Mental Health, Serotonin, Dopamine, and Neurodegenerative Disorders PART 2

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 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. In some, even in somebody with clinical depression, they're generally 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 big deal. Now, of course, and. And common sense, I'm sure y' all 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 gonna 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 they're experiencing something like clinical depression or extreme bereavement, they may not be able to put together everything and differentiate between objects in a category. So, you know, like different car makers, for example, though they can identify a van versus a car or something. But. 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? 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, 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 hypervigilant and 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. 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 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. And we do want to keep this, no pun intended, in mind when we're thinking about the impact of 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. So task completion can be difficult. Confusion and disorientation, the degree is what's important here. People who are depressed, especially super clinically depressed, you know, people who have persistent depressive disorder, which used to be called dysthymia, typically don't show a lot of confusion and disorientation. But people, people who are really clinically depressed may lose track of what they're saying, may get 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. 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 of both depression as well as dementia and neurodegenerative disorders. Metallic taste in their mouth and decreased sense of smell. That's pretty 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 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 CEU's education channel where you will find long form counselor education training videos as well as shorter overview videos geared toward the general public. We have over 900 videos, so using the search function that is underneath the subscribe button on our homepage can help you find the videos that you really want to watch. You can also find an alphabetized set of some of my most popular playlists@allce.com YouTube playlists. I absolutely love hearing from you, so keep those comments coming. We actually do read all of them and try to respond within a few days. Have a fabulous day and don't forget to click subscribe and the bell if you haven't already 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 in personality disorders they tend to be very longstanding changes in behavior, you know, and, and often have start started in childhood or adolescence in depression and anxiety. You may see changes in personality and behavior when the person is having an episode. And even in personality disorders like in B Borderline personality disorder, we do see a lot of emotional ability and some, some changes in personality so, so we, we do want to recognize that. But in dementia, 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. That's one of the things that you often see. You, you. Sometimes you will also see somebody who used to be pretty easygoing 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 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, to just the nd you know, if somebody starts developing. With my grandfather, when he started developing Parkinson's, 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 dement progression of neurodegenerative disorders, specifically dementia. But, but. So it was 22. More than 50% of dementia cases could be prevented by targeting 22 modifiable risk factors. Let that sink in for a second. More than 50% 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 got to 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. 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. 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 a 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 high stress levels. So we want to take a look at what's causing hypertension. It's good. 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 when we're working with people who are adults and they don't even have to be midlife adults to screen for hypertension. A, because if it's, if they are hypertensive and it's 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. It 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 people may experience. But COPD is one of those that's very common 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, it 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 is it as it should. 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 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, 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 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. So that's, that's important to recognize that that can happen. Now hyperglycemia has its own set of problems that go with it, but 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, 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 is 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. Hypothyroidism 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. 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. It's 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 in 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 recognize 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 as 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 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 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, 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. 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 there's a combination. Social isolation contributes to depression 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, 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. Walmart was closed. The gym was right, right nearby. If 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 200,000 to a town of 6,000. Yeah, it felt like I was in the middle of nowhere. So I felt socially isolated. Now he, on the other hand, was happy as a pig in 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, we can help some people reduce their social. 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, 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, 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 Korsakoff's syndrome, which is called alcoholic dementia, you know, layman's terms. And that can result from a thiamine deficiency. The thiamine deficiency actually causes cognitive impairment. People who have started detoxing from alcohol, regardless of whether they're being medically monitored or report that they are or, 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 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. Korsakoff 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 high 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, B6B, 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 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 purported to increase estrogen levels, and there are others 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. 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 cortisol Ism 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 our 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. These when a child is younger 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 pencil and you whack it, if it hasn't been set yet, then that pencil is going to make a mark, leave a dent, break it, misshape it in some way. If it's already been in the kiln and come out, you can whack it with that pencil and it's 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 precise, prone to chronic stress and hypercortisolism. 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 reregulate 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. But autoimmune issues are really prevalent in our society today, ranging from fibromyalgia, chronic fatigue, Crohn's disease, rheumatoid arthritis. 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. 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 blood glucose regulation. So, interesting little tidbit, gut health. The majority of our neurotransmitters are made in our gut. 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. It communicates to your brain and there's a cascade effect 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 stop worrying about digestion right now because we need the energy in other departments and order to fight or flee. So it's an interesting 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 or between the. The gut bacteria profile in people with Parkinson's in People with Alzheimer's, in 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 a hundred 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, bifidobacteria 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 for a minute for a brief period of time. And during that period of time, the body's deprived of oxygen when it happens, right? 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 going to learn tomorrow if you're in tomorrow's class, there is a really high correlation, like 76% 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, screening for sleep apnea can be, I think, is essential. 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 7% of people who refuse or are not can't afford to take the HIV drugs, about 7% 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 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, make sure that they're aware that they need to pay attention to that because that was an. 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 neurotransmitters, 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 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 doctor's 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, your B vitamins, those things do show up. Liver function, thyroid, gonadal hormones, you know, the whole blood panel really does provide a lot of really good information. And we can help people 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 college, increases the risk of having Alzheimer's disease by approximately 30% 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 don't think we develop that much cognitive reserve and prevent 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. You know, they may live in older buildings that still have asbestos insulation or something. So there are a lot of factors that 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 threes, antioxidants, B vitamins, tryptophan, tyrosine, all bolt 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.