so cognitive changes that we see in dementia and 
neurocognitive disorders memory loss difficulty   in communication especially finding the words to 
communicate or keeping track of a conversation and it's for a lot of people with dementia 
or neurocognitive disorders these aren't   something that are minor they are significant 
impacting activities of daily living and or   they may come on suddenly one of the 
issues with stroke as people can have transient ischemic attacks which are basically 
like mini strokes and they don't even really know   they're having it and those mini strokes 
can contribute to um vascular dementia   so if you're working with somebody and they 
notice especially if they notice that they've   suddenly started having some of these symptoms 
it is important to get them get them a referral   reduced ability to organize plan reason or 
solve problems difficulty handling complex tasks   confusion and disorientation like getting lost in 
familiar places and agnosia or the loss of ability   to recognize objects persons sounds shapes or 
smells while the specific sense is not defective   nor is there necessarily any significant 
memory loss now agnosia is pretty specific to neurodegenerative disorders and some 
even in somebody with clinical depression they're   generally um going to be able to recognize 
people and smells and those sorts of things   so you know that is one of those differentiating 
features that if it starts happening   it is a a big deal now of course and and common 
sense i'm sure y'all um would know this that   if they're looking at something specific like and 
i'll use cars because i can recognize a car i can   look at it and go that's a that's a vehicle 
that's a car but if you ask me whether it is   a ford fiesta or a honda something i'm 
going to look at you with this blank stare   because you know i may not be able to 
identify that even somebody who's into cars   may if if they're experiencing something like 
clinical depression or extreme bereavement   they may not be able to put together 
everything and differentiate   between um objects in a category so you know like 
different um car makers for example though they   can identify a van versus a car or something but 
um so we want to use common sense with the with   the agnosia but that is one of those that kind of 
stands out by itself away from the mood disorders   now memory loss when you're stressed people 
who are experiencing clinical depression   people who are experiencing bereavement people 
who are experiencing anxiety or ptsd i mean   not being able to remember aspects of the trauma 
is a characteristic of ptsd i mean it's right   there in the dsm so memory loss can be associated 
with a lot of different things we want to explore   you know what type of memory is it short term 
is it long term is it episodic um and and and   so we want to pay attention to that in order to 
effectively diagnose things a lot of people with   neurocognitive disorders are going to have decent 
long-term memory you know things that happened   five years ago may be a lot clearer than something 
that happened five days ago so that can be another   clue but it doesn't it isn't necessarily 
diagnostic because if somebody began having a severe major clinical depressive 
episode or something happened there was a trauma   or a loss two weeks ago then yeah the last 
two weeks is probably going to be a blur   and maybe even the week before that because 
everything starts to blend together so memory   loss is a symptom but it's a symptom of a lot of 
things difficulty in communication finding the   right words to communicate or keeping track of a 
conversation as we age our processing slows it's   not dementia it's aging we just it slows that's 
just the way it is we don't want to overreact if   somebody who's getting older takes a 
minute it's also common in people with   depression and postpartum depression 
and people who are sleep deprived   because of shift work or a new baby even without 
postpartum depression to make sometimes to have   difficulty finding the right words or to stay 
focused in a conversation so we definitely want to   explore those things reduced ability to organize 
plan reason or solve problems that's that whole   prefrontal cortex thing well here you get 
into again depression anxiety when you're   anxious when you're stressed when you're hyper 
vigilant it's hard to focus so that's one thing   but also this is also specifically an issue 
that may start to emerge with people who've had   multiple head traumas um if they've had multiple 
traumas especially to the front of their head then they might start having problems from 
that traumatic brain injury remember your your   brain sits in your skull kind of like an egg in a 
shell so think about your brain like the yolk and   the white part of the egg is kind of like 
the fluid that protects your brain and   when you shake it or when you hit it it doesn't 
just go one way it bounces back and forth and   bounces kind of around in there a little bit so 
if somebody has a hit to the back of the head   then the brain's probably going to go forward 
hit front and then go backwards for every   action there's an equal and opposite 
reaction um and we do want to keep this   no pun intended in mind when we're thinking about 
the impact of a brain injury and brain injuries   can have long lasting effects especially if 
they're repeated difficulty handling complex tasks   not uncommon with ptsd with because 
hyper vigilance you know people are so   flooded by stimuli sometimes it's hard to focus 
and handle complex tasks when people are depressed   it's hard to have the energy and the motivation 
and you know energy and motivation what does   that correspond to dopamine um so 
task completion can be difficult um   confusion and disorientation the degree is what's 
important here people who are depressed especially   super clinically depressed you know people who 
have persistent um depressive disorder which used   to be called dysthymia typically don't show a lot 
of confusion and disorientation but people who are   really clinically depressed um may lose track of 
what they're saying make it kind of disoriented   because a lot of times they're sleeping a lot 
and they get their circadian rhythms out of whack   but generally if you start seeing significant 
confusion and disorientation you know that   there's probably something else going on that 
should be evaluated so back to the questions how might these symptoms be associated with 
low serotonin or low dopamine well cognition is a function of both serotonin and dopamine so 
organizing planning reasoning solving problems   handling complex tasks and communicating finding 
words thinking stringing sentences together   that's all cognition memory part of that 
is cognition we need to recognize that if any neurotransmitter system if you want to 
think about it that way goes offline or is   dysfunctioning it's going to affect every 
other neurotransmitter system it's just the   way our body works it's a cascade effect 
the good thing is it's a cascade effect in   the positive too as something starts to get 
heal everything else starts to rebalance too   physical and sensory changes in people with 
dementia and nds difficulty with coordination   and motor functions tremor we talked about 
that because of the low dopamine levels   loss of or reduced visual perception um now we 
talked about this several weeks ago in a class   that there's actually research out now that 
shows that people who have clinical depression   have differences or the reduced capacity reduced 
contrast when they see things so instead of seeing   things as and this is literal white or black 
it looks kind of gray and if you're like me   and your vision is not what it used to be when 
you don't have your glasses on things look a   different color when i put my glasses on all of a 
sudden things look sharper and darker and crisper   well when people are depressed the same 
thing happens and they don't know why   exactly or at least not in the articles i read 
but loss of or reduced visual perception is a   symptom of both depression as well as 
dementia and neurodegenerative disorders   metallic taste in their mouth and 
decreased sense of smell that's pretty um   specific to something neurological decreased 
automatic movements such as blinking   people when they're depressed especially tend to 
be a lot slower at things but those tend to be   your um intentional movements your automatic 
movements like blinking and swallowing and   you know those things tend to you know just 
keep chugging along so if people are doing that   a lot more slowly or less frequently 
like they don't blink very often it might be something to take into consideration 
and sleep dysfunction especially insomnia   because the circadian rhythms start getting out 
of whack especially when serotonin levels are   low which means melatonin levels will be low 
then people will not be getting quality sleep   which is going to impact their circadian 
rhythms which is going to impact everything else welcome to the all ceus education channel where 
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so you can be notified when i release new videos   psychological changes in dementia there can be 
changes in personality and behavior well we see   changes in personality and behavior in bereavement 
and anxiety and personality disorders but it's important to recognize and personality 
disorders they tend to be very long-standing   um changes in behavior you know and and often of 
star started in childhood or adolescence um in   depression and anxiety you may see changes in 
personality and behavior when the person is having   an episode um and even in personality disorders 
like inverse borderline personality disorder   we do see a lot of emotional ability and um 
some some changes in personality so so we do   want to recognize that but in dementia um there 
is a marked change from what somebody used to be   like they maybe they used to be very gregarious 
and now they're very flat um that's one of the   things that you often see you sometimes you will 
also see somebody who used to be pretty easy going   become much more rigid or irritable depression 
and apathy anxiety hallucinations mood swings   agitation especially with changes in 
routine and isolation and withdrawal   well when people are anxious remember that 
anxiety is half of the fight-or-flight response   and so it makes sense that if they're already 
stressed out that changes can produce more   stress which can lead to agitation people who are 
depressed may not have the energy may not have the   the motivation the dopamine to even worry about 
getting agitated but sometimes it can cause them   to feel overwhelmed and and 
and respond with agitation   we want to look at the overlap we also want to 
consider especially while we're talking about   psychological changes if we're working with 
somebody with a neurodegenerative disorder   we don't want to chalk up any of these symptoms 
well with the exception of hallucinations   to just the nd you know if somebody starts 
developing i with my grandfather when he started   developing parkinson's um you know there was a 
distinct change in his mood and it wasn't solely   attributable to the parkinson's it was because he 
couldn't do the things that were most meaningful   to him he used to make dollhouse furniture 
miniatures out of wood very very fine work and   because of his tremors he couldn't do that 
anymore and that was devastating to him so we do want to pay attention to that 
we also want to recognize that people who   have neurodegenerative disorders and comorbid 
mood disorders have a worse prognosis because   of some of the neurochemical changes that 
are associated so anything that we can do   to intervene can be helpful and we'll get down 
to i think there's 21 maybe 22 different things   that we can do or at least educate people 
about in order to prevent or mitigate the   demand progression of neurodegenerative 
disorders specifically dementia but so it was 22 more than 50 percent of 
dementia cases could be prevented by   targeting 22 modifiable risk factors let that 
sink in for a second more than 50 percent of   dementia cases that is a lot that are basically 
caused by somewhat preventable factors now for some of those my guess would be that maybe 
it couldn't have been prevented completely but   it could have been delayed or in people 
with dementia all of these things   can be effective targets for mitigation 
for slowing the progression of the disease   so let's let's talk about them think 
about while we're going through these   what is the counselor social worker nurse case 
manager's role in modification and prevention of things that are going on what's our role in 
helping people modify these factors or prevent the   development of disease and what can we do that's 
within our scope of practice you know we gotta   keep in our lane what can we do that 
can help people modify these things   and feel free if something pops into your head 
to put that in the chat or raise your hand and   i'll and i'll call on you um but anyway so 
lack of early life education or enrichment   has been repeatedly associated with the 
development of dementia and in in people   so why is that well they don't know there is one 
theory that early life education and enrichment   builds up what is called cognitive reserves 
so it's kind of like your storage pantry   that you put all your extra vegetables and 
stuff in after the after the harvest season so   during the winter when you need more you 
can pull on it um and and they think that   early life education and enrichment when 
the brain is theoretically at its most   flexible can allow the person to create 
more cognitive stores now they've also found   that enrichment in later life you know 
staying active keeping the keeping your mind   and body active are also associated with creating 
cognitive reserve and slowing the process of   cognitive decline even quote normal cognitive 
decline so that that's kind of an interesting   thing the other aspect that has been hypothesized 
is that people who lack early life education and   enrichment they're from impoverished environments 
are often from impoverished situations so they may   have had inadequate nutrition they may have been 
exposed to more adverse childhood experiences   and they may have not gotten sufficient sleep and 
it actually impaired their development early on   the longitudinal data is somewhat scarce 
on this in terms of you know being able to really connect the dots and do it do an effective 
regression analysis to say it was this or that   they're just kind of going well could be a lot of 
things but we know that there's a high correlation   between this midlife hypertension is also 
associated with a lot of these cases and i think   it's interesting that it's midlife hypertension 
but anxiety is correlated with hypertension   midlife hypertension is also correlated 
with a poor diet as well as um   high stress levels so we want to take a look 
at what's causing hypertension it's good   um and it can be a clinical target for us and 
i'm giving you some some of the answers to the   question now it can be a clinical target for 
us uh when we're working with people who are   adults and they don't even have to be 
mid-life adults to screen for hypertension   a because if it's if they are hypertensive and 
is undiagnosed then they're at greater risk of a   stroke it really needs to be managed and monitored 
but b if they have hypertension then reducing   their blood pressure can be a clinical target you 
know some of it a lot of it may be physiological   but some of it may be due to stress and other 
dysphoric emotions that they're holding and there   are a lot of biofeedback methods that they can use 
in order to practice reducing their blood pressure   deep breathing breathing in for four or eight 
if they can holding and then exhaling for   four or eight when you slow your breathing it 
triggers rest and digest and that also triggers   the reduction in blood pressure triggers 
the reduction in heart rate so that is one   skill that they can start developing in order to 
help re-regulate when they start feeling stressed   they can also get a blood pressure monitor and 
practice and find out what helps them reduce their reduce their blood pressure or normalize 
their blood pressure if they're having a spike   if it's always up a lot of these things are 
not going to work but if they have a lot of   variability in their hypertension then we 
can certainly help them develop some skills   and tools in order to figure out what works for 
them to help regulate it when they are triggered   hypoxia lack of oxygen can be caused by 
copd chronic obstructive pulmonary disease   and that is actually not a particular disorder 
but it's kind of a group of disorders that   um people may experience but copd is 
one of those that's very common um in people especially people who smoked but also 
people with other lung problems as they get older   and because of the obstruction of the pulmonary 
area that means that the body is not oxygenating   the blood as well which means that the brain is 
not getting as much oxygenation from the blood as   it as it should um depressant misuse we already 
talked about can actually slow respiration and   slow heart rate enough that blood's not getting 
where it needs to be and stroke obesity can also   contribute is also a huge contributing factor as 
a matter of fact to dementia and neurodegenerative   disorders as well as to depression in particular 
and to a certain extent anxiety why is that   the main reason the main physiological reason as 
the is that when the adipose levels when the fat   levels in your body get to a certain percentage 
get to a certain level it increases inflammation   and there are a lot of reasons for that that you 
know whole different class this is not a you know problem because of body image you know 
body image problems if people have them can   obviously contribute but obesity being over fat 
not um can contribute to systemic inflammation   which is associated with increases in   cognitive problems increases in depression 
which often lead to less activity   increases in joint pain which can also contribute 
to inactivity which can contribute to lower levels   of serotonin and dopamine and increased depression 
and decreased oxygenation and cognitive abilities   diabetes specifically periods of hypoglycemia 
interestingly enough are associated with   the development of dementia in later life so 
it is important that people are regulating   their blood sugar now think about how many people 
you work with who have diabetes well think again   the vast majority of people who are 
diabetic or pre-diabetic don't even know it   the cdc estimates that upwards of 
24 of americans are either diabetic   or pre-diabetic which means they're 
not regulating their blood sugar very   well so there's a lot of people who 
have a very preventable risk factor why diabetes how does that relate to dementia 
and why do you care well because in order to   educate our patients about the importance of 
managing their diabetes and their a1c levels   we need to understand what the consequences 
of it are and one of the consequences is   increased risk for dementia because when the 
blood sugar gets out of whack hypoglycemic   what happens when the blood blood glucose 
your one of your energy stores gets low   the body goes crap i need more energy 
hpa axis kicks off glutamate dumps   norepinephrine dumps causes your your 
body to release glucose into the system then everything else you know it 
starts to become hunky-dory again   so when people become hypoglycemic it creates 
that excitatory neurotoxic environment again   um so that's that's important to recognize 
that uh that can happen now hyperglycemia   has its own set of problems that go with it 
but um the key is maintaining a1c levels and   keeping blood sugar within that those parameters 
that they're supposed to be in order to   prevent over-activation of that hpa axis and 
neurological the cascade of neurological problems hypothyroidism now we remember or you may remember 
that the hypothalamic pituitary adrenal axis is   your main threat response system but it dovetails 
with the hypothalamic pituitary thyroid axis when   the hpa axis kicks off glutamate norepinephrine 
adrenaline they're released they cause thyroxine   which is a stimulatory chemical to be released 
from the thyroid in order to give you more energy   when people have hypothyroid they're not making 
enough thyroid hormones so again the body's going   i don't have enough of those energy 
sources so it can kick off the hpa axis   hypothyroidism is also associated with 
low blood pressure and difficulty of the   the heart getting the blood up to 
where it needs to be think about how   much effort it must take to get the blood 
from your toes all the way up to your brain   so hypothyroidism is another risk 
factor hypothyroid and diabetes   are both associated with depressive symptoms we 
don't want to miss it again with the blood test   so important so easy to do but 
ssris ain't gonna do a dagum thing   for diabetes and hypothyroidism you 
know we really need to address the source of the dysfunction or at least rule out 
any physiological causes when and a lot of people   have hypothyroidism and don't even know it 
people can develop hypothyroidism as children   and it can happen at any time there's 
not necessarily a precipitating trigger   that you can say if you have this condition then 
you're at higher risk for developing hypothyroid   um now there are probably 
some out there but in general   the research indicates that hypothyroidism 
can begin at any point in life some people have more difficulty 
some women have more difficulty   with their thyroid regulating after they 
give birth but that's not necessarily   a good predictor it is important to monitor 
hearing loss now this is one you're scratching   your head i was scratching my head too people 
with hearing loss are at a much greater risk of   developing dementia as well as clinical depression 
now this is different than people who are born   deaf people who are born deaf do not have the 
same trajectory because they never were hearing   people who were born hearing and start developing 
hearing loss often start withdrawing because they   don't understand what people are saying is kind 
of garbled and they start getting frustrated   because it's more difficult to communicate 
or they misunderstand what people are saying   and it causes conflict and relationships so they 
start withdrawing it's important to pay attention for hearing loss in people of all ages my 
daughter is all but deaf in one ear and   we thank thankfully recognized that early on 
but it's important to to note that you know   she was six when we got her diagnosed with that 
hearing loss and hearing loss does impact people   in many many ways but hearing loss is associated 
with with with withdrawal from activities   which is associated with loss of that cognitive 
reserve because they're not in engaging   engaging is in as much stuff it's also associated 
with depression which is associated with reduced   serotonin and dopamine which is associated with 
neurodegenerative disorders it's easy enough   for people to get screened for hearing loss or get 
their hearing screened at their annual physical   doctors should be doing that at least you 
know a screening it doesn't have to be a full   test where they have the headphones on and 
everything but at least a screening smoking   because it affects the um flexibility of the blood 
vessels can contribute to circulation problems and   it also has been associated with cardiovascular 
disease both of which are associated with hypoxia   and dementia and potentially neuro 
neurodegenerative disorders so that's one of those   modifiable risk factors it's not easy 
smoking stopping smoking is really hard depression or anxiety well anxiety can keep 
that hpa axis revved so much for so long that   eventually the person starts becoming apathetic 
because the tissues have become tolerant to the   glutamate so they start feeling flat apathetic 
most of the time so a lot of times you'll have   depression and anxiety co-occurring not always 
depression can set the stage for people to also   have some level of anxiety fear of rejection 
fear of abandonment those things can come up   but we know that depression and anxiety 
are also risk factors for dementia physical inactivity has been associated with 
the development of in particular dementia as opposed to alzheimer's or or parkinson's 
parkinson's disease and it's also associated   with depression when we are physically active 
it increases serotonin dopamine and endorphins   you know a lot of our good chemicals it 
helps set our circadian rhythms because   you know our body knows hey we're supposed to be 
awake right now it increases oxygenation because   your heart's pumping harder your blood's 
moving faster you're breathing heavier   so you're getting more oxygen in into 
the body physical inactivity you know   produces the opposite effects that's another 
thing that's an easily modifiable risk factor   as clinicians we can encourage people 
to set reasonable goals and exercise   doesn't mean having to go to the gym excuse me physical activity can mean cleaning the house 
it can mean walking the dog it can mean playing   with your kids or your grandkids gardening doing 
workout videos or riding the spin bike at your   house whatever it is that you enjoy doing if 
you're moving your body it's physical activity   social isolation is another modifiable risk factor   and we'll go back through in a minute and 
talk about what we can do as clinicians to improve or to target some of these things 
social isolation is a big issue when we are   we we are programmed we have an entire 
hormone dedicated to bonding that's oxytocin   we are programmed to connect with other people 
when we are isolated because we cannot you know   for people who can't can't drive anymore if they 
have hearing loss if they are depressed if they   are living out in the middle of timbuktu whatever 
the case may be if they feel socially isolated   then it contributes to the the development 
of these problems and the hypothesis is that it's there's a combination social 
isolation contributes to depression   um and the lack of oxytocin contributes to 
neurochemical imbalances and social isolation   people who are socially isolated may have 
more stress sometimes because they don't have   social support to help buffer 
the stress of daily life   now you may be saying well what about you know 
jim bob who lives out in the cabin lives out on   a cabin on 100 acres and doesn't have internet 
well jim bob may have chosen to do that because   he didn't want to deal with um you know people 
because people stressed him out not everybody who lives an introverted life is socially isolated 
and feels socially isolated and the key here   is they feel socially isolated for and perfect 
example when we moved to a town that we moved to   when when i was living in florida we moved out 
of gainesville which was the hustle and bustle   university of florida you know stuff to do uh 
walmart was closed the gym was right right nearby   everything was you know right at my fingertips 
we moved out of town about 20 miles and   my husband still makes fun of me because he's 
like you used to complain that i moved you out   into the middle of nowhere well i went from a 
town of two hundred thousand to a town of six   thousand yeah it felt like i 
was in the middle of nowhere um   so i felt socially isolated now he on the other 
hand was happy as a pig and slop because he's   much more introverted than i am and he didn't 
care about not having all those things right   at his fingertips so social isolation in terms of 
being a predictive factor is all about perception   and one of the things that we can do you know 
thankfully with things like zoom um we can help   some people reduce their so social isolation a 
little bit it's not the same as in person contact   doesn't have the same impact on oxytocin levels 
but it does help people feel less isolated   when other things are not available alcohol and 
stimulant misuse drug use especially stimulants   can produce what they call drug of abuse induced 
neurotoxicity and can be a potential cause of neurodegenerative disorders as well 
as mood disorders we know that drugs   alcohol marijuana cocaine opioids you 
know psychoactive substances mess with   the neurotransmitter balance whenever you do that 
it's going to affect all of the neurotransmitters   not just dopamine or not just adrenaline it 
messes with everything it messes with the   the balance and stimulants rev up the system 
make it run hotter and can lead to a neurotoxic   environment it can lead to the tissues becoming 
desensitized just like we talked about earlier too much dopamine can cause changes in the tissue 
receptivity to to dopamine it can become tolerant   of it so when the person's not using they may 
not they may be in a state of dopamine deficiency   heavy alcohol use contributes 
to systemic inflammation   as well as corsica syndrome which 
is called alcoholic dementia   you know layman's terms and that can result from a 
thiamin deficiency the thiamin deficiency actually   causes cognitive impairment people who have 
started detoxing from alcohol regardless of   whether they're being medically monitored 
um or report that they are or not if they   or you know if they report they were a heavy 
drinker or not if they are detoxing from alcohol   and they start having cognitive symptoms it is a 
medical emergency if they don't get that thiamine   level balanced out then the cognitive um 
impairment can become permanent it can become a   much bigger deal so that's definitely something to 
watch out for but so we do know that there's the   alcoholic dementia if you will wernicke wernicke 
korsakoff syndrome but heavy alcohol use even if   it you never have corsicoff syndrome contributes 
so much to inflammation and contributes to so much   that inflammation causes the neuronal damage 
that there is a much higher risk of dementia   poor diet a diet that's high in flavonoids the 
compounds that are present in colorful fruits and   vegetables and omega-3s that are in you know your 
fatty fish as well as your olive oil chia seeds   a diet that is low in those things is going to be 
inflammatory diets that are too high in omega-6s   diets that don't include fruits and vegetables 
contribute to systemic inflammation diets that are   high in processed processed ingredients and diets 
that are are high in in foods that make the blood   sugar go all over the place cause stress on the 
body and can contribute to inflammation likewise   in order to make dopamine and serotonin we have 
to have the amino acids tyrosine and tryptophan   now they're pretty easy to come by if you're 
eating a decent diet but if you're not then   that's a problem in order to convert tyrosine and 
tryptophan to dopamine and serotonin respectively   your body also needs calcium zinc iron b6 
b12 folate magnesium manganese the list   goes on so a poor diet can also mean even if 
you're getting enough tyrosine and tryptophan   your body can't do anything with 
it because it doesn't have all the   tools it needs to break it down and 
reassemble it into the neurotransmitter   low levels of testosterone or estrogen talked 
about those already they are neuroprotective uh   when you have them at the right levels as they 
start to decline obviously their ability to   be neuroprotective declines with them you know 
you don't have as much it can't be as effective   stress can cause reductions in testosterone and 
estrogen levels toxins can cause imbalances in   testosterone and estrogen levels there are certain 
toxins in our environment that are um purported   to increase estrogen levels um and there 
are others that that block estrogen levels gonadal hormones easily identifiable in a 
blood test diet not so easily identifiable   in a blood test but some things are and a 
nutritionist or a dietitian can be helpful   we can educate people about what a healthy 
diet looks like we can't prescribe a diet   but we can inform them about why 
fruits and vegetables are important um chronic stress can lead to chronic 
hpa axis activation which can lead to   high neurotoxic environment it doesn't have to be 
ptsd it doesn't have to be trauma chronic stress   actually takes a toll on your brain chronic 
stress leads to chronic hyper cortisolism when   you're stressed a lot when that hpa axis is active 
then guess what the cortisol your stress hormone   is just cranking out like nobody's business as 
are glutamate norepinephrine and other things   and those all of those things 
create that neurotoxic environment   so that's one of those things that we are you 
know really poised to be able to help people with   adverse childhood experiences trauma and ptsd   i'm going to kind of lump all those in 
together right now just for time's sake um these when a child is younger and and those of you 
who've been in my classes before you've heard this   analogy a dozen times when children are younger 
their brains are kind of like a clay pot that   has not been put in the kiln yet it is really easy 
to damage and any assault you know if you take a   a pencil and you whack it 
if it hasn't been set yet   then that pencil is gonna make a mark 
leave a dent break it misshaped in some way   if it's already been in the kiln and come out you 
can whack it with that pencil and it may ding a   little bit but it's you know make a sound but it's 
probably not going to alter the vase our brains   are similar not exactly the same but similar when 
we are younger our brains are much more malleable   but they're also much more susceptible to damage 
so adverse childhood experiences have been shown   to actually alter the structure and functioning 
of people's brains that create a that set them up   to be more hyper vigilant to be more aware to be 
more stressed out to be more vulnerable to anxiety   and depressive related disorders to be more 
prone to chronic stress and hypercortisolism uh   while we can't unfortunately right now prevent 
all aces unfortunately what we can do is help   people develop an awareness of the impact of aces 
in their life and what they can do in order to   learn skills and tools like mindfulness 
and distress tolerance and urge surfing and   acceptance and commitment therapy tools 
purposeful action there's a lot of things   a lot of cognitive behavioral things as well as 
other strategies that people can use in order to help down regulate or re-regulate their hpa axis   autoimmune issues now those often can't be 
prevented because we don't exactly know why they   start but we can help people regulate them we know 
that stress greatly enhances autoimmune symptoms   therefore if we help people reduce their 
stress then they're probably going to be   able to control their autoimmune issues 
more effectively now when i say stress   i am talking physical and or psychological 
so for example somebody with crohn's disease   when they eat certain foods that causes a stress 
on their gi tract and causes inflammation so there   are certain things like gluten that they just 
shouldn't eat in order to reduce the stress   but physical stress as well as emotional 
stress will trigger that hpa axis   and we can get into the whole gut brain axis 
thing you know i think that's next month um   but autoimmune issues are really prevalent in our 
society today ranging from fibromyalgia chronic   fatigue crohn's disease um rheumatoid arthritis um 
you know the list kind of goes on i think there's i want to say there's more than 24 different 
autoimmune diseases but it could be way more   than that um but there's a lot and 
that's that's my point and a lot of   people suffer from them and a lot of people 
with autoimmune diseases have more than one   just kind of a little side fact they found that 
diabetes actually has autoimmune components   both type 1 and type 2.

Stress impairs the 
body's ability to regulate blood glucose   and diabetes is involved in the blood glucose 
regulation so interesting little tidbit gut health   the majority of our neurotransmitters are 
made in our gut um our gut communicates   with our brain through the vagus nerve to let 
the brain know the status of the body so it's   kind of like the floor supervisor talking to 
the ceo and letting them know what's going on   when your gut is not healthy when the microbiota 
get out of whack in your gut it communicates to   your brain and there's a cascade effect and 
and vice versa when you perceive a stressor   your brain tells your gut hey you need to make 
more of these excitatory neurotransmitters because   we got stuff going on and you need to you know 
stop worrying about digestion right now because   we need the energy in other in other departments   in order to fight or flee so it's an 
interesting um combination gut health is one of those things that's kind of ambiguous 
at this point eating foods that are   high in probiotics and high in prebiotics 
like fiber can be really helpful but different gut bacteria different microbiota have different 
functions and they found associations between   dementia symptoms um or between the the gut 
bacteria profile in people with parkinson's in   people with alzheimer's and people with depression 
they find that with each different disorder there   seems to be perturbations in the gut microbiota 
we can't know for a fact because there's like   over 100 million different type of bacteria they 
don't know for a fact which ones are directly   responsible or and they haven't identified all 
of them but they do know like the phytobacteria   is higher in this condition and deficient 
in this condition a nutritionist can work   with people on their gut health but gut health is 
important and it is more than just eating yogurt   sleep apnea i mentioned earlier each apnea 
episode the person stops breathing for a minute   well not for a minute but from 
it for a brief period of time and   during that period of time 
the body's deprived of oxygen   when it happens repeatedly every single night 
then it starts becoming an additive problem   a lot of people with sleep apnea have concurrent 
depression a lot of people with sleep apnea have   concurrent obesity and you're gonna learn 
tomorrow if you're in tomorrow's class   there is a really high correlation like 
76 percent correlation between sleep apnea   and ptsd irrespective of weight so even in people 
who aren't obese if they have ptsd they're at a   much higher risk of sleep apnea i thought that was 
really interesting but so if you're working with   people with ptsd or depression uh screening 
for sleep apnea can be i think is essential   um aids dementia complex tends to pop up in 
people who are not taking hiv drugs as the disease progresses it can progress into 
aids dementia complex the drugs have gotten   so good now that we're really not seeing it near 
as much as we did you know 10 15 years ago but   in about seven percent of people who refuse 
or are not can't afford to take the hiv drugs   about seven percent of them will develop dementia 
related to aids carbon monoxide poisoning   you can get a carbon monoxide 
detector to have in your home   really easy to do and i think even people even 
if you can't afford them you might be able to get   them for free from the health department or the 
fire department in a lot of cities and counties   but carbon monoxide poisoning can contribute 
to dementia as well as clinical depression   and carbon monoxide poisoning does not 
necessarily show up the symptoms don't   necessarily show up right away you can have it 
realize you have it get out of the situation   and then the cognitive symptoms may show up a 
couple of weeks later paying attention to this   uh it's unfortunately still something that's 
relatively common and repeated head trauma   if you have watched the news over the past 
15 years or so you know there are instances   of football players and boxers that have made the 
news who have suddenly become very aggressive and   repeated head trauma can lead to neurodegeneration 
and it's important to recognize that it doesn't   have to be something that happened last week 
it can be something that happened two years ago   that the effects are are finally starting to show 
up so so it is important to recognize that now   as clinicians we can't prevent repeated head 
trauma but we can educate people we can advocate   for proper hitting techniques in football in 
order to prevent as much head trauma as possible   if we're working with athletes or anybody 
who hits their head but you know like   basketball players will sometimes go up for 
a layup or something and then you know end   up flat on their back and hit their head we 
want to recognize that that is a head trauma   and be cognizant of those things make sure that 
they're aware even if they didn't black out   um make sure that they're aware that they need to 
pay attention to that because that was an insult   to their brain we can educate people about 
carbon monoxide poisoning where to get   carbon monoxide sensors we can encourage our 
patients to be tested for aids hiv and aids   and educate them about medication that's 
available if they do test positive what suggestions as i'm going back through these 
what suggestions do you have for ways that we can   implement or help make these things less prevalent 
in people's lives so they're less at risk   for dementia sleep apnea screen for it ask people 
when you're doing your intake how do you sleep do   you snore do you wake yourself up snoring if so 
that should be an automatic referral to the gp for   assessment and maybe even a sleep study better to 
be safe than sorry gut health that's something a   nutritionist is going to have to do as well as you 
know information about nutrition or a dietitian   or the physician but as clinician behavioral 
health clinicians you know whatever your   actual title we can educate people about 
how the gut communicates with the brain   how the gut is responsible for making the 
neurotrans a lot of the neurotransmitters   that help them feel anything and and why it's 
important to have a healthy gut not just because   you know it's less painful but you know it's 
important to have a healthy gut in order to   have a healthy body and be able to 
keep those neurotransmitters balanced   autoimmune conditions are balanced or are 
mitigated in part by stress management   there are a lot of things that people 
can do from meditation to yoga to   in some cases gentle exercise to stress reduction 
techniques even essential oils to reduce their   stress levels reduce their cortisol levels 
which can help them and proper nutrition   eating an anti-inflammatory diet which can reduce 
their flare-ups of their autoimmune condition   so working with the multidisciplinary team we can 
figure out what areas that as behavioral health   clinicians we can target now we can't prescribe 
their diet but if they go to the dietitian and   they get a menu plan their physician tells them 
they need to do these six things or whatever   what we can do is work with them to increase 
and maintain motivation and treatment compliance   so we do have a little bit of a part in 
some of the stuff that's outside of our lane   by virtue of our ability 
since we see people every week   to help keep them motivated and treatment 
compliant in terms of aces helping people um figure out ways to deal with whatever symptoms 
they've developed as a result of the aces   and we're going to talk about that a lot 
more tomorrow so i'm not going to go into it   today chronic stress helping people develop 
stress management tools identify what's triggering   their stress you know whether you whatever 
approach you use we can that can be helpful physical activity doctors are going to prescribe 
that you know we don't want to tell people to   exercise because we don't know what their 
physical capabilities are they need to have   doctors clearance but we can help them figure 
out what they might want to do and stay motivated   we can educate them about the 
impact of alcohol and stimulants   make sure they get a blood test to assess for 
liver function nutrition you know vitamin d   um your b vitamins those things do show up 
liver function um thyroid gonadal hormones   you know the whole blood panel really does 
provide a lot of really good information   and we can help people a screen for diabetes 
and pre-diabetes make referrals because if   we get that under control then they have a much 
better outlook for later in life and hearing loss   we can screen to a certain extent 
for hearing loss if we notice that   they're having difficulty hearing us 
or they're misunderstanding what we say then that might indicate a need for a referral   anyway a lot of these we can go back through and 
figure out ways that we can either educate clients   about so they know why it's important and we can 
make a referral so they can address it and or   we can work with that referral to implement the 
treatment plan and other things are directly   related to our you know area of expertise like 
addressing depression anxiety social isolation   some of those reasons can be communication 
skills depression self-esteem issues higher levels of intellectual activities 
and intellectually stimulating environments   may reduce the risk of cognitive decline 
just as a side a lower level of education   those people who didn't go on to to college 
increases the risk of having alzheimer's disease   by about approximately 30 percent now so let me 
ask you what do you think contributes to that just because you didn't go to college 
means you're higher risk for alzheimer's   i'm not seeing a causative factor here i mean i 
don't think we develop that much cognitive reserve   and prevent the the beta amyloid plaques 
from developing just by going to college   so what other confounding factors can you think 
of that might be associated with lower levels of   education and contribute to higher levels of 
stress poor nutrition exposure to toxins etc i would hypothesize and again they don't know for 
sure but a lot of people who don't go to college   or don't even finish high school tend to have 
lower paying jobs tend to be more impoverished   tend to have higher levels of stress tend to live 
in environments that have more toxins um you know   they may live in older buildings that still have 
asbestos insulation or something so there are a   lot of factors that uh may ultimately contribute 
you know you go back through that list of   22 things there's probably a lot of those that are 
higher in people with a lower socioeconomic status dietary modulation and i thought this was an 
interesting graphic you don't need to know it   for the for the test but dietary modulation 
omega-3s antioxidants b vitamins tryptophan   tyrosine all both bolster normal health 
mechanisms but they don't really possess   any discrete disease specificity so we can't 
say if you increase this you can prevent that   we just know that all of these 
things are needed for a healthy   functioning body factory psychobiotics 
and that's the bacteria in you know   yogurt and fermented foods and things like that 
can improve neurodegenerative disorders improve   neurodegenerative disorders including parkinson's 
disease alzheimer's disease and mood disorders mental illness and neurodegenerative disorders 
have overlapping neurodegenerative mechanisms   including oxidative stress mitochondrial 
dysfunction and inflammation   inflammation is so huge inflammation is just a 
bugger and a half for a lot of different things   dysfunction in the serotonergic and dopaminergic 
systems are implicated in both mood disorders   and neurodegenerative disorders and there are at 
least 22 modifiable physical affective cognitive   environmental and relational risk factors 
for mood disorders and neurodegeneration



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