Free Your Mind With LKJ – Dr Ashok Jansari, Neuropsychology Part 1

Hello and welcome to Free Your Mind, Let's Talk About It with LKJ. As most of the listeners have been listening to the current shows over the last 5 weeks, you know, talking in depth into dementia, Parkinson's, Alzheimer's, etc., and we've had an array of wonderful guests on the show showing their own perspective and meaning to bring a highlight to this disease that destroys the neurons in the mind. And as I was saying, after speaking with Diane Gill last week, we were going to finish in the finale of this section of Parkinson's with a wonderful neuroscience doctor. So on this week's show, Dr. Ashok Jhansari has been working in the field of neuropsychology for over 30 years. He studied— excuse me— he studied experimental psychology at King's College Cambridge, falling in love with neuropsychology through his undergraduate work with Rosalind McCarthy. He followed this with a doctorate in autobiographical memory at the University of Sussex, where where he was supervised by Professor Alan Parkin. So I'm going to bring him straight in to conclude on his bio, which is very, very extensive, and welcome this wonderful gentleman that I have had the pleasure to cross my paths and personally, you know, spoken with him at the Mojo Dementia launch, um, where, you know, we had a wonderful evening. So if I may bring you in, uh, Dr. Jan, sorry, welcome to Free Your Mind with LKJ. Sorry about that, uh, introduction there, you know, this— it's a huge bio there on yourself with a mastermind, I must say. So for all the listeners of this radio show, they, you know, when you read and tell us your bio yourself, I think there will be better to come from your, your expression rather than my own. So can you introduce yourself and who you are to all the listeners today? Hello, thank you very much for the introduction and for inviting me today. I'm very excited to speak to you. Yes, I am a neuropsychologist. I did my degree at King's College in Cambridge with this amazing woman called Rosalind McCarthy, who really lit something in my mind about why we study people with brain damage. And before I studied that, I was really flailing. I didn't know what I wanted to do. I didn't even know what psychology was, really. And this incredibly energetic woman jumped onto stage in my second year and was talking about brain damage, and I thought that that meant talking about people who were in hospital beds, horizontal, with tubes coming out of their heads and arms, and who, you know, had very little in their lives. And she started telling us about people who could tell you what happened 20 years ago, but not what happened 20 minutes ago. And I thought, that's a bit odd. I thought 20 minutes ago would be easier to remember. She told us about people who could tell you what helicopter was, but a little furry animal that walked up to you and said meow, they couldn't tell you that that was a cat. And I thought, what's this? And so she opened my eyes to this incredible world of studying brain damage where people physically look okay but who've got cognitive problems, and the cognitive problems are to do with memory, visual recognition, facial recognition, etc. And basically what we as cognitive neuropsychologists do is to study these individuals who have effectively what I'd call a hidden disability to try to understand how you and I function So by studying someone with amnesia or a memory problem, we understand something about how our memory works. By studying someone who's had a stroke, who can't speak properly now because of the stroke, we get an understanding of how our own language works. So we use people with a damaged system through brain damage as a mirror onto how we function to understand ourselves. Then that actually helps us work out ways of diagnosing and assessing future generations of patients as we develop better understanding of our own abilities. And then finally, the third area is rehabilitation. So as we understand the abilities and the difficulties of our patients, we start working out ways that we can actually help them. So effectively, this field of cognitive neuropsychology, which I am very proud to say is a British invention, it was created created in Britain by a group of neuropsychologists gives us 3 things. It gives us a window onto ourselves. It gives us a way to help people with brain damage, to diagnose and assess them. And then finally, rehabilitation. So having turned on that light in my head 34 years ago or so, I then specialized in that, came down to Sussex. I live in Brighton, wonderful Brighton, to do my PhD with a man who was a world leader in the field of biographical memory, which is how we remember things from our personal past. And that was an interesting time. Then I went to the States to work with a man called Antonio Damasio, who's one of the most important neuroscientists in the world. And he wrote a best-selling popular science book called Descartes' Error, and many others since then. But Descartes' Error was what put him on the map. And In Descartes' area, he talks about the fact that whereas following the Enlightenment we were, we were beginning to think that we're very rational beings, and Descartes famously said, um, I think therefore I am, there was a sense that our emotions weren't really important and that our emotions are effectively an evolutionary throwback. But what Antonio Damasio showed was that in fact our decision-making, the way we guide ourselves in the world, is actually guided by our emotions. It's just that that emotional understanding we have is almost unconscious. But from a very elegant series of studies with patients with certain types of brain damage, he was able to show that people who've lost the emotional connection to their decision-making end up making really big errors in everyday life. They make mistakes, they make financial decisions that make them lose all of their money, um, they can't decide basically how to get through life. So that was a very formative time for me, getting close to working with patients like that. And then subsequently I came back to the UK 22 years ago And since then I've been developing my own career as a research neuropsychologist and as a university lecturer and as a public commentator. So I, I talk to the general public about my research. I've got a YouTube channel on which I post my videos of public talks I give. I pop up on TV like the One Show every now and then discussing things. And I guess In a way, that's what brought me to meeting you, because of my interest in connecting with the general public about what it is that we're understanding about the brain and how we can get people involved in the research that we do. Yes, and it was wonderful, as I say, when I met you. And you know, you're— and you tell it so clearly, you know, for somebody, because you know, when you look at what you study, you know, with the brain, everything, you know, that's in there, it is a complicated complicated matter for myself. You know, when we was having this conversation, I explained to you some of the reasons that my speech that may go sometimes when interviewing and a little bit of dyslexia, because I had meningitis when I was 5, as I told you, that then formed into narcolepsy with cataplexy. And I'm quite one of those unique persons because I've also got epilepsy, but with Todd's paresis. So that's very, very wide spectrum, and it's very rare to have two neurological problems like that. And because obviously medication, etc., some of the medication I have to take to enable me to function and be able to do the stuff that I do, as you said, you know, has come back to the meningitis. And also there's over 11 different neurologists that work with my brain because obviously there's all different parts of that. And one of the things that, you know, when we did meet, is one of my fears is, you know, when you do become a little bit forgetful, you're confused. Now, is that the medication? Is that modafinil they give me, or is it the zonzamide they're giving me? You know, because drugs can make your mind go with that. And then obviously with studying and looking at dementia myself, thinking, you know, 1 in 3 of us are going to get this. So I was thinking, am I more likely than the other 2 with me to get it because of having that? And something that I said to the listeners last week, that there's this test that you can do. And I did say, I'm going to take your test because, you know, there is a test that you have devised. We'll come back to that on it. But just to see, to be aware before, you know, because it is a massive thing. We, you know, we all take control of our lives. And even no matter what, you know, people brain damaged, etc., people with hidden disabilities. And what you said is, it is hidden because people can look at even my photographs and say, 'Oh, there's nothing at all wrong.' But when these things happen, you know, they don't see that because we've learned how to control them and have people around us that look after us in those situations and to make us feel worthy, that we all have that right to continue. And I'm very grateful for the support that I have. As you see, we've been able to do that. I'm very honest about that, but it is frustrating that people can judge a book by a cover. And, you know, why don't you just open that book and ask and, and delve and see, um, that there are issues in that, in there, you know. And, and, you know, that is the disability inequality. But that's something that you saw straight away and I'm very proud and very grateful for that. And just in 5 minutes of talking to you, your reassurance to me and saying, you know, take this test, etc., you knew exactly from the injury to my brain and all the damage was from meningitis. I've been seeing, you know, neurologists constantly, you know, but now I'm able to work in a free society to help other people. And like, your voice is about helping other people. If I can sit in my chair here and help people and give that love, we have that right. And it's great to unite people. And that's when we talk on Free Your Mind. Let's Talk About It with LKJ is about empowering, encouraging, teaching, and we can all take something and learn from that. And Ever since I've had that wonderful evening with yourself there and watched you mingle through the room with Diane and with Sasha, etc., the passion that you express, and a very humble man, as you said, you for yourself, you know, for, for the listeners that will be listening to this show, this isn't some Eton young gentleman that's, you know, gone to Eton, growing up through that and gone through, which a lot of people like with disability or hidden disability will naturally have a forefront on something which is completely wrong. Now, you were telling me you was an immigrant, did you say? Yes, yeah. When you came over. My family moved here from Kenya in 1974 when there was a lot of racial tension in East Africa towards Indians and lots of Indians moved from Uganda and Kenya to the UK. So I was 7 when we moved here in 1974, so grew up in London. And it was a tough time. There was, I think, recession going on, there were strikes, etc. And as, as we've seen through history, when, when there are difficulties in a society, the new people tend to be the ones who are blamed. So it's a time of racism, etc. And we were a very poor family, so it was a tough time. But, you know, thanks to the education system, I was fortunate enough to get the grades to get into Cambridge, and that changed my my life, which is a reason that I'm always trying to empower my students, that it doesn't matter where you come from as long as you use what's in front of you to try to better your life. And, and those possibilities are there. And at least in, in our country, even though students now have to pay for an education, it's not as difficult as it is in some other countries. So I'm all about empowerment, and in a way I move that into my work with my patients. I don't work clinically with people. I do, I I do research with them, but I still try to give a sense that brain damage or brain dysfunction doesn't necessarily mean that you can't do things. As with anything in life, knowing our abilities and knowing our limitations then allows us to understand what is possible. And I think that as long as we're aware of both our abilities and our limitations, then it's possible to move forward. Do you find it, as you know we're talking quite openly at the moment, to build a big picture on it, do you get cross when people look at somebody because of a disability that they can't see? Does that frustrate you? I think it does because in a way, you know, this isn't to say anything against other forms of physical disability but other Physical disabilities are easier to see, you know, wheelchair or a guide dog, etc., etc. And of course, those people completely deserve the support and aid that they're getting from society. But because of the complexity of the brain, it's possible to be fully upright, mobile, breathing fine, being able to talk, etc., etc., and yet have major problems. And it's really difficult for people to understand that that's possible, that someone who is upright, mobile, and articulate has got a major dysfunction. The case study in this book, Descartes' Error, that I was talking about was a man who was the accountant for a company, and he had a massive tumor growing in the front of his brain. And they tried everything they could to remove that tumor with— or kill the tumor through drugs, radiotherapy, etc. And the tumor just was wasn't shifting. So they had to do what is always the last resort, which is surgery. And they did surgery to remove the tumor, and they saved his life, which is great. But within 2 years of removing that tumor, this man had lost his job, become bankrupt, divorced, married again, divorced again, and his whole life was a complete mess. And yet 2 years before, he was running the finances for a company. So what's going on there? I was fortunate enough to work with him when I was working with DiMaggio 20-something years ago, and the man is highly articulate. He's got an IQ of something like 135. He could charm the birds out of the trees, and sitting with him, talking to him, you would never know that there was anything wrong with him. And yet this man is incapable of making a decision. There's a description of him taking 5 hours to decide where to go for dinner. Now, this is a man who used to run the finances for a company, and yet now he can't even decide where to go to eat. And as a result of that, he can't live independently, because living independently involves making decisions, organizing yourself, remembering to do things, etc. And so what we see with someone like him is this stark example of someone who on paper in terms of his IQ, his abilities, etc., and even in person when you talk to him, sounds incredibly articulate and able, and yet in an everyday setting, which is what life is, getting about, doing things, planning your day tomorrow, etc., etc., he can't cope. So we've got a very hidden disability there, and we start seeing that when we look at even people in society. So Terry Pratchett, the famous novelist who had that very public battle with dementia, he started talking very eloquently about what was happening to his brain. And this man was now forgetting the words that he himself had made up in— for his Discworld series. But looking at him physically, you couldn't see that disability. And I think that that's the thing that I want people to understand, that just because someone looks and sounds physically okay, they can have a major disability. And what I do in my research, and particularly my teaching, is demonstrate that using all the different cognitive abilities— and the cognitive abilities are our mental abilities— and so the main ones are our memory, our language, our visual recognition, because we need visual recognition to decide what to eat and what not to eat, etc. Face recognition because we're a social species, our numerical abilities because we need that to make decisions, and then finally our ability to make decisions and plan things. All of those are known as the cognitive abilities. And what I show my students is that when one of these abilities is damaged through some sort of brain damage, it has huge consequences on one's life. So one of my patients, David, And he is an architect who— successful wife, two children. At about the age of 50, he suffered rather prematurely some sort of heart attack, and he stopped breathing. He was found not breathing, and eventually the paramedics managed to shock him back to life, but the amount of time that he was under caused brain damage because with the heart not pumping blood to the brain, very important areas of the brain that need oxygen to survive and who— which if you don't— if they don't get oxygen within a couple of minutes, they will die. These parts died, and now David is left still very articulate and he can still do his work, but he'll walk past his daughters or his wife in the street if he isn't expecting to see them. Now So initially that sounds a bit funny, but it also does mean that it's quite a devastating disability because we have such emotional responses when we see our loved ones, and we know that because we're a social species. And David has to work out, oh, that must be my wife, and then get the emotional response that most people would get from seeing their partner. So that's what I do. I try to demonstrate that just because this person is is upright, mobile, and articulate. It doesn't mean that they don't have a really severe difficulty, and in some cases the difficulty that they've got actually impairs them more than if they had a physical disability. Yes, I think it does, because people do prejudge. And what's been happening now, which I think is a disability— or not all disabilities are, you know, prominent, they are hidden.. And for people to see that, you know, if they've got a blue badge, they're pulling in and they get out, they just say, well, how come you've got— you know, and you see, I've come across these arguments, you know, in the car park, saying, why have you got that? And people shouldn't have to explain to another person what that is, because actually that is not correct, you know, to come and approach somebody. You may see somebody in that parking space, if they have a blue badge, They have that for a reason. And whether they can get out— some people can get out and walk not very far, but with the brain, what people have to understand, and all listeners to this show, is if you see somebody getting out of that vehicle in a disabled, nudging your friend thinking, 'I don't know why he's got that, he's ripping off the state,' because you hear those things, don't you? They're faking it or stuff with that. They have to go through a lot of, um, consultants, everybody have to look at somebody to be given a badge to say you have a disability and proven with X and more intensely now and obviously with stuff with the brain that they don't just have that badge for the sake of it, they have that badge but every one of those people have that badge would love to be in your position where, you know, I can go and walk and park there. Please don't. It's like having a stamp on you, and that also affects you because, you know, if you say anything, people think you're just being touchy, you know, or going on. But you cannot discriminate, and it is discrimination, and that leads on to mental health problems. Then people don't want to go out, do they, Dr. Sazari? Because they think, if I go out, you know, they get knocked, and they're going to recognize people, are they going to not like David, you know, they— the encouragement and work from personal assistants, everyone there, the encouragement to say, come on, get up. But they can be very easily knocked back. And then a small knock with somebody that's got brain damage, you know, through epilepsy, through anything, it can knock them and their morale and everything that comes through. So people like yourselves that work in this science are trying to understand what goes wrong. And with— because the emotional part plays as much as the mental part, does it, as you're saying? Absolutely, yes. Because part of that thing about being in society is that feeling of acceptance, etc., and being knocked back by people or having to explain, no, I do have— I'm not— I haven't borrowed someone else's badge, it is my badge. And then justifying it, etc. I've had to write letters for a former patient of mine who was actually a university student, and he had a major memory problem, and so I wrote a letter explaining the types of memory problems he had which would interfere with his studies. And the thing is that this is why we need research, because it's not the university's fault for not knowing, because most of the research we're doing is— it is cutting edge. Your GP wouldn't know about the work that I'm doing because your GP will have, will have trained 10, 15, 20 years ago. And when someone studies, they're usually studying something that's been in the textbooks for a while. So the knowledge that they've got is, you know, 10, 15, 20 years old, whereas we're doing research right now on patients that is yet to be published or just being published in research journals, and so it won't get into a textbook or a medical training for quite a while. So it's important to also realize that the, the lack of information is simply because the information isn't out there. Even your GP wouldn't know about the stuff that I'm going to tell you in a bit. No, exactly, because there are you know, so many different things, as you were saying. And with the research, when obviously we go to these charities and donations, raffles, the research is so important for our future, our future generations. And all this, you know, from those textbooks that become like your first testament, your second testament, third, fourth, fifth, which they will go back in to look at. They think, oh, there was a case study back 'Hey, say 100 years ago,' you may go, 'Oh yeah.' But actually looking back, which Einstein, mastermind, you know, um, you know, and how with his physics and trying to do everything on that himself, you know, and other scientists that are there, um, it is important, you know, for what's going on because there are so many different areas. So as we're saying, you know, But people with these disabilities, they are now protected under the law because they've got protected characteristics. And so, you know, when people are like that, be careful, to any listener. If you do approach somebody like that, you can end up with a lawsuit now because they have a right to be like you and be able to go in there. You may find somebody, as you know, somebody with Todd's Princes, I suffer with I could walk down that— I could stand in that street, but in the next very moment you can be paralyzed. But you don't know when the brain's going to do it. Yeah. And, and it shuts— and it can be shut down. Like myself, I was shut down. Sometimes it lasts for 2 minutes, and I spent 4 days paralyzed from the waist down in King's. You know, they give you medication, but you never know it's going to happen. You never— and you have to learn to live with it. You have to have people around you. But these are the invisible faces pieces that people don't see, aren't they, that, that offer that support. As you saw with my wonderful PA that came with me when I, I met you, so she immediately said, and she explained to you straight away that I'm here because of this, you know, because anything happens to her, this is— I have to be here. And she lets everybody know, but without causing me embarrassment, that when people look at me and say, oh, she looks wonderful, you wouldn't think anything's wrong, but also pre-warned you're not allowed to do that. It's a disability and you're entitled to it. But one of those things— and immediately, well, and I was so grateful that when you did, we did enter into a conversation, you know, with the brain, and, you know, we were chatting on that. And I said that was one of my frustrations, that people may look at you and think, no. When you have stacks of medical evidence and wishing, I wish I didn't have to have— because your independence has got You know, for these other people, I can't go anywhere unless I have somebody with me. I can't drive a car. I'm not allowed to, you know, because DBL won't let me have that. You know, I can't travel on a train by myself. You know, there's many issues, but it's not about myself. But I'm just saying, you know, as a doctor and in the neurology science, that there is a lot there. But the difference is these people help you believe in yourself. Believe in yourself with your mental health, that I am entitled to live a life. Because you could be shut away. I mean, many years ago, you were shut away in mental health institutes. You know, if you were a severe epileptic, you'd be put there, wouldn't you? They'd say, there's something wrong with you. It was hidden years ago, wasn't it? And we were shoved in all these places. Oh no, you can't do that. 'So what, you know, why not?' And now we live in a world which is acceptable. You see on TV reporters, news reporters, we're allowed to be able to have a voice, we're being able to listen, and the world that's, you know, we're not just that, in any society we've moved on, you know, with people being gay or people, you know, want to be transgender, whatever, The world has changed and we're changing for the better, that we are all entitled to be our own person no matter what makes us up or our genes. We're entitled to that. The main thing is to be kind, be truthful, be honest, and don't be jealous. You know, these are positive things you have to have, you know, because the negative side of the jealousy and the greed You know, that's more ugly than any disability you could possibly be carrying or anything, don't you agree? Yes, absolutely. I think it's just a standard thing that we've just got to respect people's difficulties, etc., and that's what open society is about, and that's why, you know, public conversations like this, sharing information, is so important. Yes, and having that, you know, and anyway, you know, so we touched on it. Another thing is what I wanted to ask you about as well— dyslexia. Is that something that, you know, when you're getting things mixed up, could that possibly lead us to dementia? I haven't heard of any links between dyslexia and dementia, I have to say. I mean, that doesn't mean that a person with dyslexia might not get dementia, but it's just like saying someone who's left-handed might get dementia, but that doesn't mean left-handedness causes dementia. So I did— I don't know of any links between the two. What causes the— what causes dyslexia? I mean, it may be in a completely different field, it's just something, you know, I, I've always wondered. So while we're on this show, I thought, well, you know, let's ask if there are some I've got some listeners that are suffering with dyslexia and they might say, is it— did they have a brain injury when they were, you know, were they starved of oxygen when they were born? It's all lots of questions because it is about the oxygen in the blood that's fed through our brains, you know, at the time of childbirth, how we were born, if there could have been some— would that have, you know, I don't understand ourselves. In fact, in neuropsychology, so the study of the brain and behavior, we have two general classes of disorder. One class is called a developmental disorder and the other is called an acquired disorder. So developmental disorder is one that the person has always had through their life and importantly where no known brain damage can be seen. The other one, an acquired disorder, is where the person was completely okay, had the ability but has now lost it and therefore has acquired the disability. So when we look at dyslexia, for example, it is possible to get dyslexia through brain damage, and we would call that acquired dyslexia, and that's the one I know more about. So you'll have people who used to be able to read, who write, etc., etc., but who following brain damage have certain problems with reading, and there's— it's quite a complex area. But for example, it can get as bizarre as seeing the letters L-E-M-O-N and saying the word orange, and that's called deep dyslexia, and that's a particular type of deep dyslexia. Now that's acquired dyslexia, but developmental dyslexia, which is the one that most of your readers will have heard of, or just dyslexia, is what we talk about kids in school, etc., and then, you know, adults as well who've got it. And that's where there's no known brain damage and the person has always had that difficulty. We don't know what causes it, we just know that it exists at some level. And then with other disorders, so face recognition, for example, there's a developmental version of the difficulty, which is called developmental prosopagnosia. But the David that I was talking to you about, who had the brain damage, he's got acquired prosopagnosia because he can't recognize faces. Having used— he used to be able to, but he can't now. So he's acquired that disorder. And if anyone is interested in this area, then a book that I would highly recommend is called The Man Who Mistook His Wife for a Hat. By Oliver Sacks, and that is a beautiful, a beautiful case description of different types of patients with different disorders all through brain damage. And it's written for the layperson, and I'd recommend that if someone wants a bit of a window into the world we're talking about. Yes, because you were saying, and very well, because, you know, people and listeners that are listening to the show Dr. Janszaj is, you know, having you express what would be good. If I was listening to the show, I think, you know, I'm going to have a read of that. I, I'd like to know that, especially if people, you know, suffering different bits in there. You were talking about, um, may just go back and touch on, you were saying about the, uh, face memories, etc., with David. But there is another one known as super recognition. This is where somebody has exceptional face memory, isn't it? And some of your latter work then, some of the latter work being done in conjunction with London's Metropolitan Police, who are actually the first police force in the world to secretly use serving officers with exceptional face memory to apprehend criminal suspects. Yes, so I, I started some work in that area a number of years ago because we noticed that whilst there are some people who have exceptional problems in face memory. And there are people who are very successful, such as Duncan Ballantine from Dragon's Den, who have developmental prosopagnosia. So Duncan Ballantine has problems with recognizing people, and, um, he probably didn't even know he realized it until he heard a nerd like me talking about it. Um, Jane Goodall, the primatologist, had the problem. Apparently Brad Pitt is not good with recognizing faces. So So we knew that that existed, but then because of actually a radio interview by one of the world leaders in this area, a number of people wrote in and said, well, I don't have that condition. I'm actually really good at face memory and I rarely forget a face. And as a result of that, there was a research study to look at whether these claims were actually genuine. And what was found is that there are some people who are exceptionally good at face memory. And a number of years ago, I did a big study at London Science Museum to try to get a window onto that. And at the same time, someone else was doing some work at Greenwich University, and then we teamed up and we did this research with the London Metropolitan Police. So, um, the, uh, the Metropolitan Police, and now other police forces around the world, they have these super recognizers who can look through CCTV camera and spot people more easily than most of us. Um, in fact, I was interviewed on Sky News a couple of years ago about the Novichok poisonings in Salisbury, because the way that they worked out who the two suspects were was by trawling through CCTV footage across Salisbury and working out the route taken by these two guys. And it was because of super recognizers that they were able to piece together the movements of these people. So yes, it just demonstrates that the first paper on super recognition was published in 2012, so that's 9 years ago, which is— which in research terms is an eye blink. So this is why we need research. We're constantly trying to push the envelope by developing new research getting studies done to look at what's happening, why people can do XYZ, etc. So, um, so yes, this is why research is so important. Yes, and obviously with your work, and it's very varied, um, and in-depth, but a wonderful, um, jigsaw puzzle that actually all connects together in all the pieces pieces. And it's almost like if you could get a puzzle of the brain and chop it up into these little puzzle pieces, and then we come on the show, we like push it together, and it fixes so well, so easily. And the stuff that you've done is— obviously our brain is like a sponge, and, you know, education and constantly, you know, feeding it and wetting it, you will, um, you know, it's fantastic in, you know, for people that want to learn, like myself. Constantly studying. I like to feed the brain and understand. And I like, you know, like when you're doing a lecture, you know, you've got to be interested. And if it's a subject that's yours and going in— but there's other things, you know, um, ASD and ADHD, you know, this is something else that you've been involved with. I, I've done it. I basically work in 3 different areas. The, the one that we first talked about at the dementia event was my work on memory disorders. Another area is one I've talked about as well, which is face recognition disorders, prosopagnosia, but also super recognition. And the third one is how the front of the brain manages behavior, and it's called executive functions. And it's a very complicated thing because the front of the brain is the most recent part of the brain. It's the newest part, and it's also the one that differentiates us from other animals.. And we know that when the front of the brain is damaged, as happened in that patient Evi-R who had the tumor in the front of his brain, all the other primary cognitive abilities of memory, language, vision, etc., they're all intact, which is why that— why he looks on the face of it really quite competent. But the one thing he can't do is to put all of that information together to make a decision, to plan things, to work out how to get out of a difficult situation where you have to think outside the box, etc. And what happened is that about 18 years ago, I supervised a study, or I developed a study for some undergraduate students, because one of the things that clinicians were saying was that we know these patients of us— ours have got real problems. So when we take them out to shopping or do things in the kitchen in the rehab center. They've got real problems. And yet when we look at the results on the clinical tests that clinicians give them, they look completely okay. And that just does not make sense. So there was a conundrum, which is that the patients in terms of clinical assessment look like there's nothing wrong with them, but but the people working with them in rehab and of course their families knew that there were real problems with them. So what's going on here? Now, what that resulted in was people starting to look at this issue called ecological validity, and ecological validity is about how accurate and representative the work is that we do in the outside world in terms of assessment. So I'll give you an example. I'm as blind as a bat, so I've been wearing glasses since I was 9 years old or something like that, and when I go to the opticians, I am told to sit in a chair and look at these letters in these different formats and read down a list, and then I'm asked whether it's clearer on the green background or the red background, etc. Now, I don't go around the world looking at letters in that formation, and I don't go around the world looking at letters on green and red backgrounds, but the prescription or diagnosis that they have of my eyesight and the diagnosis that they give, the prescription they give me for my contact lenses and my glasses, etc., allows me to look at people like yourself and recognize you, read, and get around the outside world. So although the test in the optician's room doesn't seem to make sense to me, in fact it's got ecological validity because the results from it map onto how I am outside the clinic. So those tests have validity, but what we're finding is that the tests that are done for how the front of the brain manages that complex behavior that we have when we go shopping or we're trying to order something online or we're deciding where to go for dinner, etc., which is called executive functions because it's our managerial functions. The tests that clinicians are using lack ecological validity, and therefore you get this conundrum of patients who look okay because the tests say there's nothing wrong with them. And yet the people who work in rehab with them saying, hang on, this person has got major problems even though your test says that there's nothing wrong with them. So that was the space I walked into in 2003 when I started this research, and from that I developed a test called JEF, which stands for the Gensari Assessment of Executive Functions, and it's to address this issue of ecological validity. And basically what we found is that my My test seems to be more sensitive than any test in the world at the moment. We're finding that the results from my test do map onto real-world behavior. So a patient who takes my test, if they perform poorly, we do see problems with them in the outside world. And we've used this test in many different ways. We've used it with adults with brain injury. We've also used it to look at the effects in healthy young people of stimulants such as alcohol, ecstasy, cannabis, nicotine, coffee, etc., because all of these stimulants affect the way we manage our behavior. And we've even started looking at the effects of psychiatric disorders such as bipolar disorder and schizophrenia. But then we started applying it also to younger people. So I've now got a version for children, which is instead of sending them to the work, which is the— what this computer game that I've created involves. The children are told that it's their birthday party and that their parents are letting them run their own birthday party, and their task is to manage their birthday party. So Geoff looks like a computer game played on a laptop, and the child runs around the house tidying things up, making decisions about what food Katie's going to have because Katie has an allergy to this and what food Fred's going to have because Fred is a vegetarian, etc., etc., and about what games they're going to play, etc. And from that, we get a really good understanding of what these children are capable of doing and what they are not capable of doing. And so from that, we've been able to look at how these executive functions develop during childhood and adolescence. We've had a fantastic study done by a student of mine called Kim on kids who were adopted or fostered, because we know that kids who were adopted and fostered can fall behind in the education system and, and sadly are overrepresented in the prison system. And it seems that there's a story there about the types of attachment issues that can happen for kids in the early years of life when, when that attachment to the caregiver is really important. And if they don't get sufficient of that because of adoption, fostering, etc., what can happen is that these executive functions don't develop properly, and then these kids fall behind in school, they fall behind in other ways, and then they're at greater risk of falling into the juvenile delinquency system. And then at the other end of the spectrum, we've also been working with ex-offenders, because when you go into a prison, if you were to ask everyone there if they've ever had a head injury, and you did the same thing on your high street, what you'd find is that the rate of head injuries in a prison is 8 times what you get in the outside world. Now, that's a shocking statistic that 8 times more people have had head injuries in prisons than the outside world. Now, you might think, oh well, these people are in prison, they've probably been fighting each other, etc. But guess what? Most of these people got their first head injury during childhood, and most of them got their first head injury before their first crime. And we also know that children with head injuries and brain injuries are 3 times more likely to end up with juvenile delinquency than their peers who don't have head injuries. And what that's beginning to tell us is that it's possible that the head injuries during childhood are affecting these all-important executive functions about how we manage our behavior, and that contributes to the criminality. Now, this famous example, so Fred West, the serial killer. He was, he was just average Joe, but he had a fractured skull from a motorbike accident at the age of 17. And when he came back from hospital after he'd been patched up, etc., his parents, his family said that he was very different. He'd fly into fits of rage in a way he never used to. And at the age of 19, he committed his first crime. Another example is the guy who became known as Jihadi John. Or Mohammed Emwazi, one of the ISIS assassins, as they were. Apparently, when he was a child growing up in West London, he fell into a goalpost when he was 11 years old and playing, etc., and he was knocked out, and he wasn't seen for 6 weeks. After the drone strike that assassinated him, I heard a radio interview where someone who knew him at the time said that he was just like any other child. When he came back 6 weeks later, he was very different. He, um, his behavior, his anger management, etc., was really bad. And so what we're beginning to see more and more is that there's this story that if the executive functions, which are in the front of the brain, are affected, then there can be a possibility of criminality later on. So I'm doing work with a wonderful charity called Bounce Back in London who work with ex-offenders who are coming out of prison and who are trying to transition back into society. But because having a criminal record makes it more difficult to get a job, they're working with organizations that are trying to help people get back into society. So these organizations know that these are people in prison, and what they do is that they allow them to do work experience in their organizations to get them legitimate work experience and something on their CVs. So I'm working with this organization to try to do work to see whether we can use my assessment, Jeff, to look at the executive difficulties of these people coming out of prison to see whether maybe it's the head injuries they had during childhood that are making it difficult for them to make the decisions. Because a worrying statistic is that 50% of people who come out of prison are back in prison within a year, and so that's called recidivism, which is the cycle of offending and reoffending. And given that it costs £60,000 to keep someone in prison for a year, um, that's a huge cost to society if we're not properly rehabilitating them. And my thing is that maybe what's happening here is that society thinks that we've rehabilitated these people by putting them away, but because we haven't actually addressed their underlying brain injury which they got through in childhood, we're not actually doing anything that helps them in terms of their ability to stay away from crime. And so this is potentially very exciting work if we can help people who've had a head injury in childhood to now avoid the potential of crime, then that will be hopefully good for society. So the ADHD and ASD, etc., which have all been part of this research because we've also used it for people who have these conditions. And, you know, just go— and fantastic, this test is obviously very helpful. Across the board, and not just for dementia, like you were saying, for rehabilitation, everything like that. There's so much to this test. What you were saying about— let's go back to the criminality side, you know, so, you know, for people to— you put two huge names out there, which the listeners will probably all know those But breaking it down to other offenders, we're saying about, you know, reoffending. People think if people are locked up, that's the answer, this is going to stop them and rebuild them to come back. But like you're saying, they're not actually dealing with any mental health issues, problems with the brain, etc. They're never going to go— they're just caught in this 50%, which you're saying will go back and then commit another crime because you have not got to the root of the cause. Cause and treated the cause. So with your test, you're saying, and with the mental health and everything, you've assessed it. So had they have had this years ago, we could be preventing this crime. So by doing this now and trying to highlight, is there— so for reoffending, so it'd be great to hear and have you back on the show and say, you know, in a year's time or so, and see, you know, how that's been going and how many of those— very happy. Yeah, because it would be very interesting to see, because I do believe what you're saying is very true, you know. Yes, when it has it and going, and it's very— and you explain it so reasonably, um, out there, um, you know. But is there something there? So now if, um, somebody, you know, has a fall at school, they're taken, is there not a way they could go and register that they're shown where it can be sent yourselves. I said, you know, look, if you do need to come take a test in, you know, so many months to see what's happening, how would that work? Otherwise people are going to constantly be slipping, isn't it? Like you're saying, all this money, you know, what it costs to put somebody in jail, etc. Um, this money can be used elsewhere, and like with prevention, like with children, if they are being hurt by having a fall or anything, during anybody like that, that they go on to a register that can, you know, be taken on to do this test. Could you prevent people losing their homes doing all this? Yeah, well, in an ideal society we'd be able to do that. The problem is that it costs a lot of money, it costs tracking people, keeping the records, etc. And there's also the sad fact that a lot of people who have a head injury will never see a neurologist or a neuropsychologist because they live in an area without the resources or without the specialists. So they'll be patched up, they'll be, they'll be sent back to school, and everyone will think everything's okay, but they're not. And this is why research is important. So we're trying to do research with kids with brain injury in Dublin at the moment We've done research with kids with brain injury in Paris as well with my test. And ultimately, this is why research is important, and we always have to keep replicating our results because I can tell a good story, but we need to make sure that my thing is, is really rock solid, and that takes years to build up. But yes, ultimately, in a kind of utopian world, If we could track kids, give them the kind of strategies to avoid certain difficulties, etc., if we know that they're more susceptible to it because of this type of head injury, etc., then it would be great to do that. And effectively, whenever I'm working with my students who do the research with me, I tell them to think about that kind of the what-if. So if if our research does, you know, get there, how can it help the outside world? And so we might not be able to do that immediately ourselves because research takes a long time to conduct, to replicate, to publish, to get, and then to eventually change public attitudes, etc. But if we've got an aim of where we want to go, like with, for example, the looked-after children, the kids have been fostered, etc. If we, if we can start thinking about where we want to go with this research, then at least we can start building the bricks to make that change. Yes, yeah. Well, unfortunately, we are just about to run out of time, but all we've got time for, if you could please tell the viewers how they can contact you and see, you know, your shows et cetera, very quickly. So, you know, if anybody wants to get in touch and do this test, can I ask you to just, if you may? Absolutely. And yet we didn't, we didn't manage to talk about my dementia work itself, which is the thing that brought us together. Because I know, because we're going to have to bring you on. Yeah. Okay. We're going to call this interview part 1 and I'll bring you back for part 2 because it's so in-depth. So this is part 1, and we will record another one next week for the listeners to use. So we're not going to have time, unfortunately, to give out all those details. What we will ask you to say, you know, if you've enjoyed this show, which is very, very technical and asking different things with the dementia, but opening up and freeing our mind as we were doing to bring the doctor explain that. Sometimes I have to ask for a two-part show, and we're very, very pleased that Ashka will be joining us back. And obviously, after this show will come out, um, or air on the 13th, the second part will air on the 20th of December. So we'll have a two-part which actually extends on to this show because because there are many issues. I'm sure there'll be many, many people when it goes live popping all questions in, etc. But so for the initial first thing is when you go on to Free Your Mind, let's talk about it. Okay, please get in touch with www.womensradiostation.com. They will have all Dr. Details to come into that, but he will be on the following week where we will start that next show, giving every bit of information out on there on how to contact him. Any questions you may have had from the previous show, please call through to do that because there is a lot to this. Again, you know, with the test, how to do this and etc. And obviously then actually after that we can explain, you know, how this test is used specifically for dementia as well. But obviously the show today has been absolutely wonderful, Ashok, and amazing that you've brought that. And because your brain— and you've studied so much— we've really opened that up and opened that test up to other people other than dementia, but it'd be nice to bring back in and fill that in and, you know, any other time that we have on that. So, but unfortunately for now, thank you very much and for coming on through your mind. Let's talk about Vel KJ, part 1, and cueing to record part 2 to follow the following week. Thank you very much, everybody, and goodbye.