Join renowned neuroscientist and author Lisa Genova, and William Blair’s head of Private Wealth Management, Ryan DeVore, as they explore preventative steps people can take to maintain brain health and navigate the challenges of Alzheimer’s and Dementia.

Video Podcast Transcript

Ryan DeVore
Good morning and good day. I'm very excited to spend a wonderful time with our special guest today, Lisa Genova. Lisa is the, I would say, unique combination of a neuroscientist and also a bestselling author, not something that you see every day, and just a very powerful advocate for brain health. Best known for her novel Still Alice, which not only became a New York Times bestseller, but was also adapted into an academy award-winning film starring Julianne Moore. But through a compelling fiction, including Left Neglected, Love Anthony, and her latest, which I just started to read, called More or Less Maddie, you bring to us these complex neurological conditions to life, which I think is so fulfilling and is making it accessible to folks that might be going through a similar life experience. But my introduction to you, as I just think it is powerful to see how the work that you do echoes, was in 2015. I had not heard of Still Alice, and we were spending time with one of our clients and one of our clients admitted to us or shared with us that she was going through Alzheimer’s, and she said that she was inspired by your book and then had the opportunity to see the movie.

And she said in that movie, there's a conversation that Julianne has with her husband, or Alice has with her husband. And she said it was that moment that made her have to share that with her husband. She said it inspired her to share it with her husband. So your work echoes and helps people with difficult conversations. So thank you for the gifts that you bring the world.

Lisa Genova
Thank you for telling me.

Ryan DeVore
So you have a background in neuroscience, and then you became an author.

Lisa Genova
Yep.

Ryan DeVore
Tell me about that journey.

Lisa Genova
Isn't that what all neuroscientists do? They go and write novels? Yeah. It was not a planned career path whatsoever. I did not see it coming. So I spent my young adult life training and becoming a neuroscientist, trained to become one, and then I was, and I studied the molecular neurobiology of drug addiction. I did that at Mass General and at the National Institute of Health. My grandmother developed Alzheimer's. And as the neuroscientist in my big Italian family, I felt it was my responsibility to learn everything I could about this disease and pass that education along to help us be better caregivers. And I read a lot and I learned a lot. But so I read the scientific research papers that I kind of geeked out on. That was really for me, that didn't help my family, but I read about the disease management. So what is this going to look like as it progresses?

And I read books by caregivers, so books like the 36 Hour Day, which were super helpful in learning the best practices and how to be a caregiver. But interestingly, as I spent time with my nana, I recognized that I had a lot of sympathy for her. So I felt so bad for her. I felt so heartbroken for her, but I didn't know how to feel with her. And that's the distinction between sympathy and empathy. And so what I mean, I felt really uncomfortable around her. She didn't know who I was anymore. And when she would have these symptoms of dementia and confusion, and she had these little plastic baby dolls that she tended to as if they were real babies, she was confused and lost in her own home. I got uncomfortable and didn't know how to be with her in her reality, and I would just kind of walk out of the room or I would disconnect emotionally.

So I recognized that while I knew a lot about Alzheimer's, it was very intellectual. I didn't know how to feel with her. I didn't have empathy, and everything I read was written from the point of view of an outsider. So it was a clinician, a scientist, a caregiver, a social worker. They all lacked the perspective of the person with it. And I thought, oh, isn't that interesting? The only thing I haven't read about Alzheimer's is a novel, and fiction is the place where we get the chance to walk in someone else's shoes. It's designed to create empathy. It's designed for us to feel what it might be like to be someone else. And so that was my aha. It was like, oh, what I need is a novel about a woman with Alzheimer's told from her perspective, and then I can understand what it feels like to have this. That's how I can get the empathy that I'm missing. And so I thought, well, it didn't exist. And I thought, well, maybe I'll write it.

Ryan DeVore
How about it?

Lisa Genova
And that was the seed for Still Alice.

Ryan DeVore
You mentioned in that conversation, and thanks for sharing that story about your grandmother, Nana, Alzheimer's and dementia. What's the difference?

Lisa Genova
So dementia is a symptom. It's not a diagnosis. So dementia is a term, it's kind of an umbrella term. It means that you have an impairment in memory, language, and cognition that is disproportionate to your age and education level. And that symptom can be a symptom of many different illnesses or many different causes. So it is the hallmark symptom of Alzheimer's disease. They often get used interchangeably, but there are many other symptoms of Alzheimer's. There can be emotional deregulation and personality changes. Vision can change, balance can change. There's a lot of things that can happen. Executive function and Alzheimer's, you have problems with decision making, problem solving, planning, but dementia is a symptom of many other things. So you can have dementia due to vascular dementia, frontotemporal lobe dementia, Lewy body dementia. You can have it as a result of a B12 deficiency. You can have symptoms of dementia from alcoholism. Chronic sleep deprivation can give you symptoms of dementia. So if you're presenting with symptoms of dementia, folks don't necessarily jump to like, oh my God, my mom has Alzheimer's. Dementia can be a symptom of a urinary tract infection. So you want to get in front of a physician and maybe the dementia can be resolved. There are curable forms of dementia.

And also if it's Alzheimer's, it's helpful to know as well because while we can't cure it, we have treatments. We have ways of paying attention to the lifestyle that can help stave off the progression of the illness and keep you functional for longer.

Ryan DeVore
And is there a natural bridge or moment or something that happens in the life of a patient that where the dementia becomes something where they perceive it to be Alzheimer's or where they should take that step and go to the doctor and say, Hey, these moments are happening? These things are happening in my life.

Lisa Genova
So I think that we should all be as involved in our brain health as we are in our heart health. So we don't hesitate in our annual physicals to get our blood pressure taken, get blood drawn. We check for cholesterol, we check for blood pressure. These are markers of your cardiovascular health and whether you're developing cardiovascular disease. And we're involved, right? We're like, okay, I'm going to get so many steps in a day, or I'm going to exercise, or I'm going to eat a heart healthy diet and I'm going to try and have an influence over my heart health. Similarly, I'd love us to be in conversations with our doctor about our cognitive health and way before we're even worried about it. So there are questions that the doctors can ask you. There's an exam called the mini mental state exam. It's 30 questions. It's just orienting you to time and place.

Can you remember things on a short-term basis? If I mention three words, can you say them back to me in a minute or two? Can you draw a clock? Is your spatial memory good? You'll get 30 out of 30. But as we get older, as we might be starting to develop something, forgetting is not a normal part of normal aging, but aging is a risk factor for developing things like Alzheimer's. So, conversation with your doctor. I'd like a baseline. I'd like to know what my cognitive health is today just in conversation, just in this mini mental state exam. Like I'm 54. What is my cognitive health today? Heart health is a good indicator in lots of ways of brain health, by the way, as well. So we do want to do the same things. If you've got a healthy heart that is helping you, all of that blood flow to your brain is so necessary.

So our brains are only 2% of our body mass, but it requires 20 to 25% of our blood, our oxygen and glucose. So it is a very hungry organ, so it needs good blood flow, good vasculature, so those interact. But so yeah, conversation with your doctor, what is my brain health like today? And to then track it over time and to pay attention to things like, am I getting enough sleep? Am I eating from mostly foods from the Mediterranean or mind menu of foods? Am I getting daily exercise? Am I learning new things? Am I staying socially and cognitively active? We know that these things are good for your brain. Am I reducing my reactivity to stress? Do I get stressed out and go into fight or flight every time something pinches me, every time something's stressful? Or am I able to modulate that stress response so that I don't dump adrenaline and cortisol every time?

So those are the things that we can do if I start to notice that I'm forgetting things. Is it normal forgetting or is it forgetting due to Alzheimer's? There's a couple of distinctions that I think are helpful for folks. The line is actually pretty clear. People are worried if you're over the age of 50, you're like, oh, especially if you have a parent going through this, or just as you get older. For women, we go through menopause and we're probably not sleeping very well, and that impacts our memory. So there are distinctions. So if you're having trouble remembering where you put your phone, your keys, your glasses, where you parked your car, a lot of folks will think, oh my gosh, this is the beginning of Alzheimer's. And they get really worried. And what I tell folks is, this has probably been happening your whole life, but you're noticing it now and you're not remembering where you put those things.

It's not actually your memory at all. It's not even involved. You didn't pay attention to where you put those things, and that's why you can't remember where you left them. So the first necessary ingredient in creating a memory is attention. So if we don't pay attention to where we put the phone down or pay attention to where we put the keys or park the car, you can't form a memory of that. So it's actually a symptom of distraction. We're so highly distracted. We're multitasking. We're doing too many things at once, and when you spread your attention out over many things, you're not giving your full attention to any one thing. So if I just toss my keys and go run and do 12 different things, and then I go to find the keys, I'm like, oh my God, where did I put them, I have no idea. I can't remember. Oh my gosh, am I getting Alzheimer's? No, it's not a symptom of Alzheimer's. This is a symptom of distraction. If it's the beginning of Alzheimer's, it'll be more like I find the keys in the refrigerator, or I find the keys and I think, what are these for?

Or it's, oh, I can't remember where I parked my car. It's not like, oh, did I park on level three or level four or where in this big parking lot did I park? Well, I probably raced off and didn't pay attention to where I parked, so I never formed the memory. It was, again, distraction. If it's something more like Alzheimer's, it'll be like, I can't remember how I got here. Did I drive? Did I take the bus? Did somebody else drive me? Or you're standing in front of your car and you don't recognize it as yours, or you don't remember what kind of car you drive. You're remembering a car. Maybe that was three cars ago. So that's a symptom. Remembering names is tough for all of us at every age, but we notice it more as we get older. And in part it is more difficult as we get older because our processing speeds are slower, so we're not grabbing the name as quickly, but proper nouns are always tricky for us to reach. Our brains are not designed to remember proper nouns, but if it's Alzheimer's, it's going to be more often common nouns. So instead of Mr. Baker or John or Tony Soprano, it's pens, spoon, phone, bicycle. If that starts happening dozens of times a day, you're forgetting common noun words. That's something to bring to your doctor.

Ryan DeVore
You see the object, but you can't identify it with your language.

Lisa Genova
So that will, or you're trying to tell someone something, you're like, oh, did you pack the thing? The thing you use to clean your teeth, the thing, toothbrush, yes, so that people, don't freak out. That can happen to every healthy brain. If it's happening many times a day, if it's starting to feel like a game of charades that you're playing all the time, that's a time to raise your hand and be in conversation with your doctor.

Ryan DeVore
Love the self-advocate and get a baseline, like you mentioned from your doctor. In our experience, especially in sort of this youth fueled social acceptance model where everybody's trying to stay younger, everybody's doing their best to stay younger, very hard for people to admit sometimes where they are, and it happens in the financial world as well, how they spend money, how they talk to their kids about money, et cetera. But how do they think about their own health and the idea of just that compromise with reality? They may be seeing those things. They may not know, what is that thing that I need to pack that is my toothbrush? And it's a hard bridge to cross to say something is going on, or I'm not what I used to be. In your studies and experiences, how does that form, is it self activization or is it somebody saying, Hey, I'm seeing this in you? What do you see as kind of that journey? I think it's so hard for people sometimes to see themselves.

Lisa Genova
Yes, there's still so much shame and stigma attached to memory impairment, anything going on from the neck up, people get really afraid of it really quickly, and we don't like to age. So if you're noticing issues with your memory, most people stuff it down and don't bring it to someone's attention and think, well, if I just ignore this, it'll be fine. Or they're just afraid and worried and anxious about being public with it. I've found that for most families, it is not the person with it who raises their hand and says, I need some help. It's family who's saying, we're seeing some mistakes, some lapses in judgment, some lapses in memory, and we're now worried. It usually gets to the point where it can even be dangerous, and that's when people step in, like your driving has been compromised. But I'm out there hoping that we back it up and raise our hands much sooner. And here's the reason why. We think that 40% of Alzheimer's can be prevented through lifestyle and modifiable risk factors. That's a big number.

Ryan DeVore
That is a big number.

Lisa Genova
And we know that even if you have a genetic predisposition with something like an APOE4 gene, this is the gene that Chris Hemsworth has, the guy who plays Thor. That's not a guarantee that you get Alzheimer's, that if you press on these modifiable risk factor levers, like prioritizing seven to nine hours of sleep a night, eating from the Mediterranean diet daily exercise strength training, especially in the lower extremities, have been shown to have an impact. Again, staying socially and cognitively active, reducing your reactivity to stress, that those risk factors play a role. So we know for example, that eating from a Mediterranean or mind menu of foods can reduce your risk of developing Alzheimer's by 40%. So even if you're beginning to show some symptoms, do you want to cure cancer at stage four or stage one, right? If you're developing Alzheimer's, if that is potentially your future, I want to raise my hand early.

What can I do? There are things we can do. I can start getting really serious about what I eat, how much I sleep, the exercise, am I really involved every day and exercising my brain and using my brain? So I think that knowing sooner gives us the best chance of avoiding that future that we're afraid of, which is developing Alzheimer's. We want to match our brain span to our lifespan, right? We don't want to live to be 85 but have Alzheimer's at 85. So if you're experiencing some cognition problems and you ignore it, then if it is Alzheimer's, that's going to continue on its progressive path and you're going to be diagnosed eventually. If you raise your hand and say, Hey, I think something might be up, then we can address what you can do to prevent you from getting to Alzheimer's when you're 85.

Ryan DeVore
Fascinating and helpful. You mentioned something in there about having your brain health match your health and your life expectancy. One of the things that we have been following much closer is the idea of what's called Hale. So a health adjusted life expectancy, which is obviously less than a life expectancy where just unfortunately the statistics prove out that you don't stay as healthy for as long as you'd like to throughout your lifetime. And so then thinking about mental health or even some of the other items in which you've studied and written books about, obviously your current book is on bipolar disorder and manic episodes, et cetera., another condition, you mentioned the best practices of diet, the best practice of sleep, of sleep exercise, we've been told that since our youth, and I think a lot of people struggle to have that be as routine as they need it to be, et cetera. But when you think about things like people doing puzzles, you hear just different solutions for all these different things. Do you put credibility into those moments? What really makes your memory?

Lisa Genova
So I don't know who started the thing with the crossword puzzles that this will save us.

The puzzles will save us? It's not. So there's no science behind that. And if you think about it, it makes sense. So if you're doing a crossword puzzle, you're primarily retrieving information you already know. So to build an Alzheimer's resistant brain, you want to learn new things. So every time you learn something new, you're building new neural connections. And so you can imagine that when I say build an Alzheimer's resistant brain, you can imagine that if I've built, say I've built a thousand new synapses by learning new things, and I develop Alzheimer's and I've got Alzheimer's blocking a hundred synapses, I might not notice because I can detour those with all of my backup connections. I've got an abundance and a redundancy in neural connections because I've continued to learn new things. And every time you learn something new, think about it. Your brain had to have changed. You've got new neural connections in your brain that didn't exist before. So if I can build lots of neural connections, then maybe I can have some of those connections compromised and not even notice. But let's just say, let's just say I am going to be super simplistic here. Let's say I have a hundred neural connections. By the way, you have a trillion. Let's say I have a hundred and I have Alzheimer's and I have a hundred roadblocks. I have a hundred places where it's blocking all of them.

Then I've forgotten everything. But if I have 10,000 synapses and I have a hundred blocked, I don't notice. So that's why we say that you want to continue to learn new things and they should be complex things. So the puzzles aren't enough. So what do we want you to do? What have the studies shown? It can be anything from learning a new instrument, playing a sport. A lot of people have taken up pickleball, which is actually great because you're now social as well. So if it's tennis or golf, or if you're active physically while you're learning something new, that's a two for one, it's great. Or it's even three for one if it’s social. You could read a book and be in conversation about the book. You can go watch a movie and talk about the movie. Again, it's just like using your brain to what did you feel about it? What did you think about it?

Vacations are interesting, right? Because now you're in a new place and you're having to navigate a new city and make decisions, and it's not same old, same old. When you're in your routine, when you're in day to day and you're doing the same thing every day, your brain isn't really being challenged much. So whenever you can challenge your brain, so yeah, it's learning a new language, a new instrument, making new friends, being in conversation, reading a book. Read a book, people. So getting out of your routine and trying new things is really great for your brain's ability to be healthy today and to stave off the diagnosis of something like Alzheimer's in the future.

Ryan DeVore
And staying on that topic, you've written and talked about creating meaningful memories. So in our family, one of the things we try to do every month is what we call the Polaroid moments where you have a moment with each child or as a family that it is the thing that you remember. It's the trip, it's the sunshine, it's the experience, it's something new, which sounds like it's very healthy for your brain. My understanding is you're Taylor Swift fan. So I can imagine that the Eras tour was probably a meaningful memory for you.

Lisa Genova
Yes.

Ryan DeVore
Is that the common area of where everyone should have that as brain health, as you just said, is that we're just creating meaningful memories? Is stretching those neurons as I understand it, is that the path to keeping hold of this brain health for longer? Because what are we without our memories? In other words, I guess, how would I say that? Is just your memories are what make you, I think what creates you, what also inspire you? Do you agree or challenge that?

Lisa Genova
I agree and disagree. It's certainly true. Our ability to remember is so essential to what we think of as being human. We use memory all day long for almost everything we do. So from the moment you wake up to the moment you go to sleep, and even while you're asleep, your memory processes are busy at work. So it's like everything we know how to do is the memory. It's the memorized choreography for how to type, how to brush your teeth, how to work the coffee machine, how to drive, and then who you are. Your biography is the Wikipedia of you. That's your semantic memory, all the information you know and then what happened in your life, your episodic memory. This is your life narrative, the story of you,so essential to our experience of being human in terms of meaningful. So our brains remember what's meaningful, emotional, surprising, new, and what we repeat and practice.

Ryan DeVore
Meaningful, emotional, surprising, new.

Lisa Genova
And what we repeat and practice. And if you think about, if you boil down what's the common denominator to all of those, it's what we pay attention to.

So that's sort of how our brains have evolved to work. We actually don't even need to work hard for that to happen. If something very emotional happens to you today, you'll remember that you don't even have to try to, it's not like flashcards where you're studying for vocabulary words. And how do I remember these words that don't mean anything to me? If it's emotional, it's probably meaningful in some way. We have these collective emotional memories. Where were you? Do you remember 9/11? Yes. It was a very emotional day. So if you want to remember more of what happened in your life, you make it meaningful. So you go on vacations or you create days that have meaning in them. You seek out meaningful experiences, and you'll remember more. If you just have days that are same old, same old, our brains aren't designed to remember same old, same old.

But where I disagree, interestingly is, and I'm not going to make light of this, what happens to you when you have Alzheimer's is horrible, and it's hard and it's tragic, and it's to be stripped of all of your memories and it starts with your most recent memories and personal history, and it will go back from there. So if you have Alzheimer's, I'll forget this conversation in an hour. I'll forget that I had breakfast, never mind what I had for breakfast, I'll forget that I even ate it. I'll forget what happened last week. And then as time goes on, and this is why people who have it at the beginning are very comfortable talking about what happened 10, 20, 30 years ago. Those memories are still intact for a while, and then those go. And so it's like we see the profound impact of losing memory, on, like my grandmother had this, and she didn't know who any of us were, and she didn't recognize herself in the mirror. She didn't know her house was her home. It was confusing, it was upsetting. But interestingly, you do not need memory to feel the full range of human emotion. So you'll still be able to feel joy, sadness, loneliness, anger, love, all of it. So that matters, right? So people will often say to me things like, so they'll say, my dad has Alzheimer's and he's in a nursing home now. I feel terrible about this, but I haven't been to visit him in a long time. It's because he doesn't know who I am anymore, and he won't remember that I was there. It's like, I feel like, what's the point?

I completely understand that. I had a hard time being around my grandmother toward the end too. But here's what I've learned, and I wish I knew then. What I understand now is that that guy's father might not remember that he was there five minutes after he leaves, but he'll probably remember how you made him feel, right? So he doesn't know who you are, but he might feel love and joy in the moment that you're there. That connection, that present moment connection still matters and that's meaningful. And so you can still feel loved and you can still love even if you don't know who the people are. So there's a humanity that we have that doesn't rely on memory.

Ryan DeVore
That's powerful. You also sort of touched on the idea of the, call it the power and the importance of the caregiver. And I imagine in your exploration and the work that you've done in this area, you have a catalog of stories, of best practices of caregivers and the journey of caregivers. For those that might be in our audience that are going through that right now, what would you share that they can take from that? Being just being a caregiver and seeing that.

Lisa Genova
It is a very hard journey and you're a hero. And so a couple things. One, don't go through it alone if you can help it. So a lot of folks, if they're siblings, oftentimes it's the sister's doing most of it who lives nearby, and the sister and the brother who don't live geographically near can't help out day to day. And maybe they can offer some financial help, but there can be resentment and you can feel very alone in it.

So if it's not immediate family who can be supportive, and hopefully it is, but if it's not them, there's a national Alzheimer's Association chapter probably in, it's definitely in your state, maybe nearby, and it doesn't even matter. This can all be done today over Zoom. It can all be done virtually. It's not an in-person meeting. But find people who are in this journey with you, and especially people who are a little further along than you who can sort of give you a window into what's coming or can give you the, oh, I wish I knew then what I know now.

Ryan DeVore
I've been down this path.

Lisa Genova
Yeah, I've learned some things and this is what I wish I could have told myself a year ago. So find, there's a lot of folks out there going through this, so you don't have to be alone. The loneliness, the alienation and isolation that can happen with this. Again, there's shame and stigma. A lot of times people feel like they can't let their neighbors know what's going on. Let your neighbors know what's going on. By the way, a lot of people are going through this. You'll make new friends and it'll be meaningful connections. There'll be meaningful new people in your life. If you raise your hand and say, my mom's got this. I need some help. Who else out there is going through this? The other thing I can offer to caregivers is this idea of that I learned after my grandmother had passed, and I actually learned this through a Healing Moments workshop using the rules of improv, improvisational acting to stay connected to your loved one with Alzheimer's.

So the idea is this, your loved one with Alzheimer's doesn't have access to the reality we have access to anymore. Their brains aren't giving them accurate information about where they are, who these people in the room are. They are going to start not making sense, making things up. They're going to say things that aren't correct, that aren't right or true. And the instinct can often be to argue with them and to say, no, mom, that's not right. Or, remember this. No, no, no. Remember this happened, to correct them, to quote reality, orient them. It's not helpful, and you're not going to feel good when you do this. They're not going to be like, oh, you're right, and get it. They're not going to get it. And now you're going to be butting heads perhaps, or it's going to disconnect you emotionally. So the trick is to say yes and to be the improv actor.

So with improv, so right now we've got this rug here. If we're actors and I were to say to you, Hey, you want to go for a ride on this magic carpet with me? It's your job to say yes and to the reality I've just offered and join with me. So you could say, yeah, let's go somewhere warmer. How about Tahiti? And now we're going somewhere. But if you instead said, Lisa, that's not a magic carpet. That's an ordinary rug. If you negate my reality, then the scene is dead. We've killed the scene. So similarly with Alzheimer's, I want to join you in your reality and add to it. So if my nana had said, I'm waiting for my mom, she's going to be here any minute. It's not my job to correct her and say, Nana, your mom died like 30 years ago. She's not coming.

Awful. She's going to live that information that I've just offered. She's going to experience that in real time as new information. If I instead offer a yes, and, if I say yes, I'll wait for her with you. Let's have a cup of tea while we wait. Or tell me about her. Right? I heard she was a great cook. So now we can stay emotionally connected and she's going to forget at some point that she's waiting for her mom. Maybe she was just looking for comfort and company when she was thinking of her mom, and now I can supply that in being with her.

Ryan DeVore
Lisa, that's so powerful because it's emphasized two things that you've said today. The idea that they're going to have their feelings, they may not have their memories as sharp as they have, but they're going to have their feelings. And if they feel like tension or conflict, that's real to them too, right?

Lisa Genova
They’ll get empathy. Imagine if everything that you're saying, I'm saying, no, that's wrong. That's not true. No, no. If I keep correcting you, you're going to feel annoyed. You feel like we're adversaries. Oh, that woman's a pain in the butt. She keeps correcting me. I'm not fun to be around, right? Yeah. But instead I go with you. Yeah, okay, that sounds great. Let's sit and chat about that. Now you enjoy my company, and you can see that I'm someone who's on your side. Caregiving is hard. Oh, the other resource I'll tell folks about is I'm on the board for this organization. It's Hilarity for Charity. It's run by Lauren and Seth Rogan. Her mom had early onset Alzheimer’s, and they recognized that they were in a pretty privileged position of being able to afford a lot of help. And what about the folks who don't? So they offer a lot of resources for caregivers, respite, and educational material. They're fantastic with their education. So if you're a caregiver and you're feeling overwhelmed and really just sort of struggling to stay afloat in it, Hilarity for Charity has a lot of great information and resources for help.

Ryan DeVore
That’s great. Shifting gears a bit this week as it stands today, is the five year anniversary of when we went home for the global pandemic and the world announced a global pandemic and a very memorable chapter in the world's history in so many ways. But with the gifts that you've given the world around mental health and just around brain health, what do you think about just as we've come out of it, obviously, but what are we left with? What has it given us that's been maybe the good and the bad in terms of just what changed the world mentally in the last five years.

Lisa Genova
Yeah. I often tell folks, unless you were a healthcare worker or you were really sick with it or lost someone who had it, if we were like a lot of folks who just were isolated at home, I say, it's the most memorable period of time that you won't remember, because think about it, our brains remember what's meaningful, emotional, surprising, new. It doesn't remember what's same old, same old, predictable, habitual, routine. And so when we were isolating at home, the menu of possible experiences shrunk down to the confines of where we were living with the same set of people. So we didn't experience a lot of new things.

Ryan DeVore
Right. And dose of fear on top of that.

Lisa Genova
Yes. So every day was essentially the same, and we don't remember the same. And then now we've also got anxiety. So the top three psychological stressors are social isolation, a perceived lack of control.

Ryan DeVore
Check.

Lisa Genova
And uncertainty. So we had all of those, so we were stressed out. And unless we know how to manage that stress, if we're in a constant flooded state of fight or flight, if we've got adrenaline and cortisol being released chronically with no breaks, that can actually break the feedback loop. So normally I've experienced a stressor, so this is how we've evolved, right? Something dangerous happens, there's a predator, there's an enemy. Something scary is about to happen. I have to either fight it or flee or freeze so that I'm not noticed. I dump adrenaline and cortisol. So my heart rate is going, I'm breathing fast, digestion is done cause I don't need to digest the next meal if I'm not going to be here anymore. So I am no longer in my thinking brain actually, your frontal lobe isn't really what, you're just reacting. It's not like, well, should I run or not run? It's like just react. And then what happens is cortisol is released and acts a little slower, and one of the things that cortisol does is it feeds back to the brain and shuts off the stress response so that your pituitary is no longer then activated and you're not then releasing, you shut off the adrenaline and cortisol. It's a nice negative feedback loop. Under chronic stress, the receptors that cortisol act on in the brain can either be downregulated or desensitized. They've been sitting in a bath of cortisol for too long. They were basically like, we're going to just go away. And so now the feedback loop is broken, and you just keep releasing this stuff, which is really bad for your memory. It's bad for your ability to retrieve information you already know. It can cause an impairment in your ability to make new memories. So people felt a lot of brain fog during what they're calling brain fog during the pandemic, and maybe even after if that chronic stress is still going and you don't have any way to manage it. So managing it is learning through things like meditation, mindfulness, yoga, how to stay present, how to be aware of if your thoughts are, I'm sitting here talking to you, and if while I'm listening to you talk, my brain suddenly goes to something really stressful, worrying about it, perseverating on it, ruminating. If my thoughts are somewhere else and that somewhere else is scary, if I notice it, I can stop it and say, oh, nope, come back to present. I'm listening to you again. So that's what meditation can do for us, which is really helpful.

And then the isolation of it all. I think that one of the things that maybe has changed culturally, especially for younger people, I'm 54, I have a much longer percentage of my life, larger percentage of my life where I lived, engaging with the world, being out, inviting people over, being very social.

So this one to two year period of being socially isolated was a small percentage of my life. So I was ready to get back to being social again. But if you're a young person, if you're in junior high, high school or middle school, middle school, high school, college, they missed a significant percentage of their life and development. Things were supposed to have happened socially in those ages that didn't happen. So I think a lot of younger people still live more online, more socially isolated lives than perhaps they would have otherwise. And we know that social isolation isn't great for our mental health and our brain health. It's actually a risk factor for Alzheimer's if you're socially isolated. So we're meant to connect with each other. So meaningful connection is something that we want to seek out, especially if you're feeling depressed, if your mental health is feeling fragile, that if you can summon the strength to go reach out and be among other folks, it will be helpful.

Ryan DeVore
You mentioned that in your, I'll call it your menu of four best practices, just to remind the audience, if I get this right, seven to nine hours of sleep, a Mediterranean diet, exercise 30 minutes a day, even if it's a brisk walk. And then social networks. And so to your point of hopefully what the world hasn't given us in this five year exercise is the loneliness factor, right? Where folks are getting out of what might've been for a bit back into, as you say, the power of the social connections.

Lisa Genova
A book club, a community center, a class, a photography class, a pickleball.

Ryan DeVore
Learning something new, as you mentioned as well.

Lisa Genova
Yeah. If you can learn something new, exercise and be socially engaged, I mean, that's like a great, three for one.

Ryan DeVore
Trifecta. Final question for you. What makes you curious today? What inspires you?

Lisa Genova
Well, were just coming off of International Women's Day, I am inspired by women doing exciting and important things. I love other authors. I am excited to make some movies. I've gotten four of my books in development for film, so I'm trying to make some movies in the near future for the experience itself. It was really fun to do it with Still Alice. I'd love to do it again and for the wider reach and the bigger impact that those stories can have. The very story you shared with me at the beginning of this conversation of the ripple effect that these stories can have and helping folks understand and navigate these really difficult and scary life situations that people find themselves in. So I want to make more movies, but yeah, I'm inspired by, I am very lucky. I get to know a lot of really cool scientists and a lot of really brilliant authors as well. And just to be able to cheer on people who are doing good scientific research. It's just so strange to be in a world where people are ignoring or doubting science or confused about what are good practices in health. So being part of a group of folks who are out there trying to cut through all the noise and give folks evidence-based information to help them with their health. So I'm inspired by the physicians and scientists who are out there continuing to do their good work and educating the public with real information.

Ryan DeVore
Well, thank you for staying inspired. Thank you for the gifts that you bring the world, for the people that you're helping, the people you haven't met that you're helping. It does have an echo effect, and as I say, it's powerful. So thank you for your time today. Wonderful guest, Lisa Genova. Still Alice is the book that really brought us into the conversation today about Alzheimer's and dementia and memory loss. Other books include Left Neglected, Love Anthony and her recent book, More or Less Maddie. So again, thank you for spending your time with us today. It's been an honor to spend time with you.

Lisa Genova
Thank you so much. Thank you. It was fun. Thanks.