Research Seminar Series June 2024: Neuropsychology of Aging, Cognition, and Mental Health

Estimated read time: 1:20

Summary

The seminar, organized by the BC Brain Wellness Program, focused on the neuropsychology of aging, cognition, and mental health. Dr. Sher Hayden, a clinical neuropsychologist, shared her expertise on assessing cognitive decline, including differentiating between normal aging and conditions such as mild cognitive impairment (MCI) and dementia. She emphasized the importance of mental health, explaining the interconnectedness between mental health disorders and brain health. She also highlighted prevention strategies including lifestyle changes and cognitive compensatory techniques.

Highlights

Dr. Sher Hayden discussed the differentiation between normal cognitive aging and cognitive impairments such as MCI and dementia. 📊
She emphasized that mental health is integral to brain health, with psychiatric conditions affecting cognitive functions. 🌈
Preventive measures can drastically lower the risk of developing dementia. 🚫🧠
Virtual and physical social interactions are both beneficial in maintaining cognitive health. 💬
She recommended diverse lifestyle changes to support brain plasticity and reduce dementia risk. 🏋️‍♂️

Key Takeaways

Genetic factors are less significant than lifestyle factors in determining dementia risk. 🧠
Mental health directly impacts brain health; treat both for cognitive wellness. 💪
Preventive lifestyle changes can reduce the risk of dementia by 40%. 📉
Engaging in social, mental, and physical activities supports brain health. 🤗
Technological tools and personalized strategies can help manage cognitive decline. 📱

Overview

The seminar led by the BC Brain Wellness Program highlighted the major themes of cognitive aging and mental health. Dr. Sher Hayden shared insights from her extensive career in clinical neuropsychology, providing clarity on how normal aging is differentiated from conditions like mild cognitive impairment (MCI) and dementia. She noted that mental health issues are significantly intertwined with cognitive decline and must be addressed for optimal brain health.

Dr. Hayden elaborated on the role of mental health, indicating that conditions like anxiety and depression are not just peripheral issues but critical in understanding overall brain health. She introduced the idea that many individuals may suffer from functional cognitive disorders, which are often misdiagnosed or dismissed, urging for better mental health evaluations in cognitive assessments.

A significant highlight was Dr. Hayden's discourse on the prevention of cognitive decline. She explained that 40% of dementia cases could be mitigated through lifestyle changes, underscoring activities like continuous learning, physical exercise, and social engagement. These activities help maintain neuroplasticity and cognitive function, reinforcing that both mental and physical well-being are paramount in aging gracefully.

Chapters

00:00 - 00:30: Introduction The chapter serves as an introduction to a research seminar titled 'The Neuropsychology of Aging: Cognition and Mental Health.' The speaker, Zily, who is a program assistant for the BC Brain Wellness Program, welcomes the audience and mentions they will be the Master of Ceremonies (MC) for the event.
00:30 - 01:00: Acknowledgment of Indigenous Lands The chapter acknowledges the traditional ancestral and unceded territories of the Musqueam peoples where the BC brain wellness program is conducted. It emphasizes the importance of understanding the relationships with Indigenous peoples and nurturing these connections. The chapter also highlights the privilege of offering their program on Musqueam land and encourages reflection on this matter, especially considering the various locations participants might be joining from.
01:00 - 02:00: BC Brain Wellness Program Overview The BC Brain Wellness Program is dedicated to enhancing the quality of life for individuals with brain conditions, their caregivers, and healthy agers. The program integrates clinical practices and aims to support individuals in maintaining brain health. For more information on the land history, a resource link is available in the chat.
02:00 - 02:30: Introduction to Dr. Sher Hayden The chapter provides an introduction to Dr. Sher Hayden, a clinical neuropsychologist, who is a guest in the program. It mentions that the program involves a variety of lifestyle interventions ranging from exercises to creative classes and is actively expanding its offerings. Additional details are available on their website which is linked in the chat. The introduction sets the stage for Dr. Hayden's participation in the program.
02:30 - 03:00: Dr. Sher Hayden's Background Dr. Sher Hayden is a seasoned expert in neurodegenerative disorders with over 30 years of experience at UBC Hospital. She is a clinical assistant professor and a significant contributor to the UBC's Women's Health Research Cluster. Dr. Hayden practices privately at the Neuro Health Clinic, focusing on Alzheimer's and Related Disorders, traumatic brain injuries, post-chemotherapy, and post-COVID cognitive issues, as well as mental health-related cognitive concerns.
03:00 - 04:00: Focus of Today's Seminar Today's seminar, presented by Dr. Hayden, will concentrate on preventive and lifestyle medicine. Dr. Hayden will explore neuropsychological profiles by comparing normal aging and mild cognitive impairment with neurological decline. Additionally, she will offer cognitive compensatory strategies. It is also noted that each individual's body and background is unique, which is an essential consideration in these discussions.
04:00 - 05:00: Housekeeping Notes The chapter begins by emphasizing the importance of discretion when adopting practices from the content provided, highlighting the necessity to align them with personal experiences and comfort levels. It acknowledges and thanks the donors who support the BC Brain Wellness Program, emphasizing that their generosity allows the program to offer educational events and classes for free, as it is entirely donor-funded. The message underlines the program's reliance on donor support to sustain its offerings.
05:00 - 05:30: Dr. Hayden's Presentation Begins Chapter Title: Dr. Hayden's Presentation Begins Summary: The chapter kicks off with Dr. Hayden expressing gratitude to the attendees for their continued support of the program. He reminds them of some logistical details: viewers can submit questions via the chat box or through private messaging, depending on their preference. A Q&A session is planned for the end of the event, acknowledging that it might extend past the scheduled end time of 1:00 PM. Participants are free to log off or remain online based on their personal schedule.
05:30 - 06:00: Understanding Neuropsychology The chapter introduces the event where Dr. Sher Hayden will be speaking. The moderator reminds the audience to keep their microphones muted, as only they and Dr. Hayden should be unmuted. The session is being recorded and will be available on the website in two weeks, allowing attendees to rewatch or share it. The chapter concludes with the moderator welcoming Dr. Sher Hayden to speak.
06:00 - 10:00: Neuropsychological Assessment Process The chapter discusses the process of neuropsychological assessment, specifically focusing on cognitive aging and mental health. The speaker humorously mentions a cognitive test, indicating the complexity and evaluative nature of neuropsychology. The importance of mental health in understanding cognitive changes is acknowledged, setting a foundation for the subsequent discussion.
10:00 - 14:00: Normal Aging and Cognitive Changes The chapter begins with an acknowledgment of living and working on the traditional lands of certain indigenous nations. It then transitions into discussing the importance of measuring cognition and mental health in aging populations, emphasizing the role of neuropsychology in understanding brain-behavior relationships.
14:00 - 17:00: Subjective Cognitive Decline The chapter focuses on the role of neuropsychologists in assessing cognitive and mood disorders through standardized tests, primarily within the fields of neurology and psychiatry. The author, a practicing neuropsychologist, discusses how these assessments aid in diagnosing and planning treatment for various neurocognitive issues. Although neuropsychological assessments can occur in other medical fields, the focus here remains on neurology and psychiatry due to the author's extensive experience in these areas.
17:00 - 20:00: Mild Cognitive Impairment (MCI) The chapter explains the process of assessing Mild Cognitive Impairment (MCI), particularly in a clinical setting for Alzheimer's disease and related disorders. It highlights variation between neuropsychologists in terms of the tests administered and assessment processes. The author describes conducting clinical interviews with both the patient and collateral (e.g., family members or guardians) separately to ensure each party is comfortable discussing symptoms.
20:00 - 24:00: Mental Health and Brain Health Chapter "Mental Health and Brain Health" discusses the crucial role of collateral information, which refers to insights gathered from individuals who know the patient well, such as a spouse or an adult child. This information can be vital in psychiatric and neurological cases due to potential distortions in the patient's self-perception of their symptoms. Understanding these discrepancies can aid in achieving a more accurate diagnosis and treatment plan.
24:00 - 30:00: Depression and Anxiety in Older Adults The chapter discusses the assessment process for depression and anxiety in older adults, focusing on the role of neuropsychological testing. This testing typically takes a full day, around four to six hours, including breaks. It is conducted by a psychometrist or neuropsychological technician under supervision. The testing includes cognitive and mood personality assessments. The chapter also notes changes in the assessment formats over time.
30:00 - 34:00: Functional Cognitive Disorder The COVID-19 epidemic in 2020 prompted significant changes in how patients were assessed. The clinic adapted by offering 50% of patient assessments virtually, which was beneficial as it serves the entire province of BC, reducing the need for patients to travel long distances for evaluations.
34:00 - 36:00: Dementia and its Types The chapter titled 'Dementia and its Types' discusses the ability for individuals to engage in certain activities from home, provided they have the necessary technology and knowledge to operate it. There is mention of a hybrid approach involving a mix of in-person and virtual participation, with an overall distribution of 50% in-person and 50% virtual interactions. The chapter also touches upon tests related to dementia, specifically differentiating between two types of tests: those focused on performance, referred to as PCE tests.
36:00 - 42:00: Prevention and Lifestyle Factors This chapter discusses cognitive measures based on performance tasks and psychological testing of mental health factors based on self-reports. Concerns about the accuracy of self-reports due to altered insight are addressed by using validity measures.
42:00 - 46:00: Cognitive Compensatory Strategies The chapter discusses cognitive compensatory strategies, focusing on how psychological tests are used to assess mental health symptoms. The text highlights the importance of detecting underreporting, overreporting, or random responding in test results. A psychometrist scores the tasks, comparing results with normative data to correct for age and education, which provides a more accurate understanding of the mental health factors in question.
46:00 - 47:00: Q&A Session Begins In this chapter, a neuropsychologist discusses the process of interpreting cognitive test results. The art of neuropsychology involves understanding these findings in the context of the patient's self-reported history, corroborating information from other sources, and medical documentation like CT scans and MRIs. The neuropsychologist emphasizes the importance of synthesizing various data points to understand a patient's cognitive health.
47:00 - 48:00: Neuropsychology Evaluations and Access The chapter discusses the role of neuropsychological evaluations in assessing cognitive and brain function. It emphasizes the importance of observing behaviors during interviews and testing as part of the analysis. Multiple tests are conducted across various cognitive areas, including general intellectual function, to compare and understand an individual's performance, such as in memory.
48:00 - 49:00: Cognition and Perimenopause This chapter examines various cognitive functions during perimenopause, including attention spans (both verbal and visual), short-term memory, visual-spatial and visual-motor skills, expressive and receptive language skills, and executive functions. Executive functions encompass decision-making, planning, and other complex frontal abilities.
49:00 - 50:00: Mental Health Disorders and Dementia The chapter focuses on the evaluation of cognitive factors within the context of mental health disorders and dementia. It emphasizes the importance of understanding personality traits and mood to make the evaluation meaningful to patients. The chapter highlights the commitment required for a full day of testing and underscores the value of providing feedback sessions to patients.
50:00 - 52:00: Brain Surgery and Cognitive Deficits The chapter discusses how brain surgery can lead to cognitive deficits in patients. It explores the idea that while some patients are not concerned about cognitive changes, others are interested in understanding their cognitive strengths and weaknesses relative to their age. This understanding provides healthcare professionals with an opportunity to discuss issues related to 'insight'—the difference between a patient's perception of their cognitive abilities and what is actually measured. The chapter emphasizes the variability among patients and highlights the discrepancies observed in clinical settings.
52:00 - 53:00: Virtual vs In-Person Social Interaction This chapter explores the differences between virtual and in-person social interactions, focusing on the disparity between reported and measured social abilities. It highlights cases where individuals perceive themselves as socially adept while having significant deficits, and vice versa. The importance of understanding these perceptions versus measurable outcomes in social behavior is emphasized, suggesting a complex spectrum of social interaction abilities.
53:00 - 57:00: Conclusion and Thanks The chapter discusses compensatory strategies for dealing with cognitive issues, highlighting the importance of these strategies in helping individuals navigate cognitive challenges over time. It emphasizes the significance of measuring cognitive and mental health issues as a foundation for understanding.""Normal brain aging is introduced as a topic of interest, especially for an older demographic, indicating a shift towards understanding the gradual changes associated with aging. The chapter intends to elucidate these changes and address them through proposed strategies.

Research Seminar Series June 2024: Neuropsychology of Aging, Cognition, and Mental Health Transcription

00:00 - 00:30 all right um hello everyone welcome to today's research seminar titled the neuropsychology of Aging cognition and mental health uh my name is zily and I am one of the program assistants for the BC brain wellness program and I will be your MC for today right before we dive in I do want to take a moment to acknowledge that the
00:30 - 01:00 BC brain wellness program at the Javad mobile fan Center for brain health resides on the traditional ancestral and unseated territories of the musian peoples as a settler here I think it's really crucial to understand the profound relationships we have with the indigenous peoples and the land and to continue to honor and nurture these connections um it is a privilege to be able to offer our program on musam land and I know that with zoom we're probably joining from various locations today so I urge each of us to pause and reflect
01:00 - 01:30 on the history of the land that we inhabit um you can explore more about the land's history through the resource provided in the chat so there will be a link pasted in the chat by Alisa thank you so much and in case we have anyone here today who is not familiar with the BC brain wellness program uh a little bit about us we are a program dedicated to enhancing the quality of life for individuals with brain conditions and their caregivers as well as healthy agers uh we basically integrate clinical
01:30 - 02:00 care with lifestyle interventions and we offer a really wide range of programs all the way from exercises to creative classes and we are always expanding to offer even more so please do check out our website it will be linked in the chat thank you Alisa again all right um let's dive into introducing Our Guest today Dr Sher Hayden thank you so much for joining us it's an honor to have you so a little bit about Dr Hayden uh Dr Hayden is a Clin iCal neuropsychologist
02:00 - 02:30 and clinical assistant professor at UBC with over 30 years of experience at UBC hospital in this clinic for Alzheimer's disease and Related Disorders she's also a key faculty member in upc's women's health research cluster and privately practices at the neuro Health Clinic her expertise covers neur neurodegenerative disorders traumatic brain injuries postchemotherapy and postco covid cognitive issues and also mental health related cognitive concerns um Dr Hayden
02:30 - 03:00 really focuses on emphasizing preventative and lifesty Medicine in her practice so for today's seminar Dr Hayden will deliver in will delve into the neuros pychological profiles of cognition comparing normal aging and Mild cognitive impairment with neurological decline additionally Dr Hayden will also provide some cognitive compensatory strategies so with that in mind just a friendly reminder that each individual's body and background is
03:00 - 03:30 different so please um exercise discretion with any information provided and please adopt practices that align with your personal experience and which you are most comfortable with and before we dive in I also want to take a moment to thank all our program donors for supporting the BC brain wellness program uh because of your generosity we are able to provide these accessible educational events and classes as an entirely donor funded program we really rely on your generosity to to ensure the
03:30 - 04:00 continuation and development of our program so thank you so much for your ongoing support all right and just a couple of housekeeping notes um if you have any questions feel free to type them in the chat box um you can also private message uh the question to me if you would prefer all up to you and we will have a Q&A session at the end of the event um sometimes it may go over 100 p.m so feel free to log on or log off or sorry log off or stay on as you see fit and just a
04:00 - 04:30 friendly reminder please do keep your mics muted only I and Dr Hayden should be unmuted for today's event and the session is being recorded and the recording will be made live on our website in about two weeks time so if you want to rewatch it if you want to share it with friends or family um it's a great resource all right um without further Ado I will pass on the zoom mic to our guest speaker Dr Sher Hayden welcome uh
04:30 - 05:00 the floor is all yours now thank you uh I'm just seeing where I can share slides here hold on okay hopefully everyone can hear me that was a uh cognitive test right there and I barely made it so anyway I'm happy to be here uh to speak to you about the neuropsychology of cognitive aging um and mental health I also acknowledge
05:00 - 05:30 that I um I I acknowledge and Express gratitude for living and working on the traditional unseated homelands of the musqueam Squamish and Salat tooth uh Nations so I thought that I would start with uh just a a brief overview of how we measure cognition and mental health factors in aging populations and that's really where we turn to neuropsychology and uh which is really the study of brain Behavior
05:30 - 06:00 relationships neuropsychologists such as myself myself spend our days providing assessments that involve the administration of standardized cognitive and mood tests to address the diagnosis and treatment planning for neurocognitive issues in a variety of neurological and psychiatric conditions of course neuropsychological assessment can occur in other areas of medicine but I'll be focusing on neurology and Psychiatry as this is where I primarily have practiced for over 30
06:00 - 06:30 years so in my practice and again there are individual differences amongst neuropsychologists and what tests they administer and the process in which they undertake their assessments um but from my perspective in the clinic for Alzheimer's disease and Related Disorders our assessments typically entail the following that would include clinical interviews with both the patient and collateral I do those separately so each person feels com comfortable discussing uh symptoms
06:30 - 07:00 without restraint collateral really means someone who knows the patient well that might be a spouse an adult child uh a friend that has known the patient for a long time collateral information in these cases are important because many psychiatric and neurological patients have uh distortions of their Insight meaning their view of their symptoms might not be consistent with what is actually happening and it's important to
07:00 - 07:30 get collateral information the neuropsychological testing takes typically a full day that's about four to six hours of testing with breaks of course our our role our goal is not to torture you um and the testing is conducted by what is called a psychometrist or a neuros pychological te technician under my supervision she will administer cognitive and mood personality testing throughout that time uh we conduct the Assessments in various formats that has changed since
07:30 - 08:00 covid-19 EP epidemic in 2020 we had to evolve which was a good thing um so we about 50% of the patients we see we assess entirely in person and the other 50% we see virtually which uh really has been an asset as the clinic uh that we work in at the hospital serves the whole province of BC and in the past patients would have had to travel long distances to uh come to do this assessment so now
08:00 - 08:30 they can do it in the comfort of their homes if they have appropriate technology and they're able to operate it uh in some instances we might do a hybrid of that but typically we're doing 50% in person 50% virtually um sorry and the tests uh typically can be uh divided into two types one is for performance pce tests
08:30 - 09:00 which are typically the cognitive measures uh these are based on the patient's performance of a task administered by the psychometrists uh the other type of test is usually the psychological testing of mental health factors this is based on self-report so it's based on a patient's perception through their response on self-report measures uh you might ask or wonder well if their Insight is altered how is this accurate there are validity measures what we call validity measures
09:00 - 09:30 embedded in these tests that tell me if someone is Under reporting or over reporting symptoms or maybe they're responding randomly so then I can have a context of what I'm looking at when I'm looking at those mental health factors once the testing is complete um my psychometrist scores all of those tasks it takes quite a while but she does that for me and compares the results with normative data sets this allows us to correct for agent education uh and that gives me a more accurate
09:30 - 10:00 sense of how this person is doing cognitively and this is where the art comes in of neuropsychology is I then have to interpret these findings these test results in the context of a patient's reported history both what the patient has told me and the collateral has told me as well as any medical documentation so I'm looking at CT scans MRIs and seeing how they correspond with the co cognitive profile or patterns that I see on the testing that has uh that has been scored um I also consider
10:00 - 10:30 any behavior that we've seen in interview or during throughout the day of testing which can certainly uh Aid my analysis of this information and we when what we're looking at is all aspects of cognition all aspects of your brain function uh so we have tests usually more than one test in each area uh in all of these areas that would include the general intellectual function that allows me to compare performance say of memory to
10:30 - 11:00 overall function uh we also take a good look at attention both verbal and visual short-term memory visual spatial and visual motor skills both expressive and receptive language skills so your ability to express yourself as well as understand language is is examined uh executive functions this is a complex array of abilities of frontal abilities that would include things like your your decision making planning your ability to
11:00 - 11:30 organize yourself your ability to filter all of that is uh evaluated and as I said we we take a good look at personality traits and mood so that I can understand the context of these cognitive factors uh that are presenting themselves and it's important to me and I I'm assuming important to a patient who has committed a whole day of testing for me is to make this meaningful and in that context I offer feedback sessions to our patients some
11:30 - 12:00 patients are not interested in that but those that do uh it allows us to review their current cognitive strengths and weaknesses relative to their age and this often provides us an opportunity to discuss uh Insight issues Rel meaning um a patient's perception of their cognitive abilities versus what we've measured uh and there is a spectrum there what I'm seeing in the patient in the clinic are certainly people that
12:00 - 12:30 report profound deficits but in fact on measurement they fall at or well above average range and the other end of that Spectrum are the people who are reporting that they are perfectly fine um and have profound deficits there's obviously a range of people in between so it's important for uh you know a discussion of what we're actually measuring and how that might differ from what you you experience in some inst es
12:30 - 13:00 uh it's during this feedback session I would also discuss compensatory strategies we'll touch on that later uh but the hope is that that will help people navigate through this these cognitive issues uh over time so now that we know how to measure uh some of these issues of cognition and and mental health let's talk about what normal brain aging is uh certainly those of us of a certain vintage understand understand that there are gradual
13:00 - 13:30 changes that are normal that happening in our bodies and our brains uh I think it's important to acknowledge that each of us experiences aging differently it wouldn't be uncommon for some of us to know people that look physically much younger than their uh chronological age much like this lady below and we might know people that look much older than their chronological age so there is a lot of variance and so the extent to which we experience cognitive
13:30 - 14:00 changes due to aging and when we experience those changes can vary from person to person so it's important to understand and acknowledge that and there's a Continuum of cognitive aging over time as well so that would range from what we call Super aging those are the people that really don't change even in the way that we would expect with normal aging um we have normal aging mild cognitive impairment and then of course people living with demen so there's really a a
14:00 - 14:30 Continuum there as well so let's talk about what constitutes in general normal aging when it comes to cognition we do know that there are skills that remain fairly stable with age and that would be uh things like your knowledge from education experience that's all the facts and procedural how to do things that we've learned throughout a lifetime of experience that really isn't expected to decline with age your remote memory
14:30 - 15:00 so the memory of big events that happened 20 years ago those tend to be fairly resilient with aging as as is your focused attention that means focusing on one thing uh typically till and completing a task is is is typically well preserved verbal abilities are abilities to express ourselves and our vocabul vocabulary usually uh is sustained throughout uh our aging process and some in some instances May improve uh problem solving obviously using prior
15:00 - 15:30 knowledge we've had a lifetime of solving problems and so we can apply that knowledge and that experience to solving problems as we age um so all of that is maintained as we get older but there are some things that decline with aging that is expected that is normal and that would include the ability to process novel or complex information we tend to find we probably address that information in a at a slower Pace or we find it more
15:30 - 16:00 difficult recent or short-term memory may be sporadically impacted so we might be a little more forgetful uh we may have trouble with divided attention what what that means is we may have trouble if there's lots going on we we can focus on one thing but it's much harder now for as we get older to focus on multiple things uh word retrieval can decline a bit with age so your ability to pull out words when you want them typically they come within seconds but uh sometimes that can
16:00 - 16:30 be quite a frustrating problem um it may take you longer to solve unfamiliar problems uh and processing speed both cognitive and motor we're we're physically slower but we're also mentally it can take us a little longer to do things so we just have to acknowledge that all of that uh is likely to be relatively normal with age oops sorry so let's talk about specifics or or examples uh and I wanted to do this
16:30 - 17:00 just so that you know that if you're experiencing some of these things it it may be within the realm of what is expected for normal aging so if you can't remember a detail of a conversation or event that happened a year ago that would probably be within the realm of normal as would be if you had some trouble remembering the name of an acquaintance not not someone you know really well but but someone that maybe you don't see very often uh that would be normal uh for getting things here and
17:00 - 17:30 there um would also be expected as would be finding uh words on occasion another indicator light that the issues may be more related to normal and aging than not is that if you're much more worried about it then your friends and relatives they're not noticing it at all um it may be just part of the normal aging process but it's important to acknowledge there are factors that can affect cognitive aging on a sporadic basis or on a variable basis and these
17:30 - 18:00 Health lifestyle and attitude factors certainly can affect memory and other aspects of cognition uh we know that physical health can affect cognition so if someone has chronic or acute illness obviously or chronic pain these uh issues can affect attention which can then affect other aspects of cognition we know that hormon change hormonal changes such as that happens to women uh in per menopause and Beyond has impact on cognition uh we won't be taking a
18:00 - 18:30 dive into that but just acknowledging that that can happen we will be talking about mental health factors such as anxiety depression stress and grief and how that affects cognition and there are other factors including sleep disturbance medication side effects alcohol and substance abuse an important one is impaired hearing or Vision which can happen with normal aging um you know you need to consider the fact that hearing and en vision is how we input information into our brains
18:30 - 19:00 so if that's impaired in some way uh your intake of information is going to be altered or reduced and so that's going to affect your recall of that information later so it's important to to address any hearing or Vision issues uh as we get older as I said handling lots of things at once or change in routine can be reduced so overloading yourself with too much to do or changing things too too frequently can be uh have an effect on your cognition and
19:00 - 19:30 finally your confidence if you are constantly doubting yourself um that can lead to functional failure in the future so uh it's important to acknowledge that but what we need to remember is that many of us will experience no memory problems as we get older our ability to remember will not necessarily rapidly or substant substantively decline with age we will retain the skills and knowledge that we've learned
19:30 - 20:00 throughout our lives some of us will experience mild memory loss after the age of 65 but this will be mild and it likely will not significantly impact our day-to-day lives there is a small percentage of us who will live with dementia the World Health Organization estimates about 5 to 8% uh will be living with dementia after the age of 60 so let's move to um from normal enging into subject subjective cognitive
20:00 - 20:30 decline so subjective cognitive decline is when people are reporting cognitive issues subjectively so it's not measured on testing we can't see it on the testing on the neuropsychological testing uh and they feel that it's worsening over time so they don't feel that their cognition is normal that it's changing and they have concern what we know about this group of people is about one in nine one in nine people over the age of to 45 are reporting subjective
20:30 - 21:00 cognitive decline interestingly though 81% of these people uh have at least one chronic condition so that might be a chronic medical condition like diabetes heart disease chronic pain or a chronic mental health issue and that's important to acknowledge because that might you know point to why they are experiencing these cognitive concerns uh what's concerning to me is less than half of these people who have
21:00 - 21:30 concerns about their cognition talk about it with their health provider if you're concerned about your memory or your cognition you should definitely talk to your health provider and that's because about a third to 44% of these people who are reporting changes uh are stating that it's impacting their ability to function so if it's a if you feel it's impacting your ability to F to function you certainly should talk to someone about it um and the next sort of Step uh in
21:30 - 22:00 between subjective cognitive decline and dementia is mild cognitive impairment or MCI many of you may have heard of that term um there are many different definitions and subcategories of MCI we won't get into that but what you need to know are symptoms of MCR are mild you experience cognitive symptoms but they're not severe enough to interfere with your normal daily function so the difference between MCI and subjective cognitive decline is there's now
22:00 - 22:30 measurable change we see deficit or weakness on neuropsychological testing which we wouldn't see on subjective cognitive decline right so uh for MCI we' see one or more cognitive domains have some impairment cognitively on the neuros pychological testing so just understanding uh that difference what we know about MCI is that as I said the majority of us will maintain normal cognition throughout our
22:30 - 23:00 lifespan but about 12 to 18% will have MCI after the age of 60 uh the prevalence of MCI actually increases with Advanced age that's uh the same as uh the same case as with dementia um but with MCI the prevalence is about six to 7% in those age 60 to 64 and that gradually increases to about 25% in those ages 80 to
23:00 - 23:30 84 uh we know that about 10 to 15% of people living with MCV develop dementia within a year and about a third of MCI people living with MCI due to Alzheimer's disease meet that criteria within five years so there is a portion of people that go on and progress to Alzheimer's disease but not all right not all and the reason why not all may be Mental Health what we're beginning to finally acknowledge is that mental
23:30 - 24:00 health is brain health there is a recent study in 2023 that spoke to or implored clinicians and uh researchers to acknowledge that there's a common genetic environmental and and lifestyle factors contributing to both psychiatric and neurological disorders and these impact cognition and brain health in both um in brain functioning in both uh conditions so just acknowledging that mental health is brain health is is a
24:00 - 24:30 significant uh movement in the in the field today so let's try and understand the role of mental health factors in aging and cognition if only it was this easy to look at a scan and say here you go this is what you have depression this is not the case uh it is much more complex than this but it is an important part of us understanding why people might struggle with cognition as they get
24:30 - 25:00 older we do know that mood disorders and substance abuse issues in older adults is quite prevalent uh particularly for those in the age groups from 65 to 74 you can see in this illustration that about 19% of people aged 60 65 to 74 have some primary diagnosis of substance abuse so that would be alcohol or drug abuse uh this reduces to 3% after 75 uh but more prominent is primary
25:00 - 25:30 diagnosis of mood disorders that affects about 51% 51% of 65 to 74 year olds that would be conditions like anxiety disorders depression post-traumatic stress disorder bipolar disorder somatization disorder all of these different conditions might be uh experienced in 51% of people age 65 to 74 that drops slightly to about 42% in people over 75 five but uh obviously it's a quite a
25:30 - 26:00 prominent problem in in in older adults um so we're going to talk about specifics now and when we're talking about depression we know that about 20% of older adults have symptoms of depression and these rates increase to about 40% when uh they are in hospital or in long-term care unfortunately we know that 20% of suicides per year are in people over the age of and unfortunately only 10% of those over
26:00 - 26:30 65 get um formalized treatment for their depression so you know we certainly need to do better with that I thought I would talk about somatization I see a lot of this in my practice here at the clinic um and it there is a lot of correlation with uh other mental health issues in fact one study in 2019 found that 98 8.8% of depressed participants uh in this study
26:30 - 27:00 over the age of 60 had uh some form of somatization so what is somatization well somatization or somor disorders are a set of psychological conditions uh where a person experiences body symptoms like fatigue pain um sensory changes that cannot be accounted or attributable to a medical or neurological diagnosis um along with those symptoms are
27:00 - 27:30 symptoms of persistent worry or rumination there's a tendency to mistrust medical opinion um and there's a pattern of excessive Doctor shopping and hospital visits what we know is that the co-occurring conditions with somatization tend to be anxiety depression and in some cases substance abuse what's more specific uh but related to somatization disorders is functional cognitive disorder uh this is
27:30 - 28:00 when cognitive symptoms um that are distressing to a patient exist but are not explained by any medical or neurological diagnosis uh more recently scientists are saying that functional cognitive disorder is likely more common in clinical practice and is likely under or misdiagnosed so you can see on the illustration that functional cognitive disorder overlaps considerably with subjective cognitive decline and
28:00 - 28:30 with MCI what these people are reporting are quite severe moderate to severe subjective cognitive concerns um with and in some case we can see objectively but there's no indication that it's meeting criteria or ever will meet criteria for or dementia uh this researcher in 2020 ball and Associates uh estimate that about a third of patients presenting to dementia clinics may have functional cognitive
28:30 - 29:00 disorders and that's certainly been my experience that th this issue has been more prominent and is certainly prevalent in my own practice and though as I've said that both somatization and functional cognitive disorder have undercurrents of anxiety and depression and what we know about anxiety is it also is quite prevalent 50 to 72% of older adults with depression have coexisting anxiety uh anxiety alone is also so prevalent with
29:00 - 29:30 um sorry I just need to move this with four to 15% of anxiety disorders presenting in those over 65 uh subclinical anxiety symptoms occur in about 15 to 20% of people in that age group we also know that um an approximately 30% of individuals with some form of anxiety sort have an associate cognitive impairment so there
29:30 - 30:00 certainly is relationship as we age with anxiety and cognition um but this relationship is complicated and sometimes difficult for us to clearly diagnose anxiety can lead to worsening of cognitive impairment or can cause cognitive impairment um and cognitive impairment such as MCI can lead to anxiety uh this is even further Complicated by any stressors so you can see how this can be a challenge for us
30:00 - 30:30 diagnostically and so I thought I'd talk a little bit about the complex and independent relationship between anxiety cognitive impairment and function so if we start at the anxiety point where someone is experiencing anxiety or worry they have what we call cognitive distortions what that means is that's anxiety's way of distorting how you experience and perceive uh a situation so a good example would be oh I've forgotten my
30:30 - 31:00 keys and from that moment you go okay oh no I think I have Alzheimer's disease like my mom because she used to think she used to forget her keys oh no I'm going to end up in a nursing home so you've gone from forgetting your keys to being in a nursing home within 30 seconds so those kind of cognitive distortions uh can lead to cognitive impairment because you're not focusing you're feeling overwhelmed and discombobulated so you're attention is affected and therefore you know this
31:00 - 31:30 will interfere with your memory of where you put your keys um and unfortunately this functional problem of forgetting leads to more anxiety because you go see there's more evidence I just can't find them and it's taking me forever there must be something really wrong with me so it really can feed on itself um and it's important to acknowledge and understand it and understand that uh the the significant impact it can have on your cognitive performance perance we know that there are risk for
31:30 - 32:00 anxiety in aging and in MCI uh that includes genetics there are families that have significant uh levels of anxiety that are passed from generation uh people with chronic health issues would tend to have a heightened anxiety particularly uh somatization so that's important to understand women are more uh likely to experience anxiety in fact women over 60 suffer anxiety more than any other age group and twice that
32:00 - 32:30 of men there are psychological factors such as perfectionism and obsessiveness these kind of factors that can serve people well when they're working or in school uh can be problematic as we age is there's changes that you have less control over and so there's less tolerance of that and anxiety can be the consequence stressful life events can also uh obviously be a trigger for MCI uh for anxiety uh and therefore
32:30 - 33:00 cognitive issues as can direct experience with dementia so people uh caring for someone with dementia either through their work or through their personal lives are witness witnessing the tragedy of it all and it wouldn't be uncommon that they would maybe recognize symptoms in themselves and then make the leap to oh no I think I have the same thing so uh these are all risk factors for anxiety in both normal aging and uh mild cognitive
33:00 - 33:30 impairment and I would say it's all further Complicated by some aspects of clinical care there's a there's a huge emergence which is all very exciting about of biomarkers and genetic testing in dementia this has helped us uh understand some aspects of Dementia in a in a better way but it's also LED people to be seeking diagnosis earlier as you can see in this cartoon 25 age 25 is probably too um because you know much of this stuff
33:30 - 34:00 like the genetic testing is not predictive it can tell you that you have a gene that might make you susceptible but it's not guaranteed you will get the disease for some people even uh though that will be explained to them uh knowing that they have this particular Gene will heighten their anxiety to levels that would actually cause more problems than they would have had had they not known that and I've touched on this before but other compounds in your functional
34:00 - 34:30 cognitive performance so how you perform dayto day would be sleep disorders if there's sleep apnea or you're not sleeping well it's hard for your brain to focus and you're not going to remember things then same goes for pain if you have persistent or chronic pain um this affects your ability to attend to pay attention which then will affect your ability to retain or remember that information later excess alcohol and drug use obviously as well as as I've mentioned other medical comorbidities
34:30 - 35:00 uncontrolled diabetes history of traumatic brain injury I am seeing more patients with long covid we have a lot more to understand there but it does seem to impact some people in a negative way as far as their cognition and we can't underestimate the importance of Psychosocial factors so the lifestyle and life events that are happening in a patient's life and any stressors that might be going on um we
35:00 - 35:30 know that from the literature that people who are anxious depressed Andor sleep deprived tend to score lower on cognitive tests these weaker scores do not predict your risk for dementia but it certainly supports the need for good mental health and restful sleep as an important factor in brain health um and as you can see this actually makes me this cartoon always makes me chuckle because this actually happened to me I was having a very busy day and I walked into my psychometrist office with
35:30 - 36:00 my phone in my hand in a panic because everything's on my phone um and patting my body with my other hand saying I don't know where my phone is and you need to help me find it um and she just looked at my phone looked at me looked at my phone until I looked over and realized I had it in my hand so that humiliation led me to maybe reflect on some stress uh and uh how I might manage it so that wouldn't happen
36:00 - 36:30 again and of course when we're talking about cognition we need to acknowledge uh how different forms of dementia affect cognition dementia being the umbrella term Alzheimer's disease is the most prominent type of Dementia by about 60 to 70% there are other types of dementia including vascular dementia frontal temporal dementia Louie Body Disease and other types of uh dementia listed here we're not going to take a deep dive into this uh today but just know that there are
36:30 - 37:00 different cognitive profiles or patterns that I'm looking for when I'm looking at test results to see if they are consistent with the patterns that we would expect with these different types of diagnosis so all of that is quite daunting but I wanted to uh spend the the last part of my talk talking about prevention uh and for me one of the most exciting things that came out of research certainly in 2020 if not in my
37:00 - 37:30 whole career was a study in Lancet by the commission for dementia prevention uh it came out in as I said in 2020 and what they found was that 40% 40% of worldwide dementia cases are likely attributable to modifiable or preventable risk factors that's huge we we did not think that in the past so what's what that is telling us is genes are not your destiny certainly at the beginning of my career in the early 90s we were telling patients that maybe 25
37:30 - 38:00 to 50% were genetic uh we now think it's likely less than 5% so uh it's important for people to know that your lifestyle probably has a bigger impact on your risk for dementia than your family history and it's also important to know that prevention is multifaceted so there is not one thing that you should be doing there's many different things um and most of them are common sense so obviously getting plenty of sleep if you
38:00 - 38:30 need to take naps take a nap uh eating well there is no specific diet for dementia although we often recommend the Mediterranean diet uh heavy in fish and veg staying hydrated and cutting down on sugar Obviously good for your health and your brain importantly staying socially engaged uh we know that social isolation is not only a risk factor for mortality but also a risk factor for dementia uh so we are designed to be social
38:30 - 39:00 creatures so we need to be with each other uh finding ways to connect with others is important uh limiting alcohol and quitting smoking obviously uh important for your brain health as is stimulating your brain and and learning throughout your life span this is really based on studies uh that fall under that first came probably in the early part of my career it was the nun studies the kind of nuns that uh are in coment there was a large group of nuns that came to interest uh came to the attention of
39:00 - 39:30 researchers because they were showing a very low incidence of um Alzheimer's disease or any other type of dementia despite the fact that they were getting quite elderly and they were not genetically related and what they found with that Convent was it was a Convent that encouraged learning throughout the lifespan so they might encourage each other to write a book at 70 or take a piano at 70 uh you know you may not become a concert
39:30 - 40:00 pianist if you start at 75 but their focus was the learning process we knew that learning and exposure to novelty new things uh was positive for children there were many studies with children raised and orphanages that had no stimulation uh who were found to test fairly low intellectually and on cognitive tests but we thought that that neuroplasticity is what we call it that neuroplasticity ended in early adulthood
40:00 - 40:30 when we thought the brain was uh done with developing uh the non studies really changed that for us and made us realize that the effects of neuroplasticity remain it's just probably to a lesser effect than for children so keep learning throughout your lifespan taking care of your mental health as I've said to you uh important because those mental health factors can affect your cognition as can managing stress uh and one means of managing stress would be practicing yoga and
40:30 - 41:00 meditation what we do know is there is an emerging and and increasingly large body of literature that uh focuses on the preventative and direct impact of yoga and meditation on brain structure uh there's a researcher called Dr Sarah Lazar out of Harvard who has a lab on the Neuroscience of yoga and meditation and she has done studies that suggest that these practices have a
41:00 - 41:30 significant impact on brain aging a positive impact um staying Physically Active for the same reason there's other there are other studies that show that physical activity doesn't have to be intense but moderate physical exercise uh can impact the volume of your hippocampus so that is your memory Center so keeping mentally and physically active is positive as is getting outside than enjoying some vitamin D which can be hard in um BC but
41:30 - 42:00 doing your best encouragingly there is a growth of preventative medicine and clinical care you can see that at Health Link BC uh at the Vancouver Coastal um website as well of course as the BC brain wellness program so I encourage you to look at all those uh resources and I thought I would end with just a brief discussion about cognitive compensatory strategies this really refers to those strategies uh pertaining
42:00 - 42:30 to behavior or environment that are designed to bypass or ease any persistent cognitive impairment what you do need to know is that these kinds of strategies really should be tailored and specific to a patient uh and any cognitive issues that they might be experiencing so from a neural psychological assessment we would be able to see what the strengths and weaknesses are and use the strengths to compensate for the weaknesses um but in general there are some generalities uh
42:30 - 43:00 encouraging people to remain not to be too reactive if they have a cognitive failure so staying calm and carrying on uh applies here paying attention to paying paying attention so as we get older we may have trouble with focusing when there's multiple things as I've said before so consciously focusing on the task at hand will be of benefit to you uh if if your memory is fading obviously prioritizing what's the most important thing to remember uh because
43:00 - 43:30 overloading will impact your ability to remember using strategies that suit you for me is using technology for someone else it might be writing down uh on paper and using pen and paper um but finding the strategy that works for you in your life uh developing both internal and external strategies which we'll talk about in a minute organizing your environment obviously if you have chaos in the environment it's hard for your brain to screen and decide what to focus
43:30 - 44:00 on so if you can be as organized externally uh as possible and when it comes to memory if you're asked to do something do it now you'll be less likely to forget it so I certainly know if someone emails me or texts me and asks something of me I'm going to respond to that immediately just because then I know it's done uh and that's become a habit so if um I'm not sure if I remembered I typically rely on the fact that I always have remembered so the last part here we'll
44:00 - 44:30 just touch on specific cognitive strategies many of these applied in memory but can uh be used in other ways uh obviously repeating information for those of us of a certain vintage who lived in a world prior to smartphones when you were given a telephone number and you couldn't write it down you would just repeat it in your head multiple times same goes for other information appointments if you obviously you should write it down but if you can't write it down say it a few times in your head uh and or describe it if if you have an
44:30 - 45:00 event coming the more that you describe it or talk about it with friends the more likely it's going to stick um other internal system to compensate would include visualizing so if you can picture information or create an image in your head related to that detail you you may be more likely to remember it or and or if you make associations so when learning someone's name maybe thinking of some physical characteristic that reminds you of that
45:00 - 45:30 name or someone else uh may help you link that and may help you remember it later simplifying and organizing information before uh you encode it or as you encod it is helpful chunking is just dividing it into chunks as we do with phone numbers so you can do that with other information and categorizing it so thinking about information when say when planning a trip uh what my toiletries I need what are my clothes what are my shoes instead of just
45:30 - 46:00 thinking of everything what do I need it's better to be specific and finally the external backup systems which is really what I Rely more on um and that would be writing it down obviously write it down uh in a calendar on a space I do discourage patients to use too many sticky notes because those can get lost it's better to have something that's carryable uh if you do use sticky notes you should stick into the calendar uh if possible and ideally
46:00 - 46:30 if you're comfortable using technology like a smart smartphone there are many apps you can take notes you can set reminders uh you can share appointments between family members so if a family member is worried that someone's going to forget you can you can set that so um obviously using these different systems and having like a toolbox of systems is ideal when you're addressing cognitive concerns and trying to compensate for them so I think I'll end here there's
46:30 - 47:00 about 10 minutes for me to sort of address any questions um all right yeah thank you yeah oh sorry I'll stop sharing here we go all right thank you so much Dr Hayden for such an informative presentation I really found the mental health impact on cognition to be particularly interesting um so we do have quite a few questions in the chat so we will Dive Right into to them just give me one second um all right so the first two
47:00 - 47:30 questions they're pretty similar so I'll probably just Clump them together I'll just read out the first one so the first question reads how can someone get a neuropsychology evaluation can you get it covered do you consider performing these tests to include pem with people who have additionally me/cfs along with brain injury Etc um so just how does one go about requesting for a neuros psych evaluation basically yeah so there are
47:30 - 48:00 uh neuros psychologists in private practice I do have a private practice as well and there are many neuropsychologists you can go to um the BC Psychological Association and there's a find a psychologist uh search engine and you can look uh for neuropsychology through that um those are not covered unfortunately um and they can be costly some extended health benefits cover them uh to some degree I most of my private practice are people that have been
48:00 - 48:30 referred to me through insurers through through their insurance or through their employers through their Union um and the other option the ones that I I also work in the hospital which is covered by uh MSP but that would be specific to programs so I'm situated in the clinic for Alzheimer's disease and Related Disorders and I would only see patients referred to that clinic there are other neuropsychologists the system but it would be dependent on like there's neuropsychologist certainly in
48:30 - 49:00 GF strong it would depend on program all right great thank you so much um the next question reads um the Continuum in cognitive aging diagram makes no difference to the cognitive impacts of per menopause have there been any significant studies in this area yes there as as a woman and a menopausal woman there's a lot going on I recommend always a book called The xx brain XX as if you're as you're in your
49:00 - 49:30 chromosomes and this is actually an area of passion of mine I do many talks on this but this was not what this was about um there are substantive studies now talking about how women's Brains different from Men's the challenge is that historically uh research hasn't focused on women's um health issues that's specifically brain health issues so we we we don't know as much as we should know but we do know that estrogen
49:30 - 50:00 is neuroprotective in uh the reproductive years so once a woman hits uh per menopause and there's change or decline in levels of estrogen that seems to affect cognition to some degree and raises risk uh for dementia two out of three Alzheimer's patients are women and we suspect that you know certainly estrogen plays a role in that so I always recommend that book um the XX
50:00 - 50:30 brain it's by Lisa muscone um so I would recommend that all right thank you so much um the next question is the mental health disorders you have mentioned do they predispose to MCI Dementia or are they con commented manifestations both um you know there's literature that suggests specifically that anxiety or depression can can be a risk factor but it's not consistent in
50:30 - 51:00 the literature I would say in my clinical practice um I see comorbidities so they patients who have both they're diagnosed with mild cognitive impairment or dementia and they have anxiety depression um the the greater challenge are people with the functional cognitive disorders because they can kind of look like they're um presenting with an emerging dementia but in fact it's more a mental health issue so the the importance of in the past historically
51:00 - 51:30 you know Alzheimer clinic and and are situated in neurology so there wasn't a lot of Psychiatry there uh I think we need to change that I I personally feel that uh this is at least a third of my practice probably more like half of the patients I see uh have some primary mental health issue all right thank you um then next question we have coming up is disorders like Ms or multiple sclerosis were
51:30 - 52:00 dismissed in somat form until the science and technology advanced sufficiently to identify the underlying cause um isn't it likely that many seator disorders similarly are waiting for appropriate research to Fathom the causes um depression and anxiety can be caused by living with symptoms that are repeatedly dismissed yeah I mean it's not in any way intended to dismiss valid symptoms and I would say someone with functional cognitive disorder and somatization
52:00 - 52:30 disorder has valid symptoms it's just the cause is different um and certainly there's a portion of them that may indeed have some underlying neurological cause both mental health issues including functional cognitive disorder and somatization disorders occur in the brain as do these other conditions so you know the great challenge we have is that we can't look at the cells we can't look at all of uh the functions of the brain brain we have you know MRIs and CAT scans and such but you know these
52:30 - 53:00 are not as detailed as we need to fully understand um if you have a good clinician hopefully you would have someone who would look at all the options uh and it can take many years to make a clear diagnosis so that is just where we're at my hope is that we get better um but I don't you know I don't believe that all somatization all functional cognitive disorders are necessarily a predictor of a neurological condition you know at least a portion of them are
53:00 - 53:30 going to be mental health all right thank you um the next question o this is a great one so is virtual social interaction as valuable for brain health as real life I don't know the science on it but I'd say Yes um certainly I uh from an assessment point of view I feel that I mean I I think there are variances in individuals some people are not comfortable in with that technology uh even colleagues of
53:30 - 54:00 mine may not do virtual because they're not comfortable I happen to have a psychometrist who has an IT guy for her husband so that has helped with the cameras um but yeah I I think if you connect in whatever way you connect it's just if you're isolated and you're not connecting to anyone that's problematic thank you um the next question was private message but to summarize um this person developed a cognitive I guess and
54:00 - 54:30 executive deficits of following a uh brain surgery so and it's been quite a challenge to get the proper testing and evaluation and therapy unless um basically someone has like a extended medical plan or a great income and do you have any I guess suggestions on how people can advocate for themselves in these situations yeah I'm sorry for that I really am um I had done some talks to the BC cancer agency and I was stunned that they didn't have a neuropsychologist even for their brain
54:30 - 55:00 um cancer group uh and I still find that frustrating I would say I would say this so I would say you know what what is needed then is a referral to some program in a hospital because that's where the neuros psychologist would be um so that you don't have to pay for it uh GF strong the rehab center I don't know if you've accessed that they have what's called an acquired brain injury program I don't know what their criteria is it would
55:00 - 55:30 likely require your family doctor to refer but you would you know strongly Advocate with your family doctor to refer you there uh because there's neuros pychology there if you felt like it was declining we do take people with that history in in our clinic but there has to be some indication that it's worsening over time that it's not clearly related so uh it would seem to me GF strong might be the way to go if you have an employer and say you're
55:30 - 56:00 trying to get back to work I don't know what your age is um sometimes employers will help will pay for that um and you would talk to your union about that all right thank you maybe we'll try to fit one one more in before we end the event um the next question is is brain fog a risk factor for cognitive impairment uh brain fog uh I mean as a neuropsychologist I really dislike the term brain fog I understand why it gets
56:00 - 56:30 used but I mean it's just so non-specific um brain fog could be anything brain fog I mean if you're meaning brain fog that they're identifying related to long covid maybe that's what you mean um we don't know yet we do know that there's a portion of people that seem to have cognitive changes we don't know if they're going to be permanent or worse and over time because covid started in 2020 so we don't have longitudinal data um but we
56:30 - 57:00 but but I'm certainly seeing more patients reporting uh long covid symptoms that are cognitive uh there's a lot of debate and and unclear literature on whether it will be predictive or a risk factor for dementia all right thank you so much all right since it is hitting 1 p.m. um this is the official end to the presentation everyone uh thank you so much Dr Hayden for sharing your expertise with us and all of you for joining us today as well
57:00 - 57:30 I hope you all were able to learn something new today that you can maybe apply to your own lives uh just a friendly reminder we actually do have another research seminar uh event coming up on July 17th focused on our upcoming neuros pychology and nutrition programs and so we hope to see you there uh if there's any lingering questions which I think there is some in the chat box Dr Hayden will be staying a little bit over time to help wrap up so yeah thank you so much every everyone take care