{ "version": "1.0.0", "segments": [ { "speaker": "Jane", "startTime": "0.71999997", "endTime": "27.145", "body": "As a family, we were sure mum had dementia with her increased memory problems. Because of her hearing loss, she put everything down to not hearing things. It is not my memory. She did not want a diagnosis. But we knew what was important to her and so we kept her active and involved in those things she loved. Adapting how she did things or accessed things along the way. Family was always her priority." }, { "speaker": "Tracy Parish", "startTime": "33.11", "endTime": "52.715", "body": "It's no secret. We are all getting older. So how can we age well? What happens if you or a loved one is diagnosed with dementia? In this episode, we're going to be talking with one of Australia's leading dementia experts to explore if dementia is even preventable and how research can help improve our lives." }, { "speaker": "Tracy Parish", "startTime": "53.195", "endTime": "67.1", "body": "Welcome to Help! I'm Ageing, a podcast from the National Centre for Healthy Ageing, Australia's leading healthy ageing research centre tackling the big questions we face as we get older. I'm Tracy Parish, and together with my co-host, Dr Taya Collyer." }, { "speaker": "Taya Collyer", "startTime": "67.1", "endTime": "67.82", "body": "Hi, Tracy." }, { "speaker": "Tracy Parish", "startTime": "67.82", "endTime": "93.8", "body": "Hi, Taya. We'll be talking with visionary researchers and people with living experience. We'll be sharing real stories, real evidence, real insights with you. We'll discover new ways of thinking and find out how data and science can help you have a healthier future. With Australia's population rapidly ageing, the time has never been more pressing to shine a light on what's possible when we combine research, health care, and living experience." }, { "speaker": "Tracy Parish", "startTime": "94.2", "endTime": "98.44", "body": "How can you age well? Let's find out. But firstly, Taya, come on. Who are we?" }, { "speaker": "Taya Collyer", "startTime": "98.44", "endTime": "105.274994", "body": "Tracy, I am a biostatistician doing the stats at the National Centre for Healthy Ageing, loving my spreadsheets." }, { "speaker": "Tracy Parish", "startTime": "105.274994", "endTime": "113.994995", "body": "And doing it very well, I hear. And I'm a journalist, an Olympic broadcaster turned medical research communicator, and now a podcaster. Tell me, who we've got on board today." }, { "speaker": "Taya Collyer", "startTime": "114.340004", "endTime": "136.52501", "body": "As you mentioned, Tracy, we are unpacking all things dementia today. Diagnosis, risk factors, and perhaps ways to prevent it, and how research is helping to understand this condition that is something a lot of Australians think about. Our special guest is Professor Velandai Srikanth, a geriatrician and Director of the National Centre for Healthy Ageing. Welcome." }, { "speaker": "Velandai Srikanth", "startTime": "136.605", "endTime": "138.285", "body": "Hi, Taya. Hi, Tracy." }, { "speaker": "Tracy Parish", "startTime": "138.285", "endTime": "159.325", "body": "I've gotta say, with an intro like that, we're expecting something really big here, Professor Srikanth. First of all, before we get to what dementia is, let's just paint the picture of what the scale of the issue is. I say issue, but it it's a major health factor for Australia at the moment. I'm hearing numbers like 446,000 or roundabout Australians." }, { "speaker": "Velandai Srikanth", "startTime": "159.325", "endTime": "164.845", "body": "That's about right. I think at least 450,000 people in Australia have dementia that we know of." }, { "speaker": "Taya Collyer", "startTime": "164.845", "endTime": "167.005", "body": "So that's five MCGs worth." }, { "speaker": "Velandai Srikanth", "startTime": "167.245", "endTime": "181.46", "body": "Oh, I hadn't thought about it that way. That's a lot of people. That's impressive. But the point is that that's probably just scraping top. There's there's a lot of people with dementia that we don't know about that probably live ..." }, { "speaker": "Tracy Parish", "startTime": "181.62", "endTime": "182.18", "body": "So they're diagnosed." }, { "speaker": "Velandai Srikanth", "startTime": "183.46", "endTime": "184.34", "body": "Correct. Yeah." }, { "speaker": "Tracy Parish", "startTime": "184.9", "endTime": "186.765", "body": "And recorded somewhere, obviously. Rather than self-diagnosed." }, { "speaker": "Velandai Srikanth", "startTime": "187.56499", "endTime": "205.55", "body": "Not just in Australia. I think the world is, it's a huge health condition for the current generations and future generations to deal with. If you look at dementia as such, its now probably the second most common cause of death in the country and across the world." }, { "speaker": "Tracy Parish", "startTime": "205.63", "endTime": "209.39", "body": "And is it rising because of the ageing population that I've talked about?" }, { "speaker": "Velandai Srikanth", "startTime": "209.39", "endTime": "220.265", "body": "I think that's a primary reason. As people get older they are at higher risk, but there's probably a surge in other risk factors that we could talk about could be controlled." }, { "speaker": "Tracy Parish", "startTime": "220.50499", "endTime": "235.49", "body": "Okay. We'll get to that shortly. One point seven million carers who are involved in supporting their loved one or someone they know close. And then of course, we've got residential aged care where I think it's something like more than 50 percent of the residents have dementia." }, { "speaker": "Velandai Srikanth", "startTime": "235.49", "endTime": "267.53", "body": "And that speaks to the complexity of the condition, the burden of the condition. So I've looked after parents and grandparents and in-laws who have had dementia and it's not easy. My wife has too, and it's clearly a difficult thing for people to deal with their loved ones going through a transition of dementia, losing their memories, becoming more dependent physically towards the end. It's a huge issue and I wouldn't be surprised if there are more people than that who are caring for people with dementia." }, { "speaker": "Tracy Parish", "startTime": "267.53", "endTime": "268.49", "body": "What is dementia?" }, { "speaker": "Velandai Srikanth", "startTime": "270.095", "endTime": "286.91", "body": "In the simplest way, dementia is a condition where there is a gradual loss of more than one or two cognitive abilities for a person, occurring most commonly as people get much older, but can occur sometimes in people who are younger." }, { "speaker": "Tracy Parish", "startTime": "286.91", "endTime": "289.07", "body": "So is it an umbrella term?" }, { "speaker": "Velandai Srikanth", "startTime": "289.31", "endTime": "320.7", "body": "It is an umbrella term describing what I just said to you, and there are many causes for it, that's what confuses people. So what people often refer to as Alzheimer's disease is actually a type of dementia. There's a development of proteins in the brain, which are called Alzheimer proteins, which cause the progressive cognitive decline. That's Alzheimer's dementia, that's the most common cause of dementia. There are also other causes such as vascular disease, for example, strokes and other things that occur in your brain from vascular health." }, { "speaker": "Velandai Srikanth", "startTime": "321.26", "endTime": "347.60004", "body": "There are certain specific kinds of dementia called frontotemporal dementia which are related to certain parts of the brain not being healthy or having neurodegeneration as we call it, or another one called Lewy Body dementia. So there are different kinds of dementia depending on what's happening in the brain, But dementia itself is the umbrella term which refers to that progressive loss of cognitive function that might affect a person's life and function." }, { "speaker": "Tracy Parish", "startTime": "348.64", "endTime": "353.44", "body": "And what is it not? If I start forgetting things ... \"Where am I?\" ... but I'm getting older." }, { "speaker": "Velandai Srikanth", "startTime": "353.965", "endTime": "384.635", "body": "So as I said before, ageing itself is not synonymous with dementia. So as people get older, we do have, we're a little slower in how we think, we're a little bit more, we need to focus on one thing more than focus on several things at the same time. So those kinds of changes in speed of processing and attention, the kind of fundamental cognitive abilities, just that doesn't mean you have dementia. Dementia has got to be something much more than that, that really impacts on your life." }, { "speaker": "Taya Collyer", "startTime": "385.83502", "endTime": "401.98", "body": "Srikanth you mentioned earlier that dementia is often noted as a cause of death for Australians. It's often written on a death certificate. And this is something that perhaps as a community, we don't recognise and understand. Is dementia a terminal illness?" }, { "speaker": "Velandai Srikanth", "startTime": "402.62", "endTime": "408.86002", "body": "In a way it is. But it's not a terminal illness in the way that cancer is." }, { "speaker": "Taya Collyer", "startTime": "409.73502", "endTime": "410.855", "body": "That's confusing." }, { "speaker": "Velandai Srikanth", "startTime": "410.855", "endTime": "430.96", "body": "It is confusing, isn't it? So cancer has a way of working into various parts of your body that affect the whole body and then there is a decline that leads to death in some people. Well, dementia is different. Changes the way you are. It does change some biological parts of what you do." }, { "speaker": "Velandai Srikanth", "startTime": "430.96", "endTime": "458.87003", "body": "For example, your appetite, muscle strength, degree of frailty as people call it. It can affect that. But it does increase the risk of other conditions occurring as well and the most common kinds of things that occur to people living with dementia particularly as they get to the latter stages of dementia is infections. So chest infections or urinary tract infections and these things can become quite common." }, { "speaker": "Taya Collyer", "startTime": "459.03", "endTime": "463.59", "body": "And why does dementia make those things more common or make a person more susceptible to those things?" }, { "speaker": "Velandai Srikanth", "startTime": "463.59", "endTime": "474.565", "body": "So some people with dementia can have difficulty swallowing appropriately, so they can silently aspirate fluids into their lungs and that could cause infection." }, { "speaker": "Taya Collyer", "startTime": "474.565", "endTime": "479.285", "body": "So that's fancy doctor speak for stuff that should go into your belly ends up in your lungs." }, { "speaker": "Velandai Srikanth", "startTime": "479.365", "endTime": "512.77", "body": "Right, exactly. Hygiene is often not easy for people as they get into the latter stage of dementia, and hence, infections of the urinary tract can become common. When these infections happen, they cause the person with dementia to be quite ill and much more so than an average person without dementia getting the condition. So they can get a condition called delirium, which makes them really, confused and agitated or anxious." }, { "speaker": "Velandai Srikanth", "startTime": "513.41", "endTime": "541.35", "body": "That often increases the risk of dying by itself. Medications that are given to treat people with dementia can have an adverse impact as well. For example, if a person has delirium, they're often, some of them get medications called psychotropic medications to calm them down. They could have the adverse sort of impact of causing sedation sometimes if not used appropriately, and that can lead to complications like chest infections and dying." }, { "speaker": "Velandai Srikanth", "startTime": "541.35", "endTime": "559.005", "body": "So what I'm saying is that people with dementia can develop other conditions which are more proximal to their dying than dementia itself, but because they have dementia, these conditions occur more frequently, so yes, dementia does lead to dying as you get to the latter part of the condition." }, { "speaker": "Taya Collyer", "startTime": "559.325", "endTime": "571.47", "body": "I realise, you know, you've been talking here about latest stages or the most severe stages. What are the stages? You know, what is the journey from your office in the clinic to the events you've just described?" }, { "speaker": "Velandai Srikanth", "startTime": "571.47", "endTime": "615.015", "body": "Yep. So when a general practitioner or a person like me sees people in the clinic, they're usually coming into the clinic, they're walking, they can do certain things for themselves, like usual, and they have some mild impairments of their cognitive ability and that's the mild stage, if anything. At the next stage people might have some more impairment of functions, so their daily functions such as dressing, showering, feeding themselves, or doing their finances, things like that could change and that puts them up at a different stage. Cooking, which should have been an automatic and intrinsic things if they've been doing that in the past becomes more difficult. But towards the latter or severe stages of dementia, there is much more dependency for these kind of functions." }, { "speaker": "Velandai Srikanth", "startTime": "615.495", "endTime": "624.295", "body": "Towards the very end, people might get less mobile, more chair bound or sometimes bed bound. So that's a severe stage of dementia." }, { "speaker": "Taya Collyer", "startTime": "624.93", "endTime": "633.41", "body": "Okay, let's talk now about diagnosis. How are Australians diagnosed with dementia? Where and by whom?" }, { "speaker": "Velandai Srikanth", "startTime": "633.81", "endTime": "642.025", "body": "I think people can receive a diagnosis in many settings. Primary care, general practitioners can make that diagnosis if it's quite obvious." }, { "speaker": "Taya Collyer", "startTime": "642.025", "endTime": "642.825", "body": "Is that new?" }, { "speaker": "Velandai Srikanth", "startTime": "643.385", "endTime": "673.605", "body": "I don't think it's new, it's been happening over a long time, but most often when people come with early symptoms and GPs are not quite sure of what the diagnosis is, that's when they refer to specialists. Now specialists could be in the private system, be in the public system, could be a range of kind of specialists, geriatricians, neurologists, some psychiatrists who also work in the field. That's the next level of diagnosis and that's probably where the diagnosis is clearly made or confirmed." }, { "speaker": "Tracy Parish", "startTime": "674.405", "endTime": "684.25", "body": "When you've told someone that they have dementia, it's an emotional response I'm sure, but what's it like for them, but also for you?" }, { "speaker": "Velandai Srikanth", "startTime": "685.29004", "endTime": "731.605", "body": "It's taken many years for me to get to a point when I'm comfortable with speaking about it with a patient who's come to me for help. So early on in my career, I'd be worried about how I'd say this to them. But now I understand that the reason why people come to you is because they want clarity. So being honest about the diagnosis is important, but also saying it in a way that doesn't talk about the difficulties or the deficits or the impairments, but saying that this is a condition that you've got and this is the reason why we think that's the condition, showing them the tests, sometimes even showing them the scans that give us that additional piece of information makes it real for them versus just telling them you've got this condition." }, { "speaker": "Tracy Parish", "startTime": "732.165", "endTime": "737.925", "body": "I've heard you talk about making sure that people leave your clinic with a sense of hope." }, { "speaker": "Velandai Srikanth", "startTime": "738.325", "endTime": "772.54004", "body": "Yes, and so the next step is when I speak to them, say, well, now that we've given you a diagnosis, there are things that we can do to help you work through this, and also live a life that's strong and and fruitful. And that could be through a number of things, it could be through medications, it could be through supportive care networks that we set around them, give them access to the things that we talked about such as rehabilitation if they need it, groups that they need information. The more you arm a person with information about these things, the better they're gonna be." }, { "speaker": "Taya Collyer", "startTime": "772.7", "endTime": "778.94", "body": "And how do people respond? I imagine that there's not one cookie cutter response to the news that ..." }, { "speaker": "Velandai Srikanth", "startTime": "779.5", "endTime": "807.13", "body": "No. But you'd be surprised as to how many people actually take it really well. Some people do become quite emotional, families become more emotional sometimes because it's their loved one, but each person is individual. You've got to know, what I do is I tend to stay with it and let it happen at the time. And when they walk out, what I want them to have is trust in what I've done for them and what we're going to be able to do to help them." }, { "speaker": "Tracy Parish", "startTime": "807.69", "endTime": "821.835", "body": "Tell us how hard that was for you knowing the backstory, if that makes sense, of medical expertise that you've got and yet having to talk to your in-laws or others who have got dementia." }, { "speaker": "Velandai Srikanth", "startTime": "821.995", "endTime": "865.61005", "body": "The first exposure that I had to direct family being involved was my grandmother. So she looked after me when I was doing my medical education, and, she'd had a couple of strokes. And when I went back from overseas to see her, it was getting obvious that she was losing her memory, but she was still recognising me and the more I visited, the less she was able to. And she was more, she was like a mother to me during my early childhood and later on as well. So it's quite a difficult thing to see that, but at the same time my medical knowledge helped me to rationalise, to try and find out how help could be provided." }, { "speaker": "Velandai Srikanth", "startTime": "866.17004", "endTime": "882.21", "body": "And when my mother-in-law developed dementia, my wife and I could see that happening. My job was to provide them with the expertise, the knowledge, who to connect with, who are the health professionals that they could reach out to, what kind of supports could get." }, { "speaker": "Taya Collyer", "startTime": "882.61", "endTime": "890.93", "body": "I think a lot of Australians finding themselves in that situation don't know what to do or how to help, but you obviously are in a unique position there. You are in a very lucky position." }, { "speaker": "Velandai Srikanth", "startTime": "892.45", "endTime": "899.405", "body": "Yeah. Not everyone has that luck and the ability or the potential to know what to do." }, { "speaker": "Taya Collyer", "startTime": "899.405", "endTime": "922.26", "body": "Yeah, and keep yourself busy, and I think your experience there, and thanks for sharing that with us, it reminds us that dementia is not like other medical conditions. It's not just a biological process, it changes who people are, and the experience of a relative or a family member often is that dementia takes a person away from us." }, { "speaker": "Velandai Srikanth", "startTime": "922.845", "endTime": "937.40497", "body": "Absolutely. It's not, it's not like a heart attack, is it? It's not like a blood vessel gets blocked up and you know what's happening and you can fix it. This happens over a long period of time. There is biology associated with it and what happens in the brain." }, { "speaker": "Velandai Srikanth", "startTime": "937.96497", "endTime": "950.92004", "body": "But over a period of time little things happen and it's not just one point in time that everything changes. And that change in personality that you see in people, that really defines the condition. It's a syndrome." }, { "speaker": "Tracy Parish", "startTime": "951.515", "endTime": "964.955", "body": "And it's so tough if you turn up at a residential aged care home like I had to with my own mother, and they don't really know who you are. And then at other times, she did. She came in and out, if that made sense." }, { "speaker": "Velandai Srikanth", "startTime": "965.31", "endTime": "997.17", "body": "It doesn't change the person at the core. I think it makes them look different to you maybe, but I do believe that people with dementia still have their self within them. And in windows of time that comes out when you're with them. My wife used to sit with my mother-in-law in the nursing home where she was towards the end and feed her and talk to her and joke with her. And occasionally, she'd come out with a smile and and you knew she had it. So that's always there. That's the hopeful part of it." }, { "speaker": "Tracy Parish", "startTime": "997.32996", "endTime": "1004.29", "body": "And often they remember the past, you know, their childhood or the early days, not necessarily most recently. Is that part of what happens?" }, { "speaker": "Velandai Srikanth", "startTime": "1005.25", "endTime": "1031.72", "body": "So the kind of structures in the brain that are affected are more to do with how you take in new memories and store them and be able to bring them out. So the older memories are well stored, well filed away, if you can put it that way, and they know how to access it. It's an automatic thing. Towards the end, that even that might start to go, but generally speaking, those memories are there which provides that emotional connection that you can have with your loved one." }, { "speaker": "Tracy Parish", "startTime": "1032.12", "endTime": "1051.4999", "body": "When you're having a family function and you've got a loved one who's coming along who has dementia, could be early dementia, could be late dementia, what are your tips for the families to be able to make that a really positive experience for them and for you? Because often people will say, don't you remember this or don't you remember that? Well, they don't." }, { "speaker": "Velandai Srikanth", "startTime": "1051.74", "endTime": "1085.37", "body": "Yep. Absolutely. It's not an uncommon situation, not just in settings where people family are getting together, but just on one-on-one when a relative is talking to the person living with dementia. During our lives we grow up with those kind of conversations in our heads, right? So we say, I've told you that, don't you remember I said that before? And that kind of conversation if it carries on with a person who's living with dementia, it might have an adverse impact on their self esteem, on their ability to include themselves. They might want not to be part of a conversation." }, { "speaker": "Taya Collyer", "startTime": "1085.37", "endTime": "1086.25", "body": "Their confidence, right?" }, { "speaker": "Velandai Srikanth", "startTime": "1086.25", "endTime": "1105.7399", "body": "Their confidence goes down. So I think it's important for us to be aware of that, and for family members to mindfully make the change from those kind of conversations. If a person repeats themselves, then that's the case. Go with it and respond as you would as if they've said it to you for the first time." }, { "speaker": "Tracy Parish", "startTime": "1105.74", "endTime": "1116.62", "body": "And in a group setting like that, sometimes it's handy to have one of the 'relos' go and sit one on one with them rather than expect them to follow a conversation on a large Christmas table for example." }, { "speaker": "Velandai Srikanth", "startTime": "1117.0199", "endTime": "1132.235", "body": "The one-on-one, face to face, engaging with them, giving them that connection is so important. And I think that does happen. It just needs to happen a hell of a lot more and not just have a person sitting in the corner there or in a seat when everyone else is talking the normal talk." }, { "speaker": "Tracy Parish", "startTime": "1132.555", "endTime": "1145.47", "body": "You often talk about hope. And so I think let's give some people some hope here. How can we tackle prevention of dementia? Is it possible in our own minds?" }, { "speaker": "Velandai Srikanth", "startTime": "1145.63", "endTime": "1167.9601", "body": "It's entirely possible. There's a wide body of evidence that's coming up now that suggests that you can do several things that can delay or prevent the risk of dementia occurring in yourself. If you refer to the Lancet Commission which has put out a new set of risk factors that people could attend to. There are about 14 modifiable factors that, you can attend to." }, { "speaker": "Taya Collyer", "startTime": "1167.9601", "endTime": "1172.3601", "body": "They've got some cool figures, listeners, and we're gonna put a link to those in the show notes. Check them out." }, { "speaker": "Velandai Srikanth", "startTime": "1172.3601", "endTime": "1190.695", "body": "So things like your health, blood pressure, diabetes, how physically active you could be, things like your hearing and, your sight. Those are newer things which have been recognised to say if you do try and modify them there's a potential for that to impact on your risk of dementia." }, { "speaker": "Taya Collyer", "startTime": "1190.88", "endTime": "1196.24", "body": "And over what time horizon are we talking here? Like when is the time?" }, { "speaker": "Velandai Srikanth", "startTime": "1196.24", "endTime": "1223.7699", "body": "Yeah. So this is a really interesting thing, which which I still haven't quite worked out, but I do think it happens through the lifespan. Mhmm. There are little exposures, as I call them, to these risk factors that occur through a person's life, which can impact on how the brain is, the structure of the brain, the resilience of the brain. And then as you get older, there's more conditions that occur, diseases that occur, for example, strokes, that reduce the capacity of your brain." }, { "speaker": "Velandai Srikanth", "startTime": "1224.57", "endTime": "1236.875", "body": "To my mind that prevention paradigm could be from very early life. Even childhood. Even pregnancy. Wow. Where the evidence is not quite there yet, but it's a hypothesis well worth exploring." }, { "speaker": "Taya Collyer", "startTime": "1236.875", "endTime": "1257.57", "body": "Okay, so to make it really clear for listeners, even though dementia usually manifests in older people, and we see the symptoms in people 60, 70, 80, is it the case that the beginning of the process and prevention can start in your 30s, 40s, 50s?" }, { "speaker": "Velandai Srikanth", "startTime": "1257.57", "endTime": "1268.855", "body": "Yeah. I think the understanding now is that it should clearly happen at midlife. Right. The prevention efforts should always be strongly occurring at midlife between 40 and 60 is what I would say." }, { "speaker": "Tracy Parish", "startTime": "1268.855", "endTime": "1290.535", "body": "But you know, that's when people are so busy. I mean, we talked about a sandwich generation. I'm just gonna cut in here. That's when the last thing you can think of when you're trying to not everyone's got children, but if you have got children, you're trying to juggle that, a career, you might have an older generation you're looking after. And I love the way doctors always say, look, you could just look after your weight and exercise more, it'll all work." }, { "speaker": "Velandai Srikanth", "startTime": "1292.615", "endTime": "1301.495", "body": "That's what I say to people. And guess what I do most of the time, I sit at my desk, but do cricket on the weekend. No. You're doing what I do. And try and do that in winter as well." }, { "speaker": "Velandai Srikanth", "startTime": "1301.975", "endTime": "1315.71", "body": "But you're right. The busier the person is looking after not just themselves but others, children, family, the less they are able to attend to their own health. But there must be some way that we can focus their attention on this." }, { "speaker": "Taya Collyer", "startTime": "1315.71", "endTime": "1340.0599", "body": "And let's talk about perhaps the benefits of doing so and see if we can give some encouragement and motivation to the folks out there. So can we talk about cardiovascular disease, which is not perhaps what listeners are expecting us to go deep into in an episode about dementia, but looking after stuff like your heart, your blood pressure, your blood glucose, why is that a part of dementia prevention?" }, { "speaker": "Velandai Srikanth", "startTime": "1340.38", "endTime": "1360.125", "body": "Your brain cells require good blood vessel health. So if your blood vessel health is good, your brain cells survive and do better. They function better. That's a very simple explanation. But if you look at where that blood vessel health has to be attended to, things like high blood pressure, which occurs in midlife and gets worse." }, { "speaker": "Velandai Srikanth", "startTime": "1360.9099", "endTime": "1385.3351", "body": "Keeping control of that starts to reduce your risk of strokes happening as you get older, or little white spots that might occur in your brain on an MRI which are related to high blood pressure. All that can change how efficient your brain is. Diabetes, we know that diabetes increases the risk of brain ageing and then dementia. It's not just controlling blood glucose, maybe there are other things that diabetes does by increasing inflammation, for example." }, { "speaker": "Tracy Parish", "startTime": "1386.055", "endTime": "1387.575", "body": "Both types of diabetes?" }, { "speaker": "Velandai Srikanth", "startTime": "1387.5751", "endTime": "1417.3501", "body": "Certainly Type Two Diabetes, but the evidence is gathering for Type One Diabetes and hence you're thinking about what happens even early in life. Other things like cardiovascular health, you're talking about heart attacks, preventing heart attacks, preventing rhythm problems in the heart, these are all proximal, as I say, technical term. But the kind of conditions that might occur earlier in life as you get further in life and you haven't treated them well can cause risk to the brain." }, { "speaker": "Tracy Parish", "startTime": "1417.3501", "endTime": "1422.31", "body": "If someone has a heart attack or a stroke, do doctors look at brain health?" }, { "speaker": "Velandai Srikanth", "startTime": "1422.31", "endTime": "1440.995", "body": "They're much more beginning to. So for example, there's a huge movement that occurred about 10 or 15 years ago across the globe looking at connecting the heart and the brain in research and clinical fields. That's what I do in my clinics, I do look at their cardiovascular health and try and optimise people's conditions as best as I can." }, { "speaker": "Taya Collyer", "startTime": "1440.995", "endTime": "1475.9701", "body": "Okay, so look after your heart, look after your brain. I have prepared a fun game for you, Because I think if you are on the Internet or watching the TV, you are bombarded pretty constantly with some very aggressive headlines about ways to, quote, prevent dementia. And we have experienced at the NCHA our own work kind of inadvertently fueling the media frenzy around dementia. And so I have got a fun rapid fire set of things, and I want you to let listeners know, is this worth doing to prevent dementia?" }, { "speaker": "Velandai Srikanth", "startTime": "1476.2101", "endTime": "1478.05", "body": "Is that a yes, no, but is there a don't know?" }, { "speaker": "Taya Collyer", "startTime": "1478.05", "endTime": "1479.65", "body": "Yeah. Yeah. You can phone a friend or pass." }, { "speaker": "Tracy Parish", "startTime": "1479.9701", "endTime": "1481.97", "body": "She did give you a pass? Yeah. Okay." }, { "speaker": "Taya Collyer", "startTime": "1482.6901", "endTime": "1485.01", "body": "Here we go. Drum roll. Turmeric." }, { "speaker": "Velandai Srikanth", "startTime": "1485.41", "endTime": "1486.05", "body": "I don't know." }, { "speaker": "Taya Collyer", "startTime": "1487.1749", "endTime": "1502.77", "body": "But I guess the reason I've picked this is there's a whole super food universe, blueberries, turmeric, some weird algae extract in a bottle. Like, in the scheme of things, how important are these products or these molecules?" }, { "speaker": "Velandai Srikanth", "startTime": "1502.77", "endTime": "1507.01", "body": "I think it speaks to the general principle of having a really good diet" }, { "speaker": "Taya Collyer", "startTime": "1507.17", "endTime": "1507.65", "body": "Okay." }, { "speaker": "Velandai Srikanth", "startTime": "1507.65", "endTime": "1510.37", "body": "As a preventative piece for dementia." }, { "speaker": "Taya Collyer", "startTime": "1510.37", "endTime": "1510.85", "body": "Right." }, { "speaker": "Velandai Srikanth", "startTime": "1510.85", "endTime": "1541.95", "body": "And that speaks to the kinds of diets that rely less on red meat, rely less on fats and harmful stuff, rely more on nuts and fruits and legumes, things like the Mediterranean diet might be useful too. That's what this speaks to. There is a body of evidence out there, not quite strong in my view, but others might think differently, that these antioxidant related superfoods could help. If they don't cause harm, I'm not stopping people from, you know, having them or eating them, that's what I tell my patients." }, { "speaker": "Taya Collyer", "startTime": "1541.95", "endTime": "1542.27", "body": "Mhmm." }, { "speaker": "Velandai Srikanth", "startTime": "1542.27", "endTime": "1544.11", "body": "If they cause them harm, then don't take them." }, { "speaker": "Taya Collyer", "startTime": "1544.255", "endTime": "1551.375", "body": "Right. But if you've got a good diet, if you're looking after what you eat, you perhaps don't need to race to the chemist and fill up." }, { "speaker": "Velandai Srikanth", "startTime": "1551.4551", "endTime": "1552.255", "body": "Buy some more." }, { "speaker": "Taya Collyer", "startTime": "1552.255", "endTime": "1552.655", "body": "Yeah." }, { "speaker": "Velandai Srikanth", "startTime": "1552.655", "endTime": "1568.58", "body": "Right. Exactly. But that is harder for many people, though. So not many people have access and the ability to have a good diet, and that might be because of their socioeconomic status, their condition, cost of living is really high, so how do you how do you try and have that perfect diet?" }, { "speaker": "Taya Collyer", "startTime": "1568.74", "endTime": "1571.795", "body": "Okay. Here we go. Sudoku." }, { "speaker": "Velandai Srikanth", "startTime": "1572.1951", "endTime": "1582.9401", "body": "Anything that keeps your brain active, I promote. If it is connecting play, Wordle, for example. I love Wordle because there's a bunch of us that do Wordle in the morning and then ..." }, { "speaker": "Taya Collyer", "startTime": "1583.02", "endTime": "1583.98", "body": "I think it's a cult." }, { "speaker": "Velandai Srikanth", "startTime": "1583.98", "endTime": "1625.04", "body": "Well, when it came on, it came on during COVID right? Yeah. Such a simple paradigm of just that thinking and working and reasoning, that kind of stuff is so important for us, which means having purpose in life that allows us to use those abilities in work around us and families. That's what keeping the brain active means, maintaining your brain. Professor Henry Brodaty has done this amazing study in in New South Wales and in Australia, Maintain Your Brain, it's called, and it was published in Nature. And that shows how much, not just looking after your heart health and other things, but having your brain do activities that are useful really helps reduce the risk of dementia." }, { "speaker": "Taya Collyer", "startTime": "1625.545", "endTime": "1640.745", "body": "Is there a hierarchy though? Like, I'm wondering, is a crossword or Sudoku on the weekend, is that in the same ballpark as trying to learn a new language as an adult? Trying to take up a new musical instrument or a new hobby that's really pushing your brain to the limit?" }, { "speaker": "Velandai Srikanth", "startTime": "1641.1901", "endTime": "1656.475", "body": "Truth is I don't know. Yeah. And this is an area for research. The intensity of your brain activity cause more neuronal connections? Does it prevent or give you the resilience against further decline? Truth is I don't know. This is an area well worth looking at." }, { "speaker": "Taya Collyer", "startTime": "1656.475", "endTime": "1660.315", "body": "Mhmm. So but do, like, do what you enjoy, right, and keep your brain active. That's the message." }, { "speaker": "Velandai Srikanth", "startTime": "1660.315", "endTime": "1670.07", "body": "Absolutely. If you can do certain things that keep you active, keep you connected, keep your mind working on problems, solving problems." }, { "speaker": "Tracy Parish", "startTime": "1670.07", "endTime": "1676.95", "body": "And does that relate also to people when they retire? Because they drop off sometimes in learning new things." }, { "speaker": "Velandai Srikanth", "startTime": "1676.95", "endTime": "1699.1299", "body": "I'm scared of the word retirement if you ask me. very scared of the word retirement. Don't know why, when you say retire. But the reason behind that is I think if I didn't use my brain in the way that I want to, that keeps me engaged and keeps me active in a certain way, then it's likely that I will lose that resilience to other things happening to me." }, { "speaker": "Velandai Srikanth", "startTime": "1699.21", "endTime": "1722.965", "body": "So keeping active in some fashion, not just physical activity, but brain activity in some fashion would be useful. There is good evidence though, and this is coming from Tasmania that this was a great study done in the University of Third Age. They recruited people from year three to do a university course well after their retirement, and there was some clear evidence there that they had benefits." }, { "speaker": "Tracy Parish", "startTime": "1722.965", "endTime": "1724.325", "body": "This is before AI?" }, { "speaker": "Velandai Srikanth", "startTime": "1724.9299", "endTime": "1726.0499", "body": "This is well before that." }, { "speaker": "Tracy Parish", "startTime": "1726.0499", "endTime": "1728.69", "body": "And some lecturers who are actually using AI ..." }, { "speaker": "Velandai Srikanth", "startTime": "1728.85", "endTime": "1734.37", "body": "This was about 10 years ago. If you look at that publication, it's quite an interesting piece of work." }, { "speaker": "Taya Collyer", "startTime": "1734.37", "endTime": "1738.37", "body": "Here comes an easy one, perhaps. Seeing other human beings." }, { "speaker": "Velandai Srikanth", "startTime": "1739.025", "endTime": "1766.0", "body": "Oh, it's such such an important thing. I sit in my office sometimes and I have to get out and walk just because I wanna see people or say hello to people, and having connection to others is such an integral part of a human's life. And it has, I would think, has impact on several health conditions. I can't say for certain that it does prevent dementia, but I'm certain that it has health benefits for other things." }, { "speaker": "Tracy Parish", "startTime": "1766.0", "endTime": "1777.975", "body": "And there's a link with hearing loss and lack of social cohesion where people might go out with friends but sit in a, you know, busy restaurant and can't hear or understand other people, so they stop doing it." }, { "speaker": "Velandai Srikanth", "startTime": "1777.975", "endTime": "1805.4149", "body": "Hearing loss is really an interesting phenomenon. There are probably biological connections between hearing loss and the way the brain responds. Our senses provide the brain with its input and stimuli to keep it active and engaged, so your vision, your taste, your hearing, your touch. And if that's impaired, there must be an element of your brain not being energised or cranked up, so to speak. Hearing loss has two elements to it." }, { "speaker": "Velandai Srikanth", "startTime": "1805.4149", "endTime": "1822.26", "body": "One is, yes, what you said, that is social disconnection and that it's really an important thing for people as they get older when they get sensorineural hearing loss or the nerve related hearing loss. And that combined with these biological things that I just spoke about could have an impact on how their brain works." }, { "speaker": "Taya Collyer", "startTime": "1822.26", "endTime": "1824.66", "body": "So being alone is bad for your brain?" }, { "speaker": "Velandai Srikanth", "startTime": "1824.915", "endTime": "1833.875", "body": "Being alone is bad for everything. Being alone is well, let me qualify that. Some people love being alone. Yeah. Some people like being by themselves." }, { "speaker": "Tracy Parish", "startTime": "1833.875", "endTime": "1835.395", "body": "Some people love to be alone for a while." }, { "speaker": "Velandai Srikanth", "startTime": "1835.395", "endTime": "1865.115", "body": "And some people are healthy enough by being alone. But most people require social connection to live their life well, and that means do they eat well, do they look after their health well, do they get out and walk with company and partners, and all these things have an impact on your health, your heart health, your blood vessel health, diabetes. Chronic conditions are most often occurring in people who are by themselves and not looking after themselves and not having the ability to do that." }, { "speaker": "Taya Collyer", "startTime": "1865.4199", "endTime": "1890.945", "body": "So I love what you've just said there because there are some activities that actually stack everything that we've discussed. Going out for a meal with a group of friends that is not a trashy meal, although even if it is, it's probably better than staying at home. Right? Or taking a walk with a walking group, getting that social stimulation, getting the exercise. So a dance class is something that's physical and social and mentally stimulating. Like, that's the goal. Is that right?" }, { "speaker": "Velandai Srikanth", "startTime": "1891.66", "endTime": "1908.0951", "body": "I would imagine so. Imagine trying to get all those inputs into one activity. That that is easier to do than trying to let me do Sudoku, and then I'll go just for a walk, and then I'll do something else. Getting together a bunch of people and playing cricket, that's what does it for me on a Saturday." }, { "speaker": "Tracy Parish", "startTime": "1908.0951", "endTime": "1911.535", "body": "Taya, you haven't asked the question, the big one, alcohol." }, { "speaker": "Velandai Srikanth", "startTime": "1911.6951", "endTime": "1951.7699", "body": "Oh, that is a big one. You know, alcohol has had an interesting journey over the years. There's been this recommendation that some alcohol is good for you and the recommendation that some alcohol in moderation is okay, but more is bad for you. But there is a growing body of evidence that alcohol by itself is a toxin. It can affect many organs, including your brain. If you don't drink it, it's probably better for you in the long run. If you do, keep it to a bare minimum. There are so many options coming out now in terms of alcohol. You can have things that taste like alcohol and give you that sense that you're drinking alcohol but it's not alcohol." }, { "speaker": "Taya Collyer", "startTime": "1951.85", "endTime": "1956.57", "body": "So on balance, if if you're really worried about your brain health, alcohol is something to be thinking about?" }, { "speaker": "Velandai Srikanth", "startTime": "1956.65", "endTime": "1967.1649", "body": "Absolutely. I would try and minimise and avoid it. If you do have cognitive impairment, a person has cognitive impairment or dementia, then alcohol can really make that worse." }, { "speaker": "Taya Collyer", "startTime": "1967.165", "endTime": "1971.005", "body": "Mhmm. Okay. I've got one more. Looking after your mental health." }, { "speaker": "Velandai Srikanth", "startTime": "1971.5651", "endTime": "1983.22", "body": "Yeah. There's a substantial body of evidence out there that suggests that people who have dementia have significant problems with their mental health and that is understandable." }, { "speaker": "Taya Collyer", "startTime": "1983.22", "endTime": "1989.015", "body": "So it's mood, is it? Anxiety. Right, of course, yeah." }, { "speaker": "Velandai Srikanth", "startTime": "1989.015", "endTime": "2007.28", "body": "Depression or depressed mood. But there's also another body of evidence that suggests that people who've had long term anxiety and depression, they might be a little bit more at risk of developing cognitive problems later on. And how that happens, we don't know. It may be linked to other parts of your health like your heart health, for example." }, { "speaker": "Taya Collyer", "startTime": "2007.28", "endTime": "2008.3201", "body": "Yeah. Stress, we know." }, { "speaker": "Velandai Srikanth", "startTime": "2008.3201", "endTime": "2008.64", "body": "Stress." }, { "speaker": "Taya Collyer", "startTime": "2009.04", "endTime": "2010.0801", "body": "Bad for the heart, bad for the brain." }, { "speaker": "Tracy Parish", "startTime": "2010.0801", "endTime": "2028.13", "body": "Yeah. And the final one I'll add in there is video games. Because young people are spending a lot of time online and have been for a long time now, well over 10, 15 years. And is that going to be a factor down the track? Are we going to find out later that that has been a problem?" }, { "speaker": "Velandai Srikanth", "startTime": "2028.13", "endTime": "2066.3699", "body": "I think the jury's out on that. There's a body of people who say that that active engagement with video games keeps your neurons firing, your reaction times firing, you're faster at what you do. There's another body of evidence of people that say that, well it's not giving you sustained attention on one thing, it's dividing your attention from one to another and your the structure of how your brain works is different. And I suspect that in generations we will see that, then it'll be nice to see cohort studies coming out that look at the association between use of these kind of technologies and brain health in the future." }, { "speaker": "Taya Collyer", "startTime": "2066.755", "endTime": "2069.635", "body": "I was gonna say, I'm a lifelong dedicated gamer." }, { "speaker": "Tracy Parish", "startTime": "2069.635", "endTime": "2070.595", "body": "That's why I asked it." }, { "speaker": "Taya Collyer", "startTime": "2071.555", "endTime": "2096.28", "body": "And it's gonna be like food. Like, we can't say, like, does food cause dementia or prevent dementia? I think that as a massive nerd gamer, there are some games that are so challenging, and you can sit for literally 100 hours, not an exaggeration, and work through a series of problems and have a blast. And there are other games that are like french fries for the brain, and I've got no doubt rubbish." }, { "speaker": "Taya Collyer", "startTime": "2096.415", "endTime": "2100.0952", "body": "I'm also watching this research really, really, with a lot of interest." }, { "speaker": "Velandai Srikanth", "startTime": "2100.175", "endTime": "2102.095", "body": "Anything in moderation, I think, Taya." }, { "speaker": "Taya Collyer", "startTime": "2102.095", "endTime": "2103.215", "body": "Except alcohol." }, { "speaker": "Velandai Srikanth", "startTime": "2103.215", "endTime": "2104.3352", "body": "Except alcohol." }, { "speaker": "Tracy Parish", "startTime": "2105.935", "endTime": "2106.895", "body": "And a crappy diet by the sound of it." }, { "speaker": "Taya Collyer", "startTime": "2108.43", "endTime": "2117.47", "body": "So we've talked about a range of factors that there's maybe pretty good evidence are useful for preventing dementia. Can we prevent everyone's dementia?" }, { "speaker": "Velandai Srikanth", "startTime": "2117.8699", "endTime": "2126.1853", "body": "Obviously not. I think that's probably not the case. What we're trying to do is shift the dial for most people if we can." }, { "speaker": "Taya Collyer", "startTime": "2126.3452", "endTime": "2134.905", "body": "But there are people out there, right, who are active, eating well, looking after themselves, but unfortunately ..." }, { "speaker": "Velandai Srikanth", "startTime": "2136.1199", "endTime": "2155.2249", "body": "Sometimes they do develop dementia, but I do think that these things that they do, their lifestyle activities that they take, might have delayed the onset of dementia by many years. So that's that's the paradigm to prevention of dementia. It's not just no dementia, but if you do get dementia, can you please push it out to as late as possible?" }, { "speaker": "Tracy Parish", "startTime": "2155.7048", "endTime": "2166.46", "body": "Can we pivot now and hone in on the person? They've come into your clinic, you can pick straight away that there's some issues, or can you?" }, { "speaker": "Velandai Srikanth", "startTime": "2166.46", "endTime": "2182.695", "body": "How do you assess it? Not all the time. Maybe sometimes you have a higher sense of suspicion that something's not quite right, but they're coming there because they either have noticed themselves that something's not quite right with them or family members have suggested that they come to see us because something's not quite right." }, { "speaker": "Taya Collyer", "startTime": "2182.695", "endTime": "2186.055", "body": "And how do they get there? Are they referred to you by a GP or ..." }, { "speaker": "Velandai Srikanth", "startTime": "2186.375", "endTime": "2209.3252", "body": "So I'm in a specialist clinic, so it's mostly referrals from general practitioners. The general practitioners are their first real port of call from a medical point of view. So they might have already been primed for something to a certain extent. But the first thing that I do is get to know the person. I spend about five or ten minutes really finding out who they are. I don't go to the heart of the problem about their memory symptoms straight away, I ask them ..." }, { "speaker": "Tracy Parish", "startTime": "2209.885", "endTime": "2210.7651", "body": "What are you asking me?" }, { "speaker": "Velandai Srikanth", "startTime": "2211.165", "endTime": "2214.7651", "body": "So Tracy, tell me a bit about yourself, where were you born?" }, { "speaker": "Tracy Parish", "startTime": "2215.085", "endTime": "2216.205", "body": "Well in the country." }, { "speaker": "Velandai Srikanth", "startTime": "2216.205", "endTime": "2221.0", "body": "Tell me where and how far away in the country, where was that?" }, { "speaker": "Tracy Parish", "startTime": "2221.0", "endTime": "2228.36", "body": "Well, was born in Albury. So, you know, it was a country town back then, but it's obviously not a thriving metropolis now." }, { "speaker": "Velandai Srikanth", "startTime": "2228.36", "endTime": "2230.7603", "body": "With your mum, dad, who else?" }, { "speaker": "Tracy Parish", "startTime": "2230.84", "endTime": "2238.135", "body": "A lot of us, really. I was one of five children, middle child, so there was seven of us, plus a grandmother in a three bedroom house." }, { "speaker": "Velandai Srikanth", "startTime": "2238.2148", "endTime": "2240.615", "body": "Yep. And tell me about your siblings. What are their names?" }, { "speaker": "Tracy Parish", "startTime": "2240.615", "endTime": "2241.815", "body": "Do you really wanna know all of them?" }, { "speaker": "Taya Collyer", "startTime": "2241.815", "endTime": "2245.815", "body": "I can see the cogs turning. What are you looking for? What are you noticing?" }, { "speaker": "Velandai Srikanth", "startTime": "2245.815", "endTime": "2249.96", "body": "I'm trying to get a sense of them purely that I'm not doing a test here." }, { "speaker": "Taya Collyer", "startTime": "2249.96", "endTime": "2252.28", "body": "Right. You're not like, can you remember your own sibling's name?" }, { "speaker": "Velandai Srikanth", "startTime": "2252.44", "endTime": "2271.425", "body": "No. Not at all. And things might come out in conversation which I take note of, but my purpose is not to to do that. My purpose is to put them at ease, get them to talk about themselves, to to let me know who they are because when I do if I do have to give them a diagnosis, if something's quite wrong, then I know how to approach it." }, { "speaker": "Tracy Parish", "startTime": "2271.505", "endTime": "2271.7449", "body": "Right." }, { "speaker": "Velandai Srikanth", "startTime": "2271.7449", "endTime": "2272.785", "body": "Because I know who they are." }, { "speaker": "Tracy Parish", "startTime": "2272.785", "endTime": "2276.4102", "body": "But you were asking me who I was, like where I was born." }, { "speaker": "Velandai Srikanth", "startTime": "2277.29", "endTime": "2300.335", "body": "Who you are now is a bunch of things from who you were, when you were born right up to now. So I usually ask them about what they did as children, where they went to school, how they enjoyed school, what were their interests then, what they did as adults, what work do they do, when do they meet their partner, when do they have kids, where do they travel to, where do they move to, what kind of work, when they retired, what were they doing?" }, { "speaker": "Taya Collyer", "startTime": "2300.335", "endTime": "2301.055", "body": "The whole story." }, { "speaker": "Velandai Srikanth", "startTime": "2301.055", "endTime": "2314.34", "body": "The whole story and anything else that pops out during that. They might talk about grief, about losing someone. Five or ten minutes, it's a great investment of time. It's not a huge amount of time, but it tells me about the person." }, { "speaker": "Taya Collyer", "startTime": "2314.5", "endTime": "2326.7651", "body": "And then what is the process? If if someone, you know, is referred to you because there's a question about memory problems, what is the process for working out if someone has dementia and then communicating that?" }, { "speaker": "Velandai Srikanth", "startTime": "2326.7651", "endTime": "2353.465", "body": "So when I put them at ease and they're ready to talk about their condition, then I speak to them about what they're going through, ask them to describe the kind of symptoms as we call them, how it's affecting their life and daily life, get their perspective, validate them and then say, can I ask your partner about this? If they say that's okay, I do reassure them that sometimes the partner might say something slightly differently, but it's for me to judge what's right and what's wrong, it's not about a debate." }, { "speaker": "Taya Collyer", "startTime": "2353.465", "endTime": "2355.785", "body": "And why is it important to hear from someone else?" }, { "speaker": "Velandai Srikanth", "startTime": "2355.785", "endTime": "2360.13", "body": "Because sometimes the someone else has information that goes towards a diagnosis." }, { "speaker": "Tracy Parish", "startTime": "2361.25", "endTime": "2363.25", "body": "And people mask things, don't they?" }, { "speaker": "Velandai Srikanth", "startTime": "2363.73", "endTime": "2370.45", "body": "Not intentionally. They may not mask things or deny things themselves, but they're a bit worried about saying it out." }, { "speaker": "Tracy Parish", "startTime": "2370.45", "endTime": "2384.645", "body": "Where they might say, I am really concerned about living at home because I can't work out how to put the jug on or, you know, these things but I don't want to let my husband know because he doesn't wanna go into residential aged care and then it just all becomes a bit of .." }, { "speaker": "Velandai Srikanth", "startTime": "2384.7249", "endTime": "2397.26", "body": "A big worry for people is if I diagnose them with dementia, what's gonna happen to them? Right? Are they gonna need to move into care straight away? And I say to them that's not the case. They're gonna worry about driving and that's an important issue." }, { "speaker": "Tracy Parish", "startTime": "2397.26", "endTime": "2398.7002", "body": "Do they have to declare it?" }, { "speaker": "Velandai Srikanth", "startTime": "2398.78", "endTime": "2399.6602", "body": "Declare what?" }, { "speaker": "Tracy Parish", "startTime": "2399.82", "endTime": "2401.6602", "body": "Dementia because of driving?" }, { "speaker": "Velandai Srikanth", "startTime": "2401.6602", "endTime": "2411.2249", "body": "So the legislation from Austroads, and this is a clear piece of legislation, is that someone with dementia cannot have an unconditional licence. They have to have a conditional licence." }, { "speaker": "Velandai Srikanth", "startTime": "2411.2249", "endTime": "2454.5", "body": "So the process towards going towards a conditional licence is what the next step is. Do they say, I don't want to drive anymore by themselves because they're worried about it and anxious about it? Do they say, I'd like to drive but I'd like to know how? And that might mean a practical driving assessment with an expert such as an occupational therapist or a driving assessor. Take them on the road and find out what their limits of driving might be and then we might be able to say to them, you can drive but these are the boundaries around which you should drive to be safe. And then review that and monitor that with time. It might come to the point that that driving assessment says to people, well, it's probably safe not to drive just for your own safety and others' safety, and see what happens." }, { "speaker": "Taya Collyer", "startTime": "2454.5", "endTime": "2461.405", "body": "And that intersects with what we were talking about earlier though, you know, being alone, being isolated, and that's really tough." }, { "speaker": "Velandai Srikanth", "startTime": "2462.525", "endTime": "2481.95", "body": "Driving is a huge part of a person's life, particularly in a country like here. Yeah. Right? And it takes away your independence, takes away your self worth, it takes away your ability to connect. So if we are going to say to a person, you cannot try, then I have to think about what's the alternative. How do they get to places? How do we sort of work out the support systems and get them access to supports?" }, { "speaker": "Taya Collyer", "startTime": "2481.95", "endTime": "2509.43", "body": "Mhmm. We've got a little bit sidetracked here. This is a very important and useful discussion, but, we're at the time of recording, we have a US President who has been, speaking regularly about his own cognitive assessment. So once you have had these discussions, these sort of, holistic and contextual discussions with a person and with those close to them, I'm assuming there's another layer of investigation in the room." }, { "speaker": "Taya Collyer", "startTime": "2509.43", "endTime": "2510.8699", "body": "And what does that look like? What's involved?" }, { "speaker": "Velandai Srikanth", "startTime": "2510.8699", "endTime": "2537.05", "body": "Yep. So after the history, as we call it, the accounting of the person and the partner about their symptoms and I sort of then apply a few what I call screening, brief cognitive tests to get an understanding of where they are, we might progress to asking for more detailed assessment of their cognitive status through what's called a neuropsychology assessment, there may be brain scans." }, { "speaker": "Taya Collyer", "startTime": "2537.05", "endTime": "2540.01", "body": "And what's going on in a neuropsychology assessment?" }, { "speaker": "Velandai Srikanth", "startTime": "2540.01", "endTime": "2555.825", "body": "So you sit with an expert who's trained to understand how a person's brain works, right? You sit with them and for an hour or two, depending on their ability to attend to it and tolerate it, they go through a number of tasks which could be either written or verbal tasks." }, { "speaker": "Taya Collyer", "startTime": "2556.05", "endTime": "2557.81", "body": "Right. So this is a separate appointment?" }, { "speaker": "Velandai Srikanth", "startTime": "2557.81", "endTime": "2565.25", "body": "Separate appointment. Correct. And not everyone gets it, but in case we need to confirm our thinking or disprove our thinking so to speak." }, { "speaker": "Tracy Parish", "startTime": "2565.25", "endTime": "2574.0652", "body": "And a part of it their memory recall, like, you know, five vegetables and you give them to them in a certain order and they've got to remember it again." }, { "speaker": "Velandai Srikanth", "startTime": "2574.465", "endTime": "2601.8652", "body": "There are a number of kinds of memory tests and I don't wanna go to the details of those kinds of tests because each one has a different flavour to it. But the idea is generally to test someone's memory, might be given a set of information and ask to consolidate that and know that you've taken it in, and then ask for that later on. And so how you bring it out, how much you bring out, and whether clues or prompts help you gives us a lot of information about how your memory works." }, { "speaker": "Taya Collyer", "startTime": "2601.945", "endTime": "2614.3801", "body": "And it's not just memory. Right? We've been using the terms memory and cognition sort of interchangeably, and that's very common in in the community. But there's more to our brains than just memory." }, { "speaker": "Velandai Srikanth", "startTime": "2614.4602", "endTime": "2620.54", "body": "Correct. There's a number of functions. The most fundamental of a brain's function is to be able to attend to things." }, { "speaker": "Taya Collyer", "startTime": "2620.54", "endTime": "2621.6602", "body": "Right. So to focus, concentrate." }, { "speaker": "Velandai Srikanth", "startTime": "2621.6602", "endTime": "2651.2751", "body": "What we call attention or attentional ability, and we look at that. We look at how quickly people take in information and react. We call that speed of processing. Then there's the whole function of being able to plan, problem solve, come to a conclusion that it's logical, take something to its logical end, that's called executive ability. There's all kinds of things that we tap into, so we try and get an understanding of how the complex thing that the brain is is working overall." }, { "speaker": "Taya Collyer", "startTime": "2651.2751", "endTime": "2656.0752", "body": "And the reason I ask that is does everyone with dementia have memory problems?" }, { "speaker": "Velandai Srikanth", "startTime": "2656.315", "endTime": "2687.595", "body": "No. There are different kinds of dementia where people with, say for example the most common kind of dementia which is called Alzheimer's dementia, they certainly do have memory problems. There are people with other kinds of dementia like frontotemporal dementia for example where it's more about how their ability to communicate, language or generation of words could be an issue. Right. Not necessarily their memory, they could, they remember things perfectly but it's how they express things that's a difficulty." }, { "speaker": "Tracy Parish", "startTime": "2687.595", "endTime": "2689.595", "body": "Yeah, what's vascular dementia?" }, { "speaker": "Velandai Srikanth", "startTime": "2689.595", "endTime": "2712.5752", "body": "Vascular dementia I think is a way of saying, well the person has vascular disease that is contributing to that dementia. So they could have strokes in their brain, they could have these white matter lesions or white spots on their MRIs, hypertension leading to that. So that's, that in my simple book of description is what I would call a vascular dementia." }, { "speaker": "Taya Collyer", "startTime": "2712.5752", "endTime": "2724.2", "body": "So there are lots of ways to have dementia, and I think in the community there is a stereotype, right, it's a forgetful older person, But from what you've just said, it's a bit more complicated than that." }, { "speaker": "Velandai Srikanth", "startTime": "2724.2", "endTime": "2740.7249", "body": "It's much more complicated than that, it's not just the older person who can get dementia, there are people in their younger ages, in their 30s, 40s and 50s who can also get dementia. Wow. And they might have different kinds of presentations, not just the way we think an older person commonly presents with." }, { "speaker": "Tracy Parish", "startTime": "2740.7249", "endTime": "2761.485", "body": "We talk about having people age well, live well. If you've got dementia, how can they live their best life? Can we touch on some of the amazing projects that have been underway at the National Centre for Healthy Ageing, for example? One I particularly want to talk about is rehabilitation for people with dementia. Tell us more about that." }, { "speaker": "Velandai Srikanth", "startTime": "2761.565", "endTime": "2786.01", "body": "Yep. So just because someone has a diagnosis of dementia doesn't mean that they cannot do things as they live towards the rest of their lives. There are people who can do many things. There are people who are engaged in many kinds of activities. But an important thing for people with dementia is not to be excluded from the kind of things that you and I can have access to maintain our health and rehabilitation is one of those things." }, { "speaker": "Velandai Srikanth", "startTime": "2786.445", "endTime": "2822.845", "body": "There is a stigma associated with people with dementia and we've tried to eliminate that stigma through a project conducted by one of our very senior and fantastic researchers, Michelle Callisaya, who conducted this project called the Include Project and that means including people in that framework of if they need physical rehabilitation, if they need other kinds of therapy, they should be given access to it. How do you get people to understand that access can be given? And that's come up with a fantastic set of training resources which now Dementia Training Australia have taken up and are promoting and educating health professionals about." }, { "speaker": "Taya Collyer", "startTime": "2822.845", "endTime": "2826.1401", "body": "So you're talking about a stigma within healthcare." }, { "speaker": "Velandai Srikanth", "startTime": "2826.1401", "endTime": "2839.1", "body": "Yeah. There are many kinds of stigma, and stigma commonly exists within healthcare. The most common stigma is that of ageism and the stigma of ageism is much more pronounced in a person with dementia or cognitive difficulties." }, { "speaker": "Taya Collyer", "startTime": "2839.1", "endTime": "2846.435", "body": "Right. So healthcare professionals might be making assumptions about people living with dementia that are negatively impacting their health." }, { "speaker": "Velandai Srikanth", "startTime": "2847.2349", "endTime": "2866.05", "body": "They might see a label or a term or something in the medical record that says dementia or cognitive impairment. And because they're not there, they're very ignorant about what can happen and what the variety of ways that people can live with dementia, they lock themselves away. They say, we won't offer them that." }, { "speaker": "Taya Collyer", "startTime": "2866.05", "endTime": "2871.515", "body": "And we know in the research space, people living with dementia are routinely excluded from research." }, { "speaker": "Velandai Srikanth", "startTime": "2871.9148", "endTime": "2876.795", "body": "Yes. That is a significant issue. Thanks for pointing that out." }, { "speaker": "Taya Collyer", "startTime": "2877.6748", "endTime": "2880.2349", "body": "I wish you could see that. I wish you could see the the sad face listeners." }, { "speaker": "Tracy Parish", "startTime": "2881.1948", "endTime": "2882.7148", "body": "And how are we going to fix that, guys?" }, { "speaker": "Velandai Srikanth", "startTime": "2883.54", "endTime": "2913.82", "body": "Well, take significant steps to include them because you can still examine your studies or research hypotheses by including different kinds of people, whether that be people with dementia, whether that be people with complex medical conditions, whether that's based on gender or sex as well, that's often a common sort of exclusion, and that gives us much richer information in our research projects, I think that's something which the research field is gravitating to much more strongly, particularly in the last five to ten years." }, { "speaker": "Taya Collyer", "startTime": "2913.82", "endTime": "2930.0752", "body": "We could talk about this for a hundred years, but, Tracy did bring up the important topic of living with dementia and living well. So as a clinician who's working directly with patients and their families, what kinds of things are you recommending or hoping to see?" }, { "speaker": "Velandai Srikanth", "startTime": "2930.235", "endTime": "2946.76", "body": "You know what I really love to see is for the families to understand that the person is still there just because they have a diagnosis of dementia, haven't changed as a person. So to try and keep them included in all the kind of activities that a family would have, that would be a really important thing for them to do." }, { "speaker": "Taya Collyer", "startTime": "2946.76", "endTime": "2956.1948", "body": "Right, so some people might think, okay, now this diagnosis has been made and so we are going to stop the following. And what you're saying is, don't do that?" }, { "speaker": "Velandai Srikanth", "startTime": "2956.1948", "endTime": "2984.705", "body": "Don't do that. Yeah. But there are things that health professionals can do to try and minimise problems that occur with things like medications. For example, there are certain medications that people with dementia might not like. It might be harmful to them. There's an element of saying yes, include them in many things like rehabilitation, like activities with family. But from my point of view, I'll be saying, well, how do I ensure that what they're on doesn't cause them harm? To keep them well." }, { "speaker": "Tracy Parish", "startTime": "2984.705", "endTime": "2991.5852", "body": "And what about families advocating within the hospital system? Because they will interact with the hospital system at some point." }, { "speaker": "Velandai Srikanth", "startTime": "2992.705", "endTime": "3021.845", "body": "Particularly in the last five years of life, there's a huge interaction with the hospital system for people with dementia and families struggle with that. Hospitals don't know really, even now, how best to care for people with dementia. People with dementia come in with various kinds of issues like infections. They can be delirious or confused, and recognising that as a manifestation of an underlying condition such as dementia is such an important thing. That leads to many things, right?" }, { "speaker": "Velandai Srikanth", "startTime": "3021.845", "endTime": "3052.1501", "body": "So you then know how best to try and make sure the person is calm by speaking with the family and understanding them. There's a project that one of our researchers has done and that is to develop something akin to a Go bag. So when you're pregnant and ready to go to hospital, have a Go bag which tells ... If you're organised, if you're organised, when you go to hospital that tells the nurses and people what you need and what you have. Similarly, what Chris Moran, one of our researchers has done is ..." }, { "speaker": "Taya Collyer", "startTime": "3052.31", "endTime": "3053.1902", "body": "Guest on the Pod." }, { "speaker": "Velandai Srikanth", "startTime": "3053.59", "endTime": "3072.455", "body": "Right. Has he? That's great. But what he's done is, created a passport, as you might call it, that describes the person, their needs, their preferences, what kind of things they would like the hospital staff to know about them that makes their care better." }, { "speaker": "Tracy Parish", "startTime": "3072.8552", "endTime": "3081.2", "body": "That was a great project, but it was a pilot project, wasn't it, within the National Centre for Healthy Ageing. And I think Chris did mention they need more money." }, { "speaker": "Velandai Srikanth", "startTime": "3081.2", "endTime": "3096.125", "body": "Absolutely. And imagine if you scale that. Imagine if you implement that across hospital systems, and that enables a whole bunch of people coming into hospital have a much, much better experience. That's a huge advantage to the health system." }, { "speaker": "Taya Collyer", "startTime": "3096.125", "endTime": "3106.845", "body": "But that's something that families could do for themselves. You know, a list of medications, for example, just having a list, a written down list." }, { "speaker": "Velandai Srikanth", "startTime": "3106.845", "endTime": "3107.885", "body": "And they often do." }, { "speaker": "Taya Collyer", "startTime": "3107.965", "endTime": "3108.445", "body": "What are they doing?" }, { "speaker": "Velandai Srikanth", "startTime": "3108.605", "endTime": "3114.5", "body": "They often try and do that, some of them may not know how to do that, so this gives them the structure to be able to do that." }, { "speaker": "Taya Collyer", "startTime": "3114.5", "endTime": "3121.78", "body": "So for people who are listening who are thinking like, oh well, I've got a relative who's received a diagnosis, what can I put together to perhaps help?" }, { "speaker": "Velandai Srikanth", "startTime": "3122.085", "endTime": "3137.525", "body": "First thing they need to do is be able to say confidently to the staff that are going be looking after their relative, well my relative has been diagnosed with this condition, you need to know that. They are on these medications and we have been told that these things are harmful to them." }, { "speaker": "Taya Collyer", "startTime": "3137.73", "endTime": "3138.21", "body": "Right." }, { "speaker": "Velandai Srikanth", "startTime": "3138.21", "endTime": "3159.815", "body": "They may get confused because they don't like being out of their home environment, but if they do, this is what might harm them. This is the kind of thing, for example music, of a certain kind, speaking to them in a certain language if they're from a different country or language background. The kind of things that make them a person is what needs to be expressed." }, { "speaker": "Taya Collyer", "startTime": "3159.9749", "endTime": "3170.0", "body": "And is to this something people could talk about with their GP? Okay, if I'm admitted to hospital, now I've been diagnosed with dementia, what kinds of things might be important to communicate?" }, { "speaker": "Velandai Srikanth", "startTime": "3170.24", "endTime": "3199.0", "body": "I do that in my clinic, so when I speak to people who I've diagnosed with dementia I say, some things are really important for you, that is you need to be able to understand that you might be at risk of other conditions like infections, etcetera. And when that happens, sometimes you might need to go to hospital. So have something with you or your family, have something with them that makes sure that the hospital staff know that you have this condition. Knowing that someone has dementia is the first step to further conversations and better care." }, { "speaker": "Tracy Parish", "startTime": "3199.48", "endTime": "3222.0452", "body": "And as we need to wrap up what has been a fascinating conversation, can you talk to people about how they shouldn't be scared? Is there like, it's probably one of the biggest issues in the back of people's mind as they get older, anecdotally and is there a way that you can reassure both the person listening or a loved one who is living with someone with dementia?" }, { "speaker": "Velandai Srikanth", "startTime": "3222.0452", "endTime": "3266.94", "body": "Absolutely. I think we need to know that there are certain things, many things that we now know we can do to prevent the risk of dementia, we spoke about that before. But if you do need to have medical care, there's a really good set of settings in which medical care can be provided, specialists, GPs, there's much more knowledge about dementia in the community now than there used to be. And now with the kind of work that we're doing and others are doing, care for people with dementia is getting better as well. Having dementia doesn't mean you can't do things anymore, you need to have the ability to know, you need to know that you can actually, if supported well by your family and others, do things that you want to do, travel, do other things that make you happy." }, { "speaker": "Velandai Srikanth", "startTime": "3267.34", "endTime": "3274.9949", "body": "So it's not just about the condition, it's about living a life but having the systems around that support the person to live their best life." }, { "speaker": "Tracy Parish", "startTime": "3275.075", "endTime": "3282.6748", "body": "And I'm going to ask you one last question. In 20 or 50 years, will we have a cure for dementia? Is it possible?" }, { "speaker": "Velandai Srikanth", "startTime": "3283.15", "endTime": "3286.99", "body": "Do you want my optimistic view or do you want my realistic view?" }, { "speaker": "Tracy Parish", "startTime": "3286.99", "endTime": "3288.11", "body": "Always realistic." }, { "speaker": "Velandai Srikanth", "startTime": "3288.11", "endTime": "3322.2", "body": "Okay. Realistic view is that my perception of dementia is that it occurs over a really long period of time because of multiple little causes that contribute to it. To have a cure, you must have a cause that is so strongly the cause by itself that you can actually do something about it to cure it. Look, there's a lot of work going on now for developing medications that take out proteins from your brain that might have an impact. And there's a bunch of medications that are coming on board, but none of them are going to be a cure." }, { "speaker": "Velandai Srikanth", "startTime": "3322.2", "endTime": "3339.845", "body": "They might change the way the disease progresses and so help people stay in a better position throughout the rest of their lives. So there is clearly optimism. I don't think a cure is going to be possible but certainly we might be able to prevent and modify the course of the condition over time." }, { "speaker": "Tracy Parish", "startTime": "3340.5999", "endTime": "3351.88", "body": "It's been absolutely fabulous to have you along. Thanks also to you, Taya. And thanks so much to you, Srikanth, for coming along and sharing your amazing insights. I'm glad you enjoyed it, Taya. I know we did." }, { "speaker": "Tracy Parish", "startTime": "3352.215", "endTime": "3376.47", "body": "And we hope you did out there as well. Thanks for listening. You've been listening to Help! I'm Ageing, a podcast from the National Centre for Healthy Ageing. We are proudly driving innovation and transforming health and care through research so we can all lead healthier lives as we age, especially those most vulnerable. If you want to know more, check out our website at ncha.org.au." }, { "speaker": "Tracy Parish", "startTime": "3376.7898", "endTime": "3399.29", "body": "If you like this episode, please tell your family, your friends, your colleagues, share it more widely. The more, the merrier. The more people we can reach, the greater impact that the research can have in helping people age well. Across this series, we have shared real stories, real evidence, real insights about healthy ageing. Thanks for listening. And if you've missed an episode, tune in wherever you listen to your podcasts." }, { "speaker": "Tracy Parish", "startTime": "3405.69", "endTime": "3419.815", "body": "This podcast was recorded on the land of the Boonwurrung Bunurrung people of the Kulin nations. We pay our respects to elders past and present and extend that respect to any Aboriginal and Torres Strait Islander people listening today." } ] }