Welcome back to Family Health Matters.

I’m Shelley Irwin with me today, Chris Causey, licensed mental health Counselor, National Board certified Counselor, and certified EMDR therapist.

Dr. Audrey Sanders interim medical director, and good that you are here.

Susan Woolner, neurural patient and caregiver support coordinator for Hauenstein Neurosciences, Trinity Health Grand Rapids.

You both are Dr. Sanders.

Of course, Susan, I’m glad that you are here as well.

We have an important and necessary topic to discuss.

We always set the scene with how you’re involved.

Let me start with you, Susan.. How do you spend your day?

I spend my day talking with caregivers, finding out where they are with the person that they’re caring for.

A lot of times, I’ve talked to them at one of my support groups.

So we have 13 support groups that happen every single month A very large number of them are related to other neural illnesses we treat, and memory is a component for many of those.

So a lot of times that’s maybe they came to us for Parkinson’s, and now they’re part of the memory program for lewy body.

So while I do talk with patients who have memory disorders, I have a support group for people who are mild cognitive impairment.

Most of the time that I spend is on caregvers and solving problems for them that they may have encountered trying to care for somebody and trying to understand kind of their role.

We’ll talk more in depth on that.

Dr. Sanders, thank you, Interim Medical director, of course, with the Memory Clinic, Trinity Health.

How did you get interested in this niche?

Yeah, so I’m a general neurologist by training, which means I’m kind of the jack of all trades master of none.

But as I grew into my practice and I’ve been in with Trinity Health now seven years, I started developing more of a patient population for patients with memory disorders.

And they just became a passion of mine.

It’s trying to help patients and their family members navigate this terrible condition and what are the resources available for them?

What can we do to help manage some of the other symptoms that are lesser known that can happen with dementia?

So it’s just become a passion of mine.

I enjoy counseling and spending time with patients and it’s just been very rewarding.

Great.

We’ll dig into that more.

Chris Causey, appreciate you.

EMDR.

I’ve heard that before.

Tell us about your day.

Oh, my day, I have a thriving practice.

It’s an online practice dealing primarily with trauma and addiction, usually if you have some type of trauma, there’s some kind of compulsive behavior, addiction, to help, mitigate the impact of trauma.

I work with a lot of my clients.

I primarily see mostly men, but I have a a handful of few female clients who are brave enough, but I run men’s groups, and I keep keep things going that way.

Well, every month we should be aware, but I know it’s a mental Health Awareness Month, PTSD Awareness Month also men’s mental health and that.

All right, little neuroscience 101, if I may, talk to me about this process of memory.

Yeah, so memory is very multifaceted.

I think most people, when they think memory, they think what most people notice first is difficulty with short- term memory loss, which can be repeating conversations, forgetting details of information that was just learned But that’s only one aspect of memory.

There’s also another part of memory called exececutive functions, how we process information, how fast do we process that information, navigation, planning, multitasking.

That’s a different part of the brain, but all these brains interconnect Behavior can also go into that too.

You know, how do we emotionally regulate our behavior?

And how do we act kind of mining our P’s and Qs, so to speak, in social decorum?

So those things can be affected.

How do we take in information based on our senses, like visual spatial or auditory or just tactiles?

So all these different processes can be affected when someone has memory loss.

We’ going to go to you, Susan, on defining the caregiver.

Who’s today’s caregiver?

So we definitely are in the sandwich generation where somebody has children.

They may be young children or they may be teenagers or even college age, but they’re also, by and large, caring for or helping care for one of their parents And so, you know, that is tough because that’s, those are people who generally have jobs, probably both of the people in the family, both husband and wife have jobs.

And so so they’re trying to put together a plan based on, you know, how much care is needed.

In addition to that, we have young children who are caring for parents.

So there is a lot lot of young onset dementia.

And in that case, it’s people who are maybe college age.

And that’s different because you think about what you’re doing and you’re your college age, your somebody who’s immersing yourself in learning new things and that’s difficult to come home and try to reconcile some of the changes that you’re having to do for a family member.

But that is a lot of the caregivers I talk to.

And then people who just retire and then they find out that one of them has a mild cognitive impairment or dementia.

or, you know, there’s related dementia, so primary progressive aphasia, FTD, Lewy body, all of those are types of dementia.

Alzimer’s is the largest type in the umbrella, but all of those fit underneath the umbrella, and so really, it depends on what part of the brain is affected.

Would you define PTSD?

Let’s call that your niche.

Ooh, PTSD.

I would say a lot of people think that PTSD is kind of something that happens, you know, like a car accident, combat trauma.

But PTSD, post traumatic stress is a neurological response to actual or perceived threat of safety or serious injury or even death.

And it’s a full body response with that And that can really greatly impact short-term memory and stuff.

But there is a memory component with PTSD.

So when you were pulling this together, I’m like, that’s beautiful.

And I think it hinges primarily with the hippocampus.

So if you’re out for a morning run and let’s say you’re heading down this one new road and this dog chases you, and it’s scary, but, you know.. I’ll run faster, you’ll run faster.

But he has four legs.

But somebody calls the dog back, but that was really scary for you.

So let’s say on a one to 10 scale, 10 being the most stressful.

And that comes in at around a four, you’re able to kind of say, oh, that happened on Pearl Street, and I won’t go down that anymore.

So you’re able to kind of give it meaning, but importantly encode it, time stamp it, and then move it on to long term measure.

memory.

Now, what traumatic experiences do is they overwhelm that part of your brain that allows that encoding or that time stamping to happen and that meaning making it happen.

It comes in hot, let’s say, a number eight or number nine.

The hippocampus is overwhelmed, and so that experience goes into the amygdala, which is the emotional part, as you guys know, but it also goes into primarily a right hemisphere kind of experience, which the theory is that’s more connected with the physical body.

And so what you have is a stressful, an overwhelming experience of threat that’s in a part of your body that’s not convinced that that’s still not happening.

And so that’s when these past events can really become present and cause all kinds of things.

There’s this beautiful quote by Dr. Stephen Porges that says trauma kind of compromises our ability to engage with people by replacing patterns of connection with patterns of protection.

Great.

We’ll obviously dig into that, especially when it comes to how am I treating that?

Dr. Sanders, you run the memory clinic.

What happens here?

And then would you do some education with us when it comes to Alzheimer’s dementia and some early risks factors and or symptoms?

Sure.

So the memory center at Hauenstein Neuroscience Center at Trinity Health in Grand Rapids.

I’m heavily involved in that in terms of the diagnostic aspect of that.

I also have a nurse practitioner that works with us very closely, who’s wonderful, Susan Price.

But patients will come to me or maybe they’ familyilies are concerned or spouse and they’re coming in to figure out why they can’t remember or they’re having changes in their memory that are concerning.

And is it dementia or is it something else?

So my job as a memory specialist is to kind of tease that out.

We know that there’s more than just dementia that can cause memory loss, whether it’s medications that someone may be on that’s causing cognitive impairment or untreated sleep apnea is another big one or sleep disturbance in general.

So my job is to hear their story in terms of what the patient is noticing, which sometimes they don’t have the insight into knowing they have a memory problem, and then that’s where family has to step in or someone close to them, hearing their story from their perspective, and then, you know, certainly reviewing extensively their medical history, medications that they’re on, talking about their sleep habits, talking about their current mood state, because depression, anxiety, PTSD, obviously can affect memory.

So kind of putting the whole picture together, sometimes we have to do additional memory testing called neuropsychological testing, which we do offer at our center as well which can help provide a neurocognitive profile that can be helpful for not only filing things longitudinally if someone is going to have a progressive condition, but also to kind of tease things out because different memory disorders present with different parts of memory being affected earlier before it can become more global.

So we can also introduce that and then part of the other aspect of diagnosing dementia, especially with Alzheimer’s, is how do we move into these kind of newer phases with biomarkers, is becoming a new big thing with blood testing that can be helpful to discern if someone’s at high risk for Alzheimer’s or if they are exhibiting memory loss, do they have an elevated towel level, which is a protein that aggregates in the brains so that’s something else that we can talk about pursuing in addition to imaging.

So kind of obviously coming together and making a formal diagnosis, or if this is not dementia, what do I think is contributing to memory loss, and how do we support that patient in getting the right treatment, including neuropsychology, too, or therapy.

So that’s kind of my role.

I know you mentioned asking questions about dementia just in and of itself.

And that’s kind of a very broad umbrella term.

I think that’s something that patients and family members have a hard time understanding what that means.

Dementia is really the outcome to a neurodegenerative disease.

And so patients can start milder than dementia, where they’re having memory loss, it’s more than age related, that is progressive, but they’re still fully functional.

They’re able to take care of themselves and do everything for themselves without any concerns from a safety standpoint.

And we call that mild cognitive impairment But then my job is to figure out what is the mile cognitive impairment do to?

Is it Alzimer’s, which is the most common neurodegenerative cause of memory loss?

Or is it one of the other conditions that Susan mentioned, like dementia due to Lewy bodies or Parkinson’s related dementia.

So it’s very complex.

These patients deserve a lot of our time, and I think we do a good job doing so.

Susan, add to that and just a reminder that care is needed for the caregiver, right?

And that’s one of the things many times the caregiver, you know, when Dr. Sanders actually is in there, she’s talking to the patient because the patient is the person who is there.

One thing we do differently at the memory clinic, and a lot of our clinics is really think about the caregiver and sometimes there’s an opportunity for them to actually go and talk in a separate room to our social workers and then understand kind of what’s going on with them A lot of times, the breakdowns in caring for somebody are, we want what was there before.

and sometimes that isn’t possible.

So we have to embrace where you are now.

You can’t change the person so you have to change the environment, and changing that in environment is hard, especially if you’ve been married 50 years.

If you have always, you know, asked him what he wanted for breakfast and now he’s just not answering, or he wants a steak and he’s never had a steak for breakfast.

So a lot of times it’s communication differences that go along with behavior differences, and the caregiver has to figure out a way to embrace that in themselves.

And we have great programs that can actually help them, but the best thing is peer groups that they can talk to somebody else and somebody say, here’s what I did in this situation.

I was executive where you were and the fact that they’re there and they look normal and they seem like a reasonable person that gives somebody hope that they can also be there because right now they’re in a place that they’re not comfortable.

And a lot of times it’s causing loss of sleep, which is compounding really some of the communication issues.

Chris, when is it time to ask for help?

With a sign or two of PTSD?

Well, I it’s one of those, it’s a subtle thing, depending on your ability to to navigate stressors.

Because sometimes you can have symptoms of PTSD and not know it, but everybody around you is like, you need to talk to somebody.

Sometimes the symptoms are just a high reactivity intrusive memories or images.

If it’s pinned to, let’s say, like a car accident, I see a lot of that.

Folks are just, they hear the screeching ti tires or they have dreams about it, or that one intersection where the wreck was, they’ll go the long way, or that when it does come time, the lights green they just are really hesitant going through there.

So there’s a lot of that kind of reactivity, as if the past event is still present, because your body and your neurological system is not sure that that happened.

So there’s a lot of ways, I mean, you call a therapist that specializes in trauma, or at least, I think a lot of folks now are trauma informed.

And there’s a lot of..

Define trauma informed.

Trauma informed is kind of a broader understanding that just you want to be very impact aware of how you’re talking with someone, you know, like you just want to understand that what you’re perceiving as reality may not be reality.

They may have stuff going on that you may not know about.

So you come in, I call it soft and low.

You come in really gentle with someone and making no assumptions It’s just kind of being aware of where another person is and so having that kind of trauma awareness that maybe there’s a lot going on here can be really helpful in easing that and allowing somebody to feel safe enough to open up because it’s all about safetyety a neurological safety, because if someone says to you, trust me, I’m a safe person, your body may be sending you other signals with that.

And the body never lies.

It’s just that everything else may kind of contradict some of that, but the body will always tell you the truth, whether there’s safety or not.

Yes.

Yeah.

So treatment, once a diagnosis is made, expand here, Dr. Sanders.

Right.

So if we’re talking about Alzheimer’s, I mean, unfortunately, all neurodegenerative causes of dementia are unfortunately incurable to date, but with Alzheimer’s, we have had some newer breakthrough treatments in the past couple of years that at least has been helpful in the earliest stages, meaning patients that are still fully functional and in that mild cognitive impairment stage or in mild dementia stage where they’re starting to maybe have a little bit of difficulty with things like managing their finances, taking medication safely, driving, but they’re still able to do like their basic daily activities and tasks.

So we’re in a new phase of a type of medication called anti amyid therapy, and what this is targeting is one of the proteins that builds up in the brain called amyloid, even decades before someone becomes symptomatic And so this medication, what it’s shown, is that when patients undergo, it’s an IV infusion, every two weeks for 18 months are pretty intensive, but it’s actually removing that the amyloid from the brain, which did translate to a slowing of decline by about six months, which again, doesn’t sound like a lot, but in some patients that are looking for more time to be with loved ones and able to have quality of life, that’s meaningful.

So that’s an option that we offer at Hauenstein Neurosciences There’s a couple other oral cognitive stabilizing medications that have been on or FDA approved since the early 2000s that can sometimes help with symptoms.

It’s not unfortunately a cure, something that has shown significant improvement in terms of slowing decline, but can help with patients remaining more functional at their level for a longer period of time So those are kind of more the pharmaceutical aspects of it, but like what Susan said, a lot of the treatment is really education, education of our patients to understand what to expect, understanding for family members what to expect.

The way I talk to my patients and the people they bring with them to appointments is that this is a family diagnosis.

Nobody is going spared by this, that’s involved with the patient.

So how do we navigate behavioral aspects of changes that may occurur?

So managing medications for that aspect, or how do we just help family members navigate these difficult challenges where you, mom or dad are acting different, how do we help distract or to redirect and different techniques that can help?

How do we keep the patients stimulated, you know, with activities and things that can still bring them joy?

How do we keep them safe in their home?

So treatment is really multifaceted in dealing with all of those approaches as well.

Yes.

And so that trust aspect, I use the term currency of trust.

So the currency of trust is really knowing that the information that they’re going to tell you about what they’re going through is going to be kept within a group if they’re in a group setting, or there’s a lot of hard things that they have to tell about in order to get the right type of help.

They don’t know what they don’t know.

They don’t know what they can tell you what’s happening and that’s the interpretation about helping them based on past experiences of doing this navigation for 13 years at Hollinstein Neurosciences.

But I think that currency is really connecting with them and letting them know, again, slow and low, I think is really what we do also, is making sure that they know there’s help for them and we’re going to figure this out.

We have to kind of tease it apart and see what the puzzle pieces really turn them over in order to see what the picture is And that is sometimes a process of building that trust in order for you to be safe enough for them or the situation to be safe enough for you to be able to hear that.

And a lot of times then that leads to needing resources.

So maybe, you know, somebody needs a ramp for the house or maybe they need, you know, additional maybe they need to have something moved in the house so that it’s for them, for their caregiver as well as the person with dementia.

And then sometimes that connection is, it’s modeling types of things that are going to be happening.

One of the things that people experiences, you know, repeating things over and over again or shadowing, which is where a person with dementia will follow them throughout that’s their safe person.

And so seeing them them in their site is really important.

And once they disappear from the site, even if they’re going downstairs or to a laundry room that causes anxiety on the part of the patient.

And so, you know, what can you do in those sorts of things?

And, you know, that’s where Dr. Sanders and the clinic comes in and saying, you know, where that person is and while I don’t do any of the medication management or anything having to do with that, what I do know is if they go to the clinic and we can relay that experience, they can help them understand kind of what needs to be done by by treating them and looking at kind of where they are with other medicationsations.

So it’s a process of really, again, building trust and that currency of trust is being trustworthy, but also having many people in the community who say, you know, you find somebody and say, you really need to go to one of these groups.

I’m going to send you the information.

And, you know, any of the caregiver training that we do, we have a three-part series that is you know, invaluable.

So part of it is really discerning what the caregiving role is, learning what it is you do, but also maintainingaining independence of a person if they have the ability to be independent, because it’s important for the caregiver, for them to be an independent as long as possible And then there’s the communication piece, and managing behaviors, that shadowing behavior or that repeating over, over, over again.

And one of the things that I use a lot of technology and I get technology donated to me.

And Alexa, you can ask Alexa the same question over, over, over again.

And Alexa never gets you know, upset about it.

So those are the types of things we can deploy if it’s possible if they want something like that.

But also, the tools of what would you say?

Is there a distraction case?

Can you distract them?

Can you say, yep, I heard you?

Or, you know, what’s the response they’re looking for?

Sometimes it’s not a response.

Sometimes it’s just words that they’re saying because they’re stuck in a loop and they don’t they can’t get to the next step back to education.

Chris, what is this EMDDR?

Oh.

EMDR stands for I Movement Desensitization and Reprocessing.

Dr. Francine Shapiro, late age 80s, she was doing some work down at Stanford University.

She developed this some curiosity.

It started out with looking at lights, and she discovered that if you’re talking about, let’s say, you’re a client of mine and you’re telling me the scary thing that happened to you, you’re looking at two lights and go like this, and so what that does is it involves both hemispheres of the brain through the corpus colosum.

It activates that.

So if we understand that, for the most part, that traumatic memories associations are right hemisphere in the body what we do is we bring in that left hemisphere, which is a little more cognitive, based in times space, linear sequential.

It’s almost like letting the manager part of your brain come over into the warehouse and organize things, like, let’s time stamp this and move it on, and let’s move it on.

That’s how I explain it to my clients.

And it is one of the most, it’s been around 30 years, and it’s one of the most, it’s, I think the VA endorses it.

It’s endorsed by the Department of Defense for the effective, sustainable treatment of traumatic memories.

I used it for processing trauma with my clients, and a few years back, they discovered that EMDR, or as it’s generally known as bilateral stimulation or BLS, that it also reinforces positive memories and associations So if you had a great childhood memory that you’d go to the lake house when you were a young girl, we would say, okay, well, let’s strengthen that.

And so we would do some bilateral stimulation, that you can, it’s almost like taking it out of long term storage, putting it on the desktop, where it’s a lot more vivid, it’s a lot more real to you and you have the physical associations with that.

So the MDR is it’s a wonderful multiool.

You just brought me to that lake house.

I’ve got to break that.

We’re winding down.

How do we find out more about your services, Chris Causey?

My contact information is at my website, Chriscey.com, CAU SEEY And you can reach out to me there.

And if you have any questions about anything, I’m real informal about that.

You can shoot me a text or give me a call at the number there.

Yeah.

Appreciate you.

I think that’s a question I get asked a lot.

What can I do to try to protect my memory?

And this is kind of an important point to make to patients that maybe aren’t in the office yet, because middle age seems to be a key that we’re learning about your trajectory for memory.

And a lot of that goes.. Today’s middle ages can be 30, 40.

Correct.

Yeah.

So those are patients who are living their lives in relatively healthy, but we’re learning a lot about cerebrovascular disease and cerebrovascular risk factors and how that ties into dementia risk.

So for patients that are maybe having some issues with blood pressure or cholesterol or modeling a healthy diet or physical activity.

Those things are super important we’re learning in our 30s and 40s to try to help with cognitive reserve.

A lot of patients that come to to me have kind of already missed the boat in terms of how to change that trajectory, still those things are important to manage and can help with hopefully maybe keeping quality of life improved for patients already with it mild cognitive impairment or dementia But I think this push for improving our cerebrovascular health is really important.

And so an easy tool that patients can look at is on the American Heart Association, looking at something called the essential eight.

And that’s looking at things like your sleep and your cholesterol and other aspects that we have shown that have been modifable risk factors for dementia.

So just to give people feeling empowered that there is something they can maybe do to try to help change their trajectory.

Great.

How do we find out more about you?

Trinity Health website is great, so Hauenstein Neurosciences, we’re downtown.

We have a plethora of information on our website that can show what resources that we offer.

And I’m sure Susan will talk more about that as well.

I give you one minute to do that.

So definitely Trinity Health, Michigan.org.

On that site, we have events and classes and things like that that you can find just by by putting it in the search bar and clicking the event word, and then it can drill down on the other things we have available Those are all of our support groups.

And again, some of those happen, we partner with the Alzimer’s Association.

But I also have support groups for neurocognitive.

So it’s a broader, it might be lewy.

body, it might be frontal temporal dementia.

And sometimes those are different to the caregiver.

Sometimes it’s different for the person going through it And so finding a group that has other people who are going through the same thing, a lot of times they’ll ask whether a diagnosis isn’t important.

And one of the things, is it important to you?

Is it important to know?

Some people need to know.

It depends on kind of where that person is, and that’s different for everybody But being able to get caregiving advice, the Alzimer’s Association has a 24-7 help line, 800-2283900.

Great.

Where am I?

Thank you.

Take care.