Answering Listener Submitted Questions

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters, and this is the Brain & Life Podcast.

Dr. Correa:
Welcome back to the Brain & Life Podcast. Now, this week we're going to kick it to you, our listeners. We've gotten lots of great questions and so Katy and I are going to sit here and talk, discuss some of your questions, give you some feedback. And hopefully that'll help really answer your questions and maybe even generate more questions that you'd like to hear about. How are you doing, Katy?

Dr. Peters:
I'm doing great, and I think it's just so awesome that our listeners are sending us so many great questions and that we have an opportunity to discuss them and share them with the rest of our audience.

Dr. Correa:
Yeah, it's getting lots of new ideas bubbling for topics and episodes for the podcast, but we want to make sure to get these questions and answers back to you.
Now, Katy, we got a question from Susan A. She asked, "Could you discuss the relationship between dementia and heart disease? I believe that my husband has the beginning of vascular dementia and I need to know more about it. Thanks."

Dr. Peters:
Well, Susan A., thank you so much for that question and I hope your husband is doing okay. Definitely make sure that he gets evaluated by a neurologist, but we do know that vascular disease is a secondary cause of dementia. The most common cause of dementia is Alzheimer's, which is a different type of disease, but vascular disease and dementia are linked.
In a recently published review of a meta-analyses ... Meta-analyses are studies of a condition in a population designed to collect findings from many other studies. And then they bring them all together, and then it takes a really deep dive into the data and what all those studies mean when we look at them across a continuum.
The researchers looked at the link between dementia and heart disease, in all causes of dementia, there appears to be a link between heart failure, coronary heart disease, and atrial fibrillation.

Dr. Correa:
Now, it's important though to think that one of the big things in heart disease is cholesterol, but it's still unclear, at least in that meta-analysis, this large study that looks across several studies, where the interplay with cholesterol is with dementia and heart disease, how much the two are directly related and statistically related.
There's been other studies that have linked high cholesterol and poorly controlled bad cholesterol, or the LDL, with the occurrence of dementia or its progression, but it's not been seen in some of these larger studies just yet. But all this research is ongoing. It's important that you have your vascular risk factors looked at with your primary care doctor, or for Susan A., your husband, to take a look at what we can best do to improve his health and his heart health.
There are heart-healthy and brain-healthy diets called the mind diet and the Mediterranean diet. We've had several episodes that talked about those, and we've had several episodes talking about different aspects of dementia and living with dementia. So please check those out.
And never forget that on our website and the Brain & Life Magazine, we've had many years upon years of content and information that could be very helpful to you about dementia and many other conditions.

Dr. Peters:
I think it's important to definitely see your primary care physician. They're going to be the ones to do these tests. Daniel, I'm sure you get your cholesterol checked and your blood pressure checked and you're going in and getting all those good checks with your primary care physician.

Dr. Correa:
Yeah, no, I think I was doing all those things already and now both with adding on a few more years and all of these discussions that we've been having with our community members and medical experts and scientists and seeing the patients in the hospital, just makes me think about it. Every few months I'm like, "Oh, I got to go check these things again, make sure I'm not behind the ball on something that I could get better control of."

Dr. Peters:
We've got to practice what we preach. Doctors are not necessarily the best patients, so we've got to go.
So another great question from another Daniel, Daniel D. It says, "Years ago, I had a stroke and went through physical therapy for one year afterwards. Is there anything specific that I should be doing in my daily routine to keep myself healthy for a long life?" Thoughts, Daniel, what do you think?

Dr. Correa:
Well, I think that Daniel D. has the best name ever. But I think it's important to continue staying active and doing your therapy. Now, in a study that looked at stroke patients back in 2021, it showed really that the critical window for getting your physical therapy going and improving for your symptoms after a stroke is the first two to three months after you had that stroke.
After that, more studies and many scientists have felt most likely somewhere around six to nine months, what you're doing there is less improving or getting better from the deficit or the weakness or the coordination issues you had from the stroke, but it's that your body is starting to adapt to what level of healing you've been able to do and now adapt in many other ways to getting things done.
But that doesn't mean that there isn't still room for improvement in your function and improvement in your quality of life. It just may not all be dependent on continuing that physical therapy. It may be important to you to consider staying active. What about you, Katy? What do you think?

Dr. Peters:
I definitely think you should stay active. I often tell my patients I want them to be up and be frisky and be vital. So I would say continue to exercise. Of course, make sure if you do you have any other underlying issues is to check with your physician before you do a full exercise plan. If you are working with a good physical trainer or a physical therapist, they'll often ask you, "Have you talked to your physician?"
And just like our previous question about all those things that we can do to protect our heart, like having a lower cholesterol, controlling your blood pressure and those other risk factors, you want to weave those into your exercise plan and have that be part of your mission to having a longer life.
And you did that great episode on blue zones and it was all about how do you live longer? I think this is what Daniel D. wants to do. He needs to get the blue zone philosophy. And I'm so glad that he's a survivor also from a stroke.

Dr. Correa:
Yes, keep pushing forward. I'm glad to hear that you've been moving forward and doing well. I'm particularly enthusiastic and encouraged thinking of our episode that we did recently with Ed Begley Jr., and how he does regular, vigorous exercise. And he attributes that really to his ability to continue to work and thrive with his Parkinson's disease diagnosis in how each person could keep that idea going.
It's important to almost think of not necessarily getting into the rhythm of just doing one thing, every now and then trying to challenge yourself and move forward a little bit, and whatever that means for you. Whether that's a few more steps a day, whether that's a few miles more a day, whether that's more transitions in and out of your bed or in and out of a wheelchair, you can push yourself and challenge yourself each day and each month at your own capacity.

Dr. Peters:
So I say keep moving, Daniel M.D.

Dr. Correa:
And in our show notes today, some of these article references in terms of the scientific articles, if you're interested in them, we'll have those links to that. And where it makes sense, we'll also have links to articles on the website and in the Brain & Life Magazine that could be helpful to you in these contexts.
Now, Katy, we heard from Austin L., and that's Austin L. the person, not Austin, the city. He asked, "My mother has MS and has moved in with me and my family. I'm really hoping to make things as easy as possible for her in this transition and beyond. What physical signs should I look for to see if things are progressing and what can I do to help her out day to day?"

Dr. Peters:
Well, I say kudos to Austin L., and thank you for doing so much for your mom. It really does take a village and a family, and thank you for being a great caregiver. I think this is a good question and I appreciate your being so proactive.
One of the things to know is that MS targets different parts of the brain and spinal cord, and so depending on where the MS attacks, you're going to have symptoms based on where those areas of MS ... Sometimes they're called lesions or they're called white matter damage. So it's really dependent on where it affects.
So it's important to know your mom's history and what prior symptoms she may have had. A common one is one called optic neuritis where patients will have difficulty with their vision, particularly because they could be blind temporarily or it can even progress even further. Sometimes people can have a phenomenon called diplopia, which means double vision. So it is important to know what prior symptoms that they have.
And Daniel, can you think of some instances where maybe people may have some increased symptoms, but maybe not necessarily something happening bad in their brain?

Dr. Correa:
Yeah. So this is an aspect. Sometimes people can have what looks like maybe a new MS attack or even what looks like stroke symptoms come back, but it's related because they have a urinary tract infection, maybe another viral infection going on. In some instances, people who've had an injury to their brain, some of the symptoms from that injury can start to come back when they have other situations like a medication interacts things, or really they have not been sleeping well and their sleep schedule's very thrown off.
So having a sense of the kinds of symptoms a person had with a past MS flare or attack and maybe even other things that injure the brain like stroke. And if it looks like they're having something very similar, it's a consideration to make sure that they don't have something else going on. But always, when a new or a sudden loss of function comes up, we consider that an emergency. And so if it's all of a sudden an attack, always good to make sure that there's not a stroke going on.
People who tend to have an MS attack, it's a slower process that often will occur over days. So if you're seeing, if in your mother or if in another individual who has multiple sclerosis or another autoimmune disease that affects the brain, if over the period of days they seem to have less coordination, a change in their walking or some other change in a function that they were able to do before, that is a suggestion that they may have a new lesion. Or they need to get checked out by the doctors to make sure they don't have another infection that's stressing their brain more.

Dr. Peters:
And Austin L., I think also a key thing is communication. Reach out to your mother's neurologist, be like, "Hey, I am worried." Always try to give the context of situations. So again, kudos for being proactive and thinking what to do the next step.

Dr. Correa:
Absolutely. And we've had several episodes with different community members with multiple sclerosis.

Dr. Peters:
That's right.

Dr. Correa:
And particularly, I am thinking back, early on one of our episodes was with a couple both living with different types of multiple sclerosis and caregiving for each other. I think that would be a great resource for you to hear different perspectives about what it is to live with different types of multiple sclerosis.

Dr. Peters:
I think I'll go back and recheck that episode out again because it does show that, the variation of MS. And so you need to know exactly, Austin, what sort of pattern your mom has had. So great question and great plug for to go back and listen to the retrospective podcasts from Brain & Life.
So we have another question, Daniel. It's from Melanie S. And I like this because it's got a little bit of a neuroanatomy vibe to it. So it said, "Would you talk about the cerebellar damage, or the cerebellum, and how it affects us? I have a dural fistula and I'm almost about three years post-op. I fluctuate between 70 to 60% normal most of the time with up and down dips throughout the day. It is difficult to find anyone talking about the effects of a dural AV fistula in the cerebellum. Thanks."

Dr. Correa:
Now, Katy, we have not had a chance to talk about dural AV fistulas and other arterial venous malformations in the brain on the podcast. That's a challenging concept. Please explain to our listeners a little bit what we're talking about here.

Dr. Peters:
Oh, yeah. So it is called a dural arteriovenous fistula. It's also known as a DAVFs, and it represents about 10 to 15% of all cerebral vascular malformations, and it comes on during adulthood. So let me break that down a little bit more.
So what a vascular malformation is, it's like the arteries and the veins don't connect properly together. There's these abnormal connections. And so it forms almost like what would look ... What I imagine is a big, messed up bag of blood vessels and looks like a big blood blister in your brain or spinal cord. It tends to sit on the covering, which is the dura of your brain. And it can also occur in the spinal cord. And because that dura covers all of your brain and your spinal cord, it can occur in all types of spots including the cerebellum.

Dr. Correa:
And so it is one of the types of vascular malformations, there can be other ones, and that term just broadly just refers to different types of blood vessel abnormalities of how they've grown. Sometimes they can develop with time in adulthood. Sometimes it can occur in childhood. It just depends at which point the symptoms may come out or when it starts to evolve for a person.
So there's lots of different ways that the arteries and the veins that go in and out of the head or inside the head can have little abnormal structures, and those can be at higher risk of different types of bleeding or other complications. So that's why we look at these issues in relation to many other causes, whether it's someone having a new stroke at an age we wouldn't expect, or someone having a new bleed in their head, or as a cause for all of a sudden new onset types of headaches. Those can be some of the types of situations.

Dr. Peters:
And I agree with you, Daniel, because sometimes for these AV fistulas or dural AV fistulas, when we see them, we can pick it up when somebody has a symptom, just like you mentioned, or maybe we could see it incidentally. Maybe they were being evaluated for a headache, but they find something in a totally different position that wasn't associated with those headaches. And I can often see these when I'm treating my patients with brain tumors because maybe we'll incidentally see one of these that wouldn't have been picked up.
So it really depends on the clinical scenario, what really needs to be done for these. Again, this is when you want to consult or maybe partner with a neurosurgeon. And it sounds like for Melanie S., she did have to have that taken out, and I'm glad she's doing well postoperatively.

Dr. Correa:
We, because we're nerdologists, I mean, neurologists, we anchored on the interesting aspects about the anatomy and the parts of the brain and what these blood vessels are because we also wanted to make sure you guys understood it as listeners. But she also asked about another very interesting part of the brain, the cerebellum and how it's affected by this type of condition or other conditions. Katy, can you dive into the cerebellum for us?

Dr. Peters:
Yes, and I am a nerdologist. I love a good neuroanatomy question. The cerebellum is actually one of my favorite neuroanatomy structures. Yay, go cerebellum. But it sits at the back of our brain. Sometimes we even give it another term called the posterior fossa. It plays a key role in regulating our movements. It makes our movements smooth and fine. It controls our gait. It controls our ability to balance. And just, I like to say, it keeps our sea legs on so we don't feel like we're constantly rocking on a ship.
So if somebody has a problem with the cerebellum, you could expect that maybe they have problems with their gait or their balance. Patients may complain of some dizziness or some vertigo. When your cerebellum gets affected in maybe the middle part of the cerebellum, patients can have slurred speech, sometimes a phenomenon called scanning speech or also a term we could use is called dysarthria.
And in rare circumstances for the children with some types of brain tumors, after they have a brain tumor in the cerebellum and have surgery, they can even have a condition called cerebellar mutism and cerebellar cognitive dysfunction. So the cerebellum is really a control refinement organ of our brain. That's the way I like to think about it. We're refining our movements. We're refining our speech. We're refining our cognition. We're refining our ability to stay, not on a ship, but on dry land.

Dr. Correa:
And it's fascinating because, as we think of how brains developed in various different animals over the many millions of years, this is an older part of our brain structures that integrates all these different types of coordination and movements. Some people think of it almost as a mini brain that's focused on coordinating and refining movements and actions.
So Melanie, if you have problems with the cerebellum, as Katy mentioned, you may have challenges with balance, with coordination, how you're walking, the coordination of your arms and legs movement, and movements through different types of activities with dizziness or vertigo. But it's particularly important what parts of the cerebellum are affected, like Katy was describing. And so in each situation, things might be a little bit different.
And the types of rehabilitation that's going to be most beneficial to you is physical therapy, but depending on the person, they may also need speech therapy and occupational therapy, the therapy that focuses more on your arms and how you interact with things around you. These are all important aspects.
But just like we say with the rest of the brain, the challenge is, is which parts are affected, or as what's often referred to as real estate, because there's no single way that we could simplify it to just say that the cerebellum does this one thing and this is how you treat it and fix it.

Dr. Peters:
So again, I mentioned that this is, I think that's a great question. Thank you so much for the question. As for the cerebellum, again, it's one of my favorite neuroanatomy structures. Daniel, is yours the insula? I mean, I'm just taking a guess. I don't know. Taking care of patients with epilepsy, so I was trying to ... Is it the temporal lobe? Is it the medial temporal lobe? I have to know.

Dr. Correa:
Yeah. I'm a big fan of the hippocampus.

Dr. Peters:
Hippocampus.

Dr. Correa:
Just the history of it being our memories, both of ourselves, of the world around us, and a major structure that's important in many types of seizures. And maybe one of those ones we'll dive into a little bit more in discussion in the future.

Dr. Peters:
Now I know what to get you for the holidays.

Dr. Correa:
Now we had a question from Jen N. Thank you so much, Jen N., for sending in your question. I'm going to ask Katy and go from there. So Jen N. asked, "Hi, I really enjoy the podcast and hearing from the guests. I have epilepsy, and it's good to hear others talk about it too. I'm wondering if there is a science behind the fact that having someone to relate to really helps you feel better. Is that neurologic?"
"Even in my support groups, it's a big deal just being near someone who gets it. It really makes you feel supported. I'm curious about how to bring your friends and family into the fold of you as supporters without feeling like you are asking the world of them, maybe even just sharing the podcast with them. Thanks again."
Jen, I love the idea of you sharing the podcast with everybody.

Dr. Peters:
Go Jen and woo-hoo. So Jen N., I get it. I agree that it is good to know someone or to associate with someone that gets it, and I'm so glad you get it and you know someone that gets it. So we actually did a study with our brain tumor patients, a group of patients that have a tumor called a low-grade glioma. And these patients tend to have a better prognosis than some patients with a higher grade tumor like a glioblastoma. But these patients with low-grade glioma also suffer from seizures, can be very common in that patient population.
And we evaluated what are our patients doing to adapt with their diagnosis, whether it's the seizures or having the underlying brain tumor. And the top strategy that our patients were naturally doing, and this actually occurred in 87% of our patients was they were obtaining community support. And the community they were going to were their peer patients.
They were developing relationships with them. And it wasn't necessarily in a support group that was formalized. It often was just even communities in the waiting room or learning from somebody else. Or maybe your community is the podcast that you're now listening to and reaching out.
Or maybe you're reaching out to us via Instagram for Brain & Life Magazine. Or maybe part of your community is now sharing the magazine and sharing an article from the Brain & Life Magazine with one of your friends. Maybe they have epilepsy, maybe they're just a friend or a care partner or a colleague.

Dr. Correa:
And it's great to hear of those findings at your study, both in the community living with seizures and epilepsy, but also with low-grade glioma. And you know what, Jen? You're touching on something that, as you said, is there a science behind this? And there is. In various studies, we've seen a clear interaction and interplay between social life and connections in your social life and your brain's anatomy and the brain's physiology and functions.
And improved social networks or having more and larger social networks have actually been shown to be associated with improved recovery from stroke and other neurologic injuries and conditions. And in conditions like cognitive and memory decline, even having increased social isolation can be related to a faster decline.
And so this is just to touch in on several types of findings, but in various medical conditions within neurologic disorders and conditions and in other areas, we're finding that having a greater social network is important to actually having improved outcomes.

Dr. Peters:
And Daniel, what I think is so fascinating about this is this not only exists in humans, but it translates all the way to mice. So there have been mice studies of mice that had strokes and they put the mouse with a group of other mice, unfortunately, another mouse that also had a stroke in isolation. And what they found was that the mouse that had a stroke that was with a group just did better, lived longer. And so there's probably something about those social connections.
And during the pandemic, we had to isolate. It was important. It was a public health crisis. But I think now that we have the strategies to go forward and to be with each other again, building communities, building friendships, that can only help our brains in our inherent socialization.

Dr. Correa:
This is one of the reasons we do the podcast.

Dr. Peters:
Absolutely. We're trying to share.

Dr. Correa:
Yeah, we want to share our own experiences, helping support the community, some of the experiences in our own lives and families, but also help share the stories of our community as a large living with neurologic challenges and different conditions. We're all part of the community together.

Dr. Peters:
Yeah, so keep listening and sharing and questioning. Thank you so much, Jen N., awesome question.

Dr. Correa:
Lastly, we wanted to particularly thank and read the comments we were touched by left for us by Deborah R. Deborah said, "You don't imagine how helpful and relieved I feel when I read the Brain & Life Magazine. I have read about dementia before, but it's never the same when you are actually dealing with a loved one living with dementia. I appreciate that you share real stories about this, and I feel that I'm not alone taking care of my mom. Thank you. Thank you. Thank you." Thank you, Deborah.

Dr. Peters:
Oh Deborah, that's just so lovely. Thank you. We appreciate you. Thank you very much.

Dr. Correa:
And we want to hear more from all of you. We have more questions we're going to be getting to in the future. Some of the introductions for our episodes, we might insert some of the questions. And as we get more, we could do more episodes like this where we run through a list of questions to help get that information out to you.
Also, take a look at the front of the Brain & Life Magazine. Many questions that are submitted by our listeners and readers may be answered there also. And check out the website. Many articles on these various different neurologic conditions and symptoms and many wondrous aspects of the brain are delved into on the Brain & Life website and in the Brain & Life Magazine.
Thank you again for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life Magazine for free at brainandlife.org. Don't forget about Brain & Life in Espanol.

Dr. Peters:
Also, for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org, and leave us a message at 612-928-6206.

Dr. Correa:
You can also find that information in our show notes, and you can follow Katy and me and the Brain & Life Magazine on any of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online, @neurodrcorrea.

Dr. Peters:
And Dr. Katy Peters, joining you from Durham, North Carolina and online, @KatyPetersMDPhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find the Brain & Life Podcast. See you next week.

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