“Memory loss, neurocognitive decline, and dementia” – with Dr. Jacob Fox

Dr. Nathan Fox: Welcome to the “Healthful Woman Podcast,” the fastest-growing podcast in women’s health. Today’s Monday, July 18th, 2022. Today is Part 2 of my podcast with my dad, Dr. Jacob Fox or Jack Fox. If you missed Part 1, definitely go back and check it out. As my dad would say, it was fantastic, or more precisely, as my dad would say, it was fantastic.
Today, we shift gears and talk about a really important topic, memory loss, neurocognitive decline, and dementia. This is something that many people worry about either for themselves or possibly for their parents or grandparents. And I thought my dad would be the perfect person to help explain what it means, who’s at risk for it, and how it can or unfortunately can’t be treated.
Enjoy today’s podcast. Before I go, I wanted to wish a very happy birthday to my daughter, Neely, who is also a former guest on this podcast, which was earlier this week. Neely, happy birthday. All right, everyone. Thanks for listening. Have a great week.
Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics of women’s health at all stages of life. I am your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Welcome back, Dr. Fox, Dad.
Dr. Jacob Fox: Thank you.
Dr. Nathan Fox: How are you? How you doing?
Dr. Jacob Fox: Natty, I’m great as always.
Dr. Nathan Fox: Wonderful. So, we were speaking before, and this was on our podcast last week about just your career in general, but I definitely wanted to talk to you about what was probably your area of expertise when you were practicing full-time, which is dementia and neurocognitive decline. And I think for our listeners, based on what their age is or whatever, it may be relevant to them potentially moving forward over the next few years or potentially to their parents or loved ones. And I do think that there’s a lot of confusion and lack of understanding about this. So, I think it’ll be very helpful to our listeners to try to sort this out.
Dr. Jacob Fox: I hope so.
Dr. Nathan Fox: You know, you’ve obviously spoken publicly. How do you even define, you know, these terms—dementia, impairment, decline, you know, neurocognitive, memory? How do you start by explaining what these things are and what the problems might be?
Dr. Jacob Fox: If we think about thinking, us, you know, who we are, it’s cognitive function. And when that becomes impaired, it can be impaired in different ways. Let’s say unfortunately we have a stroke. It affects our capacity to talk. So, we may be okay otherwise, but it’s hard to get those words out. So that’s a cognitive dysfunction, but it’s not dementia.
Dementia is when there is a general decline in cognitive function. Anything you want to mention or think about may have a problem. The nature of cognitive dysfunction, the illnesses that cause it tend to affect certain things more and, at certain times, of life more. The biggest risk factor for developing cognitive dysfunction, mental impairment, dementia is age. So, your chance of having dementia, let’s say, between the ages of 65 and 74, the numbers that have been given are a couple of percent. Between 75 and 84, it’s been said to be 10% to 15%. And 85 and above, it may be as high as 40%, realizing that the people at the lower age range, somebody who’s 85 is less likely to have this than somebody who is 95.
The key thing about dementia is its powerful correlation with age. To see somebody, if you meet somebody who’s 85, or 90, or 95, and they seem to have problems with their memory, that’s not surprising to you. But on the other hand, if you meet somebody who’s 40 who has it, it’s shocking. And so there’s this tremendous correlation with age. The other thing is that certain elements of cognitive function are affected earliest, the thing that we think about the most is memory, specifically recent memory, the things that have just happened. If I have difficulty remembering a conversation that I had a couple of minutes ago, that would be more typical of dementia. On the other hand, I might very well remember where I grew up, my parents’ names, where I went to school, all those things that happened long ago.
And then the first thing may be this more immediate memory or recent memory, and then as time goes on, memory for things even earlier than that. And as time goes on, things like speech is an addition of problems as the disease progresses, though remarkably sometime it can remain the same for years, and years, and years. So, you know, you can talk to somebody… Yesterday, I was talking to someone who was telling me about her mother who’s in her mid-80s who she said has been diagnosed with Alzheimer’s, who has memory problems, and she said she’s had them for 10 years, and they’re a bit worse than they were 10 years ago but not that much worse. And so the progression is variable.
As our society ages, it means there’s going to be more people with dementia because more people are living longer. I know that your program is about women’s health. There are more women than men with dementia because women live longer. So, if you go into a nursing home, you see primarily women, though there are some men. There had been or has been a bit of evidence that women may be generally more susceptible to this, though that’s not at all for sure. The major factor is that women live longer, so they’re available to have this mental decline.
Huge problem in our society because there’s so many old people. It’s as simple as other people… I mean, I don’t remember many years ago people talking about the ages of the people who were running for president, because there weren’t that many old people who ran for president. But now this is… You see, you know, people in their late 70s, maybe early 80s, and you just naturally think, “Well, is this person okay? Can he or she make the decisions that should be made?” Well, you wouldn’t think that about a 50-year-old, because it’s so unusual for a 50-year-old to have that problem. But when you’re thinking about an 80-year-old, it’s not that unusual anymore, and you start to think, “Well, is this going to be significant or is it not going to be significant?” The person who’s going to be 82, at the next election, that means he’ll be 86 by the time he’s ready to step down. We think about that. You didn’t think about that with J. F. Kennedy who is a young man, and that’s just the way it is.
Anyway, hopefully, I’ve explained that adequately.
Dr. Nathan Fox: How would someone know the difference, if there is a difference, between, sort of, what we think of as typical just, you know, “I’m getting older. I can’t remember, you know, this person’s name”?
Dr. Jacob Fox: Senility.
Dr. Nathan Fox: Yeah, just that versus now I’m on, like, the dementia train. Like, you know, this short-term memory loss to medium to long-term. Is there a difference or is it just one long continuum?
Dr. Jacob Fox: There isn’t really a difference. It’s just it’s been more clearly defined, you know, in the last… In my lifetime as a neurologist, it’s pretty clear now that late in life. In other words, when people… First of all, when the average age that people died was 70, there really weren’t all that many people around to develop dementia. But if the average age people are dying is 80, there’s a lot more people around. It was less common, so people didn’t pay that much attention, “Oh, he or she is a little bit senile.” But now we’re surrounded by people who are at the time where they’re at risk for having these things happen.
And there really isn’t that much difference. We do know more clearly what causes it, and the vast majority of cases, it’s a combination of Alzheimer’s disease, which is a disease of the brain cells themselves, of the billions of brain cells, and they can deteriorate. And for some reason, the brain cells that are critical for holding onto information as it’s occurring are most vulnerable to this change.
And the other thing that is important is changes in the blood vessels. And as we get older, our blood vessels deteriorate and therefore we have a combination of the illness in the brain cells and the illness in the blood vessels. And that is what’s causing this really epidemic of dementia late in life. Earlier in life, if somebody has dementia at age 65 or 70, it’s almost always Alzheimer’s. But at 85 or 90, the most common diagnosis is a combination of Alzheimer’s changes and vascular changes. Everybody has these, and it could be mentally quite normal. At age 85, you get killed in an accident and everybody says, “Oh, he or she was completely normal.” And you look at the brain, and there were changes. There are changes in the blood vessels and the brain cells.
So, what’s the difference between that person and the person who’s aged 85, who’s senile? Well, the answer is it’s probably more of a quantitative difference. There’s more of those changes in the person who’s got the symptoms than in the person who doesn’t have the symptoms, but that’s still an area of intensive investigation. If we want to be able to do something about this, we have to have a clear idea.
I should mention very early on in our discussion that a huge improvement, as far as I am concerned, in our ability to deal with these things is the absolute demonstration that what we call vascular risk factors, meaning high blood pressure, smoking, physical inactivity, very bad diet increases your risk of having dementia when you become old.
A study that we did in Rush, if you look at people over, let’s say, a 5 to 10-year period, the chances of somebody who has high blood pressure, and smokes, has all those vascular risk factors, that person developing dementia compared to somebody who doesn’t have those is much higher. The people who don’t have those vascular risk factors, their chance of having dementia is 60% less. It’s huge, huge.
So, whereas in the past, if a family member who sees that their father, mother, and uncle developed dementia, they say, “What can I do to prevent this from happening to me?” in the past, I would say, “I don’t know. I’m not sure.” Now, I would absolutely say you be careful about vascular risk factors. If you have high blood pressure, it should be treated. Don’t smoke. Be physically active. People say 150 minutes a week. You know, those things, it’s a big, big improvement in our understanding of these things.
Dr. Nathan Fox: And that would be most impactful for the dementia that’s caused or related to the vascular issues that you said are more common, sort of, in someone who gets dementia in their, you know, 80s, for example. But if someone has a family member with Alzheimer’s at age 60, probably it would be less impactful because that’s not so much a vascular condition, right?
Dr. Jacob Fox: That is a logical conclusion, but we don’t really know that. You know, whether any of these vascular risk factors have anything to do with the deterioration of the cells themselves, we don’t know. I would say it’s true that, if you have dementia in your family and people in their 80s or 90s, I could say with more authority that you should about your vascular risk factors. But even if it’s somebody at age 60, I would say we just don’t know enough. And besides which, care about controlling vascular risk factors has been shown to have a positive impact on so many different things like heart attacks and strokes, that really you got to be crazy not to think about it. You certainly have to be crazy to smoke and, you know, you’ve got to be crazy to have high blood pressure and not have it treated effectively. I personally think you also have to be crazy not to be physically active and exercise regularly. I think those things, you know, are not that difficult to do, and it certainly has an impact on how you function later in life.
Dr. Nathan Fox: What about weight—body weight, body fat, obesity, things of that nature?
Dr. Jacob Fox: The problem with body weight is hard to separate from some of these other things. And certainly, obesity is a risk factor for cancer. Whether it’s really a risk factor for dementia isn’t very clear.
Dr. Nathan Fox: Now, how would someone know if let’s say… So, let’s say they’re my age, right? So I’m in my late 40s. I’ll be in my early 50s soon and, you know, I don’t appear to have any dementia as far as I know, but let’s say I’m just a little more forgetful than I used to be. You know, I have a harder time pulling out someone’s name when I meet them or a harder time, you know, remembering some odd detail. How would I know if that’s just, “Hey, this is normal. This happens in your 50s, your 40s,” versus like, “Oh, my God”?
Dr. Jacob Fox: A general thing I used to say is if somebody comes to me and says, “I’m worried that I have dementia,” they don’t. You know, the people who are really…you can tell that they have Alzheimer’s disease or dementia are invariably brought in by a family member, these minor changes that you have. How significant they are is not all that clear because it’s so common. Everybody has… And a lot of the time it’s more of an attentional problem than it is what I would call actual memory. I mean, the thing that I always notice for myself, if I put something down, you know, without paying attention, I can’t remember where I put it down like everybody else. But if for some reason, I’m smart enough when I put it down to say to myself, “Hey, remember that you put it down on your dresser,” I’m going to remember that I put it down on the dresser. And it’s because when I didn’t do that, I wasn’t paying attention to it adequately. And when you get older, it’s hard.
You see teenagers they do a bunch of things at the same time, and it seems like the only things they’re not paying attention to are the parents, but everything else they can pay attention to collectively all the time. As you get older, you can’t do that. And pulling out names, names particularly are a problem. For some people, they’ve always had trouble with names. For myself, I’ve always been poor at names, so that’s something I never worry about because, if I can’t think of somebody’s name, I say to myself, “Well, I couldn’t have remembered their name when I was 50, so what do I care if I can’t remember it when I’m 80, you know?” So, you should be happy that you’re having some trouble with names at a younger age.
But I think that’s basically… You would think that we would have a much firmer idea about these things than we have, but we really don’t. But, again, I would reiterate this observation that controlling, you know, general vascular risk factors has a beneficial effect on cognitive function. As you get older, I feel it’s a huge, huge advance, because if you think, it affects everybody because people live longer and therefore it’s worth it to be careful about certain things because you’re going to be stuck with them for a long time.
Dr. Nathan Fox: What are the other causes of dementia besides… You said the most common would be Alzheimer’s as well as vascular. There’s probably a lot of rare ones, but are there other common ones?
Dr. Jacob Fox: Yeah, there are a lot of much rarer. There’s a thing called Pick’s disease, which is a different kind of degeneration in brain cells. Parkinson’s disease, in general, is not associated with dementia, but there is an illness similar to Parkinson’s disease called Lewy body disease, which is associated with dementia where there are also Parkinson’s kind of findings. And then there are many other much rarer things.
The evaluation that somebody has, if a patient would be brought to me with memory problems and they have memory problems with a test, then, well, I would get some blood tests because there are certain simply corrected blood problems that can have an effect like low thyroid level can have an effect on mental function, diminished levels of vitamin B12. But these are things…they’re not very common. It’s easy to check for them. They’re for sure ones you look for. I would usually get some sort of imaging procedure of the brain, a CT scan, or an MRI. In very, very rare cases, dementia can be due to blood clots from head trauma, even from a long time ago that are on top of the [inaudible 00:18:38] brain, what we call chronic subdural hematomas. It can be due to benign brain tumors.
And so we do that because those are things that are easy to look for. It can be corrected. And so, therefore, why shouldn’t we look for them? But the fact is that those infrequently, very infrequently cause dementia, and therefore they’re something we do, but really the yield is very, very low.
Dr. Nathan Fox: Mm-hmm, and do you find that mental health like depression has an effect on dementia, or do they, sort of, go hand in hand?
Dr. Jacob Fox: That’s a fascinating thing, and you would think they’re two things that are so common, dementia and depression, why aren’t we absolutely clear about the answer to your question? And we aren’t absolutely clear. And there’s various reasons where, first of all, people with depression, it suppresses their mental function. And therefore, if they haven’t had any brain cell changes and they don’t have vascular changes, it might look like they do because they don’t respond like they should, so there would be one obvious thing.
The other thing is the brain cells…after all, brain cells are affected in people with depression. It’s just different brain cells than the ones that are important for memory, so one wouldn’t be surprised if people with dementia have symptoms of depression, but that really isn’t such a big problem besides which it’s much more easily resolved because we have good, you know, pharmaceutical treatment for depression. And if for some reason you’re not sure, you put them on antidepressants and see if they get better. But that’s, again, remarkably infrequent for people who know what they’re doing. For doctors who know what they’re doing, it hardly ever happens.
Dr. Nathan Fox: Does it ultimately matter what the cause is? Again, unless it’s something that’s, you know, treatable like thyroid or depression, if it’s one of the other neurodegenerative diseases, does it make a difference in terms of prognosis?
Dr. Jacob Fox: Unfortunately, not. Unfortunately, it doesn’t. I hope it will make a difference as time goes on. Like all other areas of medicine, it’s going to be dealt with a piecework, that different illnesses are going to eventually be demonstrated to be due to specific problems that can be treated specifically, and therefore knowing what the specific cause of it will make a difference, but it’s not something that one can see in the immediate future. That’s for sure.
Dr. Nathan Fox: And what about in terms of genetics or, sort of, you know, familial patterns that you might see for dementia? Is it highly correlated? You know, do you have a high chance of having it if you have a parent with it? Are there genetic markers that could be tested so people can, you know, find out their risk if they want to?
Dr. Jacob Fox: There are very rare genetic causes of Alzheimer’s disease. And if somebody would come in with Alzheimer’s symptoms when they’re 30 or 40, you would certainly check for those markers. Not that anybody could do anything about it, at least not currently. Maybe with CRISPR and some of these other things, it would be an opportunity.
But it is true that, if you have a first-degree relative who has dementia, if your parent, or brother, or sister has dementia, your chances of getting it are greater than the person who doesn’t have that first-degree relative. But the chances are still you’re not going to get it, in other words. So, there is a genetic component to dementia just like almost everything. There’s hardly anything that’s wrong with anybody that doesn’t have some genetic component. But the fact is that that may not be compelling.
Let’s say, for instance, you have a father…if I developed dementia, but let’s say I had high blood pressure and I smoked and stuff like that, I mean, maybe you still wouldn’t get it because you controlled your blood pressure and you didn’t smoke. I mean, that’s why I think these vascular risk factors are such a key thing because it is something that one can do something about.
Dr. Nathan Fox: Yeah, I mean, there’s a lot of overlap, and I think that’s true. It’s the same thing. You have a family member with hypertension or diabetes. There is a relationship, but, you know, some of it probably has a genetic component. Some of it probably has, you know, a behavioral/environmental component. And it’s also hard to tease those out because people tend to live in similar circumstances as their parents, right?
Dr. Jacob Fox: You’re absolutely correct.
Dr. Nathan Fox: So, you know, I grew up in your house. So, whether it’s a genetic thing, or an environmental thing, or we have similar habits because I learned from you, like, who knows? It’s hard to really tease that all out without really, really tight research, which is hard to do.
Dr. Jacob Fox: I think that’s true with illnesses. It’s interesting, though I think that the data supporting a genetic component for things like intelligence and personality are quite powerful, looking at these people with the identical twin studies that have been raised together or apart, you know, much more than people readily admit. But that really doesn’t have that much to do with illnesses that you develop later in life. So therefore genetics are awfully important, but they don’t seem to be that important in something like dementia unless you happen to be unlucky enough to have many family members who have dementia.
Dr. Nathan Fox: So, if someone comes to you…like you said, they’re usually brought in by a family member, you know, saying, you know, “My father, my mother, my sibling has some symptoms or, you know, seems to have memory loss,” and you said you do some blood tests, some simple stuff, you do some imaging. But what is the main part of the evaluation where you can figure out, is this dementia, is it not, how severe is it, what type might it be? How does that work?
Dr. Jacob Fox: I always used to say that it seemed pretty silly for me to be an expert on dementia, which was something that you hardly ever do anything about it. And, you know, so therefore it doesn’t…I think from a medical standpoint, it isn’t the doctor really doesn’t have much to contribute unless the doctor happens to be knowledgeable about the impact this has on the families.
Well, I think the first thing one should realize is this is usually not a problem for the patient. If the patient isn’t upset, if you say, you know, “Mr. Smith or Mr. Jones, I think you probably have Alzheimer’s disease,” it’s not like the patient collapses in tears on the floor. It’s usually the family members that are upset. I think the other thing that really makes a difference is for the family member to be aware the things that they may have thought, you know, somebody was doing out of malice are really something…you know, they don’t remember things over and over again. I have the family member who brings in, “Well, I told him every five minutes. He asked me, ‘Where are we going? Where are we going? Where are we going?’ I said we’re going to see Dr. Fox, Dr. Fox, Dr. Fox, and he keeps on asking me.” And then I go in and I say, “Hello, Mr. Smith or Mr. Jones,” I always say my name because I never expected anybody to remember my name. I say, “Hi, Mr. Smith. It’s Dr. Fox.” He says, “Oh, Dr. Fox, I didn’t know I was going to see you today.”
And so I think for the family member not to get upset by that and not to make a big deal about it and not to keep on, “I told you that, I told you that, I told you that.” It doesn’t help. I mean, the fact is it really doesn’t make much difference one way or the other because the patient doesn’t remember that you got upset. But the fact is that it doesn’t help and I think being aware of that is important. I mean, and then of course there are specific symptoms that you have to be aware of is has the patient ever had a problem with wondering where they’ve opened doors and stuff like that, and left the house, and you have to think about it. Also the issue of stoves and all those practical things that make the difference for the family, but particularly that the primary caregiver, usually the spouse, realize what the problem is and not get upset about it. I mean, it’s such a big deal. It makes a huge difference as far as being able to effectively take care of the patient.
Dr. Nathan Fox: And it’s obviously very hard because it’s like they’re losing their loved one in front of their eyes, right, because it is the same person and it’s not the same person. It’s both, you know?
Dr. Jacob Fox: This is an illness where I say I can’t prove this statistically but it seems to me that men have less difficulty taking care of their wives who have dementia than vice versa. I think wives take it more personally. They’re so bothered by the fact… I mean, you know, a woman says to me, “I can’t stand it. He shaves one side of his face and forgets to shave the other side, you know, and it gets me so upset.” I said, “Well, listen, instead of getting upset, say to him, ‘Shave the other side of your face.’ Don’t get aggravated over it.” But it’s easy to say and it’s hard to do, for sure.
Dr. Nathan Fox: Is it easy for you or for neurologists, when you see someone, to know that they have dementia? Like, how long is that evaluation? Is it, like, two minutes, or does it take, like, an hour or two hours?
Dr. Jacob Fox: No, I think generally if you want to take a thorough history and do a complete neurologic examination and then talk to the patient and the family, we used to schedule an hour for those evaluations, though, I’m sure it wasn’t an hour of content with the family, but then we would also schedule a further time to meet with them and go through all these other issues regarding how they should react, and this, that, and the other. And so, you know, but it isn’t a big deal. It really isn’t a big deal. On the other hand, it’s a big deal for the family. Even though I’m retired, I get called all the time with people who are dissatisfied with the doctor who saw the patient because the doctor never, you know, talked to them about the problems that they were having, things that we usually don’t think about when we’re going to medical school. It’s not like taking a blood pressure or doing a pelvic examination. I mean, you know, the impact of these things on the family is really an issue, and I think that’s what has to be dealt with. And you’re completely right that it’s easier said than done.
Dr. Nathan Fox: There are treatments out there, right? You hear them, you hear commercials for them. Are they completely ineffective or is it just they help a little bit?
Dr. Jacob Fox: They’re unproven, completely unproven. There’s no proven treatment for, you know, people with cognitive dysfunction of aging, you know, the run-of-the-mill type. Again, if you happen to be 1 in 1,000 patients with low thyroid, it’s going to help with B12, but you’re talking about the run-of-the-mill patient where you see, “Oh, I thought my mental functions were declining, and I started, you know, drinking five cups of tea a day, and I feel I’m much brighter now than I was.” All completely, completely unproven.
Dr. Nathan Fox: And you were talking before about how there’s always a decline, but it’s variable. Is it at all predictable? Like, could you potentially see someone at 80 with dementia and have a sense that this is going to happen more quickly, the decline, versus slowly or is it just you have to see how it plays out?
Dr. Jacob Fox: Yeah, it’s like so many other things in medicine. How it’s going to play out is frequently predicted by how it has played out. If changes have been occurring rapidly, unfortunately, they’re more likely to continue to occur rapidly as far as being able to say specifically. You know, this is going to happen at this time. You can’t do it. And, again, I would repeat how rapidly it has come in is probably the best predictor of how rapidly it’s going to continue. And of course, if it happens very rapidly, I’m talking about days, weeks, or months, what we call subacute dementia that’s usually not Alzheimer’s. There’s all sorts of other uncommon illnesses with a different category, not at all what you usually see. By the way, those were the people that have, you know, peculiar illnesses, and those are the ones that tend to be referred to medical schools because people don’t see them. It’s unusual.
Dr. Nathan Fox: Yeah, is there anything that somebody could do when they’re young, other than what you talked about, vascular risk factors. So, you know, to exercise and to try to, you know, keep your weight down and eat well and not smoke. And if you have high blood pressure, keep it low. Is there anything other than that that’s been either shown to be effective or may be potentially effective just based on your experience in reducing the risk of dementia? You know, like memory games or things of that sort, using your brain, is that helpful?
Dr. Jacob Fox: Nobody has proven that it is, though it is true that if you look at Asian people who have a lifelong history of not being involved in things that require mental attention, they may be more at greater risk of developing Alzheimer’s. The problem is, you know, which is the chicken and which is the egg. You know, maybe those people who you identify at age 75 or 80 who have that history of being cognitively uninvolved, there’s something wrong for, you know, the last 50 or 60 years, some very, very slight thing.
But certainly, mental activity, people who are mentally active are less likely to have cognitive decline just like people who are physically active are less likely to have mental decline. There isn’t any evidence that any particular kind of mental activity is preferable to a different kind of mental activity. So therefore it’s not like I could say to a 50-year-old, “Well, you know, do crossword puzzles or this, that, or the other.” You know, I think the things that we typically associate with mental activity, reading, and being engaged, that’s what one is talking about.
Dr. Nathan Fox: And then as someone ages, is this something that you believe essentially would happen to everyone were we to live long enough, right? Just, you know, the fact that it’s not 100%, it’s only because people die of other causes before they have an opportunity.
Dr. Jacob Fox: Yeah. Again, a very, very interesting question that I think will be answered in the next 50 years because people are just living longer, and longer, and longer. If you look at the risk of dementia at age 100 versus at age 90, it’s higher at 100. But, again, it’s so hard to know, because we’re talking about survivors, a handful of people. Who knows? I think as people live longer and longer, it’s going to be easier to answer that question.
I don’t think anybody knows for sure the answer to that question yet it would be logical to think the answer might be asked whether… I don’t know if it would be 100%, but, look, when everybody knows somebody who’s 90 is not going to be as physically vigorous as somebody who’s 70 who’s not going to be as physically vigorous as somebody who’s 50. We know they automatically… I always say to people, gee, I don’t think this getting old is such… I find it actually quite helpful. People do all sorts of things for me that they never would’ve thought of doing before. I mean, I’m serious. If we go away for the weekend and our neighbor is keeping the mail, which happens all the time, and I call, I say, “Hey, we’re back. I’m going to come and get the mail.” “No, don’t. I’m going to bring it over to you.” “Okay.”
I’m being completely… This is what happens. I think people complain about getting old, but fortunately, if you live in a community of people who, you know, pay attention to each other, they tend to, you know, be more supportive of old people. And if you can get old and still be able to appreciate that, it’s not such a bad thing.
Dr. Nathan Fox: That’s good to know. Live around people who will bring your mail for you. It’s all good.
Dr. Jacob Fox: Yep. Listen, don’t knock it. Don’t knock it. You’re only 50.
Dr. Nathan Fox: It’s a big thing. My last question I wanted to ask you about this is you were talking about changes in the past, you know, 30 to 40 years and how, you know, it’s been, sort of, disappointing in terms of treatments for dementia. What do you see as possible innovations or treatments in the next 50 years? Do you think there’s a chance we’ll find something?
Dr. Jacob Fox: I’m sure there’s a chance. If you would’ve asked me when I started my practice and I would see… Let’s say multiple sclerosis is more common in women than in men, and I would see a 25-year-old woman who had an attack that I knew was multiple sclerosis. And I knew that, in the long run, I had nothing that could alter the natural history of that disease. And if you would’ve asked me at that time, what’s it going to be like in 30 or 40 years? I don’t know what I would’ve said. I would’ve said, “Who knows?”
Well, that’s where I think we are now with dementia. We don’t know of anything that’s going to alter the natural history except this vascular… I keep on saying over and over like a broken record. It’s a big deal. I think that there are specific things that can be done, and we’re just not smart enough yet to know what they are. I think anybody who says that there are not going to be advances in this over the next 30 or 40 years, they don’t know what they’re talking about. I surely hope there will. I mean, I look at my grandchildren. I want them to, you know… It’d great if they didn’t have to worry about developing dementia, and I surely hope that’s going to turn out to be true. And I think it may turn out to be some things that we just don’t think about. You know, we should but we don’t.
Listen, when I grew up, everybody smoked. Everybody smoked. I smoked in high school. And, you know, whoever thought about anything? But the fact is now it’s so clear that that is so detrimental. You know, it could be that there are things we’re doing now that are detrimental and we’re just not smart enough to know. Certainly, that’s what I hope.
Dr. Nathan Fox: Well, thank you so much for spending some time talking to your boy. I do appreciate it.
Dr. Jacob Fox: Natty, it’s always a pleasure to talk to you.
Dr. Nathan Fox: Thanks, Dad. I’m sure everyone’s going to adore hearing from you and is going to start lining up to deliver your mail for you.
Dr. Jacob Fox: Okay, well, if they live far away, they’ll have no choice.
Dr. Nathan Fox: Wonderful. Thank you for listening to the “Healthful Woman Podcast.” To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@helpfulwoman.com. Have a great day.
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