Tiffany Robinson (00:02.338)
Dementia symptoms don't happen all at once. And when families start to notice something, they're often not sure what they're seeing. Today's guest specializes in helping families navigate that moment when suspicion becomes diagnosis. Dr. Reza Gome is a neuropsychiatrist with specialized training in neurodegenerative disorders, including Alzheimer's, Parkinson's, and frontotemporal dementia.

And an engineer and health technology entrepreneur who spent his career building tools to make expert care more accessible. Welcome to Comfort Connections, Dr. Gomi.

Reza (00:38.317)
Thanks for having me, Tiffany.

Tiffany Robinson (00:40.672)
You came to medicine through engineering. Can you share what that process looked like and does having a background in engineering shape how you think about dementia care?

Reza (00:52.115)
Absolutely. Yes, I I studied engineering first and I I actually worked for several years before I found my way to medicine. you know, I found in engineering I was thinking in systems. I was thinking about failure points. my first job, I was designing a couple systems on a Navy destroyer, actually. And so it was all about how to be foolproof, you know, systems that couldn't fail.

And so when I made my way towards healthcare, I took some baby steps. I started doing some work in medical imaging on the engineering side. And ultimately on the care delivery, I think a lot about where systems fail. And of course, all of us, I'm sure, listening today have had experiences where those failure points have been very real. And so engineering really informs my approach, not only when I'm seeing patients personally.

But then why I work on systems to hopefully improve because one of my real beliefs is, you know, humans can't fix healthcare on their own. We do need to combine with technology to do it.

Tiffany Robinson (02:02.039)
So let's go ahead and start at the beginning for our topic today. Most families, the hardest part isn't managing a diagnosis, it's knowing when to seek one. Can you help us understand the difference between normal age-related memory change and early dementia symptoms?

Reza (02:21.056)
Right. Yeah, that's that's really the hardest part. The year or two before something's clearly off. Maybe someone family member doesn't want to really bring it up, or it's just difficult to when they try to. and and it's can be easy to miss the signs because often we're not paying attention or we're just loving them anyway, right? We're we're kind of loving them away and we're explaining it away. they're just tired, they're just forgetful. You know, that that is very common.

it's never too early. So the earlier we diagnose, the more intervention we have, and the more effective interventions are. Not just these newest drugs, which we can talk about more later, but also fixing things like sleep apnea, fixing your cholesterol, your blood sugar, all things, there's about 14 factors that will significantly impact your risk for dementia. Or even when you have dementia, you're then your path, your outlook.

So you will add years of quality of life regardless of your situation by addressing these factors. So, first things first, earlier the better. so earlier cognitive screening and work up and diagnosis. Also, diagnosis is very reassuring for people. It brings clarity to this unknown, this uncertainty that they may have been struggling with sometimes for years. And so I think it's my my first answer is it's never too early.

And then of course there's the process of how to get a diagnosis.

Tiffany Robinson (03:54.712)
What are some of those early signs that families and caregivers tend to miss or explain away?

Reza (04:01.772)
Sure. You know, I tell people, forgetting your keys is normal, forgetting what the keys are for is not normal. So if you're reaching a point where there's any sort of functional impairment, or as a loved one, if you have a concern and you're bringing it up, that's probably something to listen to because you've known this person, you know, probably for a long time. And something's not out of, you know, something's out of the ordinary.

Tiffany Robinson (04:09.143)
Right.

Reza (04:29.5)
So things like maybe they typically handle the finances, but that's getting harder. so it's it's okay. Let me really be clear. As you get older, it might take a little extra time, but you should still get to the right answer. You can still do math, you can still find your way around. You might have to take an extra second to remember, what was I doing? That's really because a combination of things. Some of it's natural with age, but a lot of it too is if you think about those of us now over 50 or 60.

We're living in an era with most competition for our attention ever, right? There's constant notifications, there's so much going on. So our working memory does decrease a little bit with age. And then our ability to keep our attention because we're forced in a way to multitask constantly. That's normal. So it's very normal to say, man, so many things competing for my attention. I forgot what I was doing.

What's not normal is, oops, I keep double paying the bill, or I missed a bill payment. Or man, I used to really enjoy making cooking food and following old recipes. Now I'm eating peanut butter and jelly every day, or something simpler, you know, or man, I forgot where I was going, but not I don't know how to get home, or I don't know how to get someplace where I usually go. So there's that line that gets crossed with dementia where it becomes functionally impairing.

Tiffany Robinson (05:51.435)
typically notices first? Is it the individual, the family, professional caregivers?

Reza (05:57.835)
Yep. The caregivers are often who notice first, but it really depends on the person. So there are folks that have some early cognitive symptoms. There are maybe we call them like maybe more type A, you know, sort of a little bit more anxious energy, a little bit more attentive, attentive attention to detail. They'll notice. So they might notice something's wrong years before. They may or may not bring it up.

But that crowd tends to have a gut feeling and they can be right. I would say for a lot of folks, they may not notice and there's some apathy that comes with it. There's a part of the dementia process commonly is a lack of self-awareness. So that can be part of the dementia and makes it very difficult to know something's wrong. So there that's where you really see the loved ones navigating and bringing them in and saying, hey, you know, we're here today because I I I'm worried.

So it can be a mixed bag. I would just say just to, you know, have that nuance to it. There are folks that do notice.

Tiffany Robinson (06:59.861)
You talked about how early, it's never too early, then there's more interventions that we can look at. You also mentioned that there are some health concerns that you can address that can maybe even help delay or or prevent. You talked about sleep apnea. What are some of those items that if we deal with them, you know, it might help us in the long run in regards to dementia?

Reza (07:22.13)
Absolutely. A few different buckets. So one bucket in terms of prevention, I would say, is just looking at existing medications. I work with folks, I I and I often joke that my job is I I went to all this training and mostly what I do is I take medications away. I just deprescribe. Of course, there's some, you know, skill involved with that. But a lot of times I'm looking at lists and saying, wow.

Not only is a number of medications significant, but the types of medications can now start to compete with your cognition. So common areas we call are they're they're called anticholinergics. And that's sort of a way like a common one is Benadryl and any cousin of Benadryl. Those really do get in the way of thinking and memory.

Now they don't cause necessarily permanent damage, but while you're actively using them, they can really make things cloudy, especially if you have a dementia process like Alzheimer's happening under the surface. So I will work people on their sleep because sleep meds are a common, common issues. Bladder medications, allergy medications, certain cardiac medications. Think about anything that kind of helps you feel drier, you know, whether it's drying your bladder, your gut, your you know, sinuses.

Very common, the old school ones are all anticholinergic. Luckily, in almost every case, there are better versions, newer versions that don't cause those issues. So medications is one of those. one c one very famous list, the the family medicine practitioners in the country published something called the beers criteria, spelled just like the the beer to the drink.

And that's been out for many decades. It's revised. That's a list of all the medications that become concerning as you get older. and so there's that. There's also things like then medical comorbidities, we say, or medical issues that really go hand in hand. They create the inflammatory environment that can cause or promote dementia. So any kind of underlying inflammation.

Reza (09:27.234)
Creates this hotbed for these proteins to kind of go awry, just like a cancer would develop, but in this case a dementia. So things like your thyroid being low, being depressed or too anxious, not having that treated, having hearing loss that's uncorrected, your vision, having high cholesterol, blood sugar, blood pressure.

And even things like sleep apnea or anything that interferes with sleep, anything that's getting in the way of your body being in as little inflammation as possible, gut issues, very common. But these all contribute. And we know we've followed people long enough that addressing those does reduce your risk for dementia. It also reduces the symptom burden once you do have dementia.

So we have medications and we have sort of reversible causes, if you will. Those are kind of like I would say two buckets to think about.

Tiffany Robinson (10:23.885)
I think a lot of times, especially in our culture, we think if there's something going on, right? I think about my grandparents, even my parents, if there's something going on, they say, I'm fine. I'm fine. And we don't want to necessarily go to the doctor and get something treated. But the way you're talking today, there's a benefit to making sure that you're healthy. And if there is something that's causing an issue, getting with your physician and getting that resolved, it can have more than just that, what that one issue is. It could affect, you know, potential of.

you know, dementia down the line. So it's important that we really make sure that we're we're going to the doctor, we're talking about the things that are, you know, maybe not feeling right or going right and and, you know, trying to correct those. Sounds like that's really beneficial.

Reza (11:05.472)
Yes, that's exactly right. It's extremely beneficial. It opens a lot of doors and it's one of those things when you're in the situation, it's hard to imagine the benefit, but it's not only the clarity, it's not only the treatment options, the reversible causes, but it unlocks a lot of help. insurance plans will start paying for caregiver support. They'll start enabling all kinds of other care that they'll pay for.

with the appropriate diagnosis. So having a diagnosis in your chart even of memory loss is often not enough. Even a generic dementia might need to say something like probable Alzheimer's disease. But that's where you need to work with a provider to help enable this care.

And I'll address one concern that comes up often when people will say, well, man, I don't know if I want a dementia diagnosis in my chart because it might impact things. And I early in my career, you know, I would I would kind of hear that concern. But now with many years behind me, I've really never seen it become an issue. Actually, I can't think of a single instance where someone said, you know, my life insurance, something happened, or my job, something happened, or my driving.

You know, the systems just don't don't work that well. You know, they're they're not connected. the information in your chart is confidential. certainly.

Tiffany Robinson (12:14.497)
Yes.

Reza (12:15.604)
You might have to disclose it. Let's say you're you're going out to apply for a life insurance after the fact and you have to disclose that. Sh certainly that might impact your your sort of premium. But I've really never had a situation where someone said, my God, with the diagnosis in my chart, I lost something significant like my job or some other ability. You know, it's really the benefits I would say far outweigh the risks of early diagnosis.

Tiffany Robinson (12:39.789)
Right. So the family has made, let's say, the call to get an evaluation. They've seen some things that are concerning. Can you walk us through what the evaluation process looks like, what families should expect?

Reza (12:52.044)
Sure. Yeah. And depends on what who you're seeing. So let's say the most common scenario is you show up to your primary care doctor. And this is national. I take care of patients in several states, covering a good section, you know, both coasts and in the middle of the country. So

Based on what I've seen, you know, especially in the Medicare world, we have something called the annual wellness visit. There's a cognitive testing component, you know, with that. And if you show up and say, I think there's an issue, most primary care, the majority, will do a brief cognitive assessment. So they'll do things like remember these few words, or maybe do solve this math problem, or draw a clock for me. Something to right there in the moment test your cognition. That, coupled with the story, the concerns from the patient or the care.

Give her the loved one. That's enough to then trigger a okay, something's going on, so we're gonna take this next step. The next step at that point often is referral to some kind of specialist. The challenge there is often that's either like a neurology or a psychiatry or geriatric provider.

There's unfortunately, you know, dementia still has a way to go with education. So s those kind of high-level specialists are not necessarily trained deeply in this area. And for the true dementia specialists like myself, you know, who go through the you know fellowships and really are spent I'd like to spend our time on rare dementias.

We're not spending there's not that many of us, so we can't unfortunately see everybody. So the reality is you'll go to your primary care, you might get in line then for many, many months. So this is one of the gaps I'm working to solve is you kind of might be waiting for a while without a lot of clarity. Now, I will say that's shifting. We're in an era now where something's shifting because A, we have new treatments in the last couple of years that have come out for the first time in decades, and B

Reza (14:48.256)
We have a new diagnostic test that's widely available now, which is a blood test for Alzheimer's. Before there was a lot of shying away from testing because it required a spinal tap and a lot of counseling, you know, it was difficult. Or very specialty imaging, which frankly, the vast, vast majority of US does not have access to, like amyloid PET, for example. Most people can't get that. And so

It is shifting. It's making it easier for primary care to take that next step to do the diagnosis. so other than a brief cognitive assessment, the clinical history, and maybe some brain imaging, you know, they might get like a head CT, which or or better yet would be a brain MRI. That's kind of that initial.

But I will say, just from experience, most people would agree the process it is frustrating for patients. The path to getting a clear diagnosis is difficult. I say, think of how it was in the 70s or 80s with cancer, right? It was a lot of uncertainty, a lot of unknown. It was very frustrating.

Think about how it is now. When you go in, there's a process, it's ex very exact. You know, you get a very specific, you know, biopsy and you get like the exact name and stage and everything else. Dementia is moving towards that and it's making some good progress.

Tiffany Robinson (15:52.876)
Right.

Tiffany Robinson (16:05.151)
What are some of the current treatment and management options, pharmaceutical and otherwise?

Reza (16:10.242)
Sure. Yeah, if we're looking big picture, the most effective treatments are addressing those 14 factors, which I write about online. And they they come from the Lancet, which is one of the world's biggest medical journals. There's a Lancet commission that publishes a widely accepted review with experts from many, many countries. So it's a very it's a consensus piece. It's not controversial. It's and they just released their most recent one in 2024.

That is the most effective, but if we drill down and look at medications, next step in step down in efficacy are some medications. Now, there's a couple buckets here. One is the ones that have been around for a while. Mainly you'll end up people, you might remember commercials back in the day for Aerosept or Donepazil and its cousins galantamine and rivastigmine. Those we still want to use as early as possible. They're effective, they're helpful, but they're effective the earlier you start and the longer you take them.

And they're not the type of medications that you notice a difference right away, typically. So it's kind of taken on faith, and that can be difficult for patients, of course. But what we know is from following people that when you start early and you and you take it a long time, it does add time to your longevity, to your independence.

Now that's kind of one bucket. The newer bucket now are drugs that are actually trying to attack the issue a little bit more in the root cause. That first bucket, it's symptomatic. It's like covering it up with a band-aid, right? It's saying your brain's getting less of this, here's more of it. You know, good luck. The second bucket, in terms of addressing the more underlying root cause, was let's see if we can get rid of some of this amyloid, which is one of the proteins in dementia and multiple dementias, especially Alzheimer's.

That builds up and builds plaques in your brain and gets in the way and messes up, you know, thinking and kind of muddies the waters. So we have a couple of drugs that are FDA approved that are available on the market that actually go in and attack that amyloid and try to clear it out. Now, what we've seen is they're very effective at cleaning it out. So the pre and post scans are very impressive. You know, pre-treatment, you have a lot of amyloid, post-treatment, a lot of it's gone.

Reza (18:23.008)
What's confused scientists now for many years is that that doesn't correlate with thinking and functioning. That's the problem. So although the amyloids are disappearing, people aren't necessarily feeling better. That's a big challenge. So that's that's kind of a one of the unfortunately one of the disappointing things. Now that's they're still being used, but the effect is modest. There are real side effects to think about. And so it's a pretty small minority of people that are.

Eligible for it and getting treatment today. Now, what I'm more excited about is there's well over 180 clinical trials in the US right now. So there's quite a bit in the pipeline. And if you go on, you know, clinicaltrials.gov, anyone can see them. They're all registered. Tons of new therapeutics, way more exciting, many that are show a lot more promise. So I would say we're in a new era now. We're finally there. I mean, it's been quiet for about 20, 30 years, very quiet, but we've definitely entered this new era.

Tiffany Robinson (19:24.279)
What I what I'm hearing is that again, early intervention is key. it's so important. With you as a technology entrepreneur, I would love to hear your feedback. Which technologies are proving genuinely useful for families right now? And where does the hype outpace the reality?

Reza (19:45.559)
Great question. And boy, there's a lot of technology. I actually went to an age tech event a couple weeks ago in Boston and

There was a bunch of these newer companies like the next generation walker, you know, with like AI on it, or a patient transfer device, a robotic one, so you can have it with no human at home, or assistive devices for eating, you know, with making utensils more accessible. But like these newer versions of these, even there was even ones where you put these devices on your legs to help you lift your feet up and walk longer. All all robotic, all with AI now.

So boy, there's a lot happening. That's just the tip of the iceberg. There's quite a bit more. I'm seeing a lot more in like the hearing impairment world, much nicer and newer hearing type of support devices. So disrupting a field that's just way too old, way too expensive. Hearing aids are just a disaster and have been for a long time. So a lot going on with technology. The ones I think right now that really move the needle are things that speed up that time to diagnosis and earlier detection.

So there are things there was a company I helped build, but really a it's a g in the general bucket of a computerized cognitive testing. So how do we make the provider do some cognitive testing but make it way faster and way make it way easier? There's now numerous examples, but patients that have access to that when they go in a clinic, you know, typically will get to a result faster. So there's that that piece of that's in the kind of diagnostic pathway. Now we're seeing AI honestly get to the point where.

The gap too with how to read brain imaging is closing. So I can't tell you how many times, right, I get a imaging report and it says brain MRI normal for age. And it might have been from five years ago, and there's clear signs of Alzheimer's on it. You know, for example, their memory center is also called the hippocampi or hippocampus. They're almost gone. But the there's no mention of it in the report. That's a huge gap. And part of that is by design, you know.

Reza (21:49.909)
On the imaging side of it, those providers, when they're reading the imaging, they're looking for things that are going to hurt you today. So they're going to comment on bleeding, stroke, aneurysms, brain tumors, and so on, right? If you have something and you know something's kind of withered away slowly, they've done they've been trained. It's it's it's not a big deal. That's changing, of course, because it is a big deal because now we have treatments and we know what we can do about it. So that gap is closing. So a couple of things. So the diagnosis, cognitive testing, brain imaging, those things.

That's an area where it's having real impact on patients. I think we will see very soon some emerging leaders in the sort of like assisted device world that will have some more impact. but even technology, there's many buckets here, but one of them is I you know, patients that can drive longer because they have smart cars that have self-driving. You know, I have patients with their full automatic, you know, self-driving package on a Tesla. They're they're able to drive longer, right? Because that it is proving out to be quite safe.

So r a lot of areas there. obviously my focus is on the clinical side, but I I see apps, phones, certain technology starting to show signs of extending the independence of of folks, which is great.

Tiffany Robinson (23:02.871)
That's really exciting just to hear about all the different things that are coming up. Can we, while we're talking about being in that kind of space of getting a diagnosis, can we talk for just a moment about the grief that can come with a dementia diagnosis, this feeling of loss for the family? sometimes feeling like dementia ends their story, it doesn't, it just changes it a little bit.

Reza (23:27.468)
Yeah, you know, what what I like to say is a diagnosis doesn't end someone's story. It changes how you build care around them. The person is still there. So I will say also, people often say, Man, it feels like I'm losing someone twice. You know, I'm losing the person they were, and then of course I'm losing them when they leave this world. But there is grief that needs space, that needs to be acknowledged.

it can be very difficult for the loved one, often the caregiver, to have that transition, to accept that this person, that relationship we had is fundamentally different now. It's not gone and needs to change though. And that's often where I'm addressing friction, like, you know, hey, you don't name I mean necessarily need to correct them on what day it is, right? Or certain, you know, bring up certain things. Just just let it go and maybe let's focus on things that are enjoyable. So I had a

I did a a webinar yesterday and it was a great question about you know how to how to deal with friction. And I said focus on the things instead of trying to sort of grapple with the reality and bring them to your reality, meet them where they are. One one of the ways to do that is with reminiscence. Spend more time pulling out old picture books, bringing up old songs from when they were younger, old stories.

That will connect with someone with much later stage of dementia than you might believe, when you might think it's gone, even at the point where they might not even you think or you see that they don't recognize you or don't remember your name. But if you go back with them to that sort of reminiscence, the age of nostalgia, that's powerful. You're accessing different parts of the brain. And so I try to coach people, think of it that way. You've now become a memory coach. You're accessing your job is to access those different parts of the brain.

So if you stimulate them with an old song, that's accessing different memory in a different place where some of that other short-term memory might be so gone that it's it gets frustrating. So absolutely. and that's completely normal. You do have to mourn the loss of the relationship, you know, now you know it's it's better to mourn now and make that adjustment, right? Than to necessarily say, well, I'm waiting until they're gone.

Tiffany Robinson (25:45.431)
That makes sense. Let's now talk about the day-to-day of living with dementia. What does a good day look like with someone with dementia at home? What are caregivers actually aiming for?

Reza (25:58.071)
Yeah. So that's great. You know, a a good day to day and obviously depends on the stage. You know, early stages of dementia, people are often quite independent. But the most part, they can be home on their own. they might just have some support. And I at that point, I will push for earlier caregiver support intervention. So often again paid by insurance. But I really advocate families to bring in someone, it might be even just be a couple hours a week. It might feel unnecessary.

But boy, do they not regret it later when they need to increase it versus having to wait to find something new. So I will say even at the early stages, I push people I've never had again, this is one of those rare times where I can say I've never had someone come back and regret it and say, Man, I wish we didn't have that caregiver, you know, last year. It's always a kind of an appreciated thing later on. So a good day, depending on stage, you might have caregiver, caregiver support, but maybe starting off, you know, with with someone kind of in involved.

But that for the person with with the memory loss, activity is key. So you know, we want we want still want a level of responsibility or fulfillment regardless of stage. Now that'll shift, of course, but I have people with early dementia, many going to workout classes, volunteering at their church, at the Y, the Senior Center, wherever it might be. Even I have, you know, one that still helps as a teacher's assistant at a school.

All kinds of things. Depends what's appropriate. That's, you know, customized. But really, I want to see them getting up. I want to see them getting out of the house. I want to see them getting at least 30 minutes of good, moderate activity, like even exercise, so where their heart rate is elevated. Not super out of breath, but you know, hard to talk type of activity. I wanna see them having their kind of three square meals a day. I spend time on nutrition, so we'll go through even a

a nutrition journal or diet journal and really get into the weeds. So it depends on the needs everyone has. But when someone has a good level of activity, some rewarding experiences, some support, you know, so that they can do things safely, like they can still get to the store with a ride. At the end of that day, you know, the caregiver feels supported, the patient feels like they accomplished something, and they were, you know, had the right amount of stimulation.

Reza (28:22.978)
I mean that that's that would be a a really good day, I think.

Tiffany Robinson (28:27.147)
How do you balance safety with a person's autonomy and dignity still intact?

Reza (28:33.814)
That's a great question. And I would say the the number one conversation, the hardest one, and often it comes to me because, you know, I think it's as for other providers very difficult to bring it up. But driving is is a really common one. another common one, and I I work in states where this is extremely common because I work with a lot of farmers and ranchers. So, like, you know, gun ownership, for example, is a big one. Things that are really tied to your identity, things that you might have been doing your entire memorable adult life.

And you can't imagine without them. So I work really closely again to keep that independence and that possession as long as safely possible. And it's often longer than people think. It's often a motivator too, because I will say, listen, if we work together, you will stay at home longer than if we don't. You know, if we ignore these things and let's say you have a bad night's sleep and you fall and you hurt yourself, you're gonna be stuck in the hospital, then rehab and

We don't know if you'll be able to get home. They may not release you to home. You know, you might have to go into an assisted, a living kind of facility. So bringing that up and making it clear first that we're on the same team. We want the same things. I want you to have all these things and keep your independence as long as possible because that's a win for me as well. so that's that's kind of a a a big thing. But ultimately that helps frame the conversation, and then we can move forward with listen, eventually we'll reach the point and I'll say.

I know it might not be d easy for you, but how would you feel, let's say, if you kept driving and you got an accident and you're saying, I I'm fine, I I I can die driving, I'd be happy. Great. But the chances are, you know, you're gonna hurt somebody else. And how would you feel about that? And early enough, you know, in the course, again, this w wor worked well in in in my experience, where people will almost always come to the conclusion themselves if you can kind of help them and say, Man, I couldn't live with myself if I hurt somebody else.

Say, okay, well, you know, you're making the decision. It's out of all the folks, I mean, the hundreds and hundreds, well over a thousand folks I've seen now, I can count on one hand how many times I've had to intervene more aggressively to say, listen, you know, I we really need to retire from driving. And, you know, we're gonna write a letter to the Department of Motor Vehicles about your license. That's very rare, I would say. So it's you can navigate it, but to your point, Tiffany, it's it's you have to do it carefully. And

Reza (30:58.324)
Over several visits you have to build rapport, right? They gotta build trust. They gotta understand that I'm on their side. Otherwise it doesn't go up.

Tiffany Robinson (31:02.975)
Absolutely. Can you also share with us how to handle moments of confusion, agitation, and repetition?

Reza (31:10.114)
Absolutely. And I've recently been going through this because my ninety-three-year-old grandmother had a fall previously, you know, pretty independent, living on her own, with some help, you know, several hours a day of someone coming in, but overnights on her own and cognitively relatively intact. But of course, at that age, after the fall, many pain medications, inpatient for several weeks, rehab for several weeks. There was sundowning happening, which is a term we like to use

kind of colloquial older term about, hey, someone's getting agitated later in the day. Like the sun kind of goes down and man, they're not themselves. Often that's tied with the memory loss. And then there was some confusion. So very recently I've been going through this. I've been actually driving down regularly to to spend time. And so one of the things I ended up working with her primary care and the other providers on with some really good results was when I got there,

the medical kind of issues that may be lingering that don't translate well from at discharge. Meaning often when thing when you get discharged home, certain medications might be there that don't no longer need to be, or there's just fallout from it that's not addressed. In this case, if you had pain and you were on pain meds, it's really common. In her case, she was constipated, really constipated. that means she wasn't eating well because she didn't have an appetite. And then that was also waking her up because she felt like she had to go, but it was a false alarm.

So her sleep and her kind of bowels were all kind of jumbled up. So that's an example of very common. There's usually a medical issue you can address that will address the agitation. With those addressed, so within a week, we made a bunch of changes. all of those symptoms got a lot better. She had no more evening agitation, it all went away. That's by far the most common thing. It's always temporary, I will tell you that. Always temporary, no matter what. But it's a matter of like trying to look closely because.

They've reached a point where they're not going to be able to tell you, you know, and as what's wrong. So as dementia progresses, someone's not gonna say, ouch, it hurts when I go to the bathroom. They might just get agitated and angry, and you know, and it's easy to take it personally. So you really have to go through and look and say, wait a second, why aren't you eating? wait a second, how when's the last time you went to the bathroom? it it's it's really getting into the weeds and working closely with their providers. And you remember, healthcare unfortunately is has its challenges. So

Tiffany Robinson (33:06.242)
Right.

Tiffany Robinson (33:14.252)
Right.

Reza (33:30.627)
Try not to get frustrated with the primary care. Try not to get frustrated with the system. The system has a long way to go. Caregivers are by far the best informants and the richest source of information. In my grandmother's case, she's had professional caregivers in the home 24-7 from discharge. I wouldn't be able to do anything if I didn't have their reports. You know, so I talk to them daily, I get a note daily, and I'm able to then put it together. she got up this many times, or this is how many times she went to the bathroom, or this is how many meals she ate.

so long the kind of the the short of it is focus on how to restore those normal daily cycles and agitation will always go away, but sometimes it can take longer and it can be a lot worse with certain dementias. You know, sometimes with Lewy body dementia later stage, there can be some significant agitation. And that's harder to address because in that situation you might be having, let's say, significant visual hallucinations. If they're seeing something.

That's not there, but it's really upsetting for them. There's not a lot you can do about it. And that that's that's kind of another story where we get into some medication and other support.

Tiffany Robinson (34:39.927)
Thank you so much for sharing your expertise with us today. As we close, for someone listening today who's in the middle of this journey, what do you want them to take away from this conversation?

Reza (34:52.29)
Sure. I would go back to making the point that a diagnosis doesn't end someone's story. It changes how you build the care around them. And that should be the focus. And that the person is still there. And just accept that your relationship is going to change, but the earlier the better, the more time you will have and the more time they will be independent.

Tiffany Robinson (35:15.895)
Thank you so much for being with us today.

Reza (35:18.6)
Absolutely, you're very welcome.