Free Your Mind With LKJ – Dr Ashok Jansari, Dementia & Menopause Part 2

Hello and welcome to this week's edition of Free Your Mind, Let's Talk About It with LKJ. As the listeners are aware, this is part 2 of the show, uh, regarding the brain, and I had the wonderful guest Ashok Jansari on last week who's going to continue this conversation. So for the listeners can see in depth now on this part about dementia, menopause, etc. That will all come on that. So we're going to go straight in and welcome Ashok. Hello, Ashok. Hello. Hello. Thank you for coming back on the show. It was a pleasure having you last week, and we covered so many different aspects and the nitty-gritty about, um, with the brain and stuff on there. And this is why this week we're going to go straight in We don't need to do the introductions again because people will know because it's part 2. So we go straight in and you take us on this journey of this hour with dementia and the brain and all, you know, the neuroscience of it, if you may. Okay, well, thank you very much for inviting me back. It's wonderful to be back. Okay, so one of my main areas of expertise is memory and also disorders of memory. Now when most people in the high street or at home think of a memory problem, the first word that comes to mind is dementia, and when people think of dementia, they usually think of Alzheimer's. Now the thing is that that's a slight misconception. Alzheimer's is a dementia, but it's one of the dementias, and a dementia is a degeneration of the brain. So it's a gradual deterioration because of, of a disease process that we don't understand, where different parts of the brain are dying away slowly. Now, there are a number of different types of dementia. Alzheimer's is the, is the one that's best known, but there's also frontotemporal dementia, vascular dementia, Louie Body dementia, Parkinson's dementia, etc. So dementia is an umbrella term. Alzheimer's happens to be the most famous one, but there are people who will have a dementia which is not Alzheimer's. The other thing is that people usually consider that dementia equals memory, and although it does for a number of the dementias, It's not necessarily the case that it does for all of them. It just so happens that with Alzheimer's, the most well-known dementia, memory is the biggest issue or the first sign. No, it's not the only problem in dementia, it's the first sign, and the reason for that is that memory is a very complex ability. So if I was to ask you what you did for your birthday last year, despite the lockdown thing, etc., you would try to conjure up a visual image of where you were, who you were with, what you talked about, what you ate, how you were feeling, and things like that. Now, each of those bits of the memory— the vision, the sound, who was there, what you were feeling, the location you were in— All of those bits are complex elements to your memory, and some people remember the sound better, some people remember the conversations better, some people remember the visuals better, etc., but they all add up to that soup of memory. Now, these different bits of memory, they're effectively processed in different parts of the brain, but a part that's really important is called the temporal lobes, and the temporal lobes are effectively the bits above your ears, and that— those areas are known to be memory central. And we know that in a number of the dementias, those areas, the temporal lobes, become affected by the disease process. And as a result of that, dementia attacks memory first. However, it's not just memory that it affects, it affects a number of other abilities as well. So that in Alzheimer's, for example, initially the signs are a bit of forgetfulness, like forgetting the conversation you had with someone earlier that day, or not knowing where your keys are, where you parked the car, and things like that. Then over time it will progress to bigger things like repeating the same conversation over and over again, or then forgetting that 'You went on holiday last year somewhere.' It then progresses to the problem becoming more complex, where face recognition, which is kind of memory but it's not memory, it's about the way we look at faces, can become compromised. So someone might think that their son is actually their husband, so they mistake one person for another. And then eventually, unfortunately, it reaches the point to the point where they don't even recognize their loved ones, they're just a stranger to them. And so what we see in the dementias just generally is this unfortunate fading away of the individual, and with memory being the very first signs, but then it's getting worse over time. Excuse me. Now, the thing about dementia is that it tends to come through in later life, so late 50s, 60s, 70s, etc. Now what we're seeing is that the rate of dementia diagnoses around the world is increasing a lot, so— excuse me— what we're seeing is that the proportion of people who are diagnosed with dementia in the world is increasing a lot. So for example, in 2015, about 47 million people in the world had been diagnosed with dementia. By 2050, that number is almost going to triple to 131 million people. So in just the space of 30 years, there's going to be a trebling of dementia in the world to 130 million people. In the UK, the statistics are similar where we're seeing a doubling or trebling of dementia cases. We're also seeing a huge cost to society because, of course, there's the care that's required for the individual with dementia. Then there's the loss of earnings for the family members who have to start taking time off work and things like that, or change their work patterns. To look after their loved one. So the cost to society is pretty big. So in 2015, the global cost of dementia was $818 billion. By 2018, it had risen to $1 trillion, and by 2030, it's predicted to rise to $2 trillion. So this is basically a healthcare epidemic. Now part of the reason for this is better healthcare, because thanks to better healthcare we're living to better lives. You know, our life expectancy today, wherever we are in the world, is better than it was 50, 100 years ago. So we're expected to live longer lives than our grandparents, for example. Now The reason that that affects dementia is that dementia only comes out later on in life. So if at that time, you know, in, let's say, the Elizabethan times in the 1600s or whenever, as a 50-year-old you probably had a good innings. 50 years was probably a good age to get to, whereas today 50 is just, you know, the beginning of life virtually. So if you get to 60, 70, etc., that means that the chances of the dementia showing itself increases. And that's why, because we're living to older years, the chances of the dementia expressing itself is coming out. Now, one of the problems globally is that the healthcare in the poorer countries thankfully is improving in sub-Saharan Africa, in parts of Asia, etc. And those are the countries where the proportion of people with dementia is, is increasing hugely. So effectively, we've got this time bomb waiting to go off. We're living to older ages, which is lovely, but that's allowing the ravages of old age to come through, such as dementia. At the moment, we don't understand dementia. We know it exists, but we don't know exactly what causes it, and there is no cure for it. So we don't have any medical way of treating dementia. So the only thing we can do is to try to understand it better. And so for a few years now, I've been working in this area to try to get better diagnosis of it, because one of the problems of with diagnosing dementia is how can you tell apart or differentiate dementia from just healthy aging. So my mother, bless her, she just turned 83 last week, she's a bit forgetful, but she doesn't have dementia. She's an 83-year-old woman who gets forgetful. Now, how can we differentiate between her forgetfulness and that of someone who's also forgetting, but whose forgetting is actually a dementia? So that is the conundrum we've got in neuropsychology, that we know that some people have got this forgetting, and we all forget. So you and I forget things all the time, and there's nothing wrong with forgetting. It's at what point does that forgetting become worrying enough that it might be the sign of a dementia or some other disorder, and that's where the problem lies— how to differentiate just general aging, and you know, we all forget things when we're tired or stressed, from this is a clinical condition. And currently, the tests for detecting dementia aren't very sensitive. So you'll have people who, who will go to a clinic, go to their GP, or eventually maybe even a neuropsychologist for assessment for this memory problem that they're developing, or their families are noticing they keep forgetting these things, they keep forgetting these things, this is not normal. They go to have the tests and the tests say there's nothing wrong with you, So what we have is this kind of awful conundrum where the individual is known to have a problem by the family, but the clinical tests aren't able to pick that up. And that's what I've been working on. So a number of years ago, I worked with a patient who had quite a severe memory problem. He, he was forgetting things very quickly and he and his wife had been around the world for their 25th wedding anniversary, and a couple of months later she was talking to him about when they were in Hawaii, and he claimed never to have been to Hawaii. Now that's a major bit of forgetting. I haven't been to Hawaii, but I imagine it's not that forgetful. Sorry, no, not at all. Yeah, Hawaii and the, you know, the Big Island, and you've got the set— you could understand if he was saying he forgot the smaller islands around, you know, in Hawaii, and not learn, but to actually forget completely. And claim that he'd never been there. Yeah. And so, but he went to the medics and they did tests with him and they gave him a clean bill of health and they said, there's nothing wrong with you. So there's this disconnect between what his wife and the rest of the family were noticing and what the medics were saying. And that's the problem with God, that the family know there's something wrong, but the clinical tests at the moment weren't good enough. So I started doing some work with this gentleman, and we demonstrated that he had a very significant memory problem, and that the problem was that the tests weren't sensitive enough. And we showed that within a day of him learning something, he was already significantly forgetting information. And in fact, I won the the CIRMAC Award from the International Neuropsychological Society for best research in memory disorders for this work, because of the way I was able to profile his memory and demonstrate that whilst on the face of it he looks completely normal, in fact he's got a major memory problem. And what we did then with this gentleman was to say, okay, we can see that he forgets a day later, but clinically that's not much use because for a clinician, they need to do a test today, do it now, see you in 1 hour, and do all of their assessments within 1 hour. They can't wait till tomorrow just because cost of healthcare, seeing you twice a day later, etc. So from that, we developed another test, and that test is the test that we now use. It's called— it's a bit of a mouthful— it's called the Verbal Associative Learning and Memory Test. But we've shortened that to ValMT. So ValMT is my test, and what we were able to demonstrate was that this man who passes the standard clinical tests that showed that he's okay has actually got a real memory problem. Then what we did next was we started using this test to look at healthy older people and comparing them to healthy younger people, and we saw that, of course, as you'd expect, younger people's memory is a bit better than older people's. But the interesting thing was that we found that within our healthy older people, some of them actually have got really good memories. They're just like young people. They look like their memory is that of a 25, 30-year-old. But some of the older people, they were forgetting very rapidly, very similar to my patient. So what we have is that within the healthy older population, people who don't have any clinical diagnosis yet, we have these two groups: one that is like young people in terms of their memory and hardly forget anything, and one that's actually got quite big memory problems and are forgetting very rapidly. And we started digging into this, and what we noticed is that those same people who were performing poorly on our tasks when we gave them tests where we actually just asked them, how good do you think your memory is on a scale of 1 to 7, where 1 is very good and 7 is very poor, we started finding that the same people who scored poorly on our test were the ones who complained about memory problems in their everyday lives. And we know that people who today start noticing that they've got little memory problems they in 4 or 5 years' time are at higher risk of some sort of cognitive impairment which can end up with dementia. So what we think we've got with mytastvalent is that we've got a preclinical signature that before the person starts showing obvious signs of dementia, we can already detect them. And if we're able to do that, to detect that someone might be on the travelator towards dementia, say 5 years before they actually develop it, then that's really important because we can provide support mechanisms for them. We can get them ready for the types of problems that may occur down the line. We could, maybe if there are drugs that come along that help kind of slow down the dementia, we could get people onto those drugs earlier if we already see that there's a problem beginning to happen. We can also help them educate, or rather, we can educate the family members about how to help your loved one who might at some point start having a memory problem. And then the final thing is that we're developing all the time forms of rehabilitation using aids such as mobile phones and other technological devices that can help someone store information so that when they forget it, it's on the mobile phone, etc. So if we can pick up a possible dementia 3, 4, 5 years before it actually starts becoming clinically obvious, we can put in those support mechanisms way earlier. We can give that person a better quality of life, we can get their family ready for what's going to happen,. And if our rehabilitation techniques are useful, we can support their poor memory. So that's why the work that we're doing is rather important, because it's not going to cure dementia, but if we can pick up and diagnose it earlier, we can provide support for these people. So at the moment, what we're doing is collecting as much data as possible with lots of people of different ages, because we need to see how people of different ages perform on our task, and we're looking to see how different variables such as your gender, your age, ethnicity, your education, etc., how each of these affects memory. And recently we've also been looking at a worrying thing called chronic traumatic encephalopathy, which is repeated head injuries through sports. Because there's been a growing understanding that young people, particularly males, who've engaged in a lot of contact sports like rugby, even football, American football certainly, they can end up with dementia quite early on in life. And the reason for that is that with contact sports where they're hitting their heads really regularly, what's happening is that you're getting very small amounts of brain damage every single time you hit your head. Now, none of those individual head injuries is going to cause concussion, but if you have, say, 20 years of playing football or rugby and every week you're having your head hit constantly, that's not good. And people tend to start playing sports at younger ages, you know, when we're children or adolescents. Now we know that the child's brain is still forming and it's still quite vulnerable, so effectively a child who's playing these contact sports is ending up with bits of small brain damage which may never get diagnosed. But what can happen is that at some point later on in life, if they end up playing sports to a fair degree, they can end up with significant dementia. And it was seen that in the 1966 England World Cup football winning team, 5 of the players ended up with dementia, and 4 of them, including Nobby Stiles, died because of dementia-related complications. Then in the 2003 England World Cup rugby— Rugby World Cup winning team, One of the players, Steve Thompson, he's now 42, I think, and he's, he's already been diagnosed with early onset dementia, and he can't even remember the most important game of his life. So what we're doing is trying to get an understanding of how playing sports can impact your brain, which can then impact your likelihood of dementia. So those are some of the things that we're doing. And then the latest thing which may be of interest to your listeners is that we're realizing— I think it's all— it's been known for a while that the menopause, or the perimenopause rather, has an impact on memory. So I have a lot of women friends who are in their 30s, largely the ones who are in their 40s who are getting to that point of the menopause, and they complain of their memory being a bit foggy-ish and being forgetful and things like that. And we know societally that the menopause isn't really treated seriously, or hasn't been treated seriously for a long time. It's been kind of pushed under the carpet at some level and people say, oh, she's just menopausal or whatever, and it's not really been given sufficient coverage. But now we're beginning to understand the impacts of these changes in the hormones that happen both at puberty and at the menopause, etc. And so what we're going to do is do a study where we're going to compare women of different ages, so women in their 20s, 30s, 40s, 50s, and 60s, to look at how memory changes as a function of where someone is in their menopausal cycle. Because before the perimenopause, we'd be expecting no memory problems. As a woman enters the perimenopause, that's when the little signs of memory problems might start showing. And then just before the point at which she officially hits the menopause, when the perimenopause is coming to an end, that's when we expect to see the biggest memory problems. And then once a woman starts, if she does start hormone replacement therapy or, or anything like that, and there's a balancing out of the hormonal system, we're expecting a kind of bounce back and an improvement in memory. So that's a really exciting new study, and there are societal implications of this type of work because, for example, if it's known that women are going to have these types of problems when they hit the perimenopause, then employers need to be aware of this because it's not the woman's fault that she might forget some things during that period. It's just part of her biology, and I think employment, HR and stuff like that needs to be aware of this, just in the same way that society has become aware of things like mental health problems or neurodiversity and how, in terms of employment law and things like that, people, companies have to be very inclusive for people who've got mental health problems or who are neurodiverse because they might have autism or dyspraxia or anything like that. I think it's important that organizations are also aware that, that there's, there's a point in, in a woman's cognitive life where there might be some lowering, but that's simply because of a phase of her life rather than because she's not good at her her work. So there are big implications of this work, and we're just about to start it. Yeah, that's very interesting, you know, when we, you know, discussing, you know, with dementia, the things that happen regarding sports, for instance, for young children going on. And we have seen change in the sporting world. You see people wear more head gear, don't you, when they are going to perform a sports activity. But when you actually look, I mean, NFL, there was a massive thing on with the American footballers because there was a lot of head contact in that, and a lot of people were suffering terribly through that. Again, with rugby, etc., you know, there are questions on the actual safety of the brain because, as you're saying, You know, each knock is a knock to the brain, you know, and the brain is, you know, would you class it as a soft muscle? Well, it's not a muscle because it's just a big tangle of nerves, but the way to think about it is that the brain is kind of like a jelly and it's in a very hard helmet, which is the skull. So you've got this, this kind of, let's say, quite a hard jelly that's moving around in this helmet, the skull, and if you move your head forward really quickly, what will happen is that that jelly is moving within that skull, and although you might be able to stop your head, the jelly still moves and it will hit the front of the skull. So you don't actually have to hit your head to end up with brain injury. This is why whiplash, for example, can cause significant problems. You don't have to hit your head on the windshield of a car to end up with subtle brain injury starting up. And when you think about the way with sports, you have people running really fast and then they might knock into someone and they decelerate really quickly, the head has stopped, that hard skull has stopped, but that jelly is still moving and it hits the front of the head and it can cause those problems. And, um, as you rightly said, there's a, a big thing in the NFL in the States when a Nigerian doctor noticed this rather odd thing where he was doing autopsies on the brains of men who I think in their 40s who'd been acting really strangely, that their, their behavior had changed enormously over the last couple of years and they've become really aggressive, etc. And he looked at their brains and they looked like the brains of 8-year-olds, and he thought, no, these guys are in their 40s and yet their brains look like those of 8-year-olds. And then he noticed this pattern that a number of times when he saw this, these were the brains of people who played semi— either professional or semi-professional football. And that's where our understanding that these small head knocks are causing what are called small micro-lesions. A lesion is any area of damage, and each little knock is causing a small lesion. Now One small lesion is okay, but if you're having that constantly over, you know, 20 years from the age of 10 years old, then that adds up to a lot. And the result was a massive lawsuit where the players union sued the NFL in the States because they're finding that one in three of their players are eventually getting some form of dementia. And there are, I think, Nobby Stiles' son Peter Stiles has been trying to campaign for the FA to take this a bit more seriously because of what happened to his father. So there are serious implications here, and of course we don't want to stop people playing these sports because sports are great for various different reasons. We just want awareness so that things can change in terms of safety, etc. And so I think even things like in Scotland they've changed the rules for football at school so that heading the ball is no longer allowed, that's a foul now, and I think in touch rugby some of the rules have changed to try to reduce the number of collisions and things like that. So I think it's about just trying to get to a point where we continue these enjoyable pastimes but in as safe a way as possible because we know that they can cause physical damage, but now we're beginning to realize that the cognitive damage can actually be much more serious. That's something that surprised me, why they— one of my questions to you with the experience that you have is, well, why don't they stop this sport? You know, because if you smoke cigarettes, you know, the risk is of cancer and all the the problems that come with smoking. And like, we've had— I think it's New Zealand— stopped all youngsters ever being able to have to smoke. They've got a complete ban on it. I'm sure it was New Zealand, um, I saw that. So like with football, you know, where they're encouraging girls to play, um, sport in these fields, uh, as well as men who are meant to be tough, strong, going on it. But the brain is still the same. Whether you're a man or female, you've still got this jelly, as you're saying, that goes around. Why don't they just stop that? I think that's a really, really, really good question there. I think part of it, unfortunately, is that you have different lobbies going on, because whilst we can say we think that there's something not very good here and potentially dangerous and sensible people wouldn't allow this. There's also a group that would say, hang on, how do you know for certain? And just as we've seen with, you know, people who did deny COVID or deny the vaccine is any use, etc., you've just got to plant a tiny bit of doubt in people's minds. And those who have already decided that they don't want to give up this sport or the smoking or whatever they'll start looking for any evidence that goes along with their incorrect belief, and that's human nature. Unfortunately, we look for evidence that goes along with our belief, so we'll have people who'll say, 'No, I love my football, there's nothing wrong with it, I've been playing football all my life and I don't have dementia, and I'm going to let my son play it.' Now, what that person is doing is saying, well, they're okay and therefore everyone else is going to be okay, and they're only looking for evidence that goes along with what suits them. The other thing, of course, and I think the smoking example is a really good analogy, is the money involved. Because the money involved in the smoking industry was so massive that it took, I think, a couple of decades for the people on the health side of things to convince governments to accept that smoking causes cancer, because the smoking lobby, which is making so much money out of the advertising and the making and selling of cigarettes, they wanted to find any way they could to make sure that they could discredit any possible ideas about cancer being caused by smoking. So what we have is that on the face of it, something that we now know is an incontrovertible fact, but which at the time there were enough strong parties who were willing to use whatever means they could to keep going. And I think that that's the problem that we will have with sports, because sports has all sorts of implications in society. You know, we have the the nationalism that goes with sports, we've got the massive advertising contracts for the football, the rugby, etc., etc. So if we try to say you shouldn't be doing that, those advertisers suddenly don't have something to advertise through, because if there isn't a football match, you can't advertise your cars and all your other goodies during the breaks. So I think that we're going to face quite a lobby here because it's not just the— I mean, it's cynical to say this, but I think it's the truth that for some of these people, the health of the 22 people who are running around on the football field is not actually the important thing. It's the money that this whole spectacle is bringing in. Yes, I totally agree with you with that because this was something, you know, as we were talking about NFL they were dismissing so much. And, you know, some of the players were going and acting in a wrong behavior. They were using that— they were too, you know, the wealth and everything that they'd had, and they were probably drinking or taking something else. They tried to, uh, kaiwash anything on it because of the merchandise, like you're saying, is so great with cigarettes. You know, it took a long time for Nan, for them to actually take where they can advertise and gloss this packet of cigarettes up, that's so shiny on the shelf, or which one can I have, like a sweet treat that's now behind shutters. And the actual president now is on the warning, these awful pictures they put on there. That person will still smoke that cigarette irrespective of that that's on it until they've told themselves or had I believe that's my own personal opinion, um, unless they have something happen to them directly or someone very close and dies of cancer, you know, relating to smoking, etc., while they're doing it. And like you were saying with the health authorities, it has taken a long time for people to say, you know, you can't be doing this, it's costing more for the NHS from smoking. So it's easier for these, you know, if they can go to the doctor's, um, to help quit, and people help to do that to help themselves. But do you think, you know, does smoking have any cause towards dementia with the memory? Have you seen any signs of that? I don't think I have seen anything myself. I know that with alcohol it can, but the smoking, I'm not sure. The thing I know that alcohol can, it does do something and can kill off some of the neurons, can't it? Damages them. So with people that do drink a lot, you know, who become alcoholics, they're actually killing part of their brain by this consistent drinking. It's why with their memories going, etc., you can see that that alcohol really does damage inside. So when people are going on, there is something else, you know, when they're looking at memory and you're going for assessment, is why the the doctor will ask you, do you smoke? Do you drink? How much do you drink? You know, etc. Like, if you fell, did you have alcohol when you fell? Because if you do fall and you've got alcohol in you, you tend to fall very differently, don't you, than without that. It masks it. And then you see this other damage. This is why somebody's been drinking, has a fall, and they've tapped their head, they can't remember. That they could have a really severe BTI, can't they, brain trauma injury, after that comes out, that the sickness comes out, the concussion and collapse. Because obviously, as you said, the jelly's inside this hard skull that's hit, you know, the forefront or something, banged your head, and then to settle back down. And then you've got, is it ducats in the brain where fluid can build up? So that jelly goes into those little areas and starts filling up. Yeah, I think the thing with the nicotine is that it's probably having an impact at some level. It's complex to tell, and that's why we need more research. And in fact, just today I was looking at the study that we're about to start on the menopause, and we are going to be asking questions about alcohol and cigarette intake. And we do these things just as in case if when we get all of the data we can look at it in terms of the age of people or the gender of people or how much they've smoked or how much they've drunk. So we can keep separating it out depending on, on the different variables just to see in case there's an impact there. Of course, with the menopause study, the big thing will be the age of the females are taking part and what what point they're at in their perimenopause, and also what type of HRT they're taking, because apparently there are two different, at least two different types, and depending on which type they're taking, there might be different effects. So because no one has done this before, for us it's quite exciting because the thing that we have with MyTest Valentin is that it's picking up subtle problems. Now the reason that that's important is that if someone's got a really obvious problem, you don't need to be a clinician to know that they've got a problem. You just need, you can say, oh look, that person's got a problem. But when something is a subtle problem, it gets masked very easily and it can be missed. And then what you can get is that this person can end up with problems later on that are completely missed because someone didn't realize that they had a memory problem. And I've worked— my career has effectively been with these people who've got subtle problems that are being missed by the standard testing. And this is why researchers always needed to push the boundaries forward and forward so that anything that today we're not sure of, if we do more research on in 10 years' time, we'll have a better idea. So we'll say, oh, on the first signs of that, it's because of this type of epilepsy or that type of degenerative disorder, or because this person has got the autistic spectrum disorder, etc. So, so the problems that, that we're seeing and that women will be experiencing during that perimenopause, they're not going to be big enough to be detected by the current clinical test because the current clinical tests are really designed for major memory problems. Now the issue becomes there that it's almost like the woman is being told, no, you don't have a memory problem, whereas I would reframe that and say, your memory problem can't be detected by our tests That, that is what we should always say. We should— we shouldn't tell the person that they don't have the problem that they, they feel that they've got. We should just say that according to the test that we've got at the moment, we can't detect it. And so I'm hoping that with ValMT, we might be able to give women a way of understanding any weakening that's happening during the perimenopause, which might then drive further research and possibly even, you know, public understanding of memory changes that happen during that as a woman moves into her menopause and beyond. Yeah, obviously, you know, when we are addressing the menopause for, you know, for the females, you know, that we all have to go through this journey, some earlier, some later, and, you know, this can last for years as you're trying to go through. Some people have forced menopause when they're having their ovaries removed, for instance. Yeah, yeah. For that, like myself, at the age of 25, I had a TAHBSI, I think, a total abdominal hysterectomy bilateral something. Oops, you know, you doctors know these long words. Why they do them so long, I don't know. Um, I said much better as they're abbreviated in those things that you know and can tell me. And immediately after I had the hysterectomy and the ovaries removed, I was put on to HRT. They said I could only go on this for 5 years. I can't remember the drug they put on. It's quite a few years ago now. And, you know, they said because I'd be suffering from hot sweats. They never said I would suffer with memory problems. Or anything like that. But I can honestly say I noticed myself having forced, uh, early menopause, that there was memory problems there where I found, you know, I have a very photographic memory, which is strange. I, you know, I can look at something, but it's in there. But then things that I've done, you know, yes, I think, what the hell was done with that? I have to write it down now. So I've got all these sticky notes everywhere And something else that I found that, you know, people, you know, when you have PAs or anything when you're working, would be like, here's this for you, here's that, that, that, and that. And then I think, well, there's my cup, I'm just going to put that there, and somebody's moved that. I found that very, very difficult going through those 5 years. As I say, I can't find it. It wasn't helping my memory. I was like, am I going if I'm losing my memory with that. Because I'd be like, well, don't, don't do this for me. Let me put it away. Let me do that. Because then I have to think whether— what I've done with that. And, um, I came off— I went to the doctor about it. I said, you know, my memory's shot with this. So he took me off the HRT. And they said— and also because my grandmother had, uh, breast problems. They said the risk was quite high at that time to get breast cancer. So they believe for taking me off and going cold turkey, actually, is the only way I can explain that horrible time of, you know, I think I was 27 at the time, going through that, the hot sweats where you just couldn't breathe, coming over your memory, everything. And to get some stability until you've gone past that, that actually my memory's improved since going through that. And I thought, well, is it because I know, you know, that please don't put stuff away from me, I have to do it myself? Because is it, uh, don't use it, lose it? I think if everybody does anything for you, stop using, stop writing with your hand, etc. So I did find the menopause very, very difficult and going through with that And you know, you're questioning that because thinking, is that a sign of that? So you know, for my age as a woman at that age, which was forced, which obviously as a doctor you'll be looking at, there's other people, you know, got in earlier than normally going through the menopause. The average age is what, mid-40s, isn't it? Mid-40s or so. So for you to have to go through that, if when you're basically a young woman, 20 years before, that's horrendous. I think there's a couple of really important points that you made. One about the fact that you wanted to find the things and put them away, etc., and other people were trying to help you. In a way, that highlights a really important aspect of memory, which is that it allows us to have an independence and be ourselves. Whereas when we lose it, or people think we've lost it, they take over and we start losing our independence. So I think that your little example there, it gives us a really important window into how important and vital memory is for our sense of who we are and allowing us to be individual beings. And then the point you made, the use it or lose it, that's such a good one. I mean, 25, 30 years ago when I was doing my PhD, we were talking about it then. And there's research that's shown that people who keep themselves active cognitively— doing crosswords, doing, you know, stuff, etc.— they are less at risk of dementia and things like that. So I think it's a really important point you made, that if we see a lessening of a particular skill, whether it's, you know, a physical skill or an emotional skill or a cognitive skill, I think making sure that we don't let it go is really important because we can still keep practicing it. It might be getting weaker, but we shouldn't just say, "Oh, I'm no good at that anymore." And I think we should help those who are showing signs of deterioration in some of these things to support them rather than take over that skill. It's because you can kill with kindness. Yes, a very powerful statement. Kill with kindness. Because if you're the housewife and you're at home, your husband comes in, you, you know, you've done it. You like to think, you know, you've got more time on your hands, your children have flown the nest, so you think, oh, I'll put his shoes here, I'll get his clothes out. You start taking over that person's mind. They do less. So it's all done for them. So you stop using it and, you know, then all of a sudden they think, oh, you know, I'm aching now, you know, because they're not walking so much because you've walked the dog for them. So they come in, they sit in their chair, you know, they don't get up and they're not so active. So then you find, oh, hang on, I'll help you with your, your shoes, I'll help you put your socks on. In actual fact, make them sit on a higher chair and, and put the sock on. Because you're going to lose that. Yeah. And, you know, when people then say, you know, you've got somebody who's an intelligent person who works in a bank, the bank manager has been a headmaster, and people run around in the end start doing everything for them, you know, laying out like we're saying, like with the PA bringing the coffee, that they stop doing anything, that you see these problems. And so when you hear people having a go, I can't believe my car's like that. He was a headmaster of a but because he stopped doing that and then would come home and retiring, and perhaps why I think I've got to do this, I'll do that for him. You know, he's retired now, he's worked. You're actually not helping. Like you said, if you are retiring as a headmaster from a bank, do the crosswords, do this stuff every day. So, you know, even if you're doing one puzzle in the morning, one puzzle in the afternoon, you're keeping it alive, you know, with your diet and walking, you you know, to stimulate the body. You, you know, how many people do you see, um, and you hear that, that somebody's retired and they died a couple of years later because they said, oh, welcome to retirement, I'm not doing anything. And they think that's a luxury. I think, oh, you know, I don't have to get up in the morning. But you lose a sense of purpose as well. Oh, quite, quite. And, and I think I'm going back to, um, let's say if women are during the perimenopause, their memory is becoming weak. I think if we can understand that it's simply because of where they are in their levels of estrogen and that this is going to bounce back up again, I think that's really powerful. Because if we were to stupidly think, oh look, she's going into her menopause and her memory is going to get worse and worse and worse, we might start treating the woman as, oh, she's going to get so forgetful, there's no point in giving her blah blah blah. Whereas if we think of this as a temporary period during which her memory will be weaker but it will bounce back and improve, then the way we see her is different. And also, knowledge is power, isn't it? If women know that during this, you know, difficult period when the hot flushes start, blah, blah, blah, etc., and that also their memory might start getting a bit dodgy, but forewarned is forearmed. They don't think, oh, I'm going mad, I'm going senile, I'm losing my marbles, etc., because I think just knowing that this is something that is par for the course, it's going to happen to me, it is going to be okay, don't freak out about it. That itself, I think, is really powerful information. Yes, completely. So you do— when we're looking at menopause now, when, you know, for the female that's got to go through this, um, you know, with, with menopause, which is very, very difficult for somebody to go through and not to be taken lightly. A lot of ladies may say, oh, I sailed through it, and another person suffers. You know, is that down to the human body or is that down to the brain? Which individuality of the genes that make up people? Why some people can sail through it and some people don't? I, I think as with many of the questions of our existence, it's probably a bit of both. There'll be, there'll be genetic differences whereby some people their, um, the way that their estrogen levels change, etc., would be pretty straightforward. They're not going to have a big, uh, impact on it. Others will have it more complex. So I've never had a baby, but, uh, but you hear of those women who say, yeah, labor was really easy and I had the child and I was fine within a day, etc. Others who talk about, oh my God, it was so bloody difficult. And yeah, that will be, you know, those two stories. And you think they went through the same process, they both gestated for about 9 months, and then one of them just popped it out and the other one found it really difficult. So part of that is going to be physical size, is the way that their, their blood system and hormonal systems work, etc. But then I think in terms of how we react to things, I think that there are lifestyle issues and then there's also the way our attitude towards things. So I'm the type of person who doesn't like getting things wrong, and if I get something wrong, I want to try to get it right later on. And I think through life there's been that struggle of not wanting to beat myself up about being rubbish at something and accepting that, you know, I might be really good at some things and a bit more rubbish at other things and just accepting that. But then also say, just because I'm not great at X doesn't mean I should never try X. And I think that that's where a really important thing lies. So for example, during lockdown, because I like cooking for others, but I didn't used to like cooking for myself. It was a bit boring, so I'd make the effort when I invited people around for dinner. That's when I'd, you know, try out a new recipe, etc., etc. And then of course during lockdown I wasn't allowed to have people over for dinner, so either I continued with the same boring food every day or I decided I was going to have a dinner party for myself. And guess what? I really got into cooking to the point where I was making things I'd never tried. I'm now, you know, pretty expert sourdough bread maker and Irish stew maker and lasagna maker, etc. Now, if I'd always kind of said, oh, I'm not that great at cooking, I'd never have given those things a go. And I think that part of that is a personality thing. So I think depending on someone's personality they will take on challenges or impairments or difficulties in different ways. And we see this actually in the brain damage world, that the way that some patients recover after a traumatic brain injury can at some levels be predicted by their type of personality beforehand. So pre-morbid personality, which is what we refer to as what the person's personality was like before the awful trauma can be a good guide to how they'll cope. Because if they were a kind of quite positive person who had a, okay, we're going to sort this out kind of mentality, then they would— of course they'd feel really bloody pissed off that— sorry for swearing— but they'd be a bit annoyed that nature had given them this stroke or whatever, but they'd find a way through it and they'd keep pushing forward, whereas someone who had a more negative attitude towards life would be less likely to push through and keep trying to get better, etc. So I think that the, the way we respond to any difficulties at least partly is our biology, and we can't, we can't change that. People have different biologies, but part of it is also us as human beings and our personalities, our upbringing, the way that we've, we've learned to cope with different things. So I think it's, it's a bit of both. So do you believe then, um, as we, you know, shortly coming to a close of this, do you believe that if you're more of a positive person that may enable you to be less likely to get dementia than somebody that is in the negative side. Because the positive person will be pushing more, even if they retire, they want to carry on doing, where are you lending more to the negative side that say, no, I've done my work, I've finished it, you know, I retire at say 67 now, they've changed rules, haven't they? I retire then, that's it, I've done all my work, this is what I'm going to do. On the balance of things, would you say the less positive person would be more likely to get dementia, or is it really basically on damage? I think that the dementia is more likely to be their biology anyway, and you can't change that, but I think the way that they respond to it would be different. So the person who's more positive will, you know, think that this sucks, but they'd find ways to improve it. So, you know, the way Terry Pratchett, you know, very famously, very publicly fought the semantic dementia that he had, his attitude was, this sucks, but I'm going to do my best to keep going. And I think that's where the biology had got him. You know, he couldn't change the fact that in his biological makeup this horrible thing was lying dormant. And, you know, it came to the fore. But because of his attitude, he was able to keep going rather than just kind of, okay, I've got dementia, I'm going to stop. So I think that's that's where the difference will lie. If you've got the genes or the biological propensity for something, you can't stop that coming out. But I think your reaction to it can be different. And then the reaction to it may have an impact on, you know, how it stretches itself out and the impact of it. Because the strategies that are developed for helping people with any type of cognitive disorder they require effort. Now the positive person is likely to put more effort into it than the person who's negative and who has a 'I can't see the point of it' attitude. So I think that that's where the attitude of someone will have a profound impact. Yes, and one other question just quickly: is it more likely that a male or a female who is more likely to get dementia? I can't remember the statistics on that, but I think that there is a gender imbalance, but I can't remember which way around it is. I feel a bit ashamed to say that because we haven't worked with people with dementia yet, we're working with people who might end up with dementia, but I think that there is a gender imbalance and It may, it may be part of the hormonal thing. Well, so that's something we will probably have you back on the show, you know, sometime next year because we'll be wanting to look at, um, you know, how these things are going and changes that are coming with that. Yes, it has been a pleasure. Um, and we are unfortunately done another hour. Ashok, uh, I mean, fantastic. Um, you know, chatting and that with this. But we will be back to cover it. But it was great to cover the menopause and the in-depth stuff on that. So unfortunately, for now, for the listeners, we have to say goodbye to Ashok, who will be back on the show next year. But for me and everybody at, um, womensradiostation.com, thank you, Ashok Jansari. And for me, thank you very much and goodbye.