On this special episode Dr. Correa speaks to David A. Evans, MBA, CEO of Texas Neurology and Natalia S. Rost, MD, MPH, FAAN, FAHA, chief of the stroke division at Massachusetts General Hospital and president-elect of the American Academy of Neurology (AAN). David and Dr. Rost speak about the AAN’s newly published position statement on brain health including the organization’s definition of brain health and vision for the future of brain health for all. Dr. Rost and David also discuss their experiences with neurologic conditions and share how they incorporate brain healthy activities into their daily lives.

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Episode Transcript

Dr. Daniel Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa. This is the Brain & Life podcast. Today we have a special episode. Instead of a typical interview or an expert interview, we're going to focus specifically on an initiative working towards improving brain health. One in six people are affected with a condition affecting their brain or the nerves in our body, but addressing what that person needs in terms of their neurologic condition, or even better, preventing it goes well beyond just the diagnosis. We're also all learning that there's more about our health than just our physical body, and it can be impacted by the way we eat and other activity levels, but by many other things that may be beyond our control. This can include even our own public transportation infrastructures in our community, water and food access, how close we are to the doctors and the other support services we need, and even access to outside environments and parks, or the status of where we are with current science and medical research and medication development.
Many of these things require the governments around us and organizations to affect change and improvement. We all need to understand who these leaders and the legislatures are who are responsible for these efforts and the organizations that advocate for us and our health. Throughout my career, I've enjoyed learning and participating with other neurologists, helping to address the needs of our community living with neurologic conditions, and much of this has been through the American Academy of Neurology. Now we're going to go to joining some guests from the American Academy of Neurology to talk about what it's doing to help us address brain health.
Welcome back to the Brain & Life podcast. Our guests today are joining to discuss the American Academy of Neurology and its efforts to improve brain health for our society. Dr. Natalia Rost and David Evans are here with me today. Dr. Natalia Rost is the chief of the stroke division at Massachusetts General Hospital and Department of Neurology and a professor of neurology at Harvard Medical School. She's internationally recognized for her expertise in stroke and blood vessel diseases that affect the brain, and she researches how to design personalized approaches to predict the outcomes after someone has a stroke. She's a lead researcher of what's called the Discovery study, which is an NIH funded study of how post-stroke someone's thinking and memory is impacted and their risk of dementia occurs over time throughout the US population.
I've been honored to work with Natalia in the AAN, where she serves as the president-elect and the vice chair of the Committee on Public Engagement and the AAN's Brain Health Initiative. We also have David Evans. He's the Chief Executive Officer of Texas Neurology, executive director of Neurologic Foundation in Dallas. He serves as the chair of the AAN's Committee on Public Engagement and this Brain Health Initiative. Thank you both for joining us today.

Dr. Natalia Rost:
Thank you for having us.

Mr. David Evans:
Thank you, Dr. Correa.

Dr. Daniel Correa:
Before we get into understanding a little bit more about this initiative and the AAN's work on brain health, can you each tell us a little bit more about how neurologic conditions have affected each of your lives or your family's lives?

Dr. Natalia Rost:
Well, thank you for asking this question, Dan, because obviously brain diseases are so prevalent that almost everyone has some sort of a personal experience with that. As a true neurologist, I'm a migraineur. I've been suffering from migraines my entire life and have learned to live with it, and this is actually something that runs in my family. You become acquainted with your own type of migraine and learn to manage, but it makes you think on how much neurologic disorders are prevalent in the population and how much they're pervasive and disruptive.

Dr. Daniel Correa:
Wow, that sounds like it's been a substantial impact not just for you but throughout your family, living with migraine, and probably helps you relate directly with the many people that you work with and how their brains are affected by the different conditions that you work with.

Dr. Natalia Rost:
Absolutely. Sharing tips and tricks with all of my patients, particularly young women with stroke. There is a coincidence sometimes of vascular disease or disease of blood vessel in the brain and migraine, so some of my young patients have benefited from discussions we've had on a personal level, and others taught me some tricks on how to live life with migraines.

Dr. Daniel Correa:
Those are all great topics also where there's really good articles on Brain & Life for our listeners, if you want to learn more about stroke and migraine and how those two might interact in your lives. Now, David, what about you? Beyond working with the clinics that you're working with and your colleagues and all your work at the AAN, how has neurologic conditions come in and touched your life?

Mr. David Evans:
My earliest memory of interacting with my mother was often being told to stay away while she had a migraine. I remember the cold rag or having to go get the rag cold and put it over her head, her not being able to work that day. She was in healthcare and it greatly impacted not only her interactions at home, but her ability to thrive in many ways when no medicines were available. As responsible for a lot of employees now, I look at this and how important this is for thinking of maximal productivity and why my interest in brain health is important to me, not only the level of those of my family and people I love, but also those that I interact with on a daily basis. I want them to have an opportunity to thrive at home and at work as well, so it's a really important topic for me.

Dr. Daniel Correa:
Yeah, sometimes people use the term our patients and stuff, but we forget that these are our neighbors, our colleagues, the people that we pass by and live with and work with every day. Now, David, many of our listeners are aware of the Brain & Life magazine and hopefully the podcast because you're listening to it right now, but those who don't know about the American Academy of Neurology, can you briefly share with our listeners what is the AAN acronym and what does it do for the community?

Mr. David Evans:
The AAN is the American Academy of Neurology. It's the preeminent neurology society for neurologists. It's the world's largest association of neurologists, and we just celebrated 75 years, so we have a very long history of serving for the interests of neurologists and their patients. We work to support the community of neurologic healthcare providers, and we also regularly strive to expand and support neuroscience research along with creating new ways to educate and assist neurologists in really providing the highest value team base and very focused on patient-centered clinical care.

Dr. Daniel Correa:
Natalia, why has the AAN moved beyond its focus of just supporting key target members or neurologists to this focus on brain health in our society?

Dr. Natalia Rost:
Well, Dan, I think these two concepts are indivisible, and actually it is the new focus on brain health is a new way of supporting neurologists. As you know, the global and also national burden of neurological diseases, diseases of the brain, both organic and functional is growing. Population is aging. We have a lot of environmental and geopolitical factors that are affecting our lives, and with this kind of a snowball of growing burden of neurological disorders or brain disorders, we're facing as neurologists with an onslaught of issues that are related to access to care, the kind of dissociation or disconnect between the need for neurological care or care for brain disorders and the availability of specialists as it stands right now in the United States. We are in the process of changing the mentality and approach on how we treat that problem.
Brain health approach is a critical change in the way we are approaching the issue. We want to thwart the diseases of the brain at its beginning. We want to make sure that we offer a successful lifetime of brain health to everyone who is born in the United States and around the globe. From the moment the baby's brain begins developing to the end of life, we want to make sure that the brain disorders do not develop and the only way to do is to prevent them from happening. Brain health is really changing the scope and also the framework in the way we are approaching the issue of neurologic care and providing neurologic care in the United States in the world.

Dr. Daniel Correa:
This really goes beyond just the recovery for someone after a stroke or them living better with epilepsy like we work in our practice. You're talking about incorporating the idea of preventative neurology and thinking of brain health well before any condition shows up, and that maximizing not just longevity but our function and our quality of life

Dr. Natalia Rost:
As neurologists, we're trained to be the experts in the brain structure and function, but we're also the custodians of the brain, and brain is this amazing organ. When I say brain, I really mean the entire neurological system because brain is connected to our body through a complex network of nerves, and muscles are important part of our neurological system. When you think about it, if we prevented pathology from happening from the very beginning, if we provided the brain with optimal conditions from the very beginning and made sure that the structure and the function of the brain have been optimized throughout the entire lifespan of any individuals we were discussing or we have in mind, that potential has set a lifetime of optimal brain health for everyone.
We're talking about the possibility of developing the best foundation for brain development. We're also hoping to be able... these children who are having the best foundation, to reach their optimal potential, ideal individual potential. Then of course, throughout the lifetime, preventing injuries, maximizing potential. If injury or disease does happen, providing opportunities for rapid recovery and optimization, and then of course, fulfilling the quality of life at the end of life.

Dr. Daniel Correa:
David, how is the AAN planning on moving forward these many goals to improve brain health?

Mr. David Evans:
Well, first thing we realized is we need to expand the tent currently. As Dr. Rost eloquently described is that we are stewards of the brain. We know that many other organizations, stakeholders, the public, are all valued in that discussion. We wanted to act as conveners to ensure that we have a strategy and clear tactics in order to address and potentially mitigate the current trajectory of what we're seeing in diseases like Alzheimer's and other diseases that we think by mitigating some of these factors, we can improve potential current disease prevalence that we're seeing.
Some of the ways we plan on doing that, and we have an approach that's aligned with the 2050 vision, so it's a multi-year and enduring effort, and the first is to evolve research so that it leads to new and scientific breakthroughs in this capacity. Also, as you both stated, preventive neurology is really key and we need to explore that as a thriving cross-disciplinary field. We also want to rethink the preventive visit or wellness visit that we think of today and include cognitive assessments and other assessments that we know are key throughout life to help us achieve better outcomes and thrive throughout life. Also, we know the importance of education not only to the public, but also to those in the healthcare realm, and that we're making sure that we're disseminating that information as best possible so that everyone knows exactly what they can do and need to do to thrive in regards to their brain health.

Dr. Daniel Correa:
It sounds like really working with some of the organization and government leaders to start incorporating these into the standards of what we expect out of our healthcare, and probably a way that people could go to their legislatures or their representatives at the federal and the state levels and express the importance from their own understanding that preventative care for brain health should be included in what we all get and have access to as our healthcare system.

Dr. Natalia Rost:
I would also say, Dan, is this is where the interface between the science patient care and public policy comes with the three pillars that we have introduced as part of the AAN's brain health platform. We want to make sure that scientific advances that help us create metrics and help measure outcomes at different stages of life are incorporated into standardized and also widely available patient care for these preventative purposes. Then that, of course, will have to be advanced as David was referring to through the public policy and advocacy. Changing the impact sounds like a very simple idea. Well brain visit, but in some way it's revolutionary. What we do right now for preventive care is so insufficient, particularly at some of the earliest stages of life, and the same thing applies later in life when we're talking about our seniors who are nowadays embarking on decades of senior living, and as we've referred to them successfulists the platinum years. Those years are the ones that we want to make sure that they also have all the satisfaction and wellness that we can provide in a setting of a well-functioning brain.

Dr. Daniel Correa:
Let's go back and build on that, Natalia. I know you've been working on understanding how the brain changes after injuries or with different conditions, its impact on cognition or our thinking and the rates are and risk of dementia after stroke. But doesn't this all start with even understanding what do we mean by brain health? What do you think about when you're thinking of brain health for the community that you care for, and what has the AAN done to get others on the same page of understanding what we are calling brain health?

Dr. Natalia Rost:
Well, brain health is a fascinating concept. As you probably know, for decades we had no single source of the definition of what brain health is. To some extent, brain health became almost anything to anyone. There are a lot of organizations who over the years put out official definitions of brain health, and many of them have been focused on particular aspects of brain health that were of interest to those organizations. When we embarked on defining brain health by neurologists and for neurologists, we've thought about ourselves first and foremost as conveners in the field because again, as specialists trained and the function and structure of the brain, we wanted to make sure that we bring everybody into the tent, and we make sure that we work together to outline a broader, more inclusive, but also very dynamic framework of the definition.
As you know in this new AAN's position on brain health, we define brain health as a continuous state of attaining and maintaining the optimal neurological function that best supports one's physical, mental, and social wellbeing throughout every stage of life. Read that definition over and over again, and you will see that each word in that definition has been carefully crafted through multiple rounds of what we call modified Delphi Approach, a methodology that allows for this kind of a pluralistic expert consensus, but we have tried to do our best to bring everybody together and put a weight on the definition elements that not only outline the determinants or particular aspects of brain health, but also give us an actionable and moving target that we can achieve and continue to work throughout the decades to optimize brain health for all.

Dr. Daniel Correa:
David, what has the AAN done already to get this initiative moving forward and to help this effort towards a better future of brain health?

Mr. David Evans:
The AAN has done a lot really from the inception of the academy, but we've really taken a deep dive and understanding that the current crisis we're in with coming out of a pandemic and understanding both the mental crises, but the prevalence of neurologic conditions and brain health overall and brain disease overall was significant. There was a committee established by the academy to address this head on, and by doing that, they outline a specific plan of action, which will be released in conjunction with our Brain Health Summit. We conducted our inaugural Summit last year in DC and this will be our second summit and we will be bringing organizations that are represented from academia, research, patient care and policy to collaborate in shaping the future of brain health.

Dr. Daniel Correa:
Building on that idea, one in six people are affected by neurologic diseases, but there aren't one in six people who are neurologists, so we need a big team and all the legislatures that affect a lot of the change that's needed to be there. It sounds like that's what the AAN has been pulling together.

Dr. Natalia Rost:
This is our second Summit, and the way we've really looked at these Summits thus far as a think tank. We really need everybody's energy, everybody's creativity, everybody's experience knowing where resources may already exist and what needs to be built from scratch, so to speak. We need this conversation, and the summits are going to continue to evolve considering the growing mission of our Brain Health Initiative and what other impact the summit per se, as well as the evolving actionable agenda or the action plan that the AAN is proposing is going to look like. That plan or a roadmap or blueprint, however you're going to look at it, is something that already has its foundations laid through these top priority areas that we've designated in research, education, direct to public communication and public policy, and building from those areas, working with the experts across the stages in the individual lifespan, we can actually start building up concrete actionable steps through collaboration. The theme of the second Brain Health Summit is collaboration indeed, so this is where we're going, but the future is wide open and bright.

Dr. Daniel Correa:
Almost like pulling together all the Avengers of brain health and saying, let's have an open discussion on how to move this forward.

Dr. Natalia Rost:
Calling on all the superheroes in brain health, yes.

Dr. Daniel Correa:
You've been part of this initiative, you've been part of the AAN, you work with neurologists every day. At this point from processing a lot of this exposure, what are some of the key areas that you feel that are needed to help improve our society's brain health? If you were going to do the ask to one of these legislatures or a leader right now, what is it that we need?

Dr. Natalia Rost:
My answer to this is always science, patient care and public engagement. These three pillars are also three magical components that will help us move brain health agenda.

Mr. David Evans:
Well, we need to at first have a national strategy, and this is what the AAN intends to do, and leading this will require work with congressional leaders, Medicare agencies that are involved in this space, but as we all know, many of this has to be done at the local level, and that's where we're really working with Centers for Brain Health that are already existing around the country, but also new ones that are being developed. We imagine more will come through as we establish guidelines through the American Academy of Neurology, and that'll require work from both local, state, but also employers have a very important role here.
We think about the most productive years are the ones where we work, where we're raising our families, we're having so many changes in our life, and to be unfortunately affected by a brain disease is an incredible setback that we all understand. Then when we start thinking about the economic impact of that, it can be crippling to communities, and we know we need to do better in regards to making our communities have better access to care, better access to understanding of things and choices they can make to improve their healthcare, and we want to lead that.

Dr. Natalia Rost:
Another point to make is that for many years, and that's what doctors tend to do, we focus on our patients. By the time patients arrive to us with neurological and other brain diagnosis, sometimes it's very difficult to recover what we consider to be an optimal state of health. I think shifting this framework, shifting the mindset to think about prevention of brain disorders and thinking about everyone as a potential patient, because diagnosis happens on a one particular day and the day before that you are not a patient. On the day after you are a patient. Thinking about that mindset that preventing that disease so then we have a lifetime of brain health is actually something that's simple, but at the same time transformative. I think that working with everyone, whether these are professionals within medical fields and different subspecialties, or whether these are non-medical stakeholders who are engaged in community or organizational health and actually working with patients, their families and the public at large is probably going to be the most important element of advancing the brain health agenda.

Dr. Daniel Correa:
Now, let's go just sort of in your own lives and day to day when you're not working in the offices or in the hospital on how to deliver better neurologic care. What are some of the things that you've been doing for yourselves or for your family to incorporate what we do understand now about brain health and to improve your overall health?

Mr. David Evans:
The first thing I think is most important, especially with podcasts like Brain and Life, is to empower patients to understand they're their best advocate. What we know already through data is that patients that are better informed about their disease have better outcomes. Making sure you are reading items and taking advice from trusted sources like the American Academy of Neurology, American Heart Association, and others that are in this space that really want to improve your health and have you have a very rich life.

Dr. Daniel Correa:
I'm touched, David. Does it means you're sending your family members articles from Brain & Life and the podcast?

Mr. David Evans:
Absolutely.

Dr. Daniel Correa:
What about you, Natalia?

Dr. Natalia Rost:
Unknowingly, the three elements of wellbeing that wound up being the part of the new definition of the AAN apparently have been part of what I've been doing throughout my life to probably in some way contribute to hopefully my brain health. Physical part is I try to exercise whenever I can. I am not a big sports woman, but I like hiking and swimming, doing something low impact, but sustainable. Clean eating is very important to me. Nutritious, clean foods is something that is part of all that stroke prevention care that we've learned throughout the years, but also just common sense approach to nutrition. Then mental as well as social wellbeing. I'm an extremely connected person. Almost every moment of the day, I'm connected to some way either to my family or to my friends, so I feel like that connectedness that constantly helps our brains take stock of fulfillment and achievement and sense of purpose and sense of engagement, and just pure human love is something that makes you feel better.

Dr. Daniel Correa:
I think we all need love and purpose in our lives. Now for our listeners, if you want to read more about the AAN's position statement on Brain Health, more about this Brain Health Initiative, and many great articles, you can go to brainandlife.org, and there is a section specifically on brain health, so that's brainandlife.org/brainhealth, and you can browse the magazine for more great information about your brain and nerves. Thank you so much, David and Natalia for joining us here and discussing with our listeners this initiative and your efforts.

Dr. Natalia Rost:
Thank you.

Mr. David Evans:
Thank you.

Dr. Daniel Correa:
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 at @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.

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