Happening Now in Neurology: Brain Health, Disability Access, and Emerging Science

Episode Transcript

Dr. Daniel Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa. This is the Brain & Life podcast.
At the end of April, the American Academy of Neurology brought together more than 15,000 neurologic care providers, scientists and leaders from around the world in the field of neurology for its 75th annual meeting in Boston. Since 1948, the American Academy of Neurology has been promoting the highest quality patient-centered care, and now over 40,000 members make up its professional organization. These are the trusted neurologists that provide you the content from the Brain & Life podcast, magazine, website, and book series. The Academy is dedicated to supporting neurologists and neuroscientists to advance neurologic care and is committed to enhanced brain health for everyone through every phase of life.
This year's AAN annual meeting featured over 200 educational programs and over 2,600 presentations on the latest advancements in brain science. I wanted to share with you some of what I learned at the meeting and some things that I thought might be interesting and helpful to the community with neurologic conditions.
In this episode, we will highlight key information and updates that's important to our community. We'll include updates on the latest science and interviews with several researchers. I also interviewed neurologists that presented on brain health, disability access, and health equity issues. We'll also feature several community organizations and learn more about services that they provide for Sjogren's, other neurodegenerative conditions including PSP and CBD. We'll touch more on what those acronyms mean in a bit, along with migraine and headache disorders. Now please join me for this tour and highlights from the 2023 AAN's annual meeting.
I had the pleasure of meeting a medical student working in Washington State, Adithya Vegaraju, to hear about his work, looking at how mental health can be associated with where we live.
I'm here now with one of the researchers who's presenting work here at the American Academy of Neurology's scientific abstracts. So this is medical student Adithya Vegaraju. He worked with Dr. Solmaz Amiri at the Elson Floyd College of Medicine at Washington State University. They did a project taking a look at whether or not living closer to parks and water throughout the state of Illinois had some effect or was related to changes in people's brains. Thank you so much for joining us.

Adithya Vegaraju:
Yeah. It's a pleasure to be here.

Dr. Daniel Correa:
So tell me, what triggered the interest in taking a look at this aspect about proximity to parks and our brains?

Adithya Vegaraju:
That's a great question. At the onset of the pandemic, it was a difficult time for all of us. I was lucky enough to live next to a nature preserve though, and I actually spent a lot of afternoons. When I felt very frustrated at home, I would go out, spend time in the nature preserve and notice that it really helped my mood. And upon some reflection I thought, why not look if there are studies about this? And that's kind of what led to the beginning of this project being introduced to Dr. Amiri and sort of looking at this from a scientific point of view.

Dr. Daniel Correa:
In your project with Dr. Amiri, how did you guys look at the possible impacts of living close to parks and water on our health and brains?

Adithya Vegaraju:
So what's really important here is the term psychological distress. And what that means is just a range of feelings from normal feelings of inadequacy, insecurity, all the way up to serious diseases like anxiety or depression. And so that's kind of the marker that we used to assess brain health and mental health in people.

Dr. Daniel Correa:
So it was really feeding into the distress that people might have and accumulating from all the different stressors in their life, both health and mental. What did you end up finding about the impacts and markers for psychological distress related to how close people lived near nature preserves or parks and water?

Adithya Vegaraju:
I think the main takeaway from this study is that it seems like older adults who are living closer to green areas like parks or closer to blue spaces that we call them like water bodies like you mentioned, are tend to exhibit less severe psychological distress than their counterparts we are living further away or have less exposure to these natural environments.

Dr. Daniel Correa:
So already just even with their distance of where they lived, are you planning on doing work and to see how much time people spent outdoors and in these spaces?

Adithya Vegaraju:
That's what we are hoping that the study will feel further studies that clarify this association, and like you mentioned, look at time, if this is something that develops over time and then clarify the association more.

Dr. Daniel Correa:
So we're still working to understand and know if it's an effect of being close to water and parks and that just changing your outlook and maybe exposure to cleaner air in the environment or if it also relates to how much time you go to these places. So maybe if you're not living close to a park already, it doesn't have to feel like, well, for me to have any of this benefit, I have to move. But looking at increasing your time in those spaces. Is there anything that you, after having this experience doing the work, are thinking about for yourself and discussing with your family about where you live?

Adithya Vegaraju:
Definitely. I think it might be too soon to use the findings that we've discovered to provide general advice to patients or people. But personally I've definitely taken some time to really take my family out to more nature preserves or parks and sort of spend some times deplugged from social media, the internet and just take in the natural environment.

Dr. Daniel Correa:
In some countries they actually even have the opportunity and the ability to prescribe or give people time or an instruction to go spend time near parks or near water. What's your thought about incorporating that into our own healthcare practices?

Adithya Vegaraju:
That would be fantastic if that could happen, but we will have to see.

Dr. Daniel Correa:
We'll need some more support from our leaders and legislators in looking at that as also opportunities and tools for healthcare. But I do agree. It seems like that would be a great option for people. And lastly, you're working now as a medical student. Are you planning to go into neurology?

Adithya Vegaraju:
At this time, yeah, I'm deciding between neurology and internal medicine.

Dr. Daniel Correa:
Okay. What is it about going into medicine that has really felt like is a passion for you and why you want to be doing this work?

Adithya Vegaraju:
The reason I came into medical school or a large part of my motivation was to build ties with the community. As an immigrant, I spent a lot of time moving from city to city growing up. So never really had a chance to put in roots anywhere and really settle down. So I think part of what fascinates me or intrigues me about medicine is the ability to meet people from all walks of life and form these long-term bonds with people. I find it really rewarding when people start building trust in me as we navigate healthcare solutions together.

Dr. Daniel Correa:
Well, we hope you have an encouraging path throughout your training in medicine. Thank you again and appreciate you sharing your findings and your interests with our listeners.

Adithya Vegaraju:
Thank you again for inviting me to this podcast.

Dr. Daniel Correa:
The importance of brain health is not limited by borders, oceans or fences. Next, we'll talk to Dr. Ilana Katz Sand from Mount Sinai in New York to hear about her project looking at how the Mediterranean diet may be able to help people with MS or multiple sclerosis preserve their thinking skills.
What got you interested in doing this study?

Dr. Ilana Katz Sand:
So we've been doing some work on diet over the last few years and what got me interested in that originally was back when I was a fellow, at this point, about 12 years ago, I noticed that a lot of our patients were asking us questions about their diet and whether it might be important in terms of their MS. And what I found was that when I tried to look in the literature, there just really wasn't a lot of work done there and it seemed to me that was a really important question for us to try to answer. That kind of combined with advances in basic science work over those next few years really helped me start on this path of doing some clinical and translational research that relates to diet. That's how we got started, and we've been building on that over the past few years.

Dr. Daniel Correa:
And what was it that made you pick the Mediterranean diet to explore in this study?

Dr. Ilana Katz Sand:
Well, there are a lot of different dietary patterns that you can think about. In this particular study, we chose to focus on a Mediterranean diet scale because there is an easily available screener that we can use and that we administer in our clinic and it's called the MEDAS, the Mediterranean Diet Adherence Screener. It's recommended by the American Heart Association as a screening tool to be used in primary care and specialty practices in the US. So it's something we can easily give to people. It's only 14 questions. It doesn't take long to fill out and it helps us because we've been really interested in this pattern more broadly. It's consistent with the work that we've been doing in MS in the last few years showing us that one's alignment in terms of their dietary habits with this pattern is associated with other disability outcomes in MS. And that's work that we published over the last year or two. For that reason, we wanted to look at it here in cognition.
In terms of why we got into studying this pattern to begin with, as we looked at different options for things that might be helpful for people, we wanted to think about something that would go along with kind of general healthy eating guidelines. And we wanted to think about a pattern that would be something that we thought would be reasonable for people to follow and that could really be more of a sustainable lifestyle change as opposed to kind of a fad diet that our patients might pick up for a year or two here and there but not really be able to do the long term. We also wanted to be really careful and aware about cultural sensitivity and impact on budget. So kind of putting all those things together is what led us down with path.

Dr. Daniel Correa:
What did you guys end up finding when you started to do the project, looking at the population that you were studying?

Dr. Ilana Katz Sand:
So in this particular project, what we found is an association between people's alignment with a Mediterranean diet pattern. So meaning that they had a higher score on this MEDAS questionnaire and their cognition. The way we measured cognition was we used data from our comprehensive annual assessment program, which is a really wonderful program that we have at Sinai. It is run through our neuropsychology clinic and led by my colleague Dr. Sumowski, who is really a wonderful MS neuropsychologist and we encourage all of our patients to participate in this program. We have people fill out questionnaires about their diet, their exercise, and other health habits. We have them fill out questionnaires about common MS symptoms like fatigue and mood and things that people with MS struggle with. And then we have them come to clinic and we measure their cognition using multiple tests. We also measure motor testing of arm and hand function, walking, balance. So we really get a lot of information and it's a wonderful clinical tool. Our patients really like it and so do the physicians, but it's also great from a research standpoint because we can look at so much.
So in this particular study, we looked at the association between people's score on that Mediterranean scale and how they performed on the cognitive tests. We put together three different cognitive tests and came up with an overall score and we found an association there. So people were much less likely to meet our criteria for cognitive impairment if they had a higher score on that Mediterranean diet scale. And importantly, this was after we controlled for all the other pieces of information we collected about people like their age, their sex, socioeconomic status, race, ethnicity and health behaviors also. So things like exercise and smoking and medical issues, body weight. We controlled for all of those factors because we had them readily available and we still found this persistent association with diet.

Dr. Daniel Correa:
I saw that in your studies you also took a look at some of the challenges that some people had in following the Mediterranean diet, getting their groceries. What kinds of issues did you identify with the people that you were working with that made it a little challenging?

Dr. Ilana Katz Sand:
So in this particular study, this part was really observational and so we were just asking people to report their health habits, but we did a prior study, which was a pilot interventional study to look to see. We randomly assigned people to follow this kind of pattern, how would it go and what are the ways that we could help promote adherence and best support people? And it was really a wonderful learning experience for us and I think it'll serve us really well going forward as we try to put together those experiences with the data that we're talking about now in terms of the observational stuff. We really are looking to move it forward and scale it up. In terms of challenges that people experienced, I think it's the things that you know might expect. Our society has really come to rely on processed foods and kind of quick and easy things.
And so we had to teach people things like cooking basics and how to shop in a grocery store and how to order in a restaurant, what things to look out for, how to read labels and really help people improve in terms of their literacy around nutrition. So those were some of the challenges we faced. Of course, it can be difficult for people who have a partner, who have children or other people living in their household, but one nice thing about this pattern is that it's healthy for everyone. So we found that if we supported people in getting their whole family to actually make these changes, that's a positive health thing for everybody and it really helps the person who's living with MS be more adherent to the pattern.

Dr. Daniel Correa:
Right now what you've been working on and the information that you've found, how is it helping you have these discussions about lifestyle and dietary changes with the community you care for?

Dr. Ilana Katz Sand:
Well, it's not a clinical trial, so we can't say from this alone that if you make these changes, we think it's going to benefit your MS. But I think what we can say is these observations are here and they help support our observations that we think the diet is important and it matters and it can help people. I'm very fortunate at Mount Sinai we have an MS patient wellness program that I co-direct with our nurse practitioner, Gretchen Mathewson, and it's a really great resource for our patients and we get to do the work of helping people change their diet and other things about their lifestyle in order to benefit their MS.
And we've seen some really great results and we hope that going forward we'll be able to keep improving the program and think about ways to make it more widely accessible. But it really allows us to make a difference for people and to really help them make some of these changes and, at the very least, people feel better. So we have a lot more work to do in terms of learning about whether diet can act as a disease modifier, but at a minimum we are pretty sure from the pilot studies that we've done and that other people have done that it helps people feel better, which is a great thing.

Dr. Daniel Correa:
Well, thank you, Dr. Katz Sand for joining us and for all that you're doing and dedicating to lifestyle and wellness changes for the community you care for and we look forward to your new science.

Dr. Ilana Katz Sand:
Thank you so much for having me.

Dr. Daniel Correa:
Another autoimmune condition that can impact the brain and nerves is a condition called Sjogren's. While at the meeting, I got a chance to talk to Matt Makara from the Sjogren's Foundation about their services.
So Matt, what is the Sjogren's Foundation?

Matt Makara:
Sure. So the Sjogren's Foundation, we are patient advocacy group based out of Washington DC and we have a few different aspects of what we do. So we do fund a lot of research, we do a lot of provider education, which is why we're here at this conference. And we do a lot of patient advocacy, patient resources just to help educate both sides on what Sjogren's is because it's a very prevalent disease. It's an autoimmune rheumatic disease with a lot of neurological manifestations, but it's also lesser known than a lot of its counterparts.

Dr. Daniel Correa:
I'd like to know for our community members, if they want to know more about Sjogren's or need other resources to find out about the condition, how do they get that or what kinds of resources does your organization provide?

Matt Makara:
Sure. So I would encourage people to visit sjogrens.org. It's S-J-O-G-R-E-N-S. It's not the easiest to read or remember, but sjogrens.org is our one-stop shop for all of our resources. We have nationwide support groups, patient resources. We do a lot of advocacy work. And again, if there's something you're looking for and you can't find it, absolutely reach out to one of our staff and we'll do what we can to help.

Dr. Daniel Correa:
What kind of patient resources do you have on the website for the community living with the condition?

Matt Makara:
We try to take a lot of the scientific information, make it easily accessible to folks. So we have fact sheets, brochures. Again, we have the support groups, we help coordinate all of those throughout the country. I want to say there's more than 60 of those in various communities. And we have things like the Sjogren's Book, which has more than 50 different authors internationally talking about different aspects of Sjogren's. So visiting the site, there's a lot that's hopefully not too overwhelming, but there's a lot of resources that both physicians and patients can find.
As I mentioned before, autonomic dysfunction is common. We recently conducted a quality of life survey with more than 3,600 responses, and as part of that we asked about comorbid neurological diagnoses as well as neurological symptoms that folks might experience. We know that brain fog, more than 80% of our patients experience that on a daily to weekly occurrence. It has a moderate to major impact in their life. We know anxiety and depression are quite high. Things such as small fiber neuropathies, forgetfulness, headaches, migraines, feeling faint or dizzy. Again, that autonomic dysfunction of POTS is also very common and we're worrying more about that POTS and Sjogren's connection now through some of our current research.

Dr. Daniel Correa:
Thank you, Matt, for all the work you're doing.

Matt Makara:
Thank you for having me.

Dr. Daniel Correa:
Beyond our zip code, address and mailing area, changes in our environment and the climate may also impact our health. Next, let's hear from Dr. Brittany Krzyzanowski from the Barrow Neurologic Institute in Arizona to hear about her study where they found air pollution exposure may be linked to Parkinson's risk and even identifies several US hotspots.
Brittany, can you tell us some about what your research team found?

Dr. Brittany Krzyzanowski:
The idea of our study was to investigate Parkinson's disease and specifically to explore where areas of high risk might be across the nation. So we're looking for Parkinson's disease hotspots. Then the second part is to explore air pollution as a potential environmental risk factor for Parkinson's disease. This work was inspired by the first aspect. So we met the hotspots and we noticed how the map of Parkinson's disease risk was suspiciously similar to that of the nationwide distribution of air pollution. So that inspired this initial study where we explored the relationship between air pollution and in particular fine particulate matter. So it's a type of air pollution. It's a very refined unit of space. It's your sort of neighborhood, your postal delivery route. So it's much smaller than zip code or census track. A lot of research likes to use these kind of mapping units, but imagine you're a very small community, your postal delivery route. So people living in postal delivery routes with the highest levels of fine particulate matter exposure have a 60% greater risk of Parkinson's disease compared to those with the lowest levels of exposure.

Dr. Daniel Correa:
I think adding to more of the discussion of many reasons why we need to be concerned both about climate change and pollution levels. So that we all have a better understanding, what are different ways that we get exposed to fine particular matter?

Dr. Brittany Krzyzanowski:
You're exposed daily just by walking outside. So particulate matter is coming from a variety of different sources and these sources are going to vary by region, time of day. So for instance, one of the most common exposures is going to be like traffic pollution. So if you live in a big city, you're exposed to combustion particles from the traffic around you. There's of course other sources including industrial manufacturing and agriculture. So depending on the source, there's some speculation and for a good reason to suggest that perhaps certain sources or certain sub-components of this particulate matter are going to be more neurotoxic than others.

Dr. Daniel Correa:
Where do you think the research needs to go next so that we all, not just the research community, but all of the community with exposure and potential for these so that we can understand this better?

Dr. Brittany Krzyzanowski:
So what I mentioned prior is this kind of interest in the different sub-components or components, the types of air pollution that we see. And in my current study, we did not differentiate between the types of air pollution. So that's the next step we want to look at what is in the actual air pollution? Is it organic particles? Is it combustion particles? Is it heavy metals that are actually contributing to the association that we found?

Dr. Daniel Correa:
Your study was looking mainly at Medicare age individuals and that population and the data you were looking at. So right now we don't necessarily know the difference or the possible impact that different ages or at what age you have different levels of exposure. It sounds like that's still an area where we'll have to find out more information.

Dr. Brittany Krzyzanowski:
Yes. There's certainly other studies in the literature that have shown associations for various populations. However, the literature as it stands seems to be a little bit split in the sense where there's mixed results with some studies finding positive associations and others finding null. So what this study brings to the current literature, it's a large nationwide study with 21 million people and using very high resolution exposure data. So like I mentioned, the postal delivery route compared to counties and zip codes, and that allowed us to do individual level analyses. So that brings a little more evidence to support that where you live has an impact on your brain health.

Dr. Daniel Correa:
I think it's something we're all looking forward to more understanding about and maybe ways that we can help improve our own brain health by maybe taking breaks from these types of exposures or understanding better what kinds of exposure, what kinds of things might put us all at greater risk. Thank you so much for taking the time to speak with us, for the science you're bringing to the research community, and I know we look forward to both yours and your team's work.

Dr. Brittany Krzyzanowski:
Thank you so much. Appreciate you having me.

Dr. Daniel Correa:
Along with other community organizations there at the meeting, we had a chance to talk to CurePSP. There's several other neurologic movement disorders beyond Parkinson's that we don't often get to hear about as much. These include PSP, Progressive Superior Nuclear Palsy, another condition called Cortical Basilar Degeneration or CBD. And last one being Multiple Systems Atrophy or MSA. There at the meeting I got a chance to talk to Jessica Sher from the CurePSP organization about their services for people living with all three of these conditions.

Jessica Shurr:
I'm the director of clinical affairs and advocacy, been here since October 2021. But before that I was in outpatient neurology for almost 10 years where I got to work hands on with the community and now I get to translate that to our larger scale work at CurePSP. So at CurePSP, our mission is to raise awareness, build community, improve care, and find a cure for Progressive Super Nuclear Palsy, Cortico Basal Degeneration and Multiple System Atrophy.
Now over 50% of them are originally misdiagnosed with Parkinson's disease as well as many other misdiagnoses. They progress very fast, yet it takes over two years still on average for them to get the correct clinical diagnosis. And then at that point it's really hard for them to know where to go. They've never heard of these diseases before. There's not as many resources or specialized care services or research opportunities as there is the Parkinson's disease. So we have these three pillars of care, consciousness and cure. So we want to support people living with it now we want to raise awareness of it and we also want to fund research that will lead to better treatments and a cure.

Dr. Daniel Correa:
Many people need more awareness about this condition already. So how does CurePSP help move forward people's understanding about PSP and the other conditions that you support?

Jessica Shurr:
We're trying to do that from many different levels. So one of the ways that we're doing that is through our centers of care network. So it's 30 medical centers across the United States and Canada that hold this designation and they have the designation because they have specialized care services and they're very dedicated to comprehensive care as well as research and outreach and education for these three diseases. We have partnerships through them, through working groups where we're working on different research and publications. We're working with them to create collaborations and outreach in their local communities across the United States of Canada.
We are also building our legislative advocacy efforts right now so that we can advocate from the grassroots and top-down levels. We are also trying to empower the community and patients and families living with it to self-advocate when they are going to see a healthcare provider that's never heard of their condition or maybe seen one person ever with it. So they have tools to be able to educate them. It's sort of a unique aspect of living with these diseases. Everyone's heard of Parkinson's disease, but they're like, "Progressive Super what?" And we're also building programming right now to educate healthcare professionals across the United States and beyond on these diseases and their unique needs.

Dr. Daniel Correa:
What's your website and what kind of resources can someone in the community find when they go there and they're looking for more information?

Jessica Shurr:
Our website is curepsp.org. Despite our name, we also support care and we also support the two other diseases I mentioned, CBD and MSA. So if someone goes to our website, they could learn about our Center of Care program, they can download or order for free if any of our educational materials. So we have different booklets about the diseases. We have wallet cards, fact sheets, things like that. We have over 15 national virtual support groups, not just national, people from anywhere can attend. I had a guy attend mine from Turkey the other day, which is pretty cool. We have a network of regional support groups and peer support groups as well. We have a brain donation assistance program and we have a number of educational opportunities. So webinars, family conferences. Just this past week we had our very first wellness workshop and that will be archived on the website as well.

Dr. Daniel Correa:
Are the support groups and the other resources that you have through the organization also available to caregivers and family members?

Jessica Shurr:
Yes. It's really meant to be for both because people are navigating these disease journeys together. We also recognize that some people don't have care partners. For those people, we have actually a support group we started about this time last year called Flying Solo. But with our support groups we have a number of for people with the disease. We have a number of care partners. We have some that are tailored to both. We even have a bereavement support group too for care partners who had lost a loved one to one of these diseases. So we try to support people living with it and the families caring for them too.

Dr. Daniel Correa:
We encourage our listeners to go the curepsp.org website to learn more about PSP, Cortical Basal Degeneration and Multiple System Atrophy. You can also find more information about these conditions on the Brain & Life magazine and website. But briefly, how are those conditions different from Parkinson's?

Jessica Shurr:
One thing is they progress a lot faster. So Parkinson's, you can live with it on average 15-20 plus years. People are living with it even well beyond that at this point because there's so many different medications. We know that exercise can slow the progression. There's tailored rehab therapies. There's a lot of evidence based behind that. We don't have the same thing with these diseases yet. So it takes still, I think I mentioned, an average of two and a half years to even get the right diagnosis from symptom onset. So that is a long time for someone to go to many providers, go through many tests, other diagnoses, and a lot of times they're diagnosed with Parkinson's and they have all these resources at their disposal. They're told all these really hopeful messages, "You can fight it. You can live well with it." And then things progress very fast.
New funky symptoms crop up. Medications don't work as well. They're not as effective as they are in Parkinson's. It's usually one of the red flags. Then people are told, "Actually, you don't have this thing anymore. You have one of these other diseases." Something they've never heard of, something that most people haven't heard of, even healthcare providers. So they lose a lot of that sense of security of at least I had something that people know about. And they're searching for hope. It's almost akin to ALS. It's about the same number of people living with these diseases. It has a very similar life expectancy of seven to eight years from symptom onset and yet people haven't heard of it. So there's a sense of isolation that can come with that and a sense of trying to search for hope and meaning and wanting to participate in research too. And there's not as many research opportunities as there is in Parkinson's disease.

Dr. Daniel Correa:
So hopefully they can find hope and community through your organization and other support organizations. But as you mentioned, we need a lot more research in this field along with many fields of neurology to understand the conditions and to change this course. Does your organization help people find opportunities for research participation?

Jessica Shurr:
We do. Our executive director has a PhD in translational research and our chief science officer, and so he collaborates with a number of biotech and pharmaceutical companies. We're working on patient journey projects right now to help to recruit for open trials. We try to stay abreast of what's going on through Centers of Care and we're recruits through them as well. And we also support fair number of basic and bench research too.

Dr. Daniel Correa:
Thank you so much for sharing your time and for opening your heart to this community to support them on their pathway.

Jessica Shurr:
Thank you for your interest in helping us to spread awareness

Dr. Daniel Correa:
Now back to the latest studies, helping us find ways to improve our brain health and reduce risk for dementia. I got a chance to talk to Dr. Pamela Rist from Brigham Women's Hospital in Boston right there where we were for the meeting to hear about how seven healthy habits may help reduce risk for dementia.

Dr. Pamela Rist:
Thanks for having me today. It's one of my favorite projects to talk about. So one of the things that we were curious about is whether or not different lifestyle factors and health factors increase your risk of dementia later in life. We took a large cohort of almost 20,000 women and we followed them for about 20 years to see how does things like physical activity, controlling your blood pressure, eating a healthy diet, influence your risk of dementia at later in life? What we did was we used something called the American Heart Association's Life's Simple 7. So it's seven health and lifestyle habits that they've advised that people adopt not only for heart health but also for brain health. We found that the more of these habits you had, the lower your risk of dementia was over time.

Dr. Daniel Correa:
And this was taking a look back at what people were doing throughout their lifetime in the past.

Dr. Pamela Rist:
Yeah. So what made our study so unique and a little bit different than what's been done in the past is we asked people in midlife, what were you doing? And then we followed them into older age. So we are actually able to see does it matter what you're doing in your forties or your fifties for your risk of dementia in your seventies or eighties? What we found is that it does matter. So even sort of middle-aged adults should be thinking about these lifestyle habits to lower their future risk of dementia.

Dr. Daniel Correa:
Were there specific habits that you found that had the largest impacts in people's aging or risks for dementia and other complications later?

Dr. Pamela Rist:
So the nice part with the Life's Simple 7 is it just counts up the number of things that you do. You get the same amount of credit, let's say, for each good thing that you do. So if you're someone who's like, "Actually I've always wanted to become more physically active," you get a point for doing that. If you're someone who's like, "No, I really want to work on controlling my hypertension," you got a point for doing that. So it just sums up all of them, which I think makes it kind of nice because you can look at it and be like, "Which one of these things do I want to try to tackle next?"

Dr. Daniel Correa:
So it really speaks back to we should all be working on all of these things and finding a balance of the activities. The research is still ongoing for knowing if there's a certain one that we really need to focus on or specifically attack in terms of balancing our life and improving our Life's Simple 7.

Dr. Pamela Rist:
Yes. Exactly.

Dr. Daniel Correa:
What have you learned from this work that has changed some of your own daily practices?

Dr. Pamela Rist:
I think actually I talked about physical activity because that's probably what's changed it the most for me is that it is a good reminder that as much as, particularly during the Boston winters, I might not want to go for a walk or maybe not a run even, but establishing those healthy habits now when I'm younger is important for my brain health as I get older.

Dr. Daniel Correa:
And you're an epidemiologist, not a neurologist. It's a big neurology meeting, but we're always glad to have other science and healthcare community members join us here. What drew you to working in epidemiology?

Dr. Pamela Rist:
I think it was the ability of epidemiology to answer questions that clinicians or even the community was posing. So I've had many people say to me, "Oh my gosh, my mother got dementia or my grandmother died of heart disease. What do I do so that doesn't happen?" And the tools that you learn as an epidemiologist really teach you how do we answer those questions? And for me, many of the questions that I found to really pique my interest were the same ones that neurologists were asking. That's sort of how I ended up being an epidemiologist who works mostly in neurology.

Dr. Daniel Correa:
Some of the things that you've been working on when you talk with family and friends, what does it seem that the community that you are part of cares the most about in terms of the type of research and work that you're doing?

Dr. Pamela Rist:
I think actually this study in particular around dementia was one that my community was very interested in. We've suspected for years that lifestyle factors matter decades before the onset of the disease. And now with these large studies that epidemiologists have been running since the eighties or nineties, we can start to answer those questions. Does it matter what you do when you're 40 for what your health is like when you're 80? And we're starting to see that yes, it does matter what you do throughout your life for your health.

Dr. Daniel Correa:
And there's lots of recommended activities to work on for your body and brain health life. Life's Simple 7 from the American Health Association is one of them. Just to finish up, can you recap for our listeners what are those Simple 7 things that we could all be working on?

Dr. Pamela Rist:
Yeah, so the Simple 7 things, it's a combination of lifestyle factors and health factors. So one is making sure that you control your blood pressure. So having blood pressure in a normal range, not having hypertension. Having lower total cholesterol is another one. Trying to avoid the onset of diabetes is one of them. Another one is body mass index, so trying to make sure that you maintain a healthy weight throughout your life course. Then there's also physical activity, which I talked about, so making sure you're getting in that 30 minute walk every day. Another one that we looked at here was smoking, so making sure that you're not currently a smoker is one of them. And then the last one is also a healthy diet and that's a combination of factors. So eating fruits and vegetables, avoiding sugar sweetened beverages, avoiding high salt intake and making sure you're eating fish and whole grains as well.

Dr. Daniel Correa:
All seems very approachable and hopefully something we can all do at least one or two of today.

Dr. Pamela Rist:
Hopefully.

Dr. Daniel Correa:
Thank you so much, Dr. Rist, for joining us and for talking and sharing your research with our listeners.

Dr. Pamela Rist:
Thank you so much for having me.

Dr. Daniel Correa:
One of the community organizations that joined us at the American Academy of Neurology's meeting is the Association of Migraine Disorders. I had a chance to talk to Neil Andrews about this organization and some of the efforts they're helping move that science for migraine forward.
So we're back here with another one of the patient organizations that are at the meeting. They're also supporting a science initiative. Neil Andrews is part of the Migraine Science Collaborative that's from the organization called the Association of Migraine Disorders. Thank you so much for taking a moment to join us here. Can you tell us a little bit about what is the Association of Migraine Disorders?

Neil Andrews:
Sure. So the Association of Migraine Disorders is a non-profit organization. It's actually based in Rhode Island, and it has a number of different programs. So one side of the organization that started out as the core of the organization provides resources for people with migraine and also for healthcare providers, tools and resources and whatnot. Migraine is such a huge problem throughout the country. Tens of millions of people suffer from it and while there are a lot of new treatments that are helping people, there are still lots of folks who aren't getting what they need. So the goal for patients out of the organization is just to help them understand what's out there and just provide anything that we can do to help people with migraines.
Then the Migraine Science Collaborative is sort of a research arm of our organization where we cover the scientific research for resources and clinicians, but I think lots of patients will find a lot of our content understandable. So if there are patients out there with migraine or other forms of headache who want to learn about the latest research, I think that's a great place to go online.

Dr. Daniel Correa:
So it sounds like if listeners want to learn more about migraine disorders, we have resources on the website for the Association of Migraine Disorders. I also encourage our listeners to check out the episode that we did with Julia Easterlin and our expert interview there with Dr. Cynthia Armand, which is our first migraine episode for the Brain & Life podcast.
What is the website people would want to go to for this information and what kind of resources do you have there?

Neil Andrews:
So people can go to migrainedisorders.org for the Association of Migraine Disorders. We do podcasts. There are written discussions that are medically reviewed by experts. What is migraine? Just some examples here. What are migrating triggers, the things that sort of get their migraines going? So there's lots of educational information in forms of podcasts, articles. We also have something called Migraine Minute, a quick recap of some of the research shows as well as news, interviews, podcasts, data visualizations, things like that.

Dr. Daniel Correa:
There's a lot of new science and new treatments coming out for migraine disorders. On your website for the Association of Migraine Disorders, do you have information to help people understand some of these different medications that are now out for migraines and maybe some of the issues in selecting medicine that might be best for them?

Neil Andrews:
Yes, AMD provides lots and lots of information about the new treatments that are coming along, how the drugs work, who they're meant for you, that sort of thing. So people, if they go to the AD website, they'll definitely be able to find information about some of the local treatments. And not only drug treatments but non-pharmacological treatments as well. Things like exercise and meditation and yoga and so forth. There are lots of treatments for migraines so people can learn about all of it, not just the drugs.

Dr. Daniel Correa:
Do you think that the science that you guys are helping support and cover through the Migraine Science Collaborative may help actually learn more about other pain condition and other types of headache disorders?

Neil Andrews:
Absolutely. So I should mention that at Migraine Collaborative, so we focus on migraine, but we also focus on other headache disorders. So cluster headache. Other types of headache are sort of fair game for us. So even though we're called Migraine Science Collaborative, it's broader than that. I've had a chance to interact with a lot of people who have migraine and chronic pain as well, and I've been told that many of them don't have hope. Migraine is so difficult as it is and just for folks to know that there is research going on is very encouraging to patients. So I think that's why something like Migraine Science Collaborative, I think patients will be interested in going there just to see that there is a ton of research going on.

Dr. Daniel Correa:
Is there something that you find most hopeful for you about what's changing with migraine?

Neil Andrews:
The thing that's amazing about migraine is that there are new treatments. Migraine is very complicated disorder and there's never going to be a single magic bullet because migraine is kind of different in different people. What's driving migraine in one person may not be what's driving it in another. So the fact though that there have been these new drugs developed, I think it's great and it's very unique when you look at other neurological conditions like Alzheimer's and Parkinson's and so forth.

Dr. Daniel Correa:
That's great to hear. You can go to the migraine disorders.org website for more information about the organization and about migraine. Thank you so much, Neil, for taking the time to talk to us today.

Neil Andrews:
Thank you for having me.

Dr. Daniel Correa:
Thank you so much for joining us for this highlight and recap of the American Academy of Neurology's meeting, some of the up-to-date science. Next week, stay tuned for our upcoming episodes as we return to our interviews and stories from people living with neurologic conditions.
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 and even get the Espanol version. 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 by email to BLpodcast@brainandlife.org and leave us a message at 612-928-6206. You can also follow the Brain & Life magazine and me on any of your preferred social media channels.
These episodes would not be possible without the Brain & Life podcast team, including Nicole Lussier, our Public Engagement Program Manager, Rachel Coleman, our Public Engagement Coordinator and Twin Cities Sound, our audio editing partner. I'm your host, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea. Most importantly, thanks to our community members that trust us with their health and everyone living with neurologic conditions. We hope together we can take steps to better brain health and each thrive with our own abilities every day. Before you start the next episode, we would appreciate it if you could give us five stars and leave a review. This helps others find the Brain & Life podcast. See you next week.

Happening Now in Neurology: Brain Health, Disability Access, and Emerging Science

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