Title: Healthy YOU Podcast, Episode 8: Memory Loss: What’s normal and what is not
Host: Frankye Myers, Chief Nursing Officer for Riverside Health System
Expert Guest: Denise Butler, Geriatric Care Specialist with the Martha W. Goodson Center
Frankye Myers: From Riverside Health System, this is the Healthy Youth Podcast where we talk about a range of health-related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health.
So let's dive into learn more about becoming a healthier you.
All right. I am really excited to have me in the studio today for our Healthy You podcast, Denise Butler. Denise is a geriatric care specialist here at Riverside Health System. Uh, we're going to talk a little bit today around memory loss. What's normal and what is. Not. Um, so I'm really excited to have you join me as my guest today.
Denise Butler: Well, thank you. And I'm excited to be here. Yes, yes. This is a subject that's near and dear to my heart,
Frankye Myers: so Absolutely. And mine as well. So thank you so much for joining us. Denise. Briefly tell me about why you decided to pursue a career in memory care.
Denise Butler: Well, that, that's, that's a great question.
And it really wasn't a decision. It's just something that happened. Right. Um, And it happened in part because I had personal experience, uh, with my mother who had vascular dementia and didn't get much information or help. And this is what happened. She was, she's about two months before she passed away, she's in the hospital and the hospitalist looks at me and goes, well, you know, your mother has dementia.
News to me. First I'd heard of it, suspected it, right? But nobody had verbalized it. Right. And this is all we got right then with my father-in-law who had dementia of the Alzheimer's type. His ex, the experience with him was, yes, you have dementia. Here's your prescription for acept , see you in six months. Nothing about the journey.
This is a resource. This is what you can do. Here's what this is, what it's going to look like. Right? Right. So my mesh mission, passion. What can I do to help other people from not having to go through that experience and wonder and go, what do we, what are, what's going on? What do we do next? How do we manage this?
Right? And there's so much out there and people don't know, and it's just sad.
Frankye Myers: Absolutely. It's, um, just, you know, just so, um, important how those experiences you have. Impact the journey that you take as it relates to your career choice. So, um, I just thank you so much for your commitment and work in this space.
Um, as you talk about, as you just mentioned, you talked about dementia and then the Alzheimer's type. And I know when I was younger, I had two really impactful experiences. Um, I had a neighbor who, um, had what. Now, I know probably was Alzheimer's, but we just called it dementia and something that happened with age.
And then I also had an experience with someone who actually formally called it Alzheimer's. Um, I used to work at a TV and stereo counter and we processed film and she came in and she would always go through the pictures. And then she sparked up a conversation with me and she referenced it as Alzheimer's.
And her husband was in a facility because he no longer, um, she no longer could take care of him and nor could he take care of himself. And I just remember it was the disease that really just stripped you away of your memories and how impactful that was on her and how she was struggling. So she would just share her stories.
Oh. Um, and so it was two generations coming together. Um, and I remember her trying to talk me through my first breakup and heartbreak. Aw. And I was able to listen to her story. So talk a little bit about the differences between Alzheimer's type and dementia.
Denise Butler: Okay, that's such a good question. Um, Alzheimer's is actually a form of dementia.
Not all dementia is Alzheimer's. Okay. And dementia's really an umbrella term. And under this umbrella we have. Potentially anywhere from a hundred to 120 different forms and causes of dementia. Not all dementia's, memory loss. So we need to get rid of, uh, dementia equals memory loss. Dementia equals Alzheimer's.
Okay? What dementia equals is brain failure. Okay? This is what dementia is. The wiring in the brain starts to go on the fritz, and it starts to solely die. So just like if heart failure, lung failure, right? Brain failure, right? So, When you put it in, that way people actually get a better understanding, right, of what dementia is, right?
One of the definitions of dementia are cognitive changes that affect your ability to live your life on a day-to-day basis. Okay?
Frankye Myers: Okay. That's a good way to remember the differences. I've never heard it broken down like that. Um, I know sometimes there's so much confusion because as you, uh, stated, there can be differences in the way it presents.
I know as a, a nurse, uh, a, you know, as a nurse, a caretaker, there's been times that I have provided care for patients and because they're recanting stories, um, you think that they are oriented. And it's only when you dig a little bit deeper. So what are some suggestions or some feedback that you could give, uh, you know, family members and even practitioners and providers.
What should we be looking for and, and in determining that on the front end?
Denise Butler: So what we're looking for is this, is this dementia or is this Yes. A normal age related memory? Yes. Yes. Nor normal age related memory loss. Right. Um, so what you looking for? What's different? Okay. What's changed? Um, and we also have to rule out other things as well.
So we want to take a look at is this could be this be the result of a medication issue. Mm-hmm. That's a good point. Is this a result of a vitamin B12 deficiency? Uh, a thyroid problem? Correct. Could there be something else going on? Could there be a depression? Or anxiety that's playing a role in this. So we need to rule out first what it is.
But the first is to I. Something's different with this individual. Mm-hmm. Now the thing we also have to keep in mind when they come into an appointment by themselves, we have 15 minutes with them. Right? People can present pretty well for 15 minutes. They can pull it together and appear normal. One of the things that stays preserved in people living with dementia for a long time is social chit chat.
Because it has a rhythm to it. Mm-hmm. And rhythm is preserved on the right side of the brain. Okay? Okay. So that's prayer, poetry, music, dance, um, social chit chat. Okay. Is also stored over there. Reciting a series of numbers, 1, 2, 3, 4, 5, 6 78 has a rhythm to it, right? So things that are rhythmic stay with us for a lot longer.
Okay? So I can do social chit chat. I can answer yes or no questions. Okay. And I may not have any insight. 50% of people living with dementia have no insight into their problems. They think they are just fine. And who are you to tell me there's a problem?
Absolutely. Yeah. Absolutely. And that was my mother, right?
Frankye Myers: And that is my mother currently, who's 80 years old. Don't you dare question. Yeah. If she's asking you something over and over again. Yes. If she's
being repetitive, right? Yeah. Right, right. Yeah.
Denise Butler: And that's a whole different thing to start, you know, how do we. Best support that person, right, and learn to communicate differently with them.
Frankye Myers: Okay. Okay, good, good. I know for me, as it relates to my own memory, if I'm sleep deprived Oh yes. So, you know, sometimes certain things are going on and you're, you're wondering, am I having memory issues? So are there things, uh, you mentioned some around medication and some of those things, but there, are there other things that if you're not a sen geriatric or a senior, that could cause
Denise Butler: Oh, absolutely.
There are lots of different things. It could be a. Specific, again, going back to an illness, right? Um, a lot of people aren't aware the impact of a vitamin B12 deficiency, right, which can cause not just interfere with your cognition, it can make you feel fatigued, right? Um, it
can cause balance problems and in some people it actually causes behavior problems.
So I think that's kind of been something that's been a little bit underestimated and we're trying to work hard to. Make people a little bit more aware of that. And we've actually had recently, in the geriatric assessment clinic, several people that had really low B12 levels. Okay. That required the B12 shots.
Wow. And they still had cognitive impairment, but the level was not, it wasn't a true picture when they came in initially. And then we retested them, we retested, we did the cognitive screening. Depression can play a role in this, like you said, fatigue, um, alcohol. Okay. All right. Can play a role. So we've got a lot of different factors here and there's so much you have to tease out.
Okay, is there a really stressful situation going on in this individual's life that's so distracting they can't focus on anything else?
Frankye Myers: Okay. So
those good points. Very good points. Um, For someone noticing some changes in memory, um, or problems with their loved one, who should they reach out to for help?
Um, is there something where they should, um, pursue as it relates to with their primary care physicians or questions they should ask? And we talked a little bit about that, but more specifically, I think what. The memory care center can do to support them as far as resources. Okay. As well.
Denise Butler: Right. So I think if you suspect there's something going on mm-hmm.
The best early, early on. Again, the rule in and rule out, we do comprehensive geriatric assessments, right? Um, so that means we're looking at that individual from a lot of different perspectives. The assessment includes, um, looking at functionality, um, uh, cognitive screen, right, depression screen. We look at appetite.
Maybe there's a nutrition problem here, right? Um, we also do a get up and go test. We take a look. How long does it from a seated position, does it take you to rise? Watch your g, is there something in your gate that's concerning? Absolutely. Um, and part of this is also talking to the person that knows them well.
Sometimes it's a friend, family member. Sometimes there isn't a family, and it's a friend or neighbor that's there to help support that person. So the goal is, First of all, rule in, rule out what it is and what it isn't. And then is this normal aging? Is this mild cognitive impairment or are we looking at a dementia?
Frankye Myers: Right, right. Very good. Um, are there resources for the caregiver?
Denise Butler: Oh yeah. We have a lot of resources for the caregiver and I actually prefer the term care partner. Oh, care partner. Okay. Um, because it's usually not a one-way street. Right.
Frankye Myers: Hopefully, hopefully it's not.
Denise Butler: Um, And we have a lot. So we have memory care navigation.
Great. Um, which is a wonderful resource and there's so many resources in Community Peninsula Agency on Aging. Okay. Alzheimer's Association. Um, if you're in the Gloucester area, um, bay Aging does an incredible job. We have so much out there. There's a lot of information online. My only thing to caution you is there's a lot of bad information online and kind of knowing the right.
Sites to go to, and that's where we can help. It's like, here's a really good website to go to to get your information. If you're looking for medical information, go to the Mayo Clinic site or go to the Cleveland. Once the clinic site stay away from me WebMD, it's, it's not going to be as good factual information.
You wanna look at things that are really evidence-based. We also have a lot of programs. Um, we do memory cafe. Okay, so Memory Cafe is a socialization opportunity for people living with cognitive change. And their care partner, and it's not a support group and it's not a respite program. It's go, let's have a cup of dec decaf.
We always serve decaf brownies in her mouth and, and you're with people, it's like an open house concept. You don't, RSV p you can come and go during that hour and a half. And one of the neat things that we found is coming out is that people develop relationships and they do things together outside of that memory cafe.
Right? Right. That, um, It's just, it's just incredible. They share information. Right.
Frankye Myers: Um, I had the pleasure of being the keynote speaker for the most recent Alzheimer's Association conference in Richmond. And, um, just to see the camaraderie among other care partners. Mm-hmm. Um, and, and knowing that they're not alone.
Um, and it was a special day just to recognize them and then provide them with just. Additional information and support, uh, because I myself have, uh, seen this. You know, dementia and Alzheimer's destroy families, uh, because sometimes one particular family member may have to take on more of the, you know, brunt of taking care of their loved one just based on their financial status or their ability as it relates to their work and job.
So, um, it's sad when you see families destroyed. Um, so to your point, it shouldn't be solely on one person. It should be a care partner. Concept. But what you're doing in the memory care space, no one has to be alone.
Denise Butler: Absolutely. And it can feel so isolating and you can feel like I'm so alone in this and nobody understands what I'm going through.
And there's so many people that are going through what you go through. Right. And one of the things we also, the concept of building a support team, right? So whether I'm in the memory care clinic or the geriatric assessment clinic, one of the things that we tell. Patients and families coming in, we're part of your support team.
I'm not going home with you. Right. But I'm only a phone call or an email away if you have a question or a concern or something happens. Same thing from memory care navigation, we're they're a phone call or an email away. Right. You don't have to go this alone.
Frankye Myers: Absolutely. And there are resources and phone lines that are available.
24 7. Mm-hmm. To support them in this space.
Denise Butler: Yeah. And because when do things usually happen? Is it during nine to five or eight to five on Monday through Friday? No, it happens on the weekend. Right? It happens on a holiday. Right? It happens at 10 o'clock at night. Absolutely. So you do, there are places you can reach out to and trying to figure out what you know, is this a true emergency?
Is this a true crisis? Um, It's kind of part of that.
Frankye Myers: Yes. I remember in nursing we used to call it the Sundown syndrome. Oh yeah. So, you know, our, in taking care of the geriatric patients, they would be fully oriented all day. But when the sun went down, is, is that still a term that's used, sundown used or you see that?
Denise Butler: Uh, sundowning is definitely a term and it's, um, when you understand somebody living with dementia go back to that brain failure. How hard. Their brain has to work just to get them through the day. Okay. Because we have all these changes that happen. So even in early dementia, their visual field is very different.
So our visual field when we're 18 is about like this. Okay, well I can, can't do a full spread here, but arms wide, well arms length, so, you know, I couldn't zoom. Right? Um, and this is more like normal aging, 75. This is your visual feel. Dementia early. This is early dementia. It's scuba vision, so you don't have peripheral vision, which means you don't have safety vision.
And as it progresses, it comes, that comes more binocular, and then it the end, it's monocular.. Wow. So understanding that field when you're approaching somebody who's living with cognitive change, it's very important. Okay. All right. The other thing that happens, this is not a hearing problem, this is processing.
Just like that visual early on, they're even gonna miss one out of every four words that's spoken to them. And I want y'all to imagine your understanding of the conversation we're having now. If you missed one out every four words, how that would change your understanding or what you think you understood.
Right? Absolutely. So we talk a lot about communication, slowing down, not talking down too. Shorter sentences. Okay.
Frankye Myers: All right. Very good. Good, good information. Are there genetic factors that are associated with actually with, with, with mild cognitive impairment or, you know, dementia?
Denise Butler: Actually there is some in some.
Research that shows there can be a genetic component to mild cognitive impairment. And we know that there is, can be a genetic component for different forms of dementia. Okay. I don't think we have enough information to say for all different forms, um, that this is, there's a genetic predisposition. The other thing I always wanna caution people about, yes sir, you may have a strong history, family history.
That does not mean that you are going to develop dementia necessarily. Lifestyle plays a big role on this. Okay, so getting enough sleep, right, get really important for all of us. Is
Frankye Myers: it eight hours? Is it six hours? What is two? Yeah,
Denise Butler: what is it? What is it? Nutrition plays a role, right? Exercise, socialization, keeping learning to do things.
Mm-hmm. Or learning things, keeping your mind engaged. One of the first things, worst things we can do is sit up front of a TV and do nothing.
Frankye Myers: And I was gonna ask you that. So when you talk about engagement, what kind of activities? Crossword puzzles. Puzzles, reading. You hear different things. Puzzles.
Denise Butler: Puzzles can be good, but I'm gonna tell if I never like to do crossword puzzles, am I gonna start doing 'em now? That's true new, but there are other things that you can do. Okay. And it's just kind of figuring out, there's a lot again, a lot out there. Okay. And there are some online. Apps that you can use.
Okay. Um, it was interesting a few years ago they did a study with people with mild cognitive impairment and they hope to just improve attention. Okay. Okay. And they use meditation. One of the unintended outcomes is it also improved cognition. So meditation can be a very much a part of that. That choir and whether you meditation for you is a short thing.
And there are lots of apps up there that are freeing that you can use. And I use them regularly, right? Because you, if you're having a bad day, boy, it's just really helpful. Take that deep breath, open that up, and for two, three minutes help refocus yourself.
Frankye Myers: That's a great idea. That's a great idea. Cuz you can get overstimulated throughout the day in the work environment.
Um, and I think. To your point that coupled with lack of sleep, you can see changes in your ability to remember things.
Denise Butler: Mm-hmm. And use of alcohol, I'm not saying be a t toller, but, um, and I have worked with one Jerry Trian, who pretty much that's his, his feel. But there is increasing evidence that for older adults, alcohol's not really good.
No, I'm not saying you should never have a glass of wine. Right. But you wanna be, maybe we may, we need to rethink a little bit. Based quantity. How, how often you, how often, right. Yeah. So that, and so there's always new information coming out and one of the challenges for us is staying on top of that information in the new developments and the new studies.
Right? Absolutely. That's a full-time job in itself. Yes,
Frankye Myers: that is, that is a full-time job. Um, I also have heard individuals who have family members or family history of dementia, Alzheimer's say that they don't want to know. They would rather not know if it's going to occur. Would you talk about the impact of that?
Because you know, as we hear more and more about memory loss, dementia, Alzheimer's, what I'm hearing is that the early you identify there are things that you can do, um, and potentially even medication that can prolong, you know, the negative side effects. Okay, so,
Denise Butler: okay. Of, of, of losing your memory. Of losing your, well the other thing I want to back and say, it's not just your memory, right.
That's fact. We kind of have five basic cognitive domains that we're looking at when we're looking at dementia. Mm-hmm. Just short-term memory loss is not dementia. Okay. Because you, most people with a short-term amnestic, you know, I'm having trouble remembering a few things, but I can basically live my life on a day-to-day basis cuz I developed some strategies.
Right. Okay. Like making a list. Like making a list. Making, taking notes. Taking notes. Absolutely. Which is helpful for all of us anyway, right. Um, to be doing that. Um, we also ha, so the other thing that happens is we age is if, think of your brain as an older model computer. Okay. And
Frankye Myers: they change frequently, right.
Every year there's a new computer.
Denise Butler: So Yeah. So I have an older model computer and I got a lot of data right. Stored up here. What happens when you have an older model of a lot of data? It's slower to process. That's normal aging. When I'm 20, I've got a newer computer model and I don't have a whole lot of data on there.
Right? So thinking of that, this way, um, somebody's 20 learn something like this. Oops, right when you are 80, this is, it's slower. I'm gonna get there. It's just gonna take me longer. So understanding that. Is important. Right.
Frankye Myers: That's a good way that of putting it. Okay. Just like when we're younger from an activities perspective, we can do a lot more as we get older, we have to modify or we can injure ourselves.
Right. So that's a good way of putting that.
Denise Butler: Well, another thing I wanted to mention, dementia's not a normal part of aging. Okay. That I just wanna make sure we didn't hear that right. Now that being said, when we look at risk factors, Age is a risk factor. At 85 you have a 50 50 chance of developing a dementia.
Wow. So it's not a normal part of aging, but it can be a risk factor of aging. Of aging. Okay. Aging can be a risk factor.
Frankye Myers: Okay. Great information. Great information. Um, As we talked about, can memory be preserved? And you talked about some of those things during the aging process.
Denise Butler: We can do a lot of things and I'm gonna go back to lifestyle.
Okay? Um, and this is one of the things, it doesn't cost anything, right? Good nutrition, okay? Adequate sleep. Socialization. Staying socially engaged is really important and that looks different for all of us. If you're a hard introvert, you're not gonna be willing to go out and spend. So finding like two or three people that you're comfortable with can, might be where you are, but you're still being social.
Okay. Um, again, you know, going back to learning something new. So people that do the courses, um, Hampton has Osher and William and Mary has osha. Right, right. They have a whole lot offer a huge variety of topics. It's sort thing you don't have to at William and Mary, I dunno if you realize this, I don't know about other universities.
If you're 65 or older, you can elect to audit a course there. Undergraduate courses. Really? Okay. I don't know that those people not know that. Yeah. Okay. My husband. So we'll just go through, my husband's an adjunct Professor William, which is how I know those. Right, right. Yeah. So you've got a lot of options out there.
Okay. Um, A lot of online courses that you can do. Okay. If that's what you wanna do. Okay. One of the things we talk about is learning another language, and one of the things that they're finding people that are especially earlier age, more bilingual, it does something. Okay? All right. So learning another language.
Anything you do that engages your brain to do something different. So if I've always done crossword puzzles, that's great. But I got a skill set there, right? I need to pull, pull something else in, right? Real simple. If you're right-handed, do things with your left hand. You real try brushing your teeth with your left hand.
Oh my goodness. It's really awkward opening a door with your left hand if you're not, if you're right-handed, you're gonna have to think a little bit more. Okay. Every time I have a social interaction, if I read a book, that's great. Discussing the book even better cuz that's going to make me evaluate and process things different.
Frankye Myers: And we call
Denise Butler: information. We call information. Right, right. And then you have this exchange with another person. So anytime I have an exchange with another person, it does help stimulate me. Okay. In, in my mind.
Frankye Myers: Yeah. Okay. Denise, that is great information. Thank you so much. Is there anything else that you would like to share with our audience today?
I know that I have just gained so much knowledge and insight and, um, I know our viewers will appreciate that. But is there anything as we wrap up, uh, that you would like to share?
Denise Butler: Um, Just, I guess we are here for you if you need us. Right. Don't hesitate to reach out and if you suspect something's different, get it checked out.
Cuz it may be something that's reversible, it may be something that's temporary. Yeah. And if it's not, then you know where you are. Right. And planning and you put things in place again. Putting lifestyle choices changes in place now. So much better. The medication we have now. Helps treat symptoms. It doesn't change things, but it can, it goes, they go into the brain and help it work harder.
Right. And one of the best explanations I've heard about how the medication that we have now that helps people living with dementia and it, and by the way, they're not appropriate for all forms of dementia. Okay. Um, imagine you have a big blow up kitty pool, right? That develops a leak and the water starts to go down.
You can't pl and you can't fix that leak, so you put more water in to bring it back up to the level. But eventually, every time that leak gets bigger and you cannot keep, doesn't matter how much water you keep putting in there, it's all gonna leak out. Okay. So that's kind of how those medications work in a leg.
Okay. Okay. I thought, I thought, I always thought that was a good visual. Right. Excellent. Excellent.
Frankye Myers: Absolutely. Those are very helpful and understanding. So thank you. Thank you so much. Thank you so much for joining the podcast. It's been my pleasure to talk with you.
Denise Butler: Um, and, uh, it's been my pleasure too.
Frankye Myers: Again, just remind our viewers if they need support or want to reach out, how to contact, um, okay. The Memory Care Center.
Denise Butler: Okay. So you can call them Martha w Goodson Center. It's 757-220-4751.
Frankye Myers: Okay. Okay. All right. Thank you. Thank you. All right. Thank you for listening to this episode of Healthy Youth.
We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
