 Welcome to Senior Moment. I am your host, David Refson. Senior Moment is for seniors and about seniors. We are very pleased to have as our guest today, Professor Rebecca Reedy. She is a neuropsychologist and director of clinical training at the University of Massachusetts. We're going to focus our attention today on areas concerning memory, cognition, and the aging process. And welcome, Professor Reedy. Thank you. It's a pleasure to be here. Thank you. So tell me about yourself and how you got involved in this whole area of aging in terms of memory and cognition. And tell me a little bit about what neuropsychology actually is. Absolutely. So I was early in graduate school and was focusing my studies on the assessment of emotion and personality. And I got the opportunity to work with a fantastic mentor who was a clinical neuropsychologist and wanted to assess personality and emotion in older adults with Alzheimer's disease. So she really wanted to partner with me in applying some of my tools to a new population and it was a very exciting collaboration. And that was my introduction to research with older adults, both healthy older adults as well as older adults suffering from Alzheimer's disease. And I really launched my passions to work with and study older adults. I particularly became fascinated with studying questions of resiliency in aging. There's a lot of challenges in growing older but there are remarkable strengths and sources of resiliency you see in older adults in basing these challenges. Is your work primarily in research? I do both clinical work and research and teaching. Training, graduate students and future neuropsychologists is a big part of my job. So all of these things. But research plays a big role as well. When you say clinical, you're doing a lot of one-on-one with folks as like a therapeutic process or an interview process? You had asked me what clinical neuropsychology is. Clinically what that means is it's not psychotherapy so I'm not a therapist but I will do an assessment with an older adult who may be complaining of memory problems and we sit down and do an interview and they fill out some questionnaires and we do sometimes hours of pencil and paper computer tests to assess all sorts of thinking abilities and then I come up with a conceptualization and a diagnosis and recommendations and then I'll sit down with the patient and sometimes family members and talk about what I think is going on and what I think would be helpful for them moving forward. So you do give them treatment options as to? Absolutely. I think that's the most important part is partly explaining what's going on but also what are the next steps? What do we do? So do you follow up at that point? Or do you make recommendations to this person about treatment options and hopefully they're going to follow what you're suggesting and now a period of time has passed or they have an opportunity to go into treatment do you then follow up at some point? Most often neuropsychologists don't have that luxury because they're not treating the treating provider. In some circumstances you do have a chance and I usually invite that chance. Most people don't take me up on it but I say process. We've gone over a lot today. I'm giving you a lot of ideas. Feel free to contact me in the future if you want to talk further about some of these things. The reason I'm asking is doing your research it would seem helpful to get outcomes down the road. Absolutely. That's a brilliant question. Some place along the line if you had enough population of folks who did get back to you. It's a major challenge in healthcare to get outcome data to show that what you're doing is effective and worth the time and effort that goes into it. Just following up for a minute before we get into other topics. How do you assess that what you're doing or what you're saying for treatment is effective? How do you know that? We give evidence based treatment recommendations so we know based on particular patients' diagnosis or condition are what are likely to be useful strategies for managing that based on previous research studies. Is there in terms of this just particular modality we're talking about is there new treatments coming down the pike? We haven't talked really yet about things like Alzheimer's and dementia and I don't know if this is quite the moment but do you see new treatment options coming down the road to folks? To be honest with you there's incredible resources being poured into the search for a cure or effective treatment or prevention for Alzheimer's disease and a breakthrough's got to be on the horizon but I don't have insights as to whether we're not on a precipice of any great breakthroughs I think. But the search is on and it needs to be with the aging population. So is it absurd to think that maybe whatever time frame we're talking about this may be a vaccine on something or is that just out of the question? I really don't know enough to actually answer that question as to I think we don't know enough about the mechanism of action I think we're still trying to figure out what exactly causes Alzheimer's disease and if it's something that could be vaccinated against that would make sense yeah that would be terrific. I know we've talked about this other areas where they're obviously doing that. Talk about the different areas of memory and how things change as we get older and what type of memory we're really talking about. So I have a feeling there's more than one here. Yeah memory can be subcategorized into many different types. So for example we could talk about verbal versus visual memory you know learning your grocery list versus learning the route to a new friend's house or you can talk about new learning versus old learning which is particularly important when we talk about concerns about aging you know we're forgetting things that happened recently but remembering things that happened a long time ago. That's me. Yeah and there's also different types of memory for example procedural memory like learning to do something riding a bike uses different parts of the brain then again remembering your shopping list for example. I'm particularly a very visual person so in order for me to remember something I need to see it because sometimes you can tell me something and it kind of goes in somewhere in there but it asks me three days later and I go oh jeez I don't know but if I see it and it's interesting it's not just the grocery list though that's one of them but it helps you with driving. I can go someplace once and I know exactly how to get there the next time because I focus in on the visual aspects of there's CVS there and so that really really helps me when it comes to kind of memorization that's going on. So the neuropsychologist in me makes me think that if I gave you an evaluation that visual memory might come out as a relative strength for you and it also makes me think that you for one reason or another pay particular attention to visual cues because they're meaningful to you they're easier to remember and so the more you pay attention to those visual cues the better you'll be able to remember them. Unquestionably me so memory changes over time obviously and the older we get you just mentioned it happens with me too. I can tell you 50 years ago in detail every second of an event that happened but sometimes last week I have to really think about it and decide carefully what it is I'm trying to remember. So what happens with the brain? I mean how does it change over time? Do we have brain cells or are we not just So that's a great question yeah in terms of and what you're describing are changes that are normal part of aging so they're not a pathology they're not a disease and they don't cause problems with daily living although they're frustrating. Learning becomes a little more inefficient as we get older but memory itself doesn't change too much. What I mean is once you learn you're likely to hold on to it so sometimes what seems like a memory problem might be more like a learning problem and paying attention to something enough so you are able to encode it and hold on to it over time. It's natural for us to forget lots of information we simply can't hold on to all the information that's coming in but it is true that we're a little less efficient in learning so it may take a little longer to hold on to the new information but once you encode it and get it in and filed away in your storage system it's probably likely to stay there. So I get a sense because I'm 73. I've had a lot of information thrown at me over 73 years so there is some place in my brain it's like almost like cloud memory almost I guess on a computer and it's there and we can just keep memory and memorizing it never seems to fill up truly I mean that's what it seems like. Well again you are forgetting lots of information a lot of information that's bombarding you now is not even reaching consciousness right so there is and we remember information that's meaningful to us so those you talk about I can remember details of events from my childhood but probably they were somewhat meaningful for you to hold on to that information. But yes in terms of storage capacity of memory it seems to be limitless I was just going to say it does seem that way because there's probably not a moment during the day when we're not sort of asked to remember something so it just keeps kind of filling up now recalls a whole other story right I mean accessing that information absolutely so it's not always easy to get at your information stores and that is definitely a phenomenon with aging it's called tip of the tongue phenomenon when you can't remember the name of the restaurant that you ate at last week but you know you know it. I am the king of that I mean I cannot begin to tell you I can tell you that like you said the restaurant where we ate but coming up with the name I have to really really try hard to come up with the name that really happens but it's not like there it really takes me a little bit to do that. And so often times you know just speaking colloquially people say oh my memory is so bad I can't remember the restaurant we ate at last week but actually you can remember it if somebody said oh was it this you'd say yes that's called recognition memory you could recognize it so the information is in your brain it's just being able to efficiently access it that changes and in fact it sounds like you try very hard to remember probably the best thing to do is stop trying and it'll just come back to you. Well I do but then I get a little frustrated because I really want to say wait I gotta really remember what this is and I don't so it gets a little kind of gets a little frustrating I want to talk a little bit about cognition and how we process information. First talk about what cognition is a little bit and maybe you can also talk about what parts of the brain I don't want to get too technical here but how that whole process works. So I'll answer that question as a clinical neuropsychologist. So when I'm doing an evaluation let's say with an older adult I sometimes explain to them what we're doing I sort of set up the situation and say today we're going to take a tour of your brain and we're going to do lots of different tasks today that assess different types of thinking abilities and my goal is to determine what are your strengths and weaknesses are you having problems in any particular area that we might be able to address and so when we're taking that tour of the brain I'll be assessing what neuropsychologists sort of consider the major domains of thinking and those can be learning and memory which are different. Attention processing speed and that is something that changes with age can you talk a little bit about that processing just the speed at which you process information so I would assess processing speed in a task that is very easy to do let's say matching numbers and letters on a code so it's not a complicated task it's simple but to see how far you can get in a minute there are decrements in processing speed starting actually about age 30 so yeah I see a slow decline so I guess it sort of goes to my next question and that is a 25 year old is going to have a faster processing speed than I am that is true. Well on average 25 year olds will you might be exceptional. No I understand but as we get older you see a slight decline but still even a 30 or 40 year old is going to process a lot quicker than I might. You're not sure it's a lot but you definitely see a decline with age and it's not to the point where it's impairing in daily life but maybe noticeable. Do you ever get into this is maybe more medical than anything else brain imaging at all is that something that would if you do it would be helpful do you coordinate if you want to do it with other areas like medical to see what might be going on in a person's brain certainly so brain imaging is a technology that is advancing at a really rapid pace and it is a useful tool clinically so often brain imaging is used when older adults present for an assessment of memory decline or dementia it can be a useful piece of the puzzle in addition to the neuropsych testing and lab results and sort of all that information is put together to conceptualize the case but it's also an incredibly useful tool for research to learn more about the aging brain and how neural networks communicate with one another and if there's changes with aging and the technology is advancing at a breathtaking kind of rate. Interesting. One of the things they notice is and this is not always true but sometimes medication is recommended for folks and you know you often see on TV the advertising of medication and they spend like five seconds on the medication and about two hours on the side effects for the medication and it's kind of a little disturbing because if you have a side effect they may give you another medication to deal with the side effect and it keeps snowballing from there. I wonder if and it's a little off the topic but I wonder if they work on those issues it seems like very difficult for a person to take a medication when potentially it could be some serious side effects it may help the initial diagnosis but then it may create other problems as well. Well yeah that's a really important issue particularly with older adults because older adults may be on as you mentioned a number of medications and oftentimes those medications have cognitive side effects. So it's something that a careful neuropsych evaluation and medical evaluation should really take into account a careful look at all the medications and the dosages and the interactions to make sure that they are in the best interest of the patient and not actually maybe causing some problems and thinking abilities. So when that happens do you sort of coordinate with like a pharmacologist or medical doctors or is it strictly that you know enough about when you do the... No this is not my field but I could yeah take a look and maybe make some recommendations that they go see their physician to have their medications reviewed. Right because you're going to do an evaluation and this obviously some people are going to need medication and realizing it's not...medication is not quite your field there's going to be a need for either a medical doctor or a pharmacologist to take a look at that and to see what's going on. And I think what might be helpful is just that somebody's calling their attention to it because sometimes medications are prescribed sometimes by different providers and people aren't talking to one another so so that's often when a neuropsychological evaluation can be really useful because it's someone taking a careful deep look at everything and may see things that other providers are missing when they're looking at their one kind of piece of the puzzle in isolation. Very interesting. You and I have talked a little bit about healthy aging and what that means particularly for the brain. Can you talk about that a little bit? Also in terms of how we keep our brains healthy what kind of activities or ideas or whatever would allow our brain to be healthier so maybe some of these things might not necessarily come about. Absolutely and there's fantastic evidence based information I can provide to you so everything that you know you need to do to keep your body healthy will also keep your brain healthy. So for example walking studies that show older adults who increase their just walking a few more miles a day it has noticeable effects on performance on cognitive tasks for example. And I think that that information maybe is not as well known then as engaging in cognitively stimulating tasks is useful like crossword puzzles, reading, Sudoku but something that may be left out of the conversation a little more are things like being socially active. Social activity is complex and challenging and excellent for your brain and your mental health as well and I think attending not only to your cognitive health but your mental health is incredibly important and there's an important interplay there. I would think the more you socialize number one it makes you feel like you're part of a social grouping but I think it makes you happier just so you know that people like you, they want to see you, they want to talk to you vice versa. And they also think about it's complicated to talk with other people and interact and hold a conversation and it's excellent for you. I know too that food becomes a factor here as well. I'm glad you brought that up. Maybe you can address that just from your, again right so nutrition, super important I also mentioned the basics of hydration and sleep sleep apnea is a common cause of mood disorders and cognitive problems in older adults so and very treatable really you can see remarkable improvements when sleep improves so all these things your mom told you to do eat your vegetables and drink water and get a good night's sleep I think sleeping is a major ordeal but I know a lot of folks I always hear it from other friends about they have hard time sleeping and they've got to do something I know there are things like melatonin and other things that certainly can help with that but it seems to be there's a lot of them but that seems to be one of the big issues with sleeping and as you get older it seems a little more difficult to get really the right amount of sleep within limits of course but getting three hours of sleep. It is challenging and sleep architecture and sleep changes with there's very good data to show that it does change with age and it's lighter and it is harder to sleep so a lot of the advice I'm giving about keeping a healthy body and brain will also help with sleep exercise helps a lot keeping daytime napping although a short daytime nap 20 minutes could sometimes facilitate nighttime sleep I used to be a great 10 minute napper and then I feel it doesn't happen so much more but in earlier years I was able to do that and take this 10 minute little power nap and it really revived me yep well there's yeah then you're living proof there's data to show that it's a good thing I got you I want to talk about word finding we talked a little bit about it and I need you to tell me a little bit what that is and how it relates to all that. Yeah so word finding is we did talk a little bit that it's very frustrating and it does increase it's one of those changes with changes in cognition with normal aging having more difficulty to find words it interferes with conversations but it's not anything in and of itself it's done anything to worry about and it's basically having less efficient access to the file drawers in your mind if you think you've got all the memories filed and stored away in your brain and they're sitting there waiting to be used it's just a little harder to pull them up at the moment that you want them yeah and what's getting about it or trying really hard to find the word is usually counterproductive it just causes anxiety and might make the problem worse it's better to just sort of laugh it off and try to find a talk around you know here's one of those more senior moments I know we don't have a lot of time left but I just want to at least broach the idea of dimension Alzheimer's you've been doing this for quite a while are you seeing a tremendous increase in people who have those diseases and why do you think that's kind of if you have a sense of why do you think this is going on we hear about Alzheimer's all the time the rates of dementia are increasing because the number one risk factor for dementia is age aging and our population is aging at unprecedented rates I guess I can't access the numbers off the top of my head but we're looking probably at maybe 50 million Alzheimer's cases by 2050 I think that is crazy yeah so it just has to do with the aging of our society and it's an age based disorder there are other risk factors there's genetic risk factors lifestyle may play a role head injury may increase the risk factor for Alzheimer's disease but really it's a disorder of aging meaning that the brain has now changed because it's older so it leaves you open more to this type of thing Alzheimer's probably starts in the brain decades before we see clinical signs so it's something that's occurring at midlife but you don't see it hasn't progressed enough to cause behavioral manifestations or symptoms until usually later in life after age 65 so the search is really on in Alzheimer's for those early early markers how do we catch people who are on the trajectory to getting Alzheimer's disease at midlife and so the earlier obviously that you catch it more the possibility is not necessarily going to cure it but possibly slow down the progression of the disease certainly if we have a cure or a prevention or a treatment the assumption is that the earlier it's implemented the better even if you could delay the onset of Alzheimer's disease by five years you would remarkably reduce the incidence of Alzheimer's disease because some people would simply age out of would pass from other causes before they ever got Alzheimer's disease so even a delay of a number of years would be a tremendous savings I mean I know we can't get into this too heavily we could talk for hours about this one last thing I wanted to kind of get into with you is the blog you have a blog so kind of we'll finish up with that and tell me a little bit about that so I blog on psychology today I was invited to do this a number of years ago they were looking for somebody who was interested in writing about the science of aging on their website and I really enjoy this activity as part of my professional life because I do do a lot of research which results in me writing journal articles for professional journals and my colleagues but it's a very limited audience and sometimes you feel like that research you do doesn't make an impact so I love the blog because I can translate what I find to be interesting research about aging and make a brief post for a general audience and get it out in the world that you may not reach perhaps a large audience but I have a feeling what you do has an impact with other folks in the field oh yeah certainly that has yeah for sure but just a general population who's getting older and experiencing all this and wanting to know more information about that so I think it's very interesting well we have certainly said a lot today I want to thank you very much Professor Reedy for coming here it's really appreciated thank you all for listening and I hope to see you again next time on Senior Moment thank you very much