Informed Aging

Episode 78: Check In On Your Brain

Robin Rountree and Edith Gendron

 This podcast episode provides valuable information about the importance of healthy brain assessments and the potential benefits of establishing a baseline cognitive assessment.
My Memory Clinic
Maureen Rabazinski, APRN


Support the Alzheimer's & Dementia Resource Center

Robin Rountree: [00:00:00] Welcome to Informed Aging, a podcast about health, help, and hard decisions for older adults. I'm Robin Rountree, a former family caregiver. I've worked in the home care industry and now work for the Alzheimer's and Dementia Resource Center. With me is my co host. 
Edith Gendron: Hi, everybody. Thank you for joining us today.
I'm Edith Gendron, Executive Director of Alzheimer's Dementia and Resource Center. I have 40 years of working with adults, primarily seniors and elders in need. I'm a certified Positive Approach to Care trainer and consultant, and ADRC is a designated Positive Approach to Care agency. 
Robin Rountree: The thoughts and opinions expressed belong to Edith and I, not our wonderful employers and sponsors.. This podcast is a service of the Alzheimer's and Dementia Resource Center.
We are not affiliated with the Alzheimer's Association. Before making any significant changes in your life or your person's life, please consult your own experts. 
Edith Gendron: Our [00:01:00] guest today is Maureen Rabizinsky. She is a nurse practitioner and chief clinical officer of My Memory Clinic, and we're going to talk about healthy brain assessments, so come back. 
 For over 37 years, the Alzheimer's and Dementia Resource Center, ADRC, has served as a Central Florida based grassroots non profit and community resource center. They are dedicated to providing support and hope for families and individuals [00:02:00] caring for someone they love who is living with Alzheimer's disease or other dementia related illnesses.
ADRC empowers caregivers with the knowledge, support, skills, and strategies they need to help them confidently prepare for the challenges that lie ahead. To learn more, visit the website ADRCCares. org.
Robin Rountree: And we are back and we've got Maureen again from My Memory Clinic. You can find them online, mymemoryclinic.
org. And when I go out into the public and I'm talking about dementia, there's a few different types of reactions I get. I get the, from the people who are either on the journey or have been on the journey. They get it. I also get fear. Oh, oh, God, I hope I never get that. I hope I never get that. Or you get a stupid joke.
So, 
Edith Gendron: or you sometimes you get people telling you outlandish things that Well, you know and my [00:03:00] neighbor had it and she ran up and down the street naked eating hot dogs. It's like wait, wait, wait That's not dementia That's something else 
Robin Rountree: But a lot of people are really really scared about getting dementia, but I tell them You need to get checked.
You need to get that base level. Just like you get your colonoscopy. We gotta see what it looks like before we see if it's healthy or unhealthy. You get your blood sugar checked every year. Maybe more than that. We get our blood pressure. You don't know if you have high blood pressure if you've taken your blood pressure reading one time.
It's, it's, you've got to see it over time. So tell us about getting that baseline for our brains. 
Maureen Rabazinski: Sure. Well, thank you, for having me here today with you. I really appreciate it. The healthy brain assessment is something that Dr. Rosemary Laird and myself, we are very passionate about it because if you [00:04:00] think dementia is about.
older age treatment and there's not much treatment. What we need to do is change that axis and it has to be midlife prevention. This is what we need to focus on because there is quite a bit of fear. So what do we do when there's fear? You have to Take a look and see what is it that I need to do to mitigate my risk of this disease.
You can sit there and be as afraid as you want for the rest of your life, right? Yes. By doing something positive, by getting your baseline and learning from what our knowledge has, you know, what we've learned. What we have now as the knowledge that we know prevents this type of dementia or this type of disease is very important right now.
So our healthy brain assessment is just that. It's a baseline, but it's very thorough. [00:05:00] So if someone were to say, Maureen, I'm really worried about my memory. My mom had Alzheimer's disease. Okay, come on in. They do a questionnaire. We go through all All of the risks that we know based out of science are the main risk factors for any type of dementia.
Robin Rountree: And so what are some of those things that you know are linked to an increased risk of dementia? 
Maureen Rabazinski: So what we do is we look at their risk. what we call their risk profile. There are many different risks that, put someone at a higher chance of developing a type of dementia down the road.
It can be anywhere from something with the heart, such as high blood pressure, high cholesterol, AFib. There could be lifestyle , risk factors such as smoking, excessive alcohol intake, a poor diet, social isolation, or just not, um, cognitively engaging in types of brain activities that really stimulate those new [00:06:00] neurons to grow.
There can be other disease processes such as. kidney disease, Down syndrome, multiple sclerosis. There can even be hearing loss. Many people don't realize that that's a risk factor. We also know there's genetics. We can't do anything about our genetic profile as far as if mom or dad had this disease, but we can.
Now we have blood markers that can tell if our risk. will be higher, and by that, then we can even come up with even a more extensive, uh, plan of care to mitigate the risk for this disease. 
Robin Rountree: And I think that people need to hear that because you think, Oh, my mom had it. I'm going to get it. But there's so much that you can do.
to lower your risk. 
Maureen Rabazinski: Oh, absolutely. And we now know that there's a study, it's called the FINGER study, and it's a study that shows the most productive things that someone can [00:07:00] do to help mitigate their risk of dementia. Do you all know what the number one way to prevent dementia is? Nope. Exercise. Ah. Yes.
Through, through the research studies, it has shown that if you are pumping blood to your heart, you're pumping it to your brain. So that's why we encourage the 30 minutes, five days a week. But our folks say, I'm not getting out there 30 minutes, five days a week. Well, we know that the brain recognizes exercise at 10 minutes.
So, I have even given, um, instructions to start at five minutes a day, and then six, then seven, and then before you know, they're up to 10, and then before you know, at 30. So what we do is once we identify these risk factors, then we move on to the cognitive test. It is not the simple three minute one that the primary care doctor does.
It's called a MOCA, which stands for Montreal cognitive assessment. [00:08:00] It's a very thorough assessment. It looks at eight different parts of the brain, not just memory, but memory and thinking. Because for instance, if someone has the beginnings of a frontotemporal dementia, their memory is spared, but we'll see the deficits in their executive functioning on that, on that MoCA test.
So it's very important to have a thorough testing. So now we have the risk factors. Now we have the MOCA scoring. Then we talk to the patient, tell us what, what you're seeing, what's others seeing. We listen to their history and then we put that all together and then we develop a plan with strategies that.
target where their risk factors are, and we go over that score with them. Now they have that baseline, just like that mammogram or that colonoscopy. They have that baseline. So that's what the healthy brain assessment is. We have caught. So many things. Really? Doing. You just can't [00:09:00] imagine. Um, I'll give one example.
I had a 60 year old lady, very physically fit. She exercised, but she says my mom had Alzheimer's disease. I'm really worried. I'm fearful. Right? Okay. So I said, come on in for your, assessment. We did her risk factors and she goes, the only thing that's strange is every time I go to the doctor, my blood pressure's up.
And she goes, they say it's white coat syndrome. So I go, well, it could be, but it couldn't be. So, one of her strategies was. Go buy this blood pressure cuff. Here is a blood pressure log. I want you to take your blood pressure this many times. I want you to come back with that log. Well, it wasn't white coat syndrome.
It was hypertension. Wow. Oh boy. So, hypertension is a huge risk factor for a dementia. Generally, a vascular type of dementia. So by doing that, she went back to her primary care. [00:10:00] She got put on blood pressure medicine. Her blood pressure is normal. She has mitigated her number one risk. So that is where the healthy brain assessment comes into play.
It is to. get that baseline. Let's identify what can you do because there's a lot you can do. I love that. It's so proactive. 
Robin Rountree: Yes. Instead of just going, yes, you're getting it or no, you're not. It's like, okay, we we've got these risks. What are you willing to do to mitigate that risk? And then you can kind of talk through that.
Maureen Rabazinski: Exactly. And I think a big key with this whole preventative type of baseline. The new medications that have just been approved by the FDA for people with dementia. It's not people with moderate dementia or advanced dementia. It's for people with mild cognitive impairment or early stage dementia. So when we see a patient and we note that they have [00:11:00] mild cognitive impairment, those are the people that will benefit from these newer drugs.
So more so than ever. A baseline assessment is essential if you want to, , keep this illness away. 
Edith Gendron: One of the things that you're talking about too is the person making changes, right? She made changes. She tracked her blood pressure and learned that she had hypertension and presumably went on to make more changes and that.
is the aspect of control. And that's critically important, right? And the more control we feel we have, even if it's perceived, the healthier we are. And somebody far smarter than me has said that if it's good for the heart, it's usually good for the brain. Do you agree with 
Maureen Rabazinski: that? Oh, I absolutely do. We see, many of our patients.
Usually have some sort of heart brain connection, whether it be high blood pressure, high cholesterol. Of course, the diabetes is a big one and that can affect your, your heart health as well. [00:12:00] So that's what we see. But we also, it's the lifestyle change, the lifestyle choices. Those are things that we can change, but some folks, they don't know.
Uh, they, it's just really, they don't know. What do you mean? They're afraid. have this type of food or not this type of food. So we promote the MIND, M I N D diet, the MIND diet. So as I mentioned to you, the number one strategy for preventing Alzheimer's disease is exercise. Number two is diet. So we promote the MIND diet.
That's number two. 
Robin Rountree: Mm hmm. And the MIND diet, from what I understand, is not like no carbs, no this, no that. It's, it's a very 
Edith Gendron: It's a combination of the Mediterranean diet and the DASH diet, which is That's 
Maureen Rabazinski: exactly it, Edith. Yeah. So it is. It is. It's really foods that you already know that you should be eating, but what we do is we give them a handout, and this handout has the foods, so when they go [00:13:00] to make their list for the grocery store, they'll pick some of those things.
No one is perfect with the diet, no one. We try to promote 80%. of your diet to be the MIND diet and if you want that pizza, go get that pizza on a Friday night, you know, but when you're making your healthy choices, look at that MIND diet because the MIND diet really is the Mediterranean with the DASH diet combined and it's been proven through research that it's the best.
Wonderful. 
Edith Gendron: We, uh, we like to terrorize our poor folks by telling them try really hard to reduce added sugar. You know, so it's a tough one, right? People have actually gotten up and walked out on me in our prevention course when I said that. 
Maureen Rabazinski: It's just amazing. Yes, that added sugar will do it, but I tell you, the brain hates sugar and it likes the sugar that's found in natural foods, your apples, your oranges, your grapes, but the added sugar, it scares me when I [00:14:00] turn a package around and I see how much added sugar is in 
Edith Gendron: In every, it's in everything.
Can we not have a single ketchup without added sugar that tastes good? Yes. I don't like ketchup, but that's the point, right? But yeah, things, I mean, bread. Yeah. Look at bread. And people say, well, you need bread for the, no, you do not. I have made bread for years. You need flour, salt, water, and some sort of leavening agent.
Either sourdough starter or yeast. 
Robin Rountree: That's it. You don't need sugar. 
Edith Gendron: You do not. The sugar, the glucose is in the flour. Right. That's why sourdough is so good. But anyways, oh boy, we'll talk about food all day. Ooh, ooh. 
Robin Rountree: Dangerous. Alright. So Maureen, let's talk money. Will my insurance plan cover this healthy brain assessment?
Maureen Rabazinski: Yes, so can you believe that a baseline brain assessment generally is not covered under insurance? 
Robin Rountree: Yes, I can. 
Maureen Rabazinski: Just [00:15:00] enraging 
Edith Gendron: stupid. Are you listening out there? 
Maureen Rabazinski: It's, it's just amazing. So, my, goal in life is to see one day that insurance companies will have that as an added benefit. So we try to make it as affordable as possible.
It is a $250 price, and that includes a full hour. With this assessment, also the cognitive testing, and then we print out this beautiful, easy to read report that we send over to the, to our patient that has completed the healthy brain assessment. So that's what we offer. But the day that I hear insurance companies will be paying for it will be a very happy day for me.
So I think it's a great, it's a great gift to give to someone. I 
Edith Gendron: just, yeah, it's exactly what I was thinking. thinking it's like, what do we get mom or dad or, or ourselves? There you go. I mean, 250. Come on. I waste that in a week on things I think are important and aren't., 
Maureen Rabazinski: right? [00:16:00] Well, I thought this was an extra or an interesting spin on the healthy brain assessment.
I went and spoke to an assisted living and these folks, they want to be as active as possible. They want to keep their brain as healthy as possible. They don't want it to advance. They don't, they don't want to advance to a dementia where they're in memory care. So, uh, the director said, I think the healthy brain would be perfect for these people.
They need to understand what their baseline is, what their risks are, what they can do. So, um, that's a whole nother area that we have opened up to our assisted livings, but also the adult children. Those are the ones that are. Probably the most fearful and they're the ones that call all the time and say, I'm here with mom, but what can I do?
And so those are probably our highest percentage right now. 
Edith Gendron: Those are the ones that need to look at their children and maybe even their grandchildren and start those good life choices now. [00:17:00] Yes, 
Maureen Rabazinski: exactly. 
Robin Rountree: That is, it is incredible. Now. I also have been approached by people going, I think my neighbor has got something going on. So sometimes we tell them about a research company that has some free memory screening. But it could also be like, I tell them, I'm a little worried about getting this healthy brain assessment.
Would you do it with me? And then try to, I hate to say trick them, but if they're in total denial. You're 
Edith Gendron: encouraging them. 
Robin Rountree: Right. And just say, you know what? It's very important for us to get a baseline. Let's go do this. I'm 
Edith Gendron: worried. Come with me. I don't want to go alone. 
Maureen Rabazinski: Yeah. Right. I think that, you know, we have had that where, you know, , I would say there are a few of our healthy brain assessment patients that we have identified, they have a problem.
Mm. More so than, you know, everything's fine, here's your risk profile, here's what you need to do to stay fine. But there are some that come that generally do have a problem and we end up diagnosing them with one of the types of [00:18:00] dementia. So if that happens, then we switch over to the insurance side. Mm hmm.
We go to either Medicare or their private insurance and then they see us through the memory care program. That's how that works. 
Edith Gendron: What do you see the most of, I know it's a little bit of an unfair question, but type wise, we know dementia is that umbrella term, but is it, does it follow the statistics? You see people who have, the majority of people have developed Alzheimer's disease or?
Maureen Rabazinski: Yeah. So what I see in my practice is we know that Alzheimer's disease is about 60 percent of those with dementia. But vascular dementia is. is a close second. Wow. What I see the most is a mix. I see Alzheimer's disease mixed with vascular because these folks generally have hypertension, high cholesterol, maybe some diabetes, plus they have the Alzheimer's.
So they say, Oh, is my loved one worse off? It's not that they're worse off. [00:19:00] I would say the majority of our patients are a mix. Now, there are certain dementias that, you know, the Lewy body is very distinct. Um, the frontotemporal dementia is very distinct. But that Alzheimer's disease and vascular dementia, they a lot of times go hand in hand.
Edith Gendron: Yeah. Yeah, that's, that's borne out too by our neuropathology reports. We see a lot of, , Alzheimer's disease and Lewy body combination too, through the neuropaths. 
Maureen Rabazinski: And what I'm seeing now, and this is why I'm so passionate about the healthy brain assessment, and I don't have my finger on it yet, but I'm seeing younger people.
Edith Gendron: Oh yes. 
Maureen Rabazinski: And um, every time I look at my schedule for the day and I see someone 60, I'm like, wait a minute, this is early, or someone in their 50s. Um, so I am getting younger. Patients than I did seven years ago. 
Edith Gendron: We thought it was because of what we did, you know, we live in the world of dementia and [00:20:00] you keep your head down And it's like yeah, we're seeing younger people, but you know, we're just you know, the words out no, there has been at least a 131 percent increase in Diagnosing and you and I understand how important that word is right and diagnosing young onset Alzheimer's disease alone and between the years of 2017 and 2018 I don't remember the year.
2020 maybe? 2013 and 2017. There you go. Something like that. Regardless, the point is, you are seeing what is actually happening. Younger people developing Alzheimer's disease, among other types of dementia, but Alzheimer's disease. 
Robin Rountree: That's heartbreaking. 
Maureen Rabazinski: Yeah. Frightening. So I think, you know, I think the, the point to take home is, um, we can't be fearful.
Um, you know, there always will be fear, but we can't live in that fear. We have to say, okay, I am fearful of this, but what can I do? So get your baseline, learn from people that are in this field, what [00:21:00] we have studied, what we have learned, and , , take it and do a little bit at a time and and it will pay off.
So 
Robin Rountree: exercise and what we eat, those are two, didn't mention a single supplement sold on TV. 
Edith Gendron: No, no, no. No, no, no. 
Maureen Rabazinski: Yeah. People ask me that all the time as well. Yeah. Hmm. 
Robin Rountree: Okay. Didn't make it to the top two or top 10 actually. 
Edith Gendron: Top 40 even.
Robin Rountree: Maureen, thank you so much for your time. We just adore you. 
Maureen Rabazinski: Oh, well, thank you so much. And I just love to be in this world with you, helping our community and keeping our brains healthy. Yeah. That's what it's all about. 
Robin Rountree: Absolutely. 
Edith Gendron: Thank you for being here. 
Robin Rountree: Thank you, Edith. Please make sure to subscribe to the podcast, Informed Aging.
Tell your family and friends about us. If you'd like to support the work we do at the Alzheimer's and Dementia Resource Center, please go to adrccares. org slash donate. You can find us at facebook. com slash informed [00:22:00] aging. Today's episode was recorded at ADRC's podcast studio. That's it for now. We're looking forward to our next visit.