Selects: How Dementia Works

25:04No, but what you should do is listen to your loved ones because they are going to be looking at you a little more closely than you can. They have more perspective. Yeah, exactly. That's what we're looking for. So don't get offended if a loved one says, let's go get you checked out. Because you can do something if you catch it early on. Right. Unless you're very wealthy and it's your no good nephew that you've never trusted anyway. You know? Very true. Then maybe bring a lawyer in on it. That's right. See what's up. So if you do go get checked out, from the second you walk in the door, your doctor is going to be eyeballing you.

25:43and looking for any signs just from their trained eye, like from how you walk to the way you answer questions to how they interact with you. They want to know, they're going to have to know your history because they need to have some context to compare it to. Right, like were you always a compulsive gambler or is this like new behavior? Yeah, and it helps to bring, you know, if you're older, maybe bring your grown son or daughter with you. or whoever has a lot of contact. Sure. Although your spouse, you never know. What? I don't know. Maybe he's trying to get rid of you. Oh, yeah? Like that no good nephew?

26:23Yeah, exactly. I'm just kidding, of course. Although I'm sure that happens. Then there are a couple of tests that they usually do in conjunction with one another. The mini mental state examination, the MMSE. Just a lot of basic questions there for mental tasks. But they're coded, the tasks are. Yeah, and they're scored individually. Yeah. And when you say question three, this person got an eight on. Yeah. You can go over and be like, yep, dementia. And it's actually pretty effective, actually. It is. And there's another test that ties into the MMSE that they both indicate one another, which apparently they're both really good at indicating dementia.

27:10But there's other tests called the clock drawing test. Did you look this thing up? Yeah, I thought it was pretty fascinating. It really is. Yeah, it seems really like why would someone tell someone to draw a clock at a certain time of the day? Yeah, usually they say draw a clock showing that it's 10 after 11. Yeah. And it makes a lot of sense in a lot of ways because it draws on all these different kinds or different regions of the brain, different skills, right? So, like, first of all, you have to remember what a clock is and what it signifies. That's a big one. What it looks like. Yeah. Clock isn't made of, like, squiggly lines or anything like that.

27:49You have to remember how a clock is laid out, the order that the numbers go in, that it doesn't keep going after 12 to 13, 14, 15. And then, once you've got all this, you have to show the hands showing that it's 10 after 11. So the hands won't be pointing at 10 and 11. It should be the longer hand should be pointing at the 2, and the shorter hand should be just past the 11, right? That's right. This requires a tremendous amount of brain power, even though it's very simple and straightforward. And you can tell a lot about a person's mental faculties just by having them draw this. Yeah, the four specific things it requires are verbal understanding, memory, spatially coded knowledge, and constructive skills.

28:31And if any of those are off in conjunction with the MMSE, then they're going to have a pretty good idea of where you fall on the dementia scale. If you don't have the constructive skills to pay the bills, you may have dementia. That's right. And they actually, I looked at one study about the clock drawing test. Basically, I think it was just a more recent, like, hey, let's go in and really look at this thing again. Right. And it checks out. Yeah. They stood behind it and said, yeah, it's actually a really good indicator. Yeah, like it really holds up. And I think they developed it in the 60s, but it didn't take off until the 80s.

29:03It seems like a very 60s thing. It does. But it's something you can do anywhere. And now they're starting to gather these different clocks that people with different types of dementia are drawing and basically compiling them into a database so you know what to look for even more. Like, oh, somebody draws a clock that has like a 13, 14, 15 on it. Right. They may have this type of dementia. Right. Or this one looks like Salvador Dali drew it. Right. Then they might have this kind of dementia. Yeah. Or they might just be super talented and creative. Yeah. You never know. All right. Let's – should we take another break?

29:38Why not? Is it time? Sure. All right. We'll be back after this to talk about treatment and some of the other pitfalls of dementia.

29:54New year, new goals, and in this economy, a better money plan is more necessary than ever. I am Matt. And I'm Joel. We are from the How to Money podcast, and every week we help you to spend smarter, save more, and make sense of what's going on out there. If you want 2026 to be the year you finally feel in control of your money, we're here to give you the tools and advice to help you make it happen. Listen to How to Money on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, Kyle. Could you draw up a quick document with the basic business plan? Just one page as a Google Doc and send me the link.

30:28Thanks. Hey, just finished drawing up that quick one-page business plan for you. Here's the link. But there was no link. There was no business plan. It's not his fault. I hadn't programmed Kyle to be able to do that yet. My name is Evan Ratliff. I decided to create Kyle, my AI co-founder, after hearing a lot of stuff like this from OpenAI CEO Sam Altman. There's this betting pool for the first year that there's a one-person billion-dollar company, which would have been unimaginable without AI, and now will happen. I got to thinking, could I be that one person? I'd made AI agents before for my award-winning podcast, Shell Game.

31:03This season on Shell Game, I'm trying to build a real company with a real product run by fake people. Oh, hey, Evan. Good to have you join us. I found some really interesting data on adoption rates for AI agents and small to medium businesses. Listen to Shell Game on the iHeartRadio app or wherever you get your podcasts. Like if we're on the air here and I literally have my contract here and I'm looking at, you know, as soon as I sign this, I'm going to get a seven-figure check. I've told them I won't be working here in two weeks. From the underground clubs that shaped global music to the pastors and creators who built the cultural empire, the Atlanta Is podcast uncovers the stories behind one of the most influential cities in the world.

31:44The thing I love about Atlanta is that it's a city of hustlers, man. Each episode explores a different chapter of Atlanta's rise, featuring conversations with Ludacris, Will Packer, Pastor Jamal Bryant, DJ Drama, and more. The full series is available to listen to now. I really just had never experienced anything like what was going on in the city as far as like, you know, seeing so many young, black, affluent creatives in all walks of life. The church had dwindled almost to nothing. And God said, this is your assignment. And that's like how you know, like, OK, are you from Atlanta for real? I ain't got to say too much.

32:18I'm a Grady baby. Shut up. Listen to Atlanta is on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts.

32:36So, Chuck, we've kind of, I think it almost goes without saying, like the problems associated with dementia, like you lose your ability to reason in a lot of cases. You lose your ability to move and take care of yourself. You lose your memories. You have trouble forming new memories. You have trouble recognizing people. So living life is extremely difficult. But there's also like other complications that you may or may not think of, right? So let's say you're an elderly person and you have a battery of medications that you need to take for unrelated heart disease. Yeah. Do you think you're going to remember to take those medications?

33:17Right. Probably not. Even if you have a timer set or some sort of calendar or something like that, you may have trouble even remembering that you have a calendar that you need to go check out to see what's on there, let alone to take the medication that's indicated that's on that calendar. Yeah, that's a big problem. Nutrition itself is a big problem. Either you forget to eat altogether or you think you've already eaten or you physically have deteriorated so that you can't control the muscles to chew and swallow and you could choke. Right. It's a real danger. So when people die from Alzheimer's, it sounds kind of strange if you think about it.

33:56It's like, well, no, they forgot. They lost their memory or whatever. Right. No, the brain is actually being slowly destroyed. Yeah. Periodically. and eventually it's going to reach the parts of the brain where you can't swallow any longer. Then you die from that kind of thing. You also can lose your sense of hunger. Like you just aren't hungry anymore. Yeah. Kind of tough to eat, especially when you're not thinking or remembering that you should eat when you're just not hungry ever. Yeah. It's a tough one. Hygiene. Reduced hygiene is a big one. And a lot of times in severe dementia cases, you either are unable to bathe and dress yourself and brush your teeth or you forget to.

34:37It just falls by the wayside. I know that was the case with my grandmother. She needed to be bathed by my dad. Because she lost interest in it or because she just couldn't do it anymore? I think both. That's another indicator. You said that when you go in for a diagnosis, the doctor is going to be watching you and just kind of sizing you up. One of the things they'll look for is whether you look disheveled. Yeah. That's a big one. And especially if your son or daughter is saying, like, this is really bizarre behavior because mom always, like, dressed to the nines. Yeah, whenever she left the house.

35:13Now she just wears this dirty old bathrobe all the time and doesn't ever want to take a shower. Yeah. That's usually an indicator of dementia. Yeah, it's not like she just gave up and doesn't care anymore. Right. It's part of the symptoms taking hold. Although another problem with dementia and one of the confounding factors is that depression can be a byproduct or comorbidity of dementia. Yeah. Because you recognize that your life is changing in ways that you're not happy about. You can't communicate anymore. You forget stuff all the time. You can become depressed. So then that could lead to you giving up on taking showers and dressing as well.

35:52Yeah, and not only depressed, but agitated and aggressive, riddled with anxiety. A lot of your emotional well-being and emotional health will be slipping away from you. Yeah, and again, this can be a direct result of chemical changes in your brain due to dementia. Or it can be like this is the result of you recognizing these changes and just becoming upset about them. We talked about communication and the hallucinations. Uh, you're going to have trouble sleeping as well in a lot of cases. Yeah. Uh, and then personal safety. Um, a lot of people die every day because of accidents that happen as a result of dementia.

36:34Right. People who shouldn't be driving get into cars. Yeah. Um, and there's this, there's a push that's going on now. I think in the last year or so, um, as part of the council on aging, like the United States council on aging, there's a new initiative called the dementia friendly America initiative. Really neat. Yeah, it's basically saying, look, we've got about one in eight people over 65 in the U.S. have dementia. We're about to have way more than that in the next couple decades. We need to be prepared for this kind of thing. So let's start training America how to recognize the signs of dementia and then how to react to it in a friendly and helpful manner so that people who are wandering around with dementia don't withdraw$80 ,000 from their bank account and walk around with it in their pockets outside.

37:23Yeah, and how do you do that? You get some money from the government as a grant to go out and hire people to literally go to businesses and go to restaurants and talk to waiters and waitresses, or should I just say waitrons. Sure. Go to banks and talk to tellers. Go to anywhere where there's interaction with another human. Grocery store, check out people. Yep. And literally train them on, like you said, how to recognize it and how to kindly deal with these people. Right, exactly. Apparently, one of the things you teach people in service industries is not take it personally. Right. That if somebody's behaving erratically or they're using incorrect words and they're of a certain age, The chances are they probably have dementia and there's ways of dealing with it.

38:12Apparently, responding to it in a soft, friendly manner tends to get results from the dementia patient. Especially if you are not... You mean not being an aggressive jerk? Right, exactly. Just being nice will frequently get good results. And yeah, it is a pretty neat initiative. Absolutely. And necessary. Yeah. You know? But I'm stricken by the idea that people are planning out this far ahead for this kind of thing. It's exceptional. It is. And scary, but awesome. So if you do have a family member, one thing that's important to remember, there's something called the caregiver burden that my dad and his wife definitely experience.

39:01It is really, really tough on you, on your family, and it can actually take a physical toll. They have some stats here. If your risk of death as a woman, if your husband has dementia, increases 28 % in the first year after they're diagnosed. And only 22 % for a husband whose wife is diagnosed. It's still a pretty significant increase. Oh, sure. Just from the dementia diagnosis. Uh-huh. Yeah. And what they recommend in this article is to take care of yourself first because they found that if you are not going into this with the right attitude and you are upset or have anxiety, you're just going to do more harm anyway.

39:49Right. So get yourself right, take care of yourself, and go into it in the right frame of mind, and you'll actually be able to help better. Yeah, and this caregiver burden or caregiver burnout is a very real thing physically, too. Like you have low energy, you have low productivity, you become snippy, resentful, angry, and you can end up basically mistreating your own parent or spouse because you're so upset with this horrific disease. One of the hallmarks of dementia is that there's no two days that are alike. And when you're dealing with the dementia patient, what worked yesterday isn't going to necessarily work today.

40:30Well, if you can no longer predict what your life is going to be like from day to day and you're spending, I think I saw this one study that found an average of 22 hours a week of unpaid care by spouses, wives, daughters, that kind of thing. You can very easily get stressed out. The main thing you have to do is ask for respite care. You can't do it by yourself. You have to have other family members, members of your church, your community come and give you a break so you can go do other stuff for a while. Absolutely. And, I mean, you could totally see how you could just very easily evolve a really unhealthy dynamic if you're just trying to do it yourself because you lose perspective.

41:14This becomes your norm even though it's totally abnormal. Yeah, and boy, you talk about a really sad way to damage what previously was a good relationship with a parent or something. Yeah. It's devastating. Sure. You know? So there are drugs that they use to help stave off dementia. Mainly, right now, they are cholinesterase inhibitors. Mm-hmm. and they suppress cholinesterase, which is an enzyme that breaks down acetylacetyl? Acetylcholine. Acetylcholine, which we've talked about before. That's what helps transmit messages between neurons. Right. So that'll help. Yeah, because if you're not communicating as much as you were before, at least the communication that is going on can stick around longer.

42:10Exactly. You know, it seems primitive as far as like brain drugs go, but it makes sense, you know? Yeah. And then there's another one. Are they still using this? I believe so. Memantine. Uh-huh. And it inhibits glutamate, which we've talked about before, which causes neuron death when overstimulated. Yeah. I can't remember where we talked about that one either. I just remember glutamate from the umami episode. Yeah, it was definitely in that one. And then there's also stuff you can, so these drugs will help some. That's for non-vascular dementia. Right. With vascular dementia, you're going to want to take blood thinners, anti-coagulants.

42:49That's just to prevent a stroke. Yeah, to keep more strokes from coming along and making the whole thing worse. And then with like Lewy body disease to deal with things like the hallucinations and stuff, you'll probably also be given antipsychotics as well. Yeah. And one thing that they're starting to realize more and more is it's very difficult to really figure out what kind of dementia people have just from, what's the scan? MRI? Yeah, MRI scans. Yeah. And you can really go back and accurately identify types of dementia from autopsies, right? Right. Right. And so for more and more autopsies, they're finding that there's a lot of what's called mixed dementia, where you have Alzheimer's and vascular dementia.

43:34Right. Or where you have Alzheimer's and Lewy body disease. And so it can be really tough to suss out all the different kinds of dementia a person might have. But if you can do that, then you can put them on a drug regimen that could really kind of help more than just treating the Alzheimer's and letting the Lewy body go unrecognized and rampant. Yeah. Or unchecked. There's also preventative stuff you can do, too. Oh, yeah? Yeah. Like what? Crossword puzzles. Yeah. I told you, Emily's grandmother, Mary, is 95. Yeah. And very sharp. Yeah. And she does word puzzles all the live long day. And is it Sudoku?

44:17Yeah, she does all kinds of word puzzles. Yeah. Things that I have never even heard of. Supposedly that helps stave it off. Oh, yeah. Apparently, this one's great, alcohol, moderate alcohol consumption, which is two a day for men or one a day for women, has a protective effect. It staves off dementia. They're not sure why. They're not sure what kind of alcohol is the best. They just know that for some reason alcohol has a protective effect. Probably up to that two drinks and then it's probably bad after that. Yes, then it becomes very bad after that. Yeah. So you want to just moderate them out.

44:56Right. In all things, people. Moderation. Moderation. And then there are some things that you can do. Here's the thing. There's a debate on whether or not you are tricking your loved one by doing things like giving them an appliance that doesn't work so they can pretend that they're ironing or something. Right. Because they used to love to take care of their laundry themselves. So here, let me remove the cord from this iron. And is that tricking someone? Is it not? And a lot of people think, no, that's what you should do because it makes them feel like they're being useful. They're not going to get hurt with a hot iron.

45:42Yeah. So it's all good. Other people say no. That means that they're not hanging on to that last bit of reality they may have. Right. I think it's fine. I think it's fine, too. And there's actually an entire village set up just outside of Amsterdam. Yeah, this is awesome. Called Hogewe, right? Yeah. Hogewe. How would you say that? I have no idea because Dutch is the weirdest language. Hogewe. We'll say that, okay? Okay. And it's what's called a dementia village, basically. Yeah. Where everyone who lives in this village, I think 150 people, all have dementia. And they live in group houses. Well, there's caretakers that live there too.

46:29Okay, yes, you're right. And they live in the group houses with them. And a lot of the people realize that this is their nurse or just think it's a good friend of theirs. They don't really remember when they became friends. Like a cool roommate? Yeah, exactly. And the houses they live in have different themes according to how the people lived, depending on whether they were blue-collar, whether their memories go back to the 70s. This whole place is basically set up so that it's a very non-threatening, safe place for these people to just kind of live and move about within. Sure, safely. Yeah, safely.

47:07And so they can go to the grocery store. They can go to the movies. They can go ride a bike. And everyone, the people at the movie theater know that the people there have dementia. Right. It's like they're real movie theater workers and real waiters in the restaurant. They're just specially trained. Exactly. So it's a less clinical setting than, say, a nursing home. And a lot of people say this is awesome because it's as close to real normal life that they were used to as they're going to get. Yeah, exactly. Then, of course, there's other people that poo-poo and say, no, you're tricking these people.

47:40But you can say, hey, okay, here's the big difference with this place. If this dementia patient gets lost in Manhattan and they run across a city worker who's collecting garbage, that city worker may do absolutely nothing to help them. Yeah. In Hojwe village, that city worker is specially trained to get that person back to their house or alert their caretaker that this person is having a crisis or something like that. It's what we're trying to train people to do in the future. Yes. They've just isolated it to a community. Yeah. Yeah. So there's, I mean, when you break it down to that distinction, I don't really see anything wrong with it, especially when you are protecting the patients themselves.

48:26Yeah. It's not like you're doing it to experiment on them. No, no. You know, or because they'll produce gold in their urine or something like that. You know, like this is strictly for their protection. Yeah. But also allowing them to live a free life outside of a clinical setting. Right. I don't see much wrong with that. I do get what the bioethicists are saying. Like, yes, you're robbing someone of their dignity by lying to them, by deluding them or playing into their fantasies. Strictly speaking, yes. in the real practical world, I think this is great. If I'm at that point, then play into my fantasies.

49:01Exactly. Please. It is 1984 all the time. In fact, one of the people that work there say that people that do criticize it, that's a very good point. He's like, they don't understand what we're doing here. These aren't actors. They're like real employees of these places. They're just helping out. Right. You know? And so Hojve Village, I hope I'm saying that right, because I'm really putting myself out there. Oh, I'm sure you're not. It's become this kind of ideal standard of care, but it's also really expensive. Yeah, I'm sure. So in a country where there's a lot of socialized medicine, it could do pretty well, like in the Netherlands or in Canada.

49:40Yeah, when they take care of people even though they don't have money. Right, exactly. There's one called, in Canada, it's called pentanguishene. Pentanguishene, Ontario. They have one. It's a little smaller than the one in Amsterdam. They're also building one in Miami as well. So it is starting to take hold. People do believe in it. Apparently, the patient's families are very happy with this kind of thing, too. Well, and hopefully with the initiative of, what's it called? Dementia Friendly America. DFA. Yeah. .org. Yeah, hopefully with those efforts, more and more people will, because it's coming.

50:23Oh, yeah, it's coming. A lot more folks are going to be out there that we need to take care of. Yeah, we don't know how to cure dementia. We just know it's coming. I'm going to be one of them. You think so? Sure, at some point, if I make it that long. But not everybody gets dementia, no matter how long you live. I don't know. I've got a feeling. Really? Yeah, it does run in my family a little bit. Yeah. And I have my father's family genes more than my mother's, I feel like. So if I had my mother's genes, they all died from heart attacks and strokes and heart disease. Young? Not a lot of cancer.

51:05Yeah, pretty young. So if you make it past 65, you beat the heart stuff. Then the Bryant genes kick in. Then you have the dementia. Yeah. Well, we're all going down one way or another. I may live to be 100. Yeah. You know? Yeah.

51:23Man, I thought of something. Oh, yeah. I wonder, Chuck, if like us, you and me specifically, cramming all this information in every week is actually beneficial? Or if we're just setting ourselves up for massive cases of dementia because we're just pushing stuff in and getting it out, pushing in new stuff and getting it out. Yeah. Like are we abusing our brains or are we exercising it? I question that sometimes. I bet someone out there, I bet there's a neurologist who has a good gut instinct answer to that one. Let us know. I want to know. Good news or bad? Okay, neurologists? There's going to be a subject line that just says, neurologist, guys, you're screwed.

52:02Yeah, I have bad news. If you want to know more about dementia, you can type that word into your favorite search engine, and it will bring up tons of information and great resources. You can also type it into the search bar at HowStuffWorks, and it will bring up a great article. Well, since I said search bar, it's time for listener mail. I'm going to call this one Hecky Krasnall Lives. Okay. Although I don't think he is with us. Hey, guys. I only just started recently listening to the show. It's been a fantastic way to pass time and learn something interesting. I'm a home-taught high schooler, so every time I listen to an episode of your show, I get a history or science credit.

52:42How about that? That is pretty great. But as great as that is, that's not why I'm emailing. I actually have a fun fact for you guys from your Play-Doh episode in which you mentioned Captain Kangaroo. Well, my great-grandfather worked on that show. He produced the songs for it, as well as several Christmas carols, including Frosty the Snowman and his biggest claim to fame, Rudolph the Red-Nosed Reindeer. That is awesome. I've always thought it was very funny that a Jewish guy was responsible for the popularity of Christmas carols. my family, all still Jewish watches the Claymation Rudolph movie every year because of that our own little taste of that irony I don't want to tell you what to do because I'm sure you have a lot of episodes on your plate already but I'm just saying Hecci Krasna was a pretty interesting person there might just be enough material for an episode on him up to you thanks for helping with my school work that is from Aiden in Maryland awesome, thank you very much Aiden And when I say Hecci Krasnel lives, I mean lives on.

53:46Sure, like Viva La Hecci. Yeah. If you want to tell us about someone interesting in your family, we love that kind of stuff. Also, if you're caring for a dementia patient, we want to hear the highs and the lows of that. Just kind of bring it on home for us, will you? You can send us an email to stuffpodcasts at howstuffworks.com. And as always, join us at our home on the web, stuffyoushouldknow.com. Stuff You Should Know is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

54:28Hi, Kyle. Could you draw up a quick document with the basic business plan? Just one page as a Google Doc and send me the link. Thanks. Hey, just finished drawing up that quick one page business plan for you. Here's the link. But there was no link. There was no business plan. I hadn't programmed Kyle to be able to do that yet. I'm Evan Ratliff here with a story of entrepreneurship in the AI age. Listen as I attempt to build a real startup run by fake people. Check out the second season of my podcast, Shell Game, on the iHeartRadio app or wherever you get your podcasts. Whether it is getting swatted or just hateful messages online, there is a lot of harm and even just reading the comments.

55:06That's cybersecurity expert Camille Stewart-Gloster on the Therapy for Black Girls podcast. Every season is a chance to grow. And the Therapy for Black Girls podcast is here to walk with you. I'm Dr. Joy Harden-Bradford, and each week we dive into real conversations that help you move with more clarity and confidence. This episode, we're breaking down what really happens to your information online and how to protect yourself with intention. Listen to Therapy for Black Girls on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Babes, what are you doing? What? I'm just mowing the lawn.

55:43No, it's blazing hot and dry out here. Don't you remember? Smokey Bear says... Avoid using power equipment when it's windy or dry. Where'd you learn this? Oh, it's on... SmokeyBear.com with many other wildfire prevention tips. Right. Thanks, honey bear. Because remember, only you can prevent wildfires. Brought to you by the USDA Forest Service, your state forester, and the Ad Council. This is an iHeart Podcast. Guaranteed human.