Selects: How Dementia Works

The number of people suffering from dementia is expected to explode in the coming decades and, in a pleasant surprise, countries around the world are taking steps to plan for the increase in friendly, caring ways. Find out all about this devastating disease and what's being done to prepare in this classic episode. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  This is an iHeart Podcast. Guaranteed Human.

• 0:04Josh Clark?

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• 0:35Speaker 02

  With no fees or minimums on checking accounts, it's no wonder the Capital One Bank guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums. He'd also talk about how Capital One cafes are open seven days a week to assist with your banking needs. Yep, even on weekends. It's pretty much all he talks about, in a good way. What's in your wallet? Terms apply. See capitalone.com/bankguy. Capital One, N-A, Member FDIC. 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.

• 1:20Speaker 02

  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.

• 1:48Speaker 03

  Welcome to Stuff You Should Know, a production of iHeartRadio.

• 1:58Josh Clark?

  Hey and welcome to the podcast. I'm Josh Clark with Charles W., Chuck Bryant, and Noel. 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.

• 2:13Speaker 02

  Alright.

• 2:14Josh Clark?

  Stuff you should know. That's too clever.

• 2:18Speaker 02

  Yeah.

• 2:19Josh Clark?

  It's a little cutesy.

• 2:20Speaker 02

  Yeah.

• 2:21Josh Clark?

  That's all. That's my only aversion to it.

• 2:24Speaker 02

  Alright.

• 2:25Josh Clark?

  What are you? Are you with Stuff You Should Know?

• 2:28Speaker 02

  Changing the name of our show? After eight years?

• 2:30Josh Clark?

  No, just the Noel Stint. The name of it. Remember the summer of Sam?

• 2:35Speaker 02

  Oh, yeah. Yeah, sure, why not?

• 2:37Josh Clark?

  I don't like it. Alright. Should we come up with a third idea?

• 2:42Speaker 02

  Yeah. The stint of Noel sounds too much like, "Something's wrong with Noel."

• 2:49Josh Clark?

  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.

• 2:56Speaker 02

  There's something you should know.

• 3:00Josh Clark?

  Now see, that's what I'm saying. It sounds like something Strickland would've come up with.

• 3:04Speaker 02

  Ooh.

• 3:04Josh Clark?

  You know?

• 3:05Speaker 02

  Man, we haven't been in a flame war with Strickland in a while.

• 3:08Josh Clark?

  It has been a while. It's been too long. It's gotten soft.

• 3:10Speaker 02

  You just launched one across the bow.

• 3:13Josh Clark?

  So, Chuck.

• 3:15Speaker 02

  Yes.

• 3:16Josh Clark?

  Are you familiar with dementia?

• 3:18Speaker 02

  Uh, yeah, sure.

• 3:20Josh Clark?

  Are you? Running your family?

• 3:21Speaker 02

  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.

• 3:34Josh Clark?

  It's probably pretty likely. It's, um, it's not, from what I understand, it's not a, um, a, just a natural consequence of age.

• 3:43Speaker 02

  Right.

• 3:43Josh Clark?

  But it's pretty prevalent.

• 3:46Speaker 02

  Sure.

• 3:48Josh Clark?

  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.

• 3:57Speaker 02

  Right.

• 3:57Josh Clark?

  It's a set of symptoms that's brought on by disease.

• 4:00Speaker 02

  Yeah, I think that is widely misunderstood.

• 4:03Josh Clark?

  Yeah.

• 4:05Speaker 02

  But you are totally correct. A set of symptoms and it is not just your garden variety forgetfulness that comes as you age.

• 4:14Josh Clark?

  No, because that is age-related and normal.

• 4:17Speaker 02

  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?

• 4:25Josh Clark?

  It is. Just like you forget your keys more often, that kind of stuff.

• 4:28Speaker 02

  Sure.

• 4:28Josh Clark?

  But when you do forget your keys more often, you go, snap your finger and go, "Ah, I forgot my keys again. What is wrong with me?"

• 4:36Speaker 02

  Yeah.

• 4:36Josh Clark?

  That's normal.

• 4:37Speaker 02

  One of the big tells of true dementia is when you don't realize that you're forgetting.

• 4:42Josh Clark?

  Right.

• 4:42Speaker 02

  So that's, that's when it gets scary.

• 4:44Josh Clark?

  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.

• 5:03Speaker 02

  Yeah.

• 5:03Josh Clark?

  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.

• 5:14Speaker 02

  Wow.

• 5:15Josh Clark?

  And as our population ages, because the 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.

• 5:33Speaker 02

  Yeah.

• 5:34Josh Clark?

  And it's very expensive, actually.

• 5:38Speaker 02

  How much money?

• 5:39Josh Clark?

  A lot. You ready for this?

• 5:40Speaker 02

  Yeah.

• 5:41Josh Clark?

  In 2015, we have spent $226 billion on healthcare for dementia.

• 5:47Speaker 02

  Wow.

• 5:48Josh Clark?

  And they're expecting by, I believe, 2050, when we are carrying for 16 million. In 2015 dollars, not futuristic, much more inflated, 250, 2050 dollars.

• 6:02Speaker 02

  Right.

• 6:02Josh Clark?

  In 2015 dollars, we'll be spending about 1.2 trillion dollars on dementia.

• 6:08Speaker 02

  Wow.

• 6:09Josh Clark?

  If somebody doesn't do something.

• 6:10Speaker 02

  Man.

• 6:11Josh Clark?

  Yeah, it's, it's very expensive. It's also extraordinarily sad as far as diseases or symptoms of diseases go.

• 6:20Speaker 02

  Yeah, and I also want to recommend our May 2011 episode, A Podcast to Remember.

• 6:26Josh Clark?

  Oh, yeah.

• 6:27Speaker 02

  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.

• 6:32Josh Clark?

  Or if you listened to it and forgot, go back and listen to it.

• 6:35Speaker 02

  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. Apaxia, and all these are super sad, if you've ever seen them up close. Apaxia, if you cannot make certain movements, even though your body physically is healthy.

• 7:02Josh Clark?

  Right.

• 7:03Speaker 02

  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, or at least one of these, you could be diagnosed with dementia.

• 7:22Josh Clark?

  Right. And so like we said, dementia is a set of symptoms, right?

• 7:26Speaker 02

  Yes.

• 7:27Josh Clark?

  It's, it's actually brought on by a disease. And the most common cause of dementia, I think something like 60 or 70% or something like that of dementia cases, is brought on by Alzheimer's disease.

• 7:40Speaker 02

  I could have sworn we did one on Alzheimer's, but we have not.

• 7:43Josh Clark?

  Yeah, I don't think we have. I don't know where.

• 7:46Speaker 02

  We've talked about it enough, I think.

• 7:47Josh Clark?

  It's, 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.

• 7:56Josh Clark?

  Something called neurofibrillary tangles, also known as beta, I'm sorry, tau protein tangles.

• 8:04Speaker 02

  Yeah.

• 8:05Josh Clark?

  And beta amyloid plaques, right?

• 8:08Speaker 02

  Yeah, and the plaques are just a protein buildup, a sticky protein buildup.

• 8:12Josh Clark?

  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.

• 8:23Speaker 02

  Yeah.

• 8:24Josh Clark?

  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.

• 8:42Speaker 02

  Yeah.

• 8:42Josh Clark?

  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.

• 8:51Speaker 02

  Yeah, and they aren't sure the cause of Alzheimer's still, genetics, 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.

• 9:09Josh Clark?

  Yeah.

• 9:10Speaker 02

  It definitely shortens your lifespan.

• 9:12Josh Clark?

  And like you said, genes are definitely part of the risk factors. Apolipoprotein, apolipoprotein E.

• 9:22Speaker 02

  Okay.

• 9:23Josh Clark?

  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.

• 9:34Speaker 02

  Yeah.

• 9:35Josh Clark?

  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 have, or 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.

• 9:55Speaker 02

  Oh, really?

• 9:55Josh Clark?

  Yeah.

• 9:56Speaker 02

  Interesting. So, that's. And we will do one on Alzheimer's, but that's how Alzheimer's can cause dementia. Uh, there's also vascular dementia, which is, uh, that was a case with my grandfather, who, he had a stroke.

• 10:10Josh Clark?

  Mm-hmm.

• 10:11Speaker 02

  And it accounts for about twenty percent of dementia cases. And, uh, you know, a stroke is when you have a, a loss of blood supply to the, to the brain or a hemorrhage.

• 10:21Josh Clark?

  Right.

• 10:22Speaker 02

  Or a blood clot. And it can be either, um, one big stroke event, uh, which causes a lot of damage, and that's a single infarct dementia.

• 10:31Josh Clark?

  Right.

• 10:32Speaker 02

  Or it can be a lot of, uh, the accumulation of, uh, symptoms, uh, because of a lot of little mini-strokes, uh, you have over the years.

• 10:39Josh Clark?

  Right. And then the damage just builds up and you finally, once, once that last one, that, that is the straw that breaks the camel's back.

• 10:46Speaker 02

  Yeah.

• 10:47Josh Clark?

  And you have dementia, um, that happens pretty rapidly after that last, that last one, that last stroke you have.

• 10:54Speaker 02

  Yeah, and that's a multi-infarct when it's a bunch of them. Um, and little mini-strokes are common, a lot, sometimes you have them and don't even realize you've had them.

• 11:01Josh Clark?

  Right.

• 11:02Speaker 02

  Uh, with my grandfather, he, he had the big one, and...

• 11:06Josh Clark?

  Oh, really?

• 11:07Speaker 02

  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.

• 11:15Josh Clark?

  Mm-hmm. Uh... So that would be aphasia.

• 11:18Speaker 02

  Yes.

• 11:19Josh Clark?

  He couldn't produce language.

• 11:20Speaker 02

  Well, he produced, yes, he could not produce language. He said things, but it, you know, it didn't make any sense.

• 11:25Josh Clark?

  Gotcha.

• 11:26Speaker 02

  But he had an understanding, you could see the frustration.

• 11:29Josh Clark?

  Yeah.

• 11:30Speaker 02

  Uh, you know, I know how to, how I'm supposed to, uh, my grandmother is driving us, let's say, and he, she doesn't know how to get there, he does, and he can't tell her, but he's telling her.

• 11:40Josh Clark?

  Yeah.

• 11:41Speaker 02

  It's just coming out all mixed up.

• 11:43Josh Clark?

  And that's, that's a hallmark of dementia is, um, there's emotional changes in the person because they, 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?

• 12:05Speaker 02

  Yeah.

• 12:05Josh Clark?

  Which is, it's one of the common results of dementia. It's a comorbidity? No, it's a complication.

• 12:12Speaker 02

  Yeah, and with the single stroke event, or actually, or with the multi-strokes, it's different for everyone. There isn't any single like, well, this is going to happen because this person had a stroke.

• 12:25Josh Clark?

  Right.

• 12:25Speaker 02

  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.

• 12:41Josh Clark?

  Right.

• 12:42Speaker 02

  That was like the most noticeable thing.

• 12:43Josh Clark?

  I remember you telling me about your grandfather before. I don't remember what it was.

• 12:47Speaker 02

  It was a long time ago.

• 12:48Josh Clark?

  We were talking about speech, like, were Nicky's area or Broca's area?

• 12:52Speaker 02

  Yeah, yeah.

• 12:52Josh Clark?

  Something like that.

• 12:53Speaker 02

  Totes.

• 12:54Josh Clark?

  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?

• 13:05Speaker 02

  Yeah.

• 13:06Josh Clark?

  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.

• 13:17Speaker 02

  With Alzheimer's.

• 13:18Josh Clark?

  With Alzheimer's.

• 13:19Speaker 02

  But not as much with the stroke.

• 13:21Josh Clark?

  Yeah, with vascular dementia, you know, there might be some other things where like, 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, like they are in Alzheimer's.

• 13:35Speaker 02

  Yes. And then in about five to fifteen percent 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?

• 13:48Josh Clark?

  He definitely did.

• 13:48Speaker 02

  He definitely did?

• 13:49Josh Clark?

  Yeah. They found in his autopsy, I think he was diagnosed with it before he died.

• 13:53Speaker 02

  Oh, okay.

• 13:53Josh Clark?

  That was one of the reasons why he took his life.

• 13:56Speaker 02

  Yeah, because that can cause severe, intense hallucinations.

• 14:00Josh Clark?

  Yeah, big time. Did you look those up?

• 14:02Speaker 02

  Oh, yeah, man. It's scary stuff.

• 14:04Josh Clark?

  You like, very, apparently a typical one is very brightly colored animal or person?

• 14:09Speaker 02

  Yeah.

• 14:09Josh Clark?

  That you see in great detail for many minutes on daily, on daily basis. Like just intense hallucinations.

• 14:16Speaker 02

  I'm sure you think you're, you know, losing it.

• 14:18Josh Clark?

  Right, and that's one of the first symptoms of Lewy body dementia.

• 14:21Speaker 02

  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.

• 14:39Josh Clark?

  Right.

• 14:40Speaker 02

  And this is also present in Lewy bodies and Parkinson's. So, as a result, not only are you gonna have symptoms similar to Alzheimer's with Lewy body dementia, but also some of the tremors and balance issues of Parkinson's.

• 14:54Josh Clark?

  Right.

• 14:55Speaker 02

  Which is super sad as well.

• 14:57Josh Clark?

  Is that what Michael J. Fox has, Parkinson's?

• 15:00Speaker 02

  Yeah.

• 15:01Josh Clark?

  Yeah. And that's what the movie Awakenings was about, weren't they, wasn't it like a group of Parkinson's patients that like El Dobo worked on?

• 15:08Speaker 02

  Is that Parkinson's? I can't remember.

• 15:09Josh Clark?

  I think they didn't, 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 completely, yeah.

• 15:21Speaker 02

  Interesting.

• 15:22Josh Clark?

  They're just, their muscles were totally contracted rather than contracting and relaxing again and again.

• 15:26Speaker 02

  And Robin Williams.

• 15:28Josh Clark?

  Yeah.

• 15:28Speaker 02

  How about that?

• 15:29Josh Clark?

  Yeah.

• 15:31Speaker 02

  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.

• 15:43Josh Clark?

  Which I couldn't really suss out what the difference is, could you?

• 15:47Speaker 02

  No. I couldn't either.

• 15:49Josh Clark?

  As long as it wasn't just me, I feel better.

• 15:51Speaker 02

  But FTD is really an umbrella term. It's about 5% of dementia cases, and it's gonna affect personality and behavior and language.

• 16:03Josh Clark?

  Like, big time.

• 16:04Speaker 02

  Big time, and it's where your frontal and temporal lobes are actually atrophying and shrinking.

• 16:09Josh Clark?

  Right. And the reason why is, you remember with Alzheimer's, you have beta amyloid plaques and tau protein tangles?

• 16:15Speaker 02

  Yeah.

• 16:16Josh Clark?

  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.

• 16:26Speaker 02

  Yeah, and this is like, I think a lot of people at first think they might have Tourette.

• 16:32Josh Clark?

  Yeah.

• 16:32Speaker 02

  Uh, because you can yell things out, inappropriate behaviors.

• 16:37Josh Clark?

  Uh, yeah, like if your grandfather suddenly becomes hyper interested in sex and like likes to talk about it in public.

• 16:43Speaker 02

  Yeah.

• 16:44Josh Clark?

  Exposes himself to people in public, there's a pretty good chance that he has developed frontotemporal dementia.

• 16:51Speaker 02

  Or if I did, because um, it's unusual in that it attacks younger people. Um, it's gonna onset between forty and seventy-five years old, which distinguishes it from other types of dementia.

• 17:03Josh Clark?

  Yeah, and if your grandfather used to do that stuff already, then that's not the case. The, the, the key here is that like, 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.

• 17:18Speaker 02

  Yeah, shoplifting.

• 17:20Josh Clark?

  Yeah.

• 17:21Speaker 02

  And be like risky investments or like pulling all their money out of the bank.

• 17:25Josh Clark?

  Yep, and with Pick's disease too, um, the 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 um, have blunted emotions.

• 17:40Speaker 02

  Yeah.

• 17:40Josh Clark?

  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?

• 17:49Speaker 02

  Or me.

• 17:50Josh Clark?

  Or you?

• 17:51Speaker 02

  Well, yeah. You're forty and seventy-five.

• 17:53Josh Clark?

  You lack empathy?

• 17:54Speaker 02

  No, no, no, I'm just saying it's because it affects younger people.

• 17:57Josh Clark?

  I thought you were saying like they turned into you.

• 17:58Speaker 02

  Oh, no, no, no, no, no.

• 18:00Josh Clark?

  You have blunted emotions and you gamble.

• 18:02Speaker 02

  Uh, there's also Huntington's disease. Uh, this is, uh, it seems like much more physical in nature. Uh, uncontrollable movements, uh, although there are changes in, in personality, but um, real fidgety, herky-jerky, uh, your brain loses the ability to control coordination, essentially.

• 18:21Josh Clark?

  Right.

• 18:22Speaker 02

  Which is, uh, I think, uh, fifty percent chance of inheriting the gene, but you can live with it for up to twenty years.

• 18:31Josh Clark?

  Yeah.

• 18:32Speaker 02

  Which seems like, as far as dementia goes, one of the longer life expectancies.

• 18:37Josh Clark?

  Mm-hmm. But again, I mean, like, I would guess this has kind of become clear. 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?

• 18:59Speaker 02

  Uh, yeah, we got a couple more types that we'll talk about and then some other good stuff.

• 19:04Josh Clark?

  Okay.

• 19:04Speaker 02

  Right after this.

• 19:18Josh Clark?

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• 20:40Josh Clark?

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• 21:04Josh Clark?

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• 21:29Speaker 04

  First thought is like, wow, how are we gonna do all this?

• 21:31Josh Clark?

  Hey, this is Josh and Chuck from Stuff You Should Know.

• 21:34Speaker 02

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• 21:50Speaker 04

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• 21:58Josh Clark?

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• 22:04Speaker 05

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• 22:18Speaker 04

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• 22:21Josh Clark?

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• 22:25Speaker 06

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• 22:37Speaker 02

  The last two, actually the last three we're gonna talk about, because there are many, many other kinds of dementia, like we could spend hours and hours talking about all the different kinds.

• 22:47Josh Clark?

  Hours.

• 22:48Speaker 02

  But we have talked about Crohn's, Jakob's disease, and I can't remember which one, and we say that all the time.

• 22:56Josh Clark?

  It was, "Is there a disease that kills by preventing sleep?"

• 22:59Speaker 02

  Oh, is that the one?

• 23:00Josh Clark?

  Which we should have rightly called how prion diseases work.

• 23:03Speaker 02

  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.

• 23:11Josh Clark?

  Like mad cow disease?

• 23:13Speaker 02

  Yeah.

• 23:13Josh Clark?

  Or kuru.

• 23:14Speaker 02

  Yeah, exactly.

• 23:16Josh Clark?

  It's a spongeiform disease.

• 23:19Speaker 02

  Yeah.

• 23:19Josh Clark?

  So crazy.

• 23:21Speaker 02

  It is, it's very interesting, could be genetic, but, and I thought we also talked about it in organ transplant.

• 23:28Josh Clark?

  Did we?

• 23:29Speaker 02

  I think so, because it can occur because of infected tissue that you are implanted with, or from an organ.

• 23:36Josh Clark?

  Yeah, and this is neuronal loss due to the, like, holes literally being eaten into your brain by this disease.

• 23:44Speaker 02

  Yeah.

• 23:45Josh Clark?

  And then you can also get dementia from, when you have HIV, 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.

• 24:02Speaker 02

  Yeah.

• 24:03Josh Clark?

  And there are plenty of diseases, there's also reversible dementia, too, if you have a vitamin deficiency, if you take certain medications, you can develop dementia, but this is reversible.

• 24:20Speaker 02

  Right.

• 24:21Josh Clark?

  For the most part, though, age-associated dementia is not reversible.

• 24:25Speaker 02

  Right.

• 24:25Josh Clark?

  And like we said, it's kinda 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... Are, do people get more forgetful? There's an intermediate stage between dementia, a dementia diagnosis, and just normal age-related forgetfulness.

• 24:51Speaker 02

  Yeah.

• 24:51Josh Clark?

  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, you can manage them a lot better and delay, say, death or like the real devastation associated with it.

• 25:18Speaker 02

  Yeah.

• 25:18Josh Clark?

  By a significant amount of time. But 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.

• 25:33Speaker 02

  No, but you, 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, that, that...

• 25:44Josh Clark?

  They have more perspective.

• 25:45Speaker 02

  Yeah, exactly, that's what I was looking for. So don't get, you know, 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.

• 25:55Josh Clark?

  Right, unless you're very wealthy and it's your no-good nephew that you've never trusted anyway. You know?

• 26:01Speaker 02

  Very true.

• 26:02Josh Clark?

  Then maybe bring a lawyer in on it.

• 26:04Speaker 02

  That's right.

• 26:04Josh Clark?

  See what's up.

• 26:05Speaker 02

  Uh, so if you do go get checked out, from the second you walk in the door, your doctor's going to be eyeballing you and looking for any signs, um, just from their, their trained eye, like, you know, from how you walk to the way you answer questions, to how they interact with you. Uh, they want to know, they're going to have to know your history because they need to have some context to compare it to.

• 26:31Josh Clark?

  Right, like, were you always a compulsive gambler? Or is this like new behavior?

• 26:35Speaker 02

  Yeah, and it helps to bring, you know, if, if, um, if you're older, maybe bring your grown son or daughter with you.

• 26:41Josh Clark?

  Right.

• 26:42Speaker 02

  Or whoever has a lot of contact.

• 26:44Josh Clark?

  Or your spouse?

• 26:44Speaker 02

  Sure. Uh, although your spouse, you never know.

• 26:47Josh Clark?

  Why?

• 26:48Speaker 02

  I don't know, maybe he's trying to get rid of you.

• 26:50Josh Clark?

  Oh, yeah, like that no-good nephew?

• 26:52Speaker 02

  Yeah, exactly. Um, I'm just kidding, of course. Although I'm sure that happens. Uh, then there are a couple of tests that they usually do in conjunction with one another. Um, the Mini Mental State Examination, the MMSE.

• 27:06Josh Clark?

  Mm-hmm.

• 27:07Speaker 02

  Um, just a lot of basic questions there, um, for mental tasks.

• 27:11Josh Clark?

  But they're coded, the tasks are.

• 27:13Speaker 02

  Yeah, and they're scored individually.

• 27:15Josh Clark?

  Yeah, um, and when you, when you say, uh, question three, this person got an eight on.

• 27:22Speaker 02

  Yeah.

• 27:23Josh Clark?

  Uh, you can go over and be like, "Yep, dementia." And it's actually pretty effective, actually.

• 27:28Speaker 02

  It is.

• 27:28Josh Clark?

  And there's another test that ties into the MMSE that, um, they're, they both indicate one another, which apparently they're both really good at indicating dementia. But this other test is called the Clock Drawing Test. Did you look this thing up?

• 27:42Speaker 02

  Yeah, I thought it was pretty fascinating.

• 27:43Josh Clark?

  It really is.

• 27:44Speaker 02

  Yeah, it seems really, like, why would someone tell someone to draw a clock at a certain time of the day?

• 27:51Josh Clark?

  Yeah, usually they say, "Draw a clock," uh, showing that it's ten after eleven.

• 27:56Speaker 02

  Yeah.

• 27:57Josh Clark?

  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, um, skills, right? So like, first of all, you have to remember what a clock is.

• 28:10Speaker 02

  Yeah.

• 28:11Josh Clark?

  And what it signifies. That's a big one.

• 28:12Speaker 02

  What it looks like.

• 28:13Josh Clark?

  Uh, yeah, is, a clock isn't made of like squiggly lines or anything like that. Um, you have to remember how a clock is laid out, the order that the numbers go in, that it doesn't keep going after twelve to thirteen, fourteen, fifteen. And then, once you got all this, you have to show the hands showing that it's ten after eleven. So the hands won't be pointing at ten and eleven. It should be, uh, the longer hand should be pointing at the two, and the shorter hand should be just past the eleven, right?

• 28:42Speaker 02

  That's right.

• 28:42Josh Clark?

  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 this.

• 28:52Speaker 02

  Yeah, the four specific things it requires are verbal understanding, uh, memory, spatially coded knowledge, and constructive skills. And if any of those are off in conjunction with the MMSE, then they're gonna have a pretty good idea of where you fall on the dementia scale.

• 29:07Josh Clark?

  If you don't have the constructive skills to pay the bills, you may have dementia.

• 29:11Speaker 02

  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.

• 29:21Josh Clark?

  Right.

• 29:21Speaker 02

  And it checks out.

• 29:22Josh Clark?

  Yeah.

• 29:22Speaker 02

  They stood behind it and said, yeah, it's actually a really good indicator.

• 29:26Josh Clark?

  Yeah, like, it really holds up. And I think they developed it in the 60s, but it didn't take off until the 80s.

• 29:31Speaker 02

  It seems like a very 60s thing.

• 29:33Josh Clark?

  It does.

• 29:34Speaker 02

  You know?

• 29:34Josh Clark?

  But it's something you can do anywhere. And now they're starting to gather these different 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.

• 29:51Speaker 02

  Right.

• 29:51Josh Clark?

  They may have this type of dementia.

• 29:52Speaker 02

  Right. Or this one looks like Salvador Dali drew it.

• 29:55Josh Clark?

  Right.

• 29:55Speaker 02

  Then they might have this kind of dementia.

• 29:58Josh Clark?

  Yeah.

• 29:58Speaker 02

  Or they might just be super talented and creative.

• 30:01Josh Clark?

  Yeah.

• 30:01Speaker 02

  You never know. All right, let's, should we take another break?

• 30:07Josh Clark?

  Why not?

• 30:07Speaker 02

  Is it time?

• 30:08Josh Clark?

  Sure.

• 30:09Speaker 02

  All right, we'll be back after this to talk about treatment and some of the other pitfalls of dementia.

• 30:26Speaker 02

  Hey, everybody. The holidays are coming up, so let us throw this out there. Are you prepared to host friends or family? Like, really prepared? Because there's a difference between having people stay at your house and properly hosting them.

• 30:37Josh Clark?

  Yeah, that's what we thought. So maybe it's time for a little refresh. Well, we have a tip. For all things hosting, Wayfair delivers high-quality, customer-trusted products for your home, so you can host and celebrate without the stress.

• 30:50Speaker 02

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• 31:00Josh Clark?

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• 31:12Speaker 02

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• 31:28Josh Clark?

  Hey everybody. The best pieces in your closet are the ones you can count on. Whether you're heading to work, or going out, or keeping things casual. And this time of year, Quince makes finding something great for everyone else just as easy. This holiday season, it's where you want to shop for yourself and everyone on your list.

• 31:46Speaker 02

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• 32:01Josh Clark?

  Yeah, plus, everything at Quince is priced 50 to 80% less than similar brands. They work directly with ethical factories and cut out the middlemen, so you can give luxury, quality pieces without the luxury price tag.

• 32:13Speaker 02

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• 32:46Josh Clark?

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

• 33:09Speaker 02

  Yeah.

• 33:11Josh Clark?

  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.

• 33:23Speaker 02

  Yeah.

• 33:23Josh Clark?

  Do you think you're going to remember to take those medications?

• 33:26Speaker 02

  Right.

• 33:27Josh Clark?

  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.

• 33:43Speaker 02

  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 to chew and swallow and you could choke?

• 34:00Josh Clark?

  Right.

• 34:00Speaker 02

  That's a real danger.

• 34:01Josh Clark?

  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.

• 34:08Speaker 02

  Right.

• 34:08Josh Clark?

  It's like, no, the brain is actually being slowly destroyed.

• 34:11Speaker 02

  Yeah.

• 34:11Josh Clark?

  Periodically, and eventually it's going to reach the parts of the brain where like you can't swallow any longer.

• 34:17Speaker 02

  Yeah.

• 34:17Josh Clark?

  Then you die from that kind of thing. You also can lose your sense of hunger, like you just aren't hungry anymore.

• 34:25Speaker 02

  Yeah.

• 34:25Josh Clark?

  It's kind of tough to eat, especially when you're not thinking or remembering that you should eat, when you're just not hungry ever.

• 34:32Speaker 02

  Yeah.

• 34:32Josh Clark?

  It's a tough one.

• 34:33Speaker 02

  Uh, hygiene, uh, 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.

• 34:46Josh Clark?

  Yeah.

• 34:46Speaker 02

  Uh, it just falls by the wayside. Um, I know that was the case with my grandmother. She needed, you know, she needed to be bathed.

• 34:53Josh Clark?

  Yeah.

• 34:53Speaker 02

  Uh, by my dad.

• 34:54Josh Clark?

  Cause she lost interest in it, or because she just couldn't do it anymore?

• 34:58Speaker 02

  Uh, I think both.

• 35:00Josh Clark?

  Yeah.

• 35:00Speaker 02

  Yeah.

• 35:01Josh Clark?

  Um, that's another indicator. You said that when you go in for a diagnosis, the doctor's 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.

• 35:11Speaker 02

  Yeah.

• 35:12Josh Clark?

  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.

• 35:21Speaker 02

  Yeah, whenever she left the house.

• 35:22Josh Clark?

  Now, she just wears this dirty old bathrobe all the time and doesn't ever want to take a shower.

• 35:26Speaker 02

  Yeah.

• 35:26Josh Clark?

  That's, that's usually an indicator of dementia.

• 35:28Speaker 02

  Yeah, it's not like she just gave up and doesn't care anymore.

• 35:32Josh Clark?

  Right.

• 35:33Speaker 02

  It's, it's part of the symptoms.

• 35:34Josh Clark?

  Yeah.

• 35:35Speaker 02

  Taking hold.

• 35:35Josh Clark?

  Although, another problem with dementia and, and one of the confounding factors is that depression can be a byproduct or a comorbidity of dementia.

• 35:46Speaker 02

  Yeah.

• 35:46Josh Clark?

  Because you recognize that your life is changing in ways that you're not happy about.

• 35:51Speaker 02

  Yeah.

• 35:51Josh Clark?

  You can't communicate anymore, you forget stuff all the time, you can become depressed. Um, so then that could lead to you giving up on. Taking showers and dressing as well.

• 36:00Speaker 02

  Yeah, and not only depressed, but agitated and aggressive, riddled with anxiety. A lot of your emotional well-being and emotional health will be slipping away from you.

• 36:12Josh Clark?

  Yeah, and again, this can be a direct result of chemical changes in your brain

• 36:18Speaker 02

  Yeah.

• 36:18Josh Clark?

  due to dementia, or it can be like this is the result of you recognizing these changes and just becoming upset about them.

• 36:26Speaker 02

  We talked about communication and the hallucinations. You're gonna have trouble sleeping as well in a lot of cases.

• 36:33Josh Clark?

  Yeah.

• 36:34Speaker 02

  And then personal safety. A lot of people die every day because of accidents that happen as a result of dementia.

• 36:42Josh Clark?

  Right, people who shouldn't be driving get into cars.

• 36:45Speaker 02

  Yeah.

• 36:45Josh Clark?

  And there's this, 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.

• 36:59Speaker 02

  Really neat.

• 37:00Josh Clark?

  Yeah, it's basically saying, look, we've got about one in eight people over 65 in the US 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 don't withdraw $80,000 from their bank account and walk around with it in their pockets outside.

• 37:32Speaker 02

  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.

• 37:45Josh Clark?

  Yeah.

• 37:46Speaker 02

  Or, should I just say waitrons?

• 37:48Josh Clark?

  Sure.

• 37:49Speaker 02

  Go to banks and talk to tellers, go to anywhere where there's interaction with another human. Grocery store, check out people.

• 37:57Josh Clark?

  Yep.

• 37:57Speaker 02

  And literally train them on, like you said, how to recognize it and how to kindly deal with these people.

• 38:03Josh Clark?

  Right, exactly. Apparently, one of the things you teach people in service industries is not take it personally.

• 38:10Speaker 02

  Right.

• 38:10Josh Clark?

  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 solid Friendly manner.

• 38:25Speaker 02

  Yeah.

• 38:26Josh Clark?

  Tends to get results from the dementia patient.

• 38:31Josh Clark?

  Especially if you are.

• 38:32Speaker 02

  You mean not being an aggressive jerk?

• 38:34Josh Clark?

  Right, exactly. Just being nice will.

• 38:37Speaker 02

  Yeah.

• 38:38Josh Clark?

  Frequently get good results. And yeah, it is a pretty neat initiative.

• 38:43Speaker 02

  Absolutely. And necessary.

• 38:47Josh Clark?

  Yeah.

• 38:48Speaker 02

  You know?

• 38:48Josh Clark?

  But it's, it's, I'm stricken by the idea that people are planning out this far ahead.

• 38:54Speaker 02

  Yeah.

• 38:55Josh Clark?

  For this kind of thing, it's exceptional.

• 38:58Speaker 02

  It is, and scary, but awesome. So if you do have a family member, one thing that's important to remember, there's something called the caregiver burden.

• 39:08Josh Clark?

  Yeah.

• 39:08Speaker 02

  That my dad and his wife definitely experience, it is really, really tough.

• 39:12Josh Clark?

  Yeah.

• 39:12Speaker 02

  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 twenty-eight percent. Twenty-eight percent in the first year after they're diagnosed.

• 39:30Josh Clark?

  Yeah.

• 39:30Speaker 02

  And only twenty-two percent for a husband whose wife is diagnosed. And then.

• 39:37Josh Clark?

  It's still a pretty significant increase.

• 39:38Speaker 02

  Oh, sure.

• 39:39Josh Clark?

  Just from the dementia diagnosis.

• 39:41Speaker 02

  Uh huh.

• 39:41Josh Clark?

  Yeah.

• 39:42Speaker 02

  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 gonna do more harm anyway.

• 39:58Josh Clark?

  Right.

• 39:58Speaker 02

  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.

• 40:04Josh Clark?

  Yeah, and this caregiver burden or caregiver burnout is a very real thing physically too, like you have low energy. You're, you have low productivity, you become snippy, resentful, angry, and you can end up basically.

• 42:43Josh Clark?

  From the Umami episode.

• 42:44Speaker 02

  Uh, yeah, it was definitely in that one.

• 42:46Josh Clark?

  Um, and then there's also stuff you can, so these drugs will help some.

• 42:52Speaker 02

  That's for non vascular dementia.

• 42:54Josh Clark?

  Right. With, with vascular dementia, you're gonna wanna take blood thinners.

• 42:58Speaker 02

  That's just to prevent a stroke.

• 43:00Josh Clark?

  Yeah, to keep more strokes from coming along and making the whole thing worse. Um, 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.

• 43:11Speaker 02

  Yeah.

• 43:12Josh Clark?

  Um, 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, um, uh, what's the scan?

• 43:24Speaker 02

  MRI?

• 43:24Josh Clark?

  Yeah, MRI scans.

• 43:26Speaker 02

  Yeah.

• 43:26Josh Clark?

  Um, and you can really go back and accurately identify types of dementia from autopsies, right?

• 43:33Speaker 02

  Right.

• 43:34Josh Clark?

  And so for 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.

• 43:42Speaker 02

  Right.

• 43:43Josh Clark?

  Or where you have Alzheimer's and Lewy bodies disease. Um, 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, you can put them on a drug regimen that could really kinda help more than just treating the Alzheimer's and letting the Lewy body.

• 44:02Speaker 02

  Yeah.

• 44:02Josh Clark?

  Go unrecognized and rampant.

• 44:04Speaker 02

  Yeah.

• 44:04Josh Clark?

  Or unchecked. There's also preventative stuff you can do too.

• 44:09Speaker 02

  Oh, yeah?

• 44:10Josh Clark?

  Yeah.

• 44:11Speaker 02

  Like what?

• 44:11Josh Clark?

  Crossword puzzles.

• 44:13Speaker 02

  Yeah. I told you Emily's grandmother, Mary, is ninety-five.

• 44:18Josh Clark?

  Yeah.

• 44:18Speaker 02

  And very sharp.

• 44:19Josh Clark?

  Yeah.

• 44:20Speaker 02

  Uh, and she does word puzzles all the live long day.

• 44:24Josh Clark?

  And so is it Sudoku?

• 44:26Speaker 02

  Yeah, she does, she does all kinds of word puzzles.

• 44:28Josh Clark?

  Yeah.

• 44:29Speaker 02

  Things that I have never even heard of.

• 44:31Josh Clark?

  Supposedly that helps stave it off.

• 44:32Speaker 02

  Oh, yeah.

• 44:33Josh Clark?

  Apparently, um, this one's great. Alcohol, moderate alcohol consumption, which is uh, two a day for men or one a day for women.

• 44:41Speaker 02

  Okay.

• 44:41Josh Clark?

  Uh, has a protective effect. It staves off Alzheimer's, or it 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.

• 44:57Speaker 02

  Uh, probably up to that two drinks and then it's probably bad after that.

• 45:00Josh Clark?

  Yes, then it becomes very bad after that.

• 45:02Speaker 02

  Yeah.

• 45:02Josh Clark?

  So you wanna just moderate amount.

• 45:04Speaker 02

  Right. In all things, people.

• 45:07Josh Clark?

  Moderation.

• 45:08Speaker 02

  Moderation. Uh, and then, uh, there are some things that you can do.

• 45:15Speaker 02

  Here's the thing, there's a debate on whether or not, um, you're tricking your loved one by doing things like, um, giving them, uh, an appliance that doesn't work so they can pretend that they're ironing or something.

• 45:32Josh Clark?

  Right.

• 45:33Speaker 02

  Because they used to love to take care of their laundry themselves. So here, let me remove the cord from this iron.

• 45:38Josh Clark?

  Mm-hmm.

• 45:39Speaker 02

  And, uh, and is that tricking someone? Is it not? Uh, and a lot of people think, no, that's what you should do because it makes them feel like they're being useful.

• 45:49Josh Clark?

  Mm-huh.

• 45:49Speaker 02

  They're not gonna get hurt with a hot iron.

• 45:51Josh Clark?

  Yeah.

• 45:51Speaker 02

  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.

• 45:59Josh Clark?

  Right.

• 46:00Speaker 02

  I think it's fine.

• 46:01Josh Clark?

  I think it's fine too. And there's actually, um, there's a, an entire village set up in, uh, I think like, uh, just outside of Amsterdam.

• 46:10Speaker 02

  Yeah, this is awesome.

• 46:11Josh Clark?

  Called Hojvee, right?

• 46:12Speaker 02

  Yeah.

• 46:12Josh Clark?

  Hojvee? How would you say that?

• 46:14Speaker 02

  I have no idea because Dutch is the weirdest, the weirdest language.

• 46:18Josh Clark?

  Hojvee? We'll say that, okay?

• 46:20Speaker 02

  Okay.

• 46:21Josh Clark?

  Um, and, uh, it's a, it is, it's in what's called a dementia village, basically.

• 46:26Speaker 02

  Yeah.

• 46:27Josh Clark?

  Where everyone who lives in this village, I think a hundred and fifty people, all have dementia. And they live in group houses that are-

• 46:36Speaker 02

  Well, there's caretakers that live there too, but-

• 46:38Josh Clark?

  Okay, yes, you're right.

• 46:38Speaker 02

  Yeah.

• 46:39Josh Clark?

  Um, and they live in the group houses with them.

• 46:41Speaker 02

  Yes.

• 46:41Josh Clark?

  And a lot of the people realize that this is their nurse.

• 46:45Speaker 02

  Uh-huh.

• 46:46Josh Clark?

  Or just think it's a good friend of theirs.

• 46:48Speaker 02

  Yeah.

• 46:48Josh Clark?

  They, they don't really remember where, when they became friends.

• 46:51Speaker 02

  A cool roommate?

• 46:52Josh Clark?

  Yeah, exactly.

• 46:52Speaker 02

  Yeah.

• 46:53Josh Clark?

  Um, and the houses they live in have different themes according to how the people lived, depending on whether they're a blue collar, whether they- Their memories go back to the seventies. This whole place is basically set up so that it's a very non-threatening, safe place.

• 47:09Speaker 02

  Yeah.

• 47:09Josh Clark?

  For these people to just kind of live and move about within.

• 47:14Speaker 02

  Sure, safely?

• 47:15Josh Clark?

  Yeah, safely. And so they can go to the grocery store, they can go to the movies, they can go ride a bike.

• 47:22Speaker 02

  And everyone, the people at the movie theater know that the people there have dementia.

• 47:27Josh Clark?

  Right.

• 47:28Speaker 02

  It's like every, they're real movie theater workers and real waiters in the restaurants.

• 47:32Josh Clark?

  They're just specially trained.

• 47:33Speaker 02

  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 gonna get."

• 47:44Josh Clark?

  Yeah, exactly.

• 47:46Speaker 02

  Then, of course, there's other people at Poopoo and say, "No, you're tricking these people."

• 47:49Josh Clark?

  But you can say, "Hey, okay, here's the big difference with this place." 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.

• 48:06Speaker 02

  Yeah.

• 48:07Josh Clark?

  In Hodgeve Village.

• 48:09Speaker 02

  Yeah.

• 48:10Josh Clark?

  That city worker is specially trained to get that person back to their house or alert their caretaker that this person is having a crisis or something like that.

• 48:19Speaker 02

  It's what we're trying to train people to do in the future.

• 48:21Josh Clark?

  Yes.

• 48:22Speaker 02

  They've just isolated it to a community.

• 48:23Josh Clark?

  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 the patients themselves. It's not like you're doing it to experiment on them.

• 48:38Speaker 02

  No, no.

• 48:38Josh Clark?

  You know, or because they'll produce gold in their urine or something like that, you know? Like, this is strictly for their protection.

• 48:46Speaker 02

  Yeah.

• 48:47Josh Clark?

  But also allowing them to live a free life outside of a clinical setting.

• 48:52Speaker 02

  Right.

• 48:53Josh Clark?

  I don't see much wrong with that. I do get what the bioethicists are saying, like, yes, you're robbing someone of their dignity by lying to them. Diluting them or playing into their fantasies, strictly speaking, yes. In the real practical world, I think this is great.

• 49:06Speaker 02

  If I'm at that point, then play into my fantasies.

• 49:09Josh Clark?

  Exactly.

• 49:10Speaker 02

  Please.

• 49:11Josh Clark?

  It is 1984 all the time.

• 49:16Speaker 02

  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.

• 49:28Josh Clark?

  Right.

• 49:28Speaker 02

  You know?

• 49:29Josh Clark?

  And so, Hodgevee Village, I hope I'm saying that right, because I'm really putting myself out there.

• 49:34Speaker 02

  Oh, I'm sure you're not.

• 49:36Josh Clark?

  It's become this kind of ideal standard of care, but it's also really expensive.

• 49:42Speaker 02

  Yeah, I'm sure.

• 49:42Josh Clark?

  So in a country where there's a lot of socialized medicine, it could do pretty well, like in the Netherlands or in Canada.

• 49:49Speaker 02

  Yeah, when they take care of people, even though they don't have money.

• 49:51Josh Clark?

  Right, exactly. There's, there's one called, in Canada, it's called Pentanguissheni. Pentanguissheni, 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 patients' families are very happy with this kind of thing, too.

• 50:17Speaker 02

  Well, and hopefully with the initiative of, what's it called?

• 50:21Josh Clark?

  Dementia Friendly America.

• 50:23Speaker 02

  America. DFA.

• 50:25Josh Clark?

  Yep. Dot org.

• 50:27Speaker 02

  Yeah, hopefully with those efforts, more and more people will, because it's coming.

• 50:32Josh Clark?

  Oh, yeah, it's coming.

• 50:32Speaker 02

  A lot more folks are going to be out there that we need to take care of.

• 50:35Josh Clark?

  Yeah, we don't know how to cure dementia, we just know it's coming.

• 50:40Speaker 02

  I'm going to be one of them.

• 50:42Josh Clark?

  You think so?

• 50:44Speaker 02

  Sure, at some point, if I'm, if I make it that long.

• 50:47Josh Clark?

  But you, not everybody gets dementia, no matter how long you live.

• 50:51Speaker 02

  I don't know, I've got a feeling.

• 50:53Josh Clark?

  You really?

• 50:54Speaker 02

  Yeah, it does run in my family a little bit.

• 50:56Josh Clark?

  Yeah.

• 50:57Speaker 02

  And I, and I have the, my father's family genes more than my mother's.

• 51:01Josh Clark?

  I got you.

• 51:02Speaker 02

  I feel like. And so if, if I had my mother's genes.

• 51:08Speaker 02

  They all died from heart attacks and strokes.

• 51:10Josh Clark?

  Oh, okay.

• 51:11Speaker 02

  And heart disease.

• 51:12Josh Clark?

  Young?

• 51:12Speaker 02

  Not a lot of cancer. Yeah, pretty young.

• 51:15Josh Clark?

  Yeah. So if you make it past sixty-five.

• 51:19Speaker 02

  Yeah.

• 51:20Josh Clark?

  You, you beat the heart stuff.

• 51:21Speaker 02

  Then the Bryant genes kick in.

• 51:23Josh Clark?

  Then you got the dementia.

• 51:24Speaker 02

  Yeah.

• 51:25Josh Clark?

  Well, we're all going down one way or another, right?

• 51:26Speaker 02

  I may live to be a hundred.

• 51:27Josh Clark?

  Yeah?

• 51:28Speaker 02

  You know?

• 51:28Josh Clark?

  Yeah.

• 51:32Josh Clark?

  Man, I thought of something. Oh, yeah. I wonder, Chuck, if like our specific, like us, you and me specifically, creaming all this information in every week.

• 51:41Speaker 02

  Yeah.

• 51:42Josh Clark?

  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.

• 51:51Speaker 02

  Yeah.

• 51:51Josh Clark?

  Like, are we, are we abusing our brains or are we exercising it? I question that sometimes.

• 51:56Speaker 02

  I bet someone out there, I bet there's a neurologist who has a good gut instinct answer to that one.

• 52:01Josh Clark?

  Let us know. I want to know. Good news or bad? Okay, neurologists?

• 52:06Speaker 02

  There's going to be a subject line that just says, "Neurologist, guys, you're screwed."

• 52:11Josh Clark?

  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 House of Works and it'll bring up a great article. Since I said "search bar," it's time for listener mail.

• 52:28Speaker 02

  I'm going to call this one "Hecky Krasnaw Lives."

• 52:34Speaker 02

  Although I don't think he is with us.

• 52:38Speaker 02

  "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?

• 52:52Josh Clark?

  That is pretty great.

• 52:53Speaker 02

  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. He produced the songs for it, as well as several, several Christmas carols, including Frosty the Snowman and his biggest claim to fame, Rudolph the Red-Nosed Reindeer.

• 53:15Josh Clark?

  That is awesome.

• 53:16Speaker 02

  I've always thought it was very funny that- A Jewish guy was responsible for the popularity of Christmas carols. My family, all still Jewish, watches the claymation Rudolph movie every year because of that.

• 53:27Josh Clark?

  Sure.

• 53:28Speaker 02

  Our own little taste of that irony.

• 53:29Josh Clark?

  Yeah.

• 53:30Speaker 02

  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, Heikki Krasnall was a pretty interesting person. There might just be enough material for an episode on him, up to you.

• 53:44Josh Clark?

  Nice.

• 53:44Speaker 02

  Thanks for helping with my schoolwork. That is from Aiden in Maryland.

• 53:49Josh Clark?

  Awesome. Thank you very much, Aiden.

• 53:52Speaker 02

  And when I say Heikki Krasnall lives, I mean, lives on.

• 53:54Josh Clark?

  Sure, like viva la Heikki.

• 53:56Speaker 02

  Yeah.

• 53:58Josh Clark?

  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 [email protected]. And as always, join us at our home on the web, stuffyoushouldknow.com.

• 54:21Speaker 03

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

• 54:37Josh Clark?

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• 55:21Josh Clark?

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• 56:06Speaker 00

  This is an iHeart Podcast. Guaranteed Human.