Selects: How Dementia Works
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Good morning, everyone. I hope you're enjoying yourself and having a great weekend with friends, family, loved ones, or I don't know, even people you might dislike a little bit.

How Dementia Works. This is a pretty brutal episode, everybody. This is from November 4th, 2015. But there's some really good information in it. If you are suffering from dementia or someone in your family is suffering from dementia, you have our deepest empathy because it is tough stuff.

And we hope this episode can bring you a little bit of comfort because knowledge is power and understanding things is what we're all about. And that can really help sometimes when you're dealing with something as devastating as dementia. So how dementia works right here, right now. Welcome to Stuff You Should Know, a production of iHeartRadio. Hey, and welcome to the podcast. I'm Josh Clark with Charles W. Chuck Bryant and Noel Harkness.

The stint of Noel continues. Everybody's like, stuff you should know. No, no, that's not what we're calling it. It's the stint of Noel. All right. Stuff you should know. That's too clever. Yeah. It's a little cutesy. Yeah. That's my only aversion to it. All right. What are you? Are you with stuff you should know?

Changing the name of our show after eight years? No, just the Noel stint. The name of it. Remember the summer of Sam? Oh, yeah. Yeah, sure. Why not? I don't like it. All right. Should we come up with a third idea? Yeah. The stint of Noel sounds too much like something's wrong with Noel. That's why I like it. It's hilarious. There's nothing wrong with Noel, by God. And if you think there is, you need to answer to me. There's something you should know.

See, that's what I'm saying. It sounds like something Strickland would have come up with. Ooh. You know? Man, we haven't been in a flame war with Strickland in a while. It has been a while. It's been too long. It's gotten soft. You just launched one across the bow.

So, Chuck. Yes. Are you familiar with dementia? Yeah, sure. Are you running your family? Doesn't run in the family, but my grandmother, who lived to be 100, had dementia at some point, which, you know, when you live to be 100, that's, I don't know about likely, but it's not surprising. It's probably pretty likely. It's not, from what I understand, it's not a...

just a natural consequence of age. Right. But it's pretty prevalent. Sure. And dementia is actually super misunderstood. It gets confused with Alzheimer's a lot, or there's a lot of different kinds of dementia. But dementia is actually, it's not a disease. Right. It's a set of symptoms that's brought on by disease. Yeah. I think that is widely misunderstood. Yeah. But you are totally correct. A set of symptoms and...

It is not just your garden variety forgetfulness that comes as you age. No, because that is age-related and normal. That is a totally age-related thing. It's called age-associated memory impairment. And that is, I think, I mean, that happens to everyone, right? It's just like you forget your keys more often, that kind of stuff. Sure. But when you do forget your keys more often, you snap your finger and go, ah, I forgot my keys again. What is wrong with me?

Yeah. That's normal. One of the big tells of true dementia is when you don't realize that you're forgetting. Right. So that's when it gets scary. Right. And we said that it's not a natural consequence of age. And one of the things that I turned up in researching this is we're not exactly sure what causes dementia.

We don't even know if some of the telltale signs of dementia are the cause of dementia in some cases or the result of dementia. Yeah. Not entirely certain. But it is very widespread among the aged population. In the United States, I think 5.3 million Americans have dementia right now. Wow. And as our population ages, because baby boomers are starting to get older...

I think they're expecting something like 16 million Americans are going to have it by 2050. 16 million is I think how many – about how many people have it around the world right now. And in America alone, we're going to have that number in 2050. Yeah. And it's very expensive actually. Yeah.

How much money? A lot. You ready for this? Yeah. In 2015, we have spent $226 billion on health care for dementia alone. Wow. And they're expecting by, I believe, 2050, when we are caring for 16 million, in 2015 dollars, not futuristic dollars,

Much more inflated, $20, $50. Right. In 2015 dollars, we'll be spending about $1.2 trillion on dementia if somebody doesn't do something. Man. Yeah. It's very expensive. It's also extraordinarily sad as far as diseases or symptoms of diseases. Yeah.

Yeah, and I also want to recommend our May 2011 episode, A Podcast to Remember. Our memory episode ties heavily into this. So if you haven't listened to that one yet, go listen to that one either before or after. Or if you listened to it and forgot, go back and listen to it. That's right.

So dementia itself is not diagnosed. It's not simply memory loss. It's memory loss along with one of the following, at least one of the following, one or more. Aphasia, which is if you can't understand or produce language any longer. Apraxia, and all these are super sad if you've ever seen them up close.

So apraxia, if you cannot make certain movements, even though your body physically is healthy. Right. Agnosia, which is you don't recognize objects like the remote control or your grandkids, stuff like that. And then executive dysfunction, when you have a lot of troubles planning and organizing and reasoning. So that, along with the memory loss, at least one of these, you could be diagnosed with dementia. Right.

And so like we said, dementia is a set of symptoms, right? Yes. It's actually brought on by disease and the most common cause of dementia. I think something like 60 or 70 percent or something like that of dementia cases is brought on by Alzheimer's disease. I could have sworn we did one in Alzheimer's, but we have not.

Yeah, I don't think we have. We've talked about it enough, I think. Yeah, it's popped up plenty of times, but we've never just done a straight-up Alzheimer's one. Alzheimer's brings on dementia through something called neurofibrillary tangles, also known as beta, or I'm sorry, tau protein tangles. Yeah. And beta amyloid plaques.

Right? Yeah, and the plaques are just a protein buildup, a sticky protein buildup. Yeah, which is so when your neurons fire and you have a thought, it's an electrochemical process and there's residual that is left behind. And these residuals can build up in your synapses and cause your synapses to not fire as well. And when your synapses don't fire as well, they start to die off and the neurons that lead from these synapses or lead to these synapses

die themselves and you have neural loss. Like literally the brain cells in your brain are dying off at a rapid rate. - Yeah. - And when it's caused by beta proteins and tau, or beta amyloid plaques and tau proteins in the cells, then what you have is Alzheimer's. - Yeah, and they aren't sure the cause of Alzheimer's still, genetics is, they think has a lot to do with it.

And you can live with Alzheimer's for a while, up to a decade. Although they said in this article, Molly says three to five years is more common. So it definitely shortens your lifespan. And like you said, genes are definitely part of the risk factors. Polypropylene?

A polypropyletin E, I think, which is weird. If you have a mutation on this gene, you have a higher risk of Alzheimer's, even though the gene just codes for a protein that carries cholesterol through your bloodstream. It doesn't have anything to do with the tau protein tangles or anything like that as far as I know. That's weird. Also, if you have a family history of dementia –

you're you have a of Alzheimer's, you have a higher likelihood. And then if you have Down syndrome, you are at a higher risk of developing Alzheimer's in middle age. Oh, really? Yeah. Interesting. So that's

And we will do one on Alzheimer's. But that's how Alzheimer's can cause dementia. There's also vascular dementia, which is – that was a case with my grandfather. He had a stroke. And it accounts for about 20 percent of dementia cases worldwide.

And, you know, a stroke is when you have a loss of blood supply to the brain or a hemorrhage or a blood clot. And it can be either one big stroke event, which causes a lot of damage, and that's a single infarct dementia. Right. Or it can be a lot of the accumulation of symptoms because of a lot of little bruises.

many strokes you have over the years. Right. And then the damage just builds up and you finally, once that last one that is the straw that breaks the camel's back and you have dementia, that happens pretty rapidly after that last one, that last stroke you have. Yeah. And that's a multi-infarct when it's a bunch of them. And little mini strokes are common. Sometimes you have them and don't even realize you've had them. Right.

Uh, with my grandfather, he, he had the big one and, oh really? Yeah. We talked about this before and I think something about speech, but, um, yeah, he lost his ability to speak, uh, you know, English. Uh, so that would be aphasia.

Yes. He couldn't produce language. Well, he produced... Yes, he could not produce language. He said things, but it didn't make any sense. Gotcha. But he had an understanding. You could see the frustration. Yeah. You know, I know how I'm supposed to...

My grandmother is driving us, let's say, and she doesn't know how to get there. He does, and he can't tell her. But he's telling her. Yeah. It's just coming out all mixed up. And that's a hallmark of dementia is there's emotional changes in the person because they're not communicating like they want to, say. People aren't responding like they want the people to, and they'll get snippy.

And then ultimately say withdraw. They'll just give up on communicating at all because it's too frustrating or just too sad, you know? Yeah. Which is one of the common results of dementia. It's a comorbidity? No, it's a complication. Yeah, and with the single stroke event, or actually with the multi-strokes event,

It's different for everyone. There isn't any single like, well, this is going to happen because this person had a stroke. Right. It could be a variety of different things from...

You know, paralysis on one side of the face or body, bowel and bladder control problems. He didn't have any of those. He looked totally the same. Physically, he walked and talked the same except for the fact that they weren't real words. Right. That was like the most noticeable thing. I remember you telling me about your grandfather before. I don't remember what it was. It was a long time ago. We were talking about speech like we're Nicky's area or broke his area. Yeah, yeah. Something like that. Totes.

So with Alzheimer's, it first attacks the hippocampus, which means that it's going to take away your episodic memory, which is your memory of recent events, right? Yeah.

And then it starts to move its way into other areas of the brain where your judgment is affected, your speech patterns are going to be affected, your personality is very much affected and changes. With Alzheimer's. With Alzheimer's. But not as much with the stroke. Yeah, with vascular dementia, there might be some other things where part of the face is sagging or the patient can't move their arm or something like that. But yeah, the personality will remain intact because those regions of the brain aren't affected. Right.

Like they are in Alzheimer's. Yes. And then in about 5% to 15% of dementia cases, it stems from something called Lewy body dementia.

which we were just talking about, they think Robin Williams might have suffered from. He definitely did. He definitely did? Yeah. They found in his autopsy. I think he was diagnosed with it before he died. Oh, okay. That was one of the reasons why he took his life. Yeah. Because that can cause severe, intense hallucinations. Yeah, big time. Did you look those up? Oh, yeah, man. Scary stuff. He was very...

Apparently a typical one is very brightly colored animal or person that you see in great detail for many minutes on a daily basis, like just intense hallucinations. I'm sure you think you're losing it. Right, and that's one of the first symptoms of Lewy body dementia. And it was discovered by Frederick Lewy in 1912, and it has...

Has nothing to do with your body. A Lewy body is there are deposits, again, protein deposits of the alpha synuclein that appear on the brain. So don't think of body in the terms of like your physical body. Right. And this is also present Lewy bodies and Parkinson's. So as a result, not only are you going to have symptoms similar to Alzheimer's with Lewy body dementia, but also some of the tremors and balance issues of Parkinson's. Right.

Which is super sad as well. Is that what Michael J. Fox has? Parkinson's? Yeah. Yeah. And that's what the movie Awakenings was about, wasn't it? Like a group of Parkinson's patients that like El Doble worked on? Was that Parkinson's? I can't remember. I think they didn't realize what... They thought they were locked in or something. And then they realized their Parkinson's tremors were so acute that they were like...

They were not even shaking. They were just frozen. Yeah. Interesting. Their muscles were totally contracted rather than contracting and relaxing again and again. And Robin Williams. Yeah. How about that? Yeah. Then we have something that used to be, well, it's called now frontotemporal dementia. It used to be called Pick's disease, but now Pick's disease is a specific version. Which I couldn't really suss out what the difference is. Could you? No. No.

I couldn't either. As long as it wasn't just me, I'd feel better. But FTD is really an umbrella term. It's about 5% of dementia cases, and it's going to affect personality and behavior and language. Like big time. Big time, and it's where your frontal and temporal lobes are actually atrophying and shrinking.

Right. And the reason why is, you remember with Alzheimer's, you have beta amyloid plaques and tau protein tangles? Yeah. Well, with the frontotemporal dementia, you don't have the beta amyloid plaques. You just have the tau protein tangles, but it's enough to cause massive neuronal loss. Yeah. And this is like, I think a lot of people at first think they might have Tourette.

Yeah. Because you can yell things out, inappropriate behaviors. Yeah, like if your grandfather suddenly becomes hyper-interested in sex and likes to talk about it in public or exposes himself to people in public, there's a pretty good chance that he has developed frontotemporal dementia. Or if I did, because it's unusual in that it attacks younger people. It's going to onset between 40 and 75 years old.

which distinguishes it from other types of dementia. Yeah, and if your grandfather used to do that stuff already, then that's not the case. The key here is that this has come out of the blue. Somebody has really just completely changed in their personality. They might get into really risky behavior like gambling all of a sudden. Yeah, shoplifting, gambling.

and be like risky investments or like pulling all their money out of the bank. Yep. And with Pick's disease too, apparently apathy is a big indicator of this. There's a big personality change and the person is no longer, they have no empathy. They have blunted emotions. Yeah. And then they may also be engaging in risky behavior. So basically your grandpa or your grandma has just turned into like the transporter, you know? Or me.

Or you? Well, yeah. You're 40 and 75. You lack empathy? No, no, no. I'm just saying it's because it affects young people more. I thought you were saying like they turned into you. Oh, no, no, no, no. You have blunted emotions and you gamble. There's also Huntington's disease. This is, it seems like much more physical in nature. Uncontrollable movements, although there are changes in personality, but...

Real fidgety, herky-jerky. Your brain loses the ability to control coordination, essentially. Right. Which is, I think, a 50% chance of inheriting the gene, but you can live with it for up to 20 years. Yeah. Which seems like, as far as dementia goes, one of the longer life expectancies. But again, I mean, like, I would guess this has kind of become clear that

The hallmark of dementia is memory loss paired with some other problem, like not being able to create speech any longer, recognize speech, or not being able to move, that kind of thing, or not being able to plan. And like we said, well, we should probably take a break, huh? Yeah, we got a couple of more types that we'll talk about and then some other good stuff. Okay. Right after this. One, two, three, four.

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The last two, actually, the last three we're going to talk about, because there are many, many other kinds of dementia. Like, we could spend hours and hours talking about all the different kinds. Hours. But we have talked about Creutzfeldt-Jakob disease.

And I can't remember which one. And we say that all the time. Is there a disease that kills by preventing sleep? Oh, is that the one? Which we should have rightly called how prion diseases work. Yeah, because it's a prion infection. It's very rare. About one out of a million people will be affected in any given year. Like mad cow disease. Yeah. Or Kuru.

Yeah, exactly. It's a spongiform disease. Yeah. So crazy. It is. It's very interesting. It could be genetic. But and I thought we also talked about it in organ transplant. Did we? I think so, because it can occur because of infected tissue that you are implanted with or from an organ. Yeah. And this is neuronal loss due to the like holes literally being eaten into your brain.

by this disease. Yeah. Um, and then you can also get dementia, um, from, from when you have HIV. Uh, if you are a boxer or say a football player in the NFL, you may have dementia from a traumatic brain injury, like a concussion or repeated concussions. Yeah. Um, and there are plenty of diseases. There's also, um, reversible dementia too. If you have a vitamin deficiency, uh, if you, um,

take certain medications, you can develop dementia, but this is reversible. Right. For the most part, though, age-associated dementia is not reversible. Right. And like we said, it's kind of tricky to diagnose this stuff because it is normal for people to become more forgetful as you age. And then to make it even more confounding, if you're a diagnostician,

not only do people get more forgetful, there's an intermediate stage between dementia, a dementia diagnosis, and just normal age-related forgetfulness. Yeah. And that is called mild cognitive impairment. So if you can catch this, from what I understand, and we'll talk about treatments and everything later, but if you can catch things like Alzheimer's and other diseases that lead to dementia early,

Although there's no cure for any of them, you can manage them a lot better and delay, say, death or the real devastation associated with it by a significant amount of time. But it's catching is the tricky part. And especially if you have dementia, you don't really realize that there's any kind of problem. So you're probably not going to take yourself to the doctor. Right.

No, but what you should do is listen to your loved ones because they are going to be looking at you a little more closely than you can, you know. They have more perspective. Yeah, exactly. That's what we're looking for.

So don't get offended if a loved one says, let's go get you checked out because you can do something if you catch it early on. Right. Unless you're very wealthy and it's your no-good nephew that you've never trusted anyway. You know? Very true. Then maybe bring a lawyer in on it. That's right. See what's up. So if you do go get checked out, from the second you walk in the door, your doctor is going to be eyeballing you and looking for any signs, signs.

just from their trained eye, like, you know, from how you walk to the way you answer questions to how they interact with you. They want to know, they're going to have to know your history because they need to have some context to compare it to. Right, like, were you always a compulsive gambler? Yeah. Or is this, like, new behavior? Yeah, and it helps to bring, you know, if you're older, maybe bring your grown son or daughter with you. Right. Or whoever has a lot of contact. Sure. Sure.

Although your spouse, you never know. What? I don't know. Maybe he's trying to get rid of you. Oh, yeah? Like that no good nephew? Yeah, exactly. I'm just kidding, of course.

Although I'm sure that happens. Then there are a couple of tests that they usually do in conjunction with one another. The mini mental state examination, the MMSE. Just a lot of basic questions there for mental tasks. But they're coded, the tasks are. Yeah, and they're scored individually. Yeah, and when you...

Say, question three, this person got an eight on. Yeah. You can go over and be like, yep, dementia. And it's actually pretty effective, actually. It is. And there's another test that ties into the MMSE that they both indicate one another, which apparently they're both really good at indicating dementia. But there's other tests called the clock drawing test. Did you look this thing up? Yeah, I thought it was pretty fascinating. It really is. Yeah, it seems really...

Like, why would someone tell someone to draw a clock at a certain time of the day? Yeah, usually they say draw a clock showing that it's 10 after 11. Yeah. And it makes a lot of sense in a lot of ways because it draws on all these different kinds or different regions of the brain, different skills, right? Yeah.

So, like, first of all, you have to remember what a clock is and what it signifies. That's a big one. What it looks like. Yeah. A clock isn't made of, like, squiggly lines or anything like that. You have to remember how a clock is laid out, the order that the numbers go in, that it doesn't keep going after 12 to 13, 14, 15. Yeah.

And then once you got all this, you have to show the hands showing that it's 10 after 11. So the hands won't be pointing at 10 and 11. It should be the longer hand should be pointing at the two and the shorter hand should be just past the 11, right? That's right. This requires a tremendous amount of brain power, even though it's very simple and straightforward. And you can tell a lot about a person's mental faculties just by having them draw them.

Yeah, the four specific things it requires are verbal understanding, memory, spatially coded knowledge, and constructive skills. And if any of those are off in conjunction with the MMSE, then they're going to have a pretty good idea of where you fall on the dementia scale. If you don't have the constructive skills to pay the bills, you may have dementia. That's right. And they actually – I looked at one study about the clock drawing test.

Basically, I think it was just a more recent like, hey, let's go in and really look at this thing again. And it checks out. They stood behind it and said, yeah, it's actually a really good indicator. Yeah, like it really holds up. And I think they developed it in the 60s, but it didn't take off until the 80s. It seems like a very 60s thing. It does. But it's something you can do anywhere. And now they're starting to gather these different indicators.

clocks that people with different types of dementia are drawing and basically compiling them into a database so you know what to look for even more. Like, oh, if somebody draws a clock that has like a 13, 14, 15 on it, they may have this type of dementia. Right. Or this one looks like Salvador Dali drew it. Right. Then they might have this kind of dementia. Yeah. Or they might just be super talented and creative. Yeah. You never know.

All right. Let's – should we take another break? Why not? Is it time? Sure. All right. We'll be back after this to talk about treatment and some of the other pitfalls of dementia. Thank you.

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So, Chuck, we've kind of I think it's it almost goes without saying, like the problems associated with with dementia, like you lose your ability to reason. In a lot of cases, you lose your ability to to move and take care of yourself. You lose your memories. You have trouble forming new memories. You have trouble recognizing people, memories.

So living life is extremely difficult. Yeah. But there's also like other complications that you may or may not think of. Right. So let's say you're an elderly person and you have a battery of medications that you need to take for unrelated heart disease. Yeah.

Do you think you're going to remember to take those medications? Right. Probably not. Even if you have like a timer set or some sort of calendar or something like that, you may have trouble even remembering that you have a calendar that you need to go check out to see what's on there, let alone to take the medication that's indicated that's on that calendar. Yeah, that's a big problem. Nutrition itself is a big problem. Either you...

forget to eat altogether or you think you've already eaten or you physically have deteriorated so that you can't control the muscles of

To chew and swallow and you could choke. Right. That's a real danger. So when people die from Alzheimer's, it sounds kind of strange if you think about it. It's like, well, no, they forgot. They lost their memory or whatever. Right. No, the brain is actually being slowly destroyed. Yeah. Periodically. And eventually it's going to reach the parts of the brain where like you can't swallow any longer. Then you die from that kind of thing. You also can lose your sense of hunger.

Like you just aren't hungry anymore. Yeah. Kind of tough to eat, especially when you're not thinking or remembering that you should eat when you're just not hungry ever. Yeah. It's a tough one. Hygiene, reduced hygiene is a big one. A lot of times in severe dementia cases,

You either are unable to bathe and dress yourself and brush your teeth or you forget to. It just falls by the wayside. I know that was the case with my grandmother. She needed to be bathed by my dad. Because she lost interest in it or because she just couldn't do it anymore? I think both. Yeah. Yeah.

That's another indicator. You said that when you go in for a diagnosis, the doctor is going to be watching you and just kind of sizing you up. One of the things they'll look for is whether you look disheveled. Yeah. That's a big one. And especially if your son or daughter is saying like this is really bizarre behavior because mom always like dressed to the nines. Yeah, whenever she left the house. Now she just wears this dirty old bathrobe all the time and doesn't ever want to take a shower. Yeah. That's usually an indicator of dementia. Yeah.

Yeah, it's not like she just gave up and doesn't care anymore. Right. It's part of the symptoms taking hold. Although another problem with dementia and one of the confounding factors is that depression can be a byproduct or comorbidity of depression.

Yeah. Because you recognize that your life is changing in ways that you're not happy about. You can't communicate anymore. You forget stuff all the time. You can become depressed. So then that could lead to you giving up on taking showers and dressing as well. Yeah. And not only depressed, but agitated and aggressive, riddled with anxiety. A lot of your emotional well-being and emotional health will be depressed.

slipping away from you. Yeah, and again, this can be a direct result of chemical changes in your brain due to dementia, or it can be like this is the result of you recognizing these changes and just becoming upset about them. We talked about communication and the hallucinations. You're going to have trouble sleeping as well in a lot of cases. Yeah. And then personal safety. A lot of people die every day because of

that happen as a result of dementia. Right. People who shouldn't be driving get into cars. Yeah. And there's a push that's going on now, I think in the last year or so, as part of the Council on Aging, like the United States Council on Aging, there's a new initiative called the Dementia Friendly America Initiative.

Really neat. Yeah. It's basically saying, look, we've got about one in eight people over 65 in the U.S. have dementia. We're about to have way more than that in the next couple decades. We need to be prepared for this kind of thing. So let's start training America how to recognize the signs of dementia and then how to react to it in a friendly and helpful manner so that people who are wandering around with dementia can

Don't withdraw $80,000 from their bank account and walk around with it in their pockets outside. Yeah, and how do you do that? You get some money from the government as a grant to go out and hire people to literally go to businesses and go to restaurants and talk to waiters and waitresses. Sure.

should I just say waitrons, go to banks and talk to tellers, go to anywhere where there's interaction with another human, grocery store, check out people, and literally train them

on, like you said, how to recognize it and how to kindly deal with these people. Right, exactly. Apparently, one of the things you teach people in service industries is not take it personally. Right. That if somebody's behaving erratically or they're using incorrect words and they're of a certain age, the chances are they probably have dementia and there's ways of dealing with it. Apparently,

responding to it in a soft, friendly manner tends to get results from the dementia patient. Especially if you are... You mean not being an aggressive jerk? Right, exactly. Just being nice will frequently get good results. And yeah, it is a pretty neat initiative. Absolutely. Yeah.

And necessary. Yeah. You know? But I'm stricken by the idea that people are planning out this far ahead for this kind of thing. It's exceptional. It is. And scary, but awesome. Yeah.

So if you do have a family member, one thing that's important to remember, there's something called the caregiver burden that my dad and his wife definitely experience. It is really, really tough on you, on your family, and it can actually take a physical toll. They have some stats here. If you, your risk of death as a woman, if your husband has dementia, increases 28%.

28% in the first year after they're diagnosed. Yeah. And only 22% for a husband whose wife is diagnosed. It's still a pretty significant increase. Oh, sure. Just from the dementia diagnosis. Uh-huh. Yeah. And what they recommend in this article is to take care of yourself first because they found that if you are...

not going into this with the right attitude and you are upset or have anxiety, you're just going to do more harm anyway. Right. So get yourself right, take care of yourself, and go into it in the right frame of mind and you'll actually be able to help better. Yeah, and this caregiver burden or caregiver burnout is a very real thing physically too. Like you have low energy, you have low productivity, you become snippy, resentful, angry, and

You can end up basically mistreating your own parent or spouse because you're so upset with this horrific disease. One of the hallmarks of dementia is that there's no two days that are alike. And when you're dealing with the dementia patient, what worked yesterday isn't going to necessarily work today. Well, if you can no longer predict what your life is going to be like from day to day and you're spending, I think...

I saw this one study that found an average of 22 hours a week of unpaid care by spouses, wives, daughters, that kind of thing. You can very easily get stressed out. The main thing you have to do is ask for respite care. Like you can't do it by yourself. You have to have...

other family members, members of your church, your community, come and give you a break so you can go do other stuff for a while. Absolutely. And, I mean, you could totally see how you could just very easily evolve a really unhealthy dynamic if you're just trying to do it yourself because you lose perspective. This becomes your norm even though it's totally abnormal. Yeah, and, boy, you talk about a really sad way to damage relationships.

what previously was a good relationship with a parent or something is devastating. Sure. You know? Um, so there are drugs that they use, uh, to help stave off dementia. Um, mainly right now they are, uh, colon esterase inhibitors. Mm-hmm. Uh, and they suppress colon esterase, which is an enzyme that breaks down, uh,

Acetylcholine, which we've talked about before. That's what helps transmit messages between neurons. So that'll help.

Yeah, because if you're not communicating as much as you were before, at least the communication that is going on can stick around longer. Exactly. It seems primitive as far as brain drugs go, but it makes sense. Yeah, and then there's another one. Are they still using this? I believe so. Memantine. And it inhibits glutamate, which we talked about before, which causes neuron death.

When overstimulated. Yeah. I can't remember where we talked about that one either. I just remember glutamate from the umami episode. Yeah, it was definitely in that one. And then there's also stuff you can, so these drugs will help some. That's for non-vascular dementia. Right. With vascular dementia, you're going to want to take blood thinners. That's just to prevent a stroke. Yeah, to keep more strokes from coming along and making the whole thing worse. Yeah.

And then with like Lewy body disease to deal with things like the hallucinations and stuff, you'll probably also be given antipsychotics as well. And one thing that they're starting to realize more and more is very difficult to really figure out what kind of dementia people have just from what's the scan?

MRI? Yeah, MRI scans. And you can really go back and accurately identify types of dementia from autopsies, right? Right. And so from more and more autopsies, they're finding that there's a lot of what's called mixed dementia, where you have Alzheimer's and vascular dementia. Right. Or where you have Alzheimer's and Lewy body disease. And so...

It can be really tough to suss out all the different kinds of dementia a person might have. But if you can do that, then you can put them on a drug regimen that could really kind of help more than just treating the Alzheimer's and letting the Lewy body go unrecognized and rampant. They're unchecked. There's also preventative stuff you can do, too.

Oh, yeah? Yeah. Like what? Crossword puzzles. Yeah. I told you, Emily's grandmother, Mary, is 95. Yeah. And very sharp. Yeah. And she does word puzzles all the live long day. And is it Sudoku? Yeah, she does all kinds of word puzzles. Yeah. Things that I have never even heard of. Supposedly that helps stave it off. Oh, yeah. Apparently, this one's great. Alcohol.

moderate alcohol consumption, which is two a day for men or one a day for women, has a protective effect. It staves off

or stays off dementia. They're not sure why. They're not sure what kind of alcohol is the best. They just know that for some reason alcohol has a protective effect. Probably up to that two drinks and then it's probably bad after that. Yes, then it becomes very bad after that. So you want to just moderate amount. Right. In all things, people. Moderation. Moderation. And then there are some things that you can do

Here's the thing. There's a debate on whether or not you are tricking your loved one by doing things like giving them an appliance that doesn't work so they can pretend that they're ironing or something. Right. Because they used to love to take care of their laundry themselves. So here, let me remove the cord from this iron. And is that tricking someone? Is it not?

And a lot of people think, no, that's what you should do because it makes them feel like they're being useful. They're not going to get hurt with a hot iron. Yeah. So it's all good. Other people say no. That means that they're not hanging on to that last bit of reality they may have. Right.

I think it's fine. I think it's fine, too. And there's actually an entire village set up in, I think, just outside of Amsterdam. Yeah, this is awesome. Called Hojve, right? Yeah. Hojve. How would you say that? I have no idea because Dutch is the weirdest language on Earth. Hojve. We'll say that, okay? Okay. And it's what's called a dementia village, basically. Yeah. Where...

Everyone who lives in this village, I think 150 people, all have dementia. And they live in group houses. Well, there's caretakers that live there too. Okay, yes, you're right. And they live in the group houses with them. Yes. And a lot of the people...

realize that this is their nurse or just think it's a good friend of theirs. They don't really remember when they became friends. Like a cool roommate. Yeah, exactly. And the houses they live in have different themes according to how the people lived, depending on whether they're a blue collar, whether their memories go back to the 70s. This whole place is basically set up so that it's a very non-threatening, safe place for these people to just kind of live.

and move about within. Sure, safely? Yeah, safely. And so they can go to the grocery store. They can go to the movies. They can go ride a bike. And everyone, the people at the movie theater, know that the people there have dementia. Right. They're real movie theater workers and real waiters in the restaurants. They're just specially trained. Exactly. So it's a less clinical setting than, say, a nursing home. And a lot of people say...

This is awesome because it's as close to real normal life that they were used to as they're going to get. Yeah, exactly. Then, of course, there's other people that poopoo and say, no, you're tricking these people. But but you can say, hey, OK, here's here's the big difference with this place. If this if this.

dementia patient gets lost in Manhattan and they run across a city worker who's collecting garbage, that city worker may do absolutely nothing to help them. Yeah. In Hojve village. Yeah. That city worker is specially trained to get that person back to their house and

or alert their caretaker that this person is having a crisis or something like that. It's what we're trying to train people to do in the future. Yes. They've just isolated it to a community. Yeah. So there's, I mean, when you break it down to that distinction, I don't really see anything wrong with it, especially when you are protecting people

The patients themselves. It's not like you're doing it to experiment on them. No, no. You know, or because they'll produce gold in their urine or something like that. You know, like this is strictly for their protection. Yeah. But also allowing them to live a free life outside of a clinical setting. Right.

I don't see much wrong with it. I do get what the bioethicists are saying. Like, yes, you're robbing someone of their dignity by lying to them, by deluding them or playing into their fantasies. Strictly speaking, yes. In the real practical world, I think this is great. If I'm at that point, then play into my fantasies. Exactly. Please. It is 1984 all the time.

In fact, one of the people that work there say that people that do criticize it, it's a very good point, he's like, they don't understand what we're doing here. These aren't actors. They're like real employees of these places. They're just...

helping out. Right. You know? And so Hojve Village, I hope I'm saying that right because I'm really putting myself out there. Oh, I'm sure you're not. It's become this kind of ideal standard of care, but it's also really expensive. Yeah, I'm sure. So in a country where there's a lot of socialized medicine, it could do pretty well, like in the Netherlands or in Canada. Yeah, when they take care of people even though they don't have money. Right, exactly. There's one called, in Canada, it's called, um,

Pentanguishene. Pentanguishene, Ontario. They have one. It's a little smaller than the one in Amsterdam. They're also building one in Miami as well. So it is starting to take hold. People do believe in it. And apparently the patient's families are very happy with this kind of thing too. Well, and hopefully with the initiative of what's it called? Alzheimer's. Dementia-Friendly America. Dementia-Friendly America.

DFA. Yeah. Dot org. Yeah. Hopefully with those efforts, more and more people will because it's coming. Oh, yeah, it's coming. A lot more folks are going to be out there that we need to take care of. Yeah. We don't know how to cure dementia. We just know it's coming. I'm going to be one of them. You think so? Sure. At some point, if I make it that long. But not everybody gets dementia, no matter how long you live.

I don't know. I've got a feeling. Really? Yeah, it does run in my family a little bit. Yeah. And I have my father's family genes more than my mother's, I feel like. So if I had my mother's genes, they all died from heart attacks and strokes and heart disease. Young? Not a lot of cancer.

Yeah, pretty young. So if you make it past 65, you beat the heart stuff. Then the Bryant genes kick in. Then you've got the dementia. Well, we're all going down one way or another, right? I may live to be 100. Yeah. You know? Yeah.

Man, I thought of something. Oh, yeah. I wonder, Chuck, if like our specific like us, you and me specifically, cramming all this information in every week. Yeah. Is actually beneficial or if we're just setting ourselves up for massive cases of dementia because we're just pushing stuff in and getting it out, pushing in new stuff and getting it out. Yeah. Like are we are we abusing our brains or are we exercising it?

I question that sometimes. I bet someone out there, I bet there's a neurologist who has a good gut instinct answer to that one. Let us know. I want to know. Good news or bad? Okay? Neurologists? There's going to be a subject line that just says, neurologist, guys, you're screwed. Yeah, I have bad news.

If you want to know more about dementia, you can type that word into your favorite search engine, and it will bring up tons of information and great resources. You can also type it into the search bar at HowStuffWorks, and it will bring up a great article. Since I said search bar, it's time for Listener Mail. I'm going to call this one, Heckey Krasnow Lives, although I don't think he is with us.

hey guys only just started recently listening to the show it's been a fantastic way to pass time and learn something interesting i'm a home-taught high schooler so every time i listen to an episode of your show i get a history or science credit how about that that is pretty great uh but as great as that is that's not why i'm emailing i actually have a fun fact for you guys from your play-doh episode in which you mentioned captain kangaroo well my great-grandfather worked on that show

That is awesome.

Watches the Claymation Rudolph movie every year because of that. Our own little taste of that irony. Yeah. I don't want to tell you what to do, because I'm sure you have a lot of episodes on your plate already, but I'm just saying, Hecky Krasnaw was a pretty interesting person. There might just be enough material for an episode on him. Up to you. Nice. Thanks for helping with my schoolwork. That is from Aiden in Maryland. Awesome. Thank you very much, Aiden.

And when I say Heckey Krasnow lives, I mean lives on. Sure, like Viva La Heckey. Yeah. If you want to tell us about someone interesting in your family, we love that kind of stuff. Also, if you're caring for a dementia patient, we want to hear the highs and the lows of that. Just kind of bring it on home for us, will you? You can send us an email to stuffpodcasts at howstuffworks.com. And as always, join us at our home on the web, stuffyoushouldknow.com.

Stuff You Should Know is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

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