doesn’t stop the disease, but it slows it down a little bit. So, there’s a lot of enthusiasm about continuing that sort of approach. They require intravenous medication, it’s very expensive, and as I say, it doesn’t cure the disease. So, it’s a long way to go, but, at least, it’s a start. So, that’s the key thing is to understand that dementia is the larger category, and it simply means confusion, cognitive problems, and loss of memory. Alzheimer’s is one of those causes of dementia, and it’s considered the most common cause of dementia, especially in the elderly. Two things correlate with the frequency of Alzheimer’s disease, or your likelihood of developing it: age, the older you get, the more likely you are to experience it; and genetics. So, the more people you have in your family who have had dementia, the more likely you are to also develop it. So, there are strong genetic components to Alzheimer’s disease, and they vary from being absolute, where if you have a mutation in a particular gene, you will get Alzheimer’s disease, and you usually get it at an early age; meaning before the age of 65 or 70. There are other genetic factors that don’t cause a disease, but if you happen to have them, your risk goes up. Those are fascinating pieces of what’s known about the disease, and they hopefully will give us clues to ways to treat the disease. The genetic forms are quite rare; the ones where they’re caused by a specific gene represent about 1% of all Alzheimer’s disease. So, they’re not at all common. But if you happen to have it in your family, your risk goes way up.  

Rob Shallenberger: On this note, Dr. Bird, this was a real gut check for us. Because when I talked with you five years or so ago when my mom was tested, we had her do whatever blood panel it was that you recommended. And if I remember right, you said, CHey, just so that you kids know,” meaning there are six of us children, “I’m pretty sure, based on her age, being in mid-50s, that she’s going to test positive to this rare genetic variation. And if she has that, there’s a 50/50 chance that each of you children likewise have it.” And if I remember that number right, you said it was something like a 95% predictor of early-onset Alzheimer’s. In other words, it’s kind of like that death sentence you’re referring to — a very strong correlation. So, we’re going — my brothers and sister — “Who would want to get tested?” “I do. I don’t. I do. I don’t.” And, surprisingly, she came back negative to all of those. What’s left it as a mystery to us as to why she ever had that. She did get a pretty significant virus, her and her sisters, when they went to Cambodia and Malaysia, and that sickness lasted for a year, and we wonder if that has something to do with it, but I don’t know. So, this is kind of a fascinating topic, isn’t it? For as much as we do know, there’s still so much it seems like we don’t know. 

Dr. Thomas Bird: A huge amount is unknown. I talked about those two proteins that accumulate in the brain, the amyloid and the tau. But, in fact, no one knows why they’re accumulating. Why do some brains accumulate it, and others don’t? If you happen to have the genetic variety, that’s an explanation. But for the vast majority of people, they do not have the genetic variety. So, why is it accumulating? And why is it not accumulating in other brains? And that’s simply unknown. 

Rob Shallenberger: I’m curious to hear your perspective on this, having your life’s work on this. Alzheimer’s, as well as heart disease and other things, just seem to have skyrocketed since the ‘70s. I don’t know if that’s directly attributed to the diet that we have or is it just that we’re tracking these more than we used to track them? What is your opinion on that? Is there a correlation with where we are today, over the last 50 years, in our diet with processed foods and things like that? Or is it just that we’re tracking better than we used to and it’s been this way always? 

Dr. Thomas Bird: Good question. You’re asking me to guess, and so I will guess, as my personal opinion. I think the major factor is the aging of the population. So, when I started as a doctor, more than 50 years ago, you hardly ever heard of a person living to be 100 years old; that was a big deal. And if somebody lived to be 100 years old, they would get their picture in the paper, and they’d have a big birthday celebration; that was a huge deal. You just didn’t see it very often. Nowadays, 50 years later, that’s not so rare. You can go to any retirement home or nursing home in the country, and you’ll find somebody who’s 100 years old. And that’s because people are living longer, the average age of the population has gone up and there’s no question about that; the number of people over the age of 80 is much higher now than it was 20 or 30 years ago, and it’s even going to be higher in the coming years. Certainly, in terms of dementia and Alzheimer’s, I think that’s the number one issue. No one’s really been able to relate it to changes in diet or processed food. I don’t think that’s the answer. But it does raise the question of, are there things you can do to prevent dementia? And I use the term “dementia” now because there are other causes of dementia besides Alzheimer’s disease. 

Rob Shallenberger: Yeah, that’s a good reminder. I keep interchanging them as if they were the same thing. So, you’re distinguishing Alzheimer’s as being directly related to age. But what you’re about to lead into is that dementia can have a lot of other potential causes, is that correct? 

Dr. Thomas Bird: Right. In fact, there have been research studies that have shown that people who stopped smoking, people who treat their high blood pressure, people who treat their high cholesterol and high lipids, people who exercise, people who have a good diet, and people who stay mentally active, have a reduced frequency of developing dementia. It’s quite clear that that is the case. That’s often said to be while they’re reducing their incidence of Alzheimer’s disease, but it may not be that they’re actually reducing Alzheimer’s disease; they’re reducing other causes of dementia. There’s something called vascular dementia, which is not Alzheimer’s disease. It’s problems with the blood vessels in the brain that are weakening and causing damage to the brain; that’s called vascular dementia. There’s no question that that’s related to blood pressure, diabetes, and smoking. So, if you treat those kinds of things, your blood vessels are happier, your heart’s happier, and your chances of developing dementia actually go down. It’s probably not Alzheimer’s disease that’s going down, but who cares? If you’re preventing your chances of developing dementia, that’s important. So, those things do help and they are recommended, but they may not actually be affecting Alzheimer’s disease, it may be other kinds of dementia. That reminds me to mention that Alzheimer’s disease doesn’t stand alone in these diseases that affect older people. It turns out, there’s an overlap between Alzheimer’s disease and Parkinson’s disease. There’s an overlap between Alzheimer’s disease and ALS, Lou Gehrig’s disease. There’s an overlap between Alzheimer’s disease and another kind of dementia called Frontotemporal dementia. Bruce Willis, the actor, apparently has Frontotemporal dementia. So, that’s another cause. So, the proteins that are accumulated in the brain in Alzheimer’s also accumulate in different places in different diseases. So, there’s actually overlap. For example, people with Parkinson’s can become demented, and that overlaps with Alzheimer’s disease. People with ALS can develop problems with their memory and thinking, and that overlaps with Alzheimer’s disease. So, it’s quite complicated, but it’s possible that finding a treatment for one of those may affect Alzheimer’s, and finding the treatment for Alzheimer’s may affect others. So, it’s a fascinating topic. 

Rob Shallenberger: Yeah, it sounds like they’re close cousins in many ways, and that there is a lot of overlap. So, there’s a lot of people listening to this, Dr. Bird, say, who are in their 30s, their 40s, and there’s this tendency, at least I have—I was a fighter pilot for 11 years flying F-16s—to treat our bodies, maybe kind of like a car. In other words, unless there’s a clunking, or unless there’s an abnormal noise, we just keep driving it many times, rather than being very proactive about changing the transmission fluid, oil, and so on. So, with our bodies in the 20s, 30s, and maybe even early 40s, many times they seem to run pretty well. Not always, but to your point, the majority of people don’t have major issues at that phase in their lives. “Hey, whatever, I’ll just eat anything I want. I don’t need to exercise.” Until all of a sudden things start to catch up with us. So, my question, where I’m going with that is, someone in their 20s, 30s, 40s? What are things that they ought to be thinking about to be cognizant of this kind of stuff coming down the road? What are the things that they probably ought to be thinking about and doing at that pace? And then, I’m gonna shift the question to 50s, 60s, and 70s; what are things that people can be doing and thinking about? And there’s probably overlap in those answers. But let’s start with the younger group—20s, 30s, and 40s—what does that group ought to be thinking about or doing? 

Dr. Thomas Bird: As you say, they need to be checking in their oil and their transmission fluid, rather than just ignoring those kinds of things. And what that means is taking care of your general health; there are things that seem simple, although, for some people, they’re actually difficult. An example of that would be smoking. It is perfectly clear that smoking is bad for your health, and it’s bad for your brain. And the same goes for alcohol; if somebody is drinking alcoholic beverages to excess, that’s not good. Another thing is your weight; keep track of your weight. Obesity leads to all kinds of problems; you want to take care of that. And then have health checkups from time to time, and particularly check your blood pressure. High blood pressure can occur at any age. And if your doctor says you got high blood pressure, which is also called hypertension, you need to keep track of that. And if it’s too high, it needs to be treated, and it can be treated. So, that’s important. The same goes for diabetes; you get your blood sugar checked. And if you develop early diabetes, you want to treat that. So, being proactive, finding out about those things, and treating them early, probably makes a very big difference. And those same things go for people in middle age, people in their 40s, 50s, and 60s, except that things like high blood pressure are beginning to be even more common. Diabetes is beginning to be more common. So, you need to be sure you find out whether or not you have those conditions. And if you do, treat them. The same thing probably goes for high lipids, high cholesterol, high LDLs, and things like that; if your doctor says these ought to be treated, go ahead and treat them. One of the things that’s not clear at all is the whole business about diet. There are certainly bad diets, but whether there’s a specific diet that prevents dementia is not so clear. People talk a lot about the Mediterranean diet, but I think there’s general agreement that large amounts of red meat, large amounts of fats, and large amounts of carbohydrates are not good. You want to keep those to a minimum, and emphasize fruits and vegetables. I think that’s true, and I think that’s also good for your general health, and it may be good for brain health as well. 

Rob Shallenberger: Can I ask you a question on that note? I don’t know if you’re familiar with this; I just happen to be listening to the book right now: “The End of Alzheimer’s” by Dr. Bredesen, The Bredesen Protocol. Are you familiar with that by chance?  

Dr. Thomas Bird: Yes.  

Rob Shallenberger: What are your thoughts on that? 

Dr. Thomas Bird: I think he’s actually talking about dementia. 

Rob Shallenberger: I think so because that’s where I’m going with it on this discussion. It sounds like what he’s really focused on is dementia. 

Dr. Thomas Bird: Yeah, that’s where it gets tricky. He’ll use the term Alzheimer’s disease, and the recommendations he makes are solid, good recommendations. But whether they actually prevent Alzheimer’s disease is not so clear. But I think they do lower your risk of developing other kinds of dementia, like vascular dementia. As I said, who cares? If you’re lowering your risk for dementia, that’s what you want to do. I’m not so sure it’s affecting what we call Alzheimer’s disease, but it is good to help you prevent other kinds of dementia, which is fine.  

Rob Shallenberger: So, I’m really glad you’ve distinguished. I’ve spent more than 1000 hours probably just studying stuff related to the brain since my mom’s diagnosis. Even though I knew there was a difference, even this short conversation is even clarifying that more for me about how often we probably are overlapping and using those terms when we really shouldn’t be. So, maybe, here’s a separate question. A lot of people are diagnosed with Alzheimer’s now on the Alzheimer’s side of it, not the dementia side. You can share your thoughts in any direction you want on this, but I’m just going where this conversation is taking us. Number one, how does someone look at their genetics if they want to? Because I realize this is a sensitive subject for some people; some people don’t want to know if they have certain things. But others say, “Hey, I have the APOE ε4 variation, maybe there are things I can do to offset my risk.” Or maybe there’s not. I don’t know; that’s where my question is going with you. So, number one, where can someone look at these genetic tests and get them? And number two, on the Alzheimer’s side of it—now, the genetic side—are there things people can do to offset these things that we’ve talked about already? Or is it just it is what it is? Or it’s a little bit of genetic/environmental? 

Dr. Thomas Bird: So, it’s good that you mentioned APOE ε. So, that’s a protein that’s controlled by a gene; it’s called the APOE ε gene, which has to do with lipid metabolism in the body and in the brain. It’s been shown for quite a few years now that there are various genetic types of APOE ε, and there’s one that’s called type four. And, if you happen to inherit type four, your risk for Alzheimer’s disease is a little higher. If you inherit two copies of the APOE ε4, one from your father and one from your mother, your risk for Alzheimer’s disease is even higher. It’s not 100%. It’s not even 90%. But it is higher than the general population. And that test is available; doctors can order it, people can actually have it done in these 23andMe and genetic testing that you can get without a doctor’s prescription. They ask you specifically if you do or do not want APOE ε. But if you say you do, they’ll do it. You can find out if you have the APOE ε4 genotype or not. To me, there are a couple of problems with that. One is, that can scare people because if it comes back positive for APOE ε, they think, “Oh my god, I’m going to develop Alzheimer’s disease.” And that’s not true. You can have APOE ε4 and not develop Alzheimer’s disease. It’s not a one-for-one relationship. It just increases your risk a bit. But then, to me, it’s a little bit silly to say, “Oh, I’ve got that. So, I need to take care of my health.” I think people should take care of their health, whether they have APOE ε or not. 

Rob Shallenberger: Back to the dementia discussion; it’s going to help you either way.  

Dr. Thomas Bird: You need to do those things. Maybe having APOE ε4 makes them try a little harder, but you should be aware of and take care of your health whether you have APOE ε4 or not. You shouldn’t become depressed and unhappy and give up if you do have APOE ε4. And also, if you don’t have APOE ε4, you shouldn’t say, “Oh, there I go. I can smoke and drink and be wild and gain 100 pounds, and I’m going to be fine.” That’s not the case either. So, I think people have to think carefully about it and not overreact to the test one way or the other. 

Rob Shallenberger: Can I ask another question related to genetic testing? To your point, and having watched my mom go through this, I got the 23andMe test. And then I uploaded my raw data to a place called Nebula Genomics, and I’m sure there are other multiple places like that. But for me, that was more confusing than it was helpful because it was showing me different tests that were almost conflicting. It just wasn’t helpful to me. So, I don’t know much more about Nebula Genomics, other than that’s just one of many that are out there. And for me, it was more confusing than it was helpful, as it had these different interpretations based on studies. So, I guess my question is, for all these people listening out there; number one, why get genetic testing done? What’s the benefit of doing that or not getting it done? And what’s the benefit of not getting it done? I mean, you just alluded to one, it’s not gonna freak some people out. But, why get genetically tested? What’s the advantage to doing that? And 23andMe is the basic one, that’s the APOE ε4. There are obviously others that you have my mom do at the University of Washington, they have much more detailed panels. So, what’s the advantage to getting that done versus not? 

Dr. Thomas Bird: The APOE ε4 is the only one that’s generally available. We’ve just talked about that; there are reasons you might want to do it, and reasons you might not. You have to be careful not to overinterpret it. The other genetic tests, as I mentioned, there are some genes that have been identified. And if you have a variant or a mutation in those genes, the chances you will get Alzheimer’s disease goes way up to greater than 95%. There are three genes like that. They’re called Presenilin-1, Presenilin-2, and APP. There are families that have mutations in one of those three genes, and they have a very high risk for Alzheimer’s disease. Those families, as I mentioned, are very rare. It’s less than 1% of all Alzheimer’s cases that have those genes. And the tests are not readily available; you can’t get those tests through 23andMe and those other kinds of general commercial labs. They have to be ordered by a physician from certain genetic laboratories. You just can’t get them willy-nilly. The only reasons you would do that are two. One is if your family is full of dementia, and then you should talk to your doctor. By “full of dementia,” I mean, for example, if you have two or three generations, where there are five or six people with dementia, that’s more than usual, and that would be a good reason to get those genetic tests done. The other is age, and that’s what you dealt with, with your mother. Those mutations in those three genes tend to produce early-onset Alzheimer’s disease, frequently with onset before age 60. And in some people, before age 50, there are people who get Alzheimer’s in their 40s, and they’re much more likely to have mutations in one of those genes. 

Dr. Thomas Bird: So, if you have very early onset, or if you have a very strong family history, you should talk to your doctor about the possibility of ordering one of those rare genetic tests. But other than that, they’re not available and I wouldn’t do it. And if you just have one family member, like a father, or a mother, or an aunt, or an uncle, with dementia or Alzheimer’s, it’s not worth doing it. What you really need, if you do one of those tests, is you need someone who has the disease. Because if you’re testing people in the family who don’t have the disease, who are not demented, they may be negative, but the gene could still be in the family and they just haven’t inherited it. So, you have to have somebody who’s got the dementia and get a blood sample from them, that’s the person that you have to test because you have to go where the dementia is to find those positive tests. But as you’re discovered, you can meet the criteria of having really early onset, like 50, and you still may not have a mutation in one of those genes. But there’s something unusual about having dementia that early. So, it may well be that there’s a genetic factor, and it’s a genetic factor that we haven’t discovered.  

Rob Shallenberger: I just know several people that are also in a similar situation, although they’re a little bit later. And I don’t want to spend too much time on this because it is such a small subset of the population. But in that case, where there isn’t a genetic propensity or variation, but someone is diagnosed with it, say, 50 or 55, is that what you would call extremely rare, very rare, rare to not have any genetic?  

Dr. Thomas Bird: 50-55 is rare and unusual, and you need to be seen by a neurologist. First of all, they need to come to their conclusion of whether it really is Alzheimer’s or not. It could be one of these other kinds of dementia. One that I mentioned was Frontotemporal dementia. That kind of dementia is more common in the 50s and 60s. So, the person who may demented, but they may actually not have Alzheimer’s could have Frontotemporal dementia. There are tests, MRIs, PET scans, and so forth that can sort that out. Another one that we didn’t mention is called Lewy body dementia, you may hear about that. There are people who have Lewy body dementia. I have a person in my family who has Lewy body dementia. That’s the overlap with Parkinson’s disease, and that’s not Alzheimer’s. But that can occur at a relatively early age. So, if you’ve got an early-onset dementia, you need to be seen by a neurologist. And they need to sort out what kind of dementia it is likely to be. And then, if they decide it is probably Alzheimer’s, and you’re 50 years old or 55 years old, I would say that’s a point where you need to check those rare genes to be sure whether or not you happen to have that or happens to be in your family. For example, I’ve seen people who had no family history of it, they had the onset of dementia at 48. They had no family history of it. And then we discovered they were adopted. So, all bets are off; you don’t know your family history. That’s another reason for getting the genetic testing done if you have early-onset disease.  

Rob Shallenberger: So, here’s maybe a final question. And, boy, we could go for two hours talking about this. With what’s coming down the road related to either dementia or Alzheimer’s, what are some things that you see—you’re right on the leading edge of research in many cases—what are some things that you see coming down the road that might have an impact in a positive way on dementia or Alzheimer’s? 

Dr. Thomas Bird: Well, in terms of treatment, for Alzheimer’s, there are two major approaches that are being used. One, as I said, is trying to reduce the amyloid plaque in the brain. There have been some recent modest successes at that, but any success is excellent. So, it looks like that’s a pathway that researchers and drug companies are going to continue to approach to try and find things that bind to and remove the amyloid plaque in the brain. But it’s also clear that that’s not enough. So, another path is to go after that other protein, and that’s the tau that’s in the neurofibrillary tangles. The approaches to that are falling behind the amyloid approaches, because those tau proteins are in the neurons, so they’re harder to get your drug into the nerve cell. But the general philosophy is that it will take both kinds of drugs to take care of Alzheimer’s. An example is cancer. There are many kinds of cancer, for example, where people do better when they have more than one therapeutic approach. Many people who are getting treatment for cancer, or getting two different cancer drugs, then they have a better chance of success than just one. It’s likely that Alzheimer’s is going to go that way; you may need to remove both the plaque and the tangle before you really approach success with the disease. It also is possible that there are other degenerative processes in the brain that need to be attacked, that people haven’t even started to attack yet. One of those is the Lewy body, that’s another protein, that accumulates sometimes in Alzheimer’s, and you need to figure out a way to attack that. There’s even a fourth protein that probably people have never heard of. It’s called TDP-43. It’s a hot topic in the Alzheimer’s research field. That’s another protein that’s accumulating in the brain. People are beginning to think about trying to remove that as well. So, there are multiple approaches going on. It takes time, very expensive to do appropriate clinical studies, it’s very expensive to come up with the treatments, and so the time factor is huge, but it’s well worth it. I think, particularly, a combination of the government and National Institutes of Health, The Veterans Administration, and drug companies need to get together and keep pursuing this because the disease is so devastating and it’s so common. 

Rob Shallenberger: I keep saying “last question,” but I just think this is such an important topic. So, maybe I will go for just a few more minutes if that’s all right with you, and then we’ll wrap this up. But I had another question, and it’s been interesting, I don’t know if this is COVID-related or what it is related to, but it seems like a lot of people I’ve talked with, especially since COVID, which I don’t know if that has anything to do with it or not, have seen an increase in things like brain fog, head pressure, just things like that. Yet, they haven’t seen cognitive decline. But they’ve seen other things like head pressure, I keep talking about that brain fog, and just not quite being able to put your finger on it, but just saying it’s just not quite right. When you take a cognitive assessment, they’re still okay in that arena. So, for someone who falls right there, what would you suggest to that person, since I know a lot of people are in that area right now? 

Dr. Thomas Bird: If they’ve had COVID, that’s something to think about. Because there’s no question that you can get over the acute symptoms of COVID, but it can linger in some people for a long time. So, that certainly can be a factor. There are so many other things that can play a role, and you need to think about them and sort them out. Another is the medications or drugs that people are taking; they can have side effects. And those side effects can be to fog your thinking, fog your brain. And it sometimes can be surprising, things people take for a runny nose, or take for a sore throat, or take, for example, to get to sleep at night; all of those kinds of things, over-the-counter kinds of medications, can fog the brain. Another thing that I can see happening is air pollution in the Seattle area, over the last few summers, we’ve been inundated with smoke from forest fires. It’s just been incredible. If you look at your phone and look at your air pollution index on your phone, we’ve had some very high indexes. You can see the smoke in the environment. When you get out there and you start smelling that, there’s no doubt in my mind that that can fog your thinking and fog your brain. So, I think there are things floating around in the air that are kinds of air pollution that can do that, too. And then all your attitude, things like worry, anxiety, and depression can also do that. And I think we’re living through very difficult times. When you look at what’s going on in the political theater, you look at what’s going on in Ukraine, you look at what’s going on in Palestine and Gaza, and you look at what’s going on in Syria. People see that and read it in the news every day. I think that gets on people’s minds; it gets on my mind I know. I think that can cause a little brain fogging sometimes. So, I think there are multiple factors. And the other thing is aging. When you talk to your friends and neighbors, they’re all older than they used to be.  

Rob Shallenberger: Because you’re also a neurologist, where would you say there is a typical time where aging might play a role in that? Even though I know that it’s still possible to have a healthy brain, where do you start to see people complain about that more often? Is it just too general of a question? 

Dr. Thomas Bird: I think it’s too generalized. I see people in their 40s who worry about it sometimes, and they probably shouldn’t. I have friends who are in their 90s, and their brains are just as sharp as you can imagine; they’re reading, they’re writing, they’re still occupied, sometimes they still have their jobs. I’m amazed to see these people in their 90s doing so well. So, it can happen at any age, but people in their 70s and 80s, I can tell you for sure start to complain. A particular common complaint is forgetting names. I experienced this myself. I will meet somebody on the street, and I’ll know who they are, and I can tell you their age, their occupation, where they went to school, the last time we had a conversation. I just know them really, really well, and I can’t think of their name. That’s very frustrating. When I talked to my friends about that, and they all experience that. So, there are certain things like that are pretty common. Although they’re frustrating, they’re not as serious as they may seem. 

Rob Shallenberger: I think a lot of us can relate to that. So, as we get ready to wrap up here, Dr. Bird, is there any place where — and this is one of the challenges, and here’s the premise for maybe this final question: when we knew that my mom was going to go down this track, it was like there was this overwhelming abundance of information, but yet no place to start. 8 million websites, but it really is just over inundation of information to the point where it’s like, “Well, where do I even start?” So, if someone’s curious about learning more about dementia or Alzheimer’s — notice I’m separating those now, I’ve learned — where is a good starting point for someone to really learn more about those because of the inundation of information? 

Dr. Thomas Bird: There’s a National Alzheimer’s Association. It’s national and it’s very good. They have a lot of good people affiliated with it. They support research. They have a lot of information. They have a website; they have brochures and booklets. That’s the place I would go with is the National Alzheimer’s Association. I think that’s the first place to stop and look for information. And most of them have local chapters. Many cities, and even small cities, have a chapter of the National Alzheimer’s Association. You can often look them up. I used to say, “Look them up in the phone book.” I don’t think we use phone books anymore. But they’re locally available, and you can find them when you Google them. Your local city probably has a chapter of the Alzheimer’s Association. 

Rob Shallenberger: That’s a great starting point. So, National Alzheimer’s Association, search that up. I think I actually get a weekly email from them as well because I joined their email list. They have some great stuff. They just share what’s some of the latest on research and clinical trials.  

Dr. Thomas Bird: If you’re really concerned about the disease, and you’re worried you might have it, or you’re worried somebody in your family might have it, you can go to those Alzheimer’s Associations. Also, most of the large cities around the country have something called Alzheimer’s Disease Research Centers or ADRCs, and there are about 40 of them around the country. Most of the large cities have one; they’re funded by the National Institutes of Health. They are specifically there to see people who are worried about Alzheimer’s disease and also plug people into research projects. So, if you’re in a fairly large metropolitan area, there’s usually an Alzheimer’s Disease Research Center somewhere near you. 

Rob Shallenberger: I’m so glad you shared that. Having spent more than 1000 hours learning about the brain, I did not know about the research centers. I’ve not even heard of that. So, I’m going to look those up. I’m curious myself just to see what that looks like.  

Dr. Thomas Bird: For example, we have one here at the University of Washington in Seattle. Portland has one. I’m pretty sure Salt Lake City has one. San Francisco has one. San Diego has one. Los Angeles has one. The cities back west and in the Midwest. As I said, there are about 40 of them and they’re spread all over the country. They’re just called ADRCs — Alzheimer’s Disease Research Centers. 

Rob Shallenberger: Well, Dr. Bird, thank you so much for being on this podcast. This was fascinating and enlightening. Any final comments or words before we wrap up? 

Dr. Thomas Bird: If people are concerned about dementia, they should be; it’s a good thing to be concerned about, both for themselves and their family members, and for society as a whole. But don’t get too concerned. Don’t be too worried. If you forget somebody’s name, don’t get too worried about it. 

Rob Shallenberger: Well, it’s been an honor having you here, Dr. Bird. Thank you for sharing what you shared with our listeners. Hopefully, this has been helpful to you. As I started out, I’m going to finish with this: Everybody knows somebody that this has touched, whether directly or indirectly, and we know that this is a big deal. So, just being conscious of our brain health and our overall health. A good reminder from Dr. Bird that there are so many things we can do. The research gives us a lot of hope. Yet right now, some of the basics we hear about — exercise, to tie it back into our content, pre-week planning. Someone who does pre-week planning is more likely to make time for those things that are important. So, all of that being said, Dr. Bird, thanks so much for being here. Our listeners, thank you. We hope you have a wonderful day and a great rest of your week. 

Rob Shallenberger

CEO, Becoming Your Best

Leading authority on leadership and execution, F-16 Fighter Pilot, and father

Dr. Thomas Bird

Neurologist, Medical Geneticist

Director of the University of Washington Neurogenetics Clinic, and the University of Washington Huntington’s Disease Center of Excellence

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