Join us for a hope-filled conversation about transforming Alzheimer's care with Dr. Dani Cabral, board-certified neurologist and psychiatrist who left traditional medicine to launch BrainLove, an innovative Alzheimer's clinic redefining what's possible! Hosted by Nirvana Tari, Chief Patient Officer at CareYaya.
In this powerful episode, Dr. Cabral shares why she walked away from a prestigious memory clinic to create a practice built on a radical philosophy: there is so much you can do about Alzheimer's, and we need to focus on what remains rather than what's lost. Discover why loneliness (not just social isolation) literally changes your brain through chronic inflammation, how the new anti-amyloid medications are giving families years back together, and why she believes the best brain investment under fifty dollars is joining a group or club, not buying a brain game.
From leading groundbreaking clinical trials for Lecanemab and Donanemab to creating a membership model where care partners can get mental health support independently, Dr. Cabral reveals the paradigm shift happening in Alzheimer's research right now. Learn why forgetting your keys at forty-five is almost never Alzheimer's (there are two hundred other more likely causes), the critical difference between mild cognitive impairment and the newly recognized mild behavioral impairment, and why men especially need to intentionally create social connections starting in their twenties.
Key insights include when to consider biomarker testing (fifty-five plus with symptoms only), why quality relationships in your forties predict longevity more than anything else, her vision for intergenerational play centers staffed by young people where older adults thrive, and the uncomfortable truth that most people with Alzheimer's actually have multiple neurodegenerative diseases simultaneously that require combination treatments.
Brought to you by CareYaya, America's number one rated solution for in-home senior care, providing industry-leading quality care at the most affordable rates. CareYaya is known especially for delivering the most reliable and affordable overnight senior care and 24/7 care in many major metro areas including Atlanta, LA, New York, San Francisco, and Washington D.C.
This episode is essential for families navigating a recent Alzheimer's diagnosis, anyone in their forties worried about memory changes, care partners feeling burned out and invisible, or medical professionals seeking a more holistic approach to brain health that honors both Western medicine and the unmeasurable power of human connection.
Episode Transcript:
Hello and good afternoon, everybody. Maybe good morning if you're on the West Coast like Dr. Dani Carvalho is. I'm here with the one and only Dr. Dani Carvalho today. Thank you so much for being here. How are you doing today? Thank you for having me. I am doing great. How are you? I'm so good. I've been so excited about this podcast. It's been in the works for a couple of months now, so I'm happy to finally have you here with us. Same. Per usual, we're going to go ahead and dive right in with our lightning round questions. So, Dr. Cabral, complete this sentence for me. If I could ban one myth about Alzheimer's forever, it would be? There's nothing you can do. Oh, I love that. What's your go-to brain food when you need to think clearly? Oh, I love this question. So for me, it would be a smoothie with fruit. And, you know, I add some things like granola, chia seeds, water in the blender. So easy. You know, they have these smoothie blenders that are so easy to clean now. So it's like my go to like every day. It's amazing. And it's so convenient, too, because you can just like take it really easily on the go. Love it. I love it. And then kind of on that same vein, is there like an overrated brain food that you can think of? Sorry, I missed that. Is there an overrated brain food? Overrated brain food. I would say anything that you think is going to solve all your problems or is going to prevent Alzheimer's or these diseases of aging, there's no one thing that will do the job. It's really a whole person, whole life systems perspective, which in some ways feels more complicated, but also is the route to healing resilient and healthy. That's such a good answer. That actually makes a lot of sense. And what would you say the best brain exercise is that's not a crossword puzzle? Oh, nice. I would say anything that you do with another human being that you enjoy and care about. Look at that social connection. I love it. I feel like that always comes up when we do talk about brain health, like the importance of social connection. And I have like four questions lined up about that. So I'm really excited that you brought that up just early. And can you give our audience a good brain investment, maybe under fifty dollars? Yeah, goes along with my answer to the last question is that I actually think the best investment is not like a brain game or a, you know, tech. It's actually getting involved in a group or a club, getting a membership to something that's under fifty dollars where you're going to be engaging in activity that you like in a consistent way and ideally with other people. If you like being around other people, not everyone does. And I respect that. But it's about getting out there, trying new things, growing new muscles. And you can do that for fifty dollars or much less in many ways. Yeah, you could do that for free in many cases. Yeah, sure. So heck, yeah, that's That is a good piece of advice right there. So those at home may not know, Dr. Cabral is a neurologist and a psychiatrist who specializes in Alzheimer's. And she recently made, maybe not recently, a few years ago, made the bold decision to leave traditional medicine and open her own clinic called Brain Love, which is an Alzheimer's clinic. So I guess my question is, what was the aha moment that made you realize you needed to do things differently? And maybe tell us about the philosophy behind the name and how it approaches your how it shapes your approach to patient care. Thank you. So I was in a large hospital system at a memory clinic, seeing patients and families, doing clinical trials and research. And definitely we state of the art, we had all the bells and whistles there. And I felt like I was contributing, but people still, patients and families were still seemed to that they weren't getting all that they needed, and kind of the same things, they were disappointed. And often, like, why didn't anyone tell me this? Why didn't I know this? Why didn't I expect no, this was gonna, you know, like, why, you know, why couldn't I have been more prepared? And I would think, like, it seems like there are patterns that happen with patients and families, and why can't we change the system, so they are proactive. instead of reactive right like we hear that a lot in our healthcare system so that's that's what i was seeing and then internally in this world i was in for me you know i kept trying to bring my ideas to light and talk about them and like wanting to change things in a very exuberant way that you know um i noticed like my approach wasn't working in that system so at first i was And I think this is also a commentary maybe on being a female and these, you know, systems that I my voice when I was expressing myself was first viewed as, you know, I was called to accommodating, like I was so eager to do things. And then and then and then I was frustrated because nothing was changed or, you know, not much was changing from my perspective. And it was maybe the narrative changed toward me being called negative. And that happens when people feel like you're trying to change or destroy their systems that they've created. And so I was just like, you know what? They're doing great things at this place. And I have all these ideas. And I have this philosophy. I want to have no regrets when I'm on my deathbed. And I want to try these things. And I have all these ideas. And so I'm going to have to step outside of that and try them and find a way to try them and create a different system where people who enter into this system of brain love also see the possibilities. And so the mission is really to transform the narrative about what's possible while we address the challenges of aging and of diseases like Alzheimer's disease. But open up people's eyes too. There's so much left. There's so much there. We can still even grow. There's neuroplasticity as we know that happens with age still. And there's many things that can be changed for the person and the family. The name brain love came from shifting that perspective from everything just declines and goes downhill when you get these and they're progressing to let's focus on what's what's there. Let's go to that. I'll just say it like that touchy feely place that we don't that we tend to downgrade in Western medicine because taboo. Well, and yeah, we don't have the technology to know all the biologic substrates of social connection and of love and touch. Science is more open to looking at these things, but our technologies are limited. We only have certain ways we can look at the brain and the body. So I'm putting that forward. I'm saying there are practices. that have continued throughout the entirety of humanity. And we are downgrading them like human touch, because we don't know how to study it and measure it very well. So we're saying it doesn't actually help yet. In my work, yeah, consistently, I've seen these things, these touchy feely things do help. So we upgrade these in brain love to be equally or maybe more important than like the medical piece, but truly in all of them. And I fully am a Western trained physician and I want people to have all of the advances that we found in that space also. But it's, I guess, like, I don't know why, maybe I've seen this theme oftentimes where it's like, it's either or, and a lot of the times you can do both. Like you can very much combine these two. very, I guess, like proven in science methods and proven time and time again, and combine the two of them and make something really, really beautiful, which I feel like is what you're doing here right now. And you're actually, I love that you touched on, you touched on so many different amazing things just in that one question. But the fact that, you know, touching on being a woman in and in like, quote unquote, I guess, position of power, it it is difficult and there are more things that you have to do in order to kind of like have your voice heard. And what better way to do that than open your own clinic and be the boss because that's, I love it. I just really, really do love it. And you are, for our audience at home, you're one of the rare physicians who is board certified in both neurology and psychiatry. So I guess, does this influence the way that you've designed BrainLove and maybe a couple of examples of things that you can do at Brain Love that maybe you haven't been able to do in the past in traditional medicine settings. Yeah, I think having that dual training inter, like my professional identity is like interdisciplinary at the core. And so to be real specific, I guess, in concrete ways, how I bring this into the care. And I always have. But I can sit down with the person and family and listen and receive the information they're giving about what they've gone through. and just asking the right questions and present creating a space for that and being silent at the right times can be therapeutic in itself but then what i can do is really think deeply and intensely about what is going on in their brain and i'm doing a full neurologic exam and i'm putting all these pieces together and i'm reviewing the imaging, the brain imaging and understanding these things in a way and then integrating them and then thinking about the whole family system. And so that provides a more holistic treatment plan that people appreciate. And then with brain love, the practice and the business, What I've been able to do is, so we just started seeing patients a few weeks ago. We have a membership model where we have three options. We have the patient only membership, the care partner only membership, or the dual care partner. So the unique feature there is that as a psychiatrist, I can be the mental health provider for the care partner who maybe is experiencing stress, burnout, overwhelm, or they want to prevent that. And so what's cool, what is exciting to me about this is any care partner for someone with progressive cognitive changes like Alzheimer's disease can sign up on their own. They don't have to have their person as a patient. in our clinic. And we focus on them and themselves in their own right. And how do you take care of yourself? How do you fill your cup? What's important to you? And, you know, there's a lot that goes with caregiving where, you and especially women, you know, really take that on as like, you know, it's like, I'm going to be the best caregiver and men too, but I'm the best caregiver I can be. And like that caregiver hat becomes like sewn onto their head and they can't take it off to like, remember and, and devote time to all that other things that are who they are. And then that's what leads to this imbalance and this burnout. So it's like, by someone coming in for that care partner membership, they get permission to invest time in themselves. And the irony is that their person does better when they're feeling better. Absolutely. I mean, I think we see this all the time at Keriaya because I, for the most part, I engage with the family caregivers and the care partners rather than the patient themselves. And so often they just, they forget that they need love and care as well. And they need to be taking care of themselves. And it's, I get it. It's difficult. It is very, very hard to being a family caregiver. I mean, I feel like most of us know is one of the hardest jobs in the world that you don't really sign up for or get paid for. So it's, it's something. And I love that you have a whole section dedicated to that because I do believe that that genuinely probably really improves the care experience for the care recipient too, in the process, which is really, really awesome. And you did touch on, you know, um, mood disorders and like psychiatry and things like that. And I've read that there's this like fascinating intersection between depression, anxiety and general cognitive decline. So can you maybe break down the chicken and egg relationship there and are mood disorders a symptom, a cause or just something else entirely? Yeah, I'd say all of you both is the answer to that last question. But so the way generally just overall with anyone who has mood changes, especially when they're in an intense depression, anxiety, um, and even grief, profound grief. So what those things are doing is they're taking away lots of resources from your brain that would be used for your thinking, your cognition, your higher cognitive functions, especially those things like planning, multitasking, organizing. Um, and so you can think about any of us if we're deeply anxious or depressed, like we're not thinking straight. Usually, like no matter the age. And also often when you have those mood changes, you also maybe aren't sleeping well. And so then that like the sleep disruption impacts your thinking too. So, but at twenty five, if that's happening to you, you know, it's not Alzheimer's disease. I mean, right. Right. So what what we see, though, in older adults is that there are individuals, interestingly, who have had no history of any kind of mood issues, depression, anxiety, anything. yet maybe at age sixty suddenly they become worried about things that they were never worried about or maybe like irritable and they were never an irritable person and there's no precipitating factor, there's no stressful thing going on in their lives. So it turns out a subset of those individuals, they have the beginnings of Alzheimer's disease and that's their first symptom. So we call this, this has been called mild behavioral impairment it's sort of the counterpart to the diagnosis mild cognitive impairment and so not everyone who has this has neurodegenerative disease I want to make sure you know that so if you've noticed your parents more irritable they may have like stressors going on that you don't know but but I would say that it's important to get checked out and I've been doing a lot of education with mental health providers out there of older adults to be like, or midlife even, to be like, you may be the first, you may be the one to catch Alzheimer's disease really early. And now that we have treatments for the earliest stages, for you to direct them to get that checked out is so important. Right. That's so fascinating. Obviously, I'd heard of mild cognitive impairment. It's thrown out a lot, but I'd never heard of mild behavioral impairment. That's a really, really interesting concept and definitely something, I guess, to both look out for, but not necessarily stress yourself out too much about either. But great practical advice. Thank you so much. Speaking of, I guess you mentioned earlier that you were in clinical trials and Alzheimer's research as well. I believe you have maybe almost two decades of experience in this. So you've watched the field evolve dramatically over this period of time. So has there been a paradigm shift that you've witnessed? And if so, what is that? And are there any really exciting advancements in Alzheimer's that you would want to share with our audience? Yeah. So many things. So I would say that the major change shift paradigm shift is there's now hope. So, so while I, you know, I've always, I talk about, there's always hope, like, yes, we don't yet have a cure, but there's hope that there's so many things we can do. But that hasn't been the general feeling, you know, overall. And what has led to this are the advances in our, diagnostic abilities, and then that has spurred treatment advances to where now we have two approved Alzheimer's medication treatments that are for the early symptomatic stages. So those are called mild cognitive impairment or mild dementia, which is also more recently called stage three and four through the Alzheimer's Association guidelines. And so these are medications that very effectively remove the beta amyloid plaque buildup from the brain. And so those are these changes in the brain that happen to people and they actually start twenty years before any symptoms. So they're going on in our forties, fifties, sixties, way before the symptoms start. So these these new drugs show that if you start at these early stages, you have a statistically significant slowing of the progression of cognitive and functional decline compared to those who don't take the drug or who aren't placebo in the studies. So these have been approved for you know, one to over, you know, a couple years now or more. And that has led the much more excitement in the field, like, for people that are very focused on medication treatments, they're finally like, there's something we can do. And so there is more money and attention being directed to this field. And it's opened this window where now there's much more talk about, you know, when these drugs were approved, there's certainly a lot of people in controversy about do these, are these really worth the money to help people at this age who are already affected by Alzheimer's disease? And so that term that we use is clinical meaningfulness. So now we're talking more about like, and studying like what do individual people and communities like really need and want. And this is being studied more rigorously. And I, that's so uplifting and heartening to me because it did feel like for a long time, there was a disconnect between the neuroscience community or the Alzheimer's science community and the human beings that are living with this and experiencing it. Now that disconnect is smaller, but it's still more than I would hope. So yeah. Baby steps. Yeah. Yeah. I'm curious, have you prescribed these medications to anyone? And have you seen like changes in your own practice? Yeah. So I led the, I was the site principal investigator for the phase three trials of both of these medications. Wow. Yeah. So those are called lacanumab and dinanumab. So they're anti-amyloid monoclonal antibody treatments. And so basically, would see in the study you know i didn't i was blinded to if they were on drug or placebo but um there were people who were hanging in there doing well longer than you know maintaining longer than i would have expected and then it turns out you know when they unblinded some of these um those people were on the active drug now um and in the real world i have prescribed and similarly, people seem to do better now. They continue, they will, I want to say like, this isn't a cure. They will continue to progress, progressing slower. And so what that means is that they can do more of what they want to do. And, and so their families also benefit and the community benefits from that having their problem. So it's the quality of the years, not necessarily the quantity I feel like. So that's, that's awesome. And it's fully giving, it's giving years back to people and their families to them. So I think, I think that's a huge win all around and I just love it. So, you know, we've been talking a little bit about social isolation and being social and things like that. And I've been really excited to ask this question patiently waiting, but we've kind of seen through our work here at Keriaya that social essentially the smoking of our generation and even the surgeon general, I think made a comment saying that It's being socially isolated if you're over the age of sixty five is worse than smoking fifteen cigarettes a day. So how does loneliness literally change the brain if it actually does? And what does this mean for aging population? Is there something that we can do to start preventing this maybe? Yeah, so firstly, great question. I love this topic. I do want to draw a distinction between social isolation and loneliness. Those are studied, you know, they have different definitions and they're studied independently. Obviously, there's a connection. Now, I'm not, you know, that's not my area of research, but I have certainly, you know, it's a really important topic to me and I've learned a lot about it. And so I would focus on loneliness in this case because that is really that subjective feeling that you don't have what you need. in terms of other people and relationships and could, because you could be someone who's a loner or you're fine, but, or you could be someone who's in a group in a big family or a big community, but you don't really feel truly connected to anyone. So you could feel lonely. And so, and we know that, um, studies consistently show that those, the, the marker. So in your, I think it's like age, um, that big Harvard longevity study shows that it's the number of quality relationships that predicts your health and wellbeing and longevity, you know, overall. So those who have the best, strongest, high quality relationships in their forties live the longest and the healthiest. So that's really meaningful. And I think, you know, I think we're still understanding what happens in the body. So we know that someone who's lonely is basically gets into a high stress state and a pro-inflammatory state, chronic inflammation, and that wreaks havoc on the body in a number of ways. And I think it just depends on the individual and their genetics and things like which body system, which organ system, does it hurt the brain the most? Does it hurt like the cardiovascular system? All of it. um and so i think part of this we don't know because we don't have the technologies maybe in even the imagination to know like what to measure or how to look for it yeah even um in my field you know i'm brain centric but more and more i'm like well where is this stuff in the body like maybe we can measure something better in the body than in the brain so um so but this is a huge area and I think that this time is right for and what you're doing is amazing with. Yeah, yeah, yeah. It's really inspiring and bringing older adults and young people together. I would imagine it's a reciprocal benefit. It really is. As I actually started out as a caregiver on the platform myself, and I think truly it was one of the most I only did the caregiving for less than a year, but it was genuinely one of the most life-changing and monumental experiences of my life. Every single one of the relationships I developed was meaningful and held a place in my heart. And one of my most beloved patients passed a little over a year ago. I'm so happy and proud to say that I still keep in touch with his family. And I've even had the opportunity to get lunch with his family after his passing. And Um, it's something that I will be telling my children about in the future. So I feel like it's the, the value of the intergenerational relationships is really magical. And that's something that we do witness. I carry. Um, each and every day patients literally light up, um, in ways that we haven't really, we hasn't really been studied in the past with, um, and maybe traditional caregivers. So from, I guess, a neuropsychiatric perspective, uh, what's happening in the brain during an intergenerational connection and um how can we like harness this lighting up effect to kind of you know share share the love with everyone yeah I don't I don't know that we really know what's happening in the brain you know like with an intergenerational experience I would love to study that so let's do that um oh my gosh absolutely do it I think firstly like there's some bonding hormone happening um And I think it's different for the young person versus the older adult. So I just in my, I have a podcast called Resilient Aging Unfiltered. And I just, I'm about to release the latest episode with one of the foremost scholars of wisdom, Dr. Dalib Jeste. Um, so he, he's written books on this. He's doing, he's a geriatric psychiatrist emeritus from UCSD. So, um, so he's studying, you know, you know, he talked about what's going on in the brain, as far as we know, with wisdom, what people who have wisdom, and it seems to be, there's a connection with the prefrontal cortex, the limbic system, um, And we talked a little bit about intergenerational experiences. And from my perspective, there's the older adult imparting the wisdom and there's a younger person who's bringing some kind of, I think I'm calling it curiosity right now. It's like an openness and an energy that the two connect. And I don't know what the biologic substrates are of that and the younger person in that setting. But there's a nourishing that's happening. There's a nutrition that's being given to each other that lights up both, whether or not they're conscious of it, I believe. But I do think there needs to be some openness on both parties, even if it's a little like, okay. know because when you're young and you're like kind of volunteering or doing some like job that maybe will help you on your resume too um you may not realize like the benefits at first and you're just doing it but but then i you know i'd love to hear like that was that's what i was gonna just say like from my experience i well okay to be completely let's take it back for a second so i've Ever since I was a little girl, I was like, oh, I want to be a doctor. You know, I want to help people. I want to kind of like be be a positive person in someone's like a lifetime. And I was like, I love kids. I love hanging out with kids. I want to have ten kids like all of this stuff. So I want to go into pediatrics. and that was literally exactly what i wanted to do until the moment that i went on my first care shift and i was like wait a dang second no one had even told me that this was an option first of all like i feel like a lot of the times fields like maybe geriatrics or hospice or palliative or things like that are just kind of overlooked and not really talked about as much especially to the younger generation so i didn't realize that it would be benefiting me the same amount, if not more, to be engaging and interacting with the population. And for me, I'm an immigrant and my grandparents live in a completely different country. And I sadly have not had the opportunity to see them in almost seven years now. it really filled a gap in my heart and like allowed me, which I, again, did not realize was going to happen at all until I was in that position. And in that situation, I was like, I feel I'm feeling a type of love that I genuinely didn't realize was missing from my life. Like this relationship that I'm like building is so different than any other one that I have. And it really does start to feel like family, but in a different way, because it's not like mom or dad or like brother or sister type of family. It's like, oh my gosh, these people have lived four times as long as I have. This patient that I was just referring to fought in World War II. And to get to hear those experiences and accounts first person, it's just something that I wouldn't change for the entire world. Yeah, sorry, I got on my little soapbox there. So I do feel like the benefits are definitely both ways. And it's just not nearly as like thought of or studied when it comes to the younger self. Yeah. So I love that you're creating the space and these opportunities for young people and make it in an appealing way for them that they will definitely benefit in some way. And they probably, yeah, they have no idea all the many ways they'll benefit. And I would just say these benefits continue and may not show up till you're older. I was a hospice volunteer when I was pre-med and I I didn't know anything about Alzheimer's disease or these brain diseases of aging at the time. And I was sitting with a man who was, you know, in the last days or weeks of his life, he was in the severe stages of that. And so I, he was just going on and on like rambling, you know, how it can happen and like telling stories. And I would just ride the wave of whatever he was saying and ask like follow-up questions. And then, you know, just like in a neutral way. And it was like, I was with him for two weeks and it was my last day there. And usually I was sitting down so he couldn't really see me. I would just hear my voice. And then, so when I stood up to say bye and thank you, he hadn't really moved. And he surprisingly like, he like picked up his hand and like grabbed my hand and he was like, thank you. And it was so like, so I didn't realize at the time, cause I was, I was like, okay, you're welcome. And then like, now what I know, I'm like, that took so much for him to summons. Like, yeah, he literally awoke something in him and he was like, you know, and, um, it was so, it was like, it's, it's, my point is, is like, I didn't know at the time I was like, you're welcome. You know, um, that's such a good point. You don't even realize something is going to affect you. Like, and then five years down the road, you look at it and you're like, wait, maybe that's why I did, I did this or I am doing what I'm doing. So, and we've been focusing on our, um, you know, pre-meds and younger generation, but, um, so I guess generally for our younger listeners that are tuning in right now are gonna listen in later, what should they be doing now to protect their brains for the next fifty years? Is there a checklist or something that you would recommend everyone starts doing this weekend? Yeah, well, I think it's all about finding the right balance for you, right? So you have people who are like, hardcore exercisers, super fit, but they have no real quality relationships or friendships, or they drink a lot, like they drink a ton, or do certain things, put certain things in their bodies that are actually, very counterproductive. Um, so it's like looking at trying to, trying to look at the everything and like, obviously like we're humans, like everything's like in flux a little bit, but it's for you yourself. So I would say the three big areas that we should all always be checking in on, like, how are we doing with that would be, um, like moving your body, body moving, like however that is for you in your, in your phase of life. um then uh then social connection yes um and i'd say especially for men uh like that are getting into the forties and later like we we've found that it's clear that that gets in our current society there aren't as much um spaces for them to gather and so you they really have to make intentional efforts and so starting in your twenties is great like yeah like men's groups and things um which that might be a controversial topic for some, but that's fine. And then the third one would be cognitive stimulation. And so what does that mean when you're twenties and thirties? getting out of your normal day to day and trying new things and putting yourself, getting out of your comfort zone, pushing yourself a little bit, even if that's like, okay, I'm going to talk to this new, I'm going to talk to the cashier. I'm going to be friendly or I'm going to travel to this like new place or whatever it is. It doesn't have to be like, I'm going to learn, you know, Mandarin. Like, you know, you don't have to go. And that's the thing too. There's so many resources at our disposal these days to kind of be able to do that. Like, it's I mean I don't know you don't have to like sign up for a Mandarin class and then two days in you're like wait actually I don't like this I want to try Japanese instead you can just do a lingo or something and like start today and kind of do it while you're sitting on the toilet even like I feel like there's the convenience of the technology yeah amazing so we need to use it more thank you you just motivated me to redownload my duolingo actually because I've been meaning to for so long and I'm like I love learning languages and There was a time in my life where in high school, I was taking like three different languages at the same time. And I just completely forgot about that when I got to college. So I love it. Can I hop on that and make a follow-up suggestion, which is Duolingo fine. But also what's available now is you can have a virtual teacher in that another country that's going to be like, maybe less expensive, honestly, sometimes. And then like, you can get on a system, like see them one hour a week or one hour every two weeks. And you're going to get a lot more out of that. Oh yeah, because it's a native speaker. That's a really good idea. I love that. I used to, my, I guess, quote unquote, hack for doing that was I would watch my favorite shows in those languages. So like, I don't know, I've rewatched Friends a couple of times at this point. So I'd be like, all right, let me go try and find like a French language like friends and then like watch that and understand as much as I can. So that's what I used to do. But learning it from an actual human being sounds like a pretty good idea. And it builds on the social connections. So it all ends up working out. So I feel like this is a question that maybe a lot of our audience might have in the back of their mind. but not let them think about. So let's get real for a second. If I'm forty five and I forget where I put my keys or I walk into a room and I'm like, wait, why did I come in here again? How worried should I be? And maybe my question here is what's normal aging versus I should probably call my doctor territory. Yeah, that's a great question. That's coming up a lot more now because we're talking about Alzheimer's prevention more because of all the advances. So You know, these diseases are one of the major risk factors is age. And so if you are forty five and your your trouble with your thinking is actually due to Alzheimer's, that is very, very, very rare at this point. And there are these rare autosomal dominant mutations that cause these early onset Alzheimer's disease. So you would probably know that in your family. But if you are forty five and you're having trouble thinking, there are so many other reasons that could be happening. There's a hundred reasons. Right. So so what you want to do is look at your life like I'm in that age range right now. And so. when these things happen to me, I say, okay, I have so much going on in my life now and a lot of change that with this, you know, I launched this business and I have two school age kids. So like every day for me is different now. And so if you're not in like a set routine and everything's all, you know, set up for you, like you're going to have, the main thing I think can happen is you're not paying attention and you're not focusing. so that's the most attention to everything all the time yeah right so so then there's ways to improve one's attention and one's focus and i'd say the first thing to do is to to to try to do that to pay more attention or to catch yourself because i've caught myself being like oh my goodness i really just stopped listening to my family member when they were like i went off in my head to like whatever i was doing next Yeah. And then, of course, I'm not going to remember because you know what? If you can't pay attention, you can't even encode it in your brain. You can't store it. It's just it doesn't even go in. Right. So you can't retrieve it later. Right. So that's the point. And so, yeah. So I would say where we're moving towards, there's, you know, there's these treatments if you have the early stages of Alzheimer's disease. But I would say if you're fifty five or older and that happens, then now is the time not to wait, but to get checked out, to talk to your doctor, to be like, let's let's figure out what's going on. Yeah, absolutely. And is that just does that something you just bring up to your primary care physician and then they'll kind of see what to do from there? Or do you have to go straight to a neurologist? Definitely with your primary care physician. And even before you get in with them, start keeping track of what you're forgetting and look at your lifestyle. So this is what the primary care doctor is going to ask you. They're going to be like, how's your sleep? Do you have new stressful things going on? How's your mood? What's your routine like? are you on medications? Do you have like chronic or medical issues that are not in good control, like diabetes or high blood pressure, which, you know, four to five, that's less common, but that's absolutely possible. So they're going to do a panel of labs. They're going to examine you. And then if there is concern after that, they'll get brain imaging. You know, you could have thyroid dysfunction. There's a hundred, there's two hundred things that could be causing that at that age. Just one of them is Alzheimer's. So that's... That's a little comforting to know, I feel like. And that's again, that's much less likely at forty five to be the cause. Yeah. But eventually we're going to have treatments that are started in this asymptomatic period in these twenty years before the symptoms start. When we identify these changes in the brain with these biomarker tests, we can do to look for the amyloid plaques and the other things that we know. So that's going to happen probably in the next three to five years. I love it. That's great. Within most of our audience and everyone's lifetime. So that's really, really awesome. I have one more question that I want to ask you, but I definitely want to give our audience an opportunity to ask their questions as well. So we'll do that. And then if we have time, then I'll get to ask my last question. So our very first question here is going to be, let's see. Ah, super cool to hear about your work at Brain Love. If you had unlimited resources and no constraints, what current challenge in brain health would you most want to solve? Ooh, I like that. I love that question too, Maggie. Ooh, unlimited resources. So I would love... So to get at those three things with brain health for all of us, so that's cognitive stimulation, movement or physical activity and, um, social connection. Yep. So I, I want to address those by making like a really tricked out older adult play center where. It's staffed by young people, and it has a variety of things that are appealing to everyone. Of course, there's the physical activity, there's the classes, there's the music, there's the art. It's sensory-based. And there's also where the older adults are helping tutor kids with their homework. And there's things that everyone's benefiting because in that space, everyone is getting... I say like the way I feel as a physician for this population is people are transmitting things to me. Like I feel calmer a lot of times after visits, you know, they have often older adults have more nervous system regulation just by getting older and us young. Well, I'm in midlife, but you know, young people need the hat, like it's normal. And so just creating like these spaces that are full of life and possibility and imagination. I freaking love that. It's a community center at its core, like where it's just intergenerational relationships, community building. Okay. Call a real estate agent because we're going to make this happen. Oh my goodness. I have so many thoughts and ideas in my mind. I will be sending you a follow-up email about that. We're going to get the show on the road. I know you're busy with brain love, so I can take the bulk of the work, but we can do this. I love it. I love, love, love it. We have one more question here. Oh, if you could give one piece of advice to a family who just received an Alzheimer's diagnosis for their loved one, what would you say? OK, I would say it's each person in their own way needs to engage in mindset work. So that mindset is that, yes, OK, we have this really difficult thing. And we are going to open up to each other, be open and honest, and know that there's so much we can do to live the lives we want to live. And this is actually an opportunity for growth and transformation that's hidden in there maybe, but it is there. And when these crises and tragic things happen, it does create a window inside of all of us that we can step into. And to have a whole family together, be able to be open and honest. Those families do the best that oftentimes families try to, everyone try to protect the other one. Like, I don't want to hurt their feelings. Like the patient is like, I don't want to hurt their feelings. And the care partner is like, I don't want to like hurt their feelings. But it's like, then it's too late if you wait ten years or five years, right? Because not everyone can engage in the conversations. And so by opening up that space for You know sharing real feelings grief loss. It really leads families to be stronger and people do amazing things Check out my podcast episode with Mike Zendel. He's like my hero One who has the early stages of Alzheimer's disease and he's changing the world and he talks about like how him and his family like came together and when he found this out. I love it. Can you just really quickly give yourself a plug? Where can people find your podcast? Oh, sure. So any of the Spotify or Apple podcast platform, look for Resilient Aging Unfiltered. I love it. That's amazing. I'll put that in the comments later on as well for people so that they can find it too. But that's great. So just really coming together and having open and honest conversations and laying it all on the table because that's all we can do, huh? We got another one here. This is actually a question I had in my list that we didn't get to ask, so I'm really excited. But what's your take on when patients should start considering biomarker testing? And should people even consider biomarker testing? Yeah, so at this point, biomarker testing is only recommended for people who have symptoms, so older adults who have memory loss and cognitive changes that could be due to Alzheimer's disease. or there are some other non-specific biomarker or, you know, tests we can do for other neurodegenerative diseases. But so in terms of Alzheimer's at this point to be tested without symptoms is not recommended because we don't have any, you know, Western medicine approved treatments for if you're asymptomatic, but you're on the path to Alzheimer's disease. And I would say it is, Well, we know that there's not protections if you are asymptomatic and you have, turns out you are, you have the P tau two-seventeen abnormality showing that you have probable Alzheimer's disease going on. You can't maybe get long-term care insurance. There's things that it's a pre-existing condition at that point. So I would say if you're fifty-five or older and you have cognitive concerns, then you're a candidate for biomarketing. interesting okay well that's good to know that's certainly good to know and then this one we did kind of touch on a little bit but if there's any additional thoughts you have um given your background in alzheimer's drug development what do you foresee as some of the most promising upcoming research related to slowing which i know we kind of talked about a little bit but maybe potentially reversing the um functional symptoms can be very early stage or just theories he won't hold you to a prediction yeah So our field is heading in the direction of where cancer, the cancer field, the way the treatments are there. So there's combination treatments, they're targeting more specific to the person's disease entity. And so you have, we, you know, we currently, we have the anti-amyloid monoclonal antibodies. We're getting more better at how those can engage the target, the amyloid with less side effects. And so delivering those better. Plus, in addition to those, we're looking at anti-Tau medications and making progress with that. And also studying those GLP-I agonists that are very popular weight loss drugs, but are being studied in Alzheimer's disease. So Those are, you know, there's theories on how those impact and can improve the brain. And a lot of, you know, some of that is about like metabolism and inflammation, anti-inflammatory. So it's a multi or combination treatment approach. there's many other things happening and i would just i want to wait to see because you know i've been in this long enough that a lot of things don't pan out and it's and it's not necessarily because they don't work but it's because of this the trial design right who they're bringing in i would say maybe a big thing that everyone should be aware of is that we know now that most people who are older, who have one of these neurodegenerative diseases, like Alzheimer's have a second or a third neurodegenerative disease pathology in their brain at the same time. So when we look at brains at autopsy, we see, okay, this person has Alzheimer's disease throughout their brain, but also they have Lewy body disease changes, or they have these, this is something else called TDP, forty-three proteinopathy. And so it's, So treatments will be targeting multiple disease, neurodegenerative disease entities. So we will therefore have biomarkers to detect all of those, you know, that's where we're going. And it turns out if you're familiar with Lewy body disease, which is in the Parkinson's spectrum. Yep. There is this Alzheimer's Lewy body disease copathology that we found out now that those people progress really quickly. So if you've had a family member that progressed very quickly with their Alzheimer's, they probably had the Lewy body disease and didn't show the symptoms. Yeah. That's so, so amazing. Interesting. I love it. I mean, it's great. Hope, again, is all that we could have. And I feel like this episode has been filled with lots and lots and lots of that. So thank you so very much. If you have time, maybe in one sentence, since you're, in my mind at least, rewriting the rules of Alzheimer's care. And if you could give one takeaway from this podcast or just one thing from your approach at Brain Love, what would you want that to be for our listeners today? I would say that Knowledge is power. There's so much we can do to take control of our own lives. We're the only ones that can do this. And if you have something like this going on or your family member does, the sooner you find out, the more you can do and you can change the entire trajectory of the rest of your life in good ways that you never would if you wait and don't address it. Oh, I love that. And I do think that that's really practical advice because a lot of it's it can be a scary thing to think about. But knowing that there are tools at your disposal and it is knowledge is power and it always will be is an amazing thought to leave our audience with. So thank you again so much for being here today and for spending this afternoon with us. I've loved every single moment of getting to know you and we will be making that center together one way or another. Again, Dr. Cabral, have a lovely rest of your day.