Brain health for the whole family: Answering your questions

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I Am Dr. Katy Peters. And this is the Brain Health Podcast.

Dr. Correa:
Welcome back. Now, you may have noticed we got new music. There's a new name. There's artwork that you're seeing. What's going on? Well, welcome to the newly updated Brain Health Podcast. So we've made some updates and changes from the Brain and Life brand across our different network. And now, we're glad to have you, and you're joining us on the Brain Health Podcast.

Dr. Peters:
Make sure also to check out our new website, brainhealth.com, to see what we've been up to, and check out this new hub of info for you and your brain health.

Dr. Correa:
And you may have had some articles and resources through the Brain and Life resources online that you really loved, and make sure and know that a lot of those are coming to the newbrainhealth.com website. Things are all undergoing updates. and we're going to have those resources still available to you in the future.
This week on the podcast, we'll start with a discussion with... This week, we'll start out by discussing some of our own submitted brain health questions. This week, we'll start out by discussing some of your own submitted brain health questions with a colleague and preventative neurology expert. I'm really looking forward to his tips on how we can all live well, whether we're living with a neurologic condition or even tips for everyone in the family on maintaining and improving their brain health.
As we were just mentioning, I'm so glad to introduce you and our listeners to Dr. Benham Sabayan. He's a vascular and preventative neurologist, neuroepidemiologist, and a clinical investigator at Hennepin Healthcare. He there works as an associate professor also at the University of Minnesota. His work explores how vascular and social factors shape our brain health and aging, and how individual choices along with broader community support and interventions might help preserve cognitive function, prevent stroke and dementia. So really thinking about brain health for all of us in our communities. Today, he'll help us think about some of the science and practical steps for all the individuals in a family.
Thank you so much, Benham, for joining us today.

Dr. Sabayan:
Thank you so much for having me. What a pleasure.

Dr. Peters:
And I'm also here to help Dr. Correa ask some questions, Benham, so I'm really looking forward to it.

Dr. Correa:
Yeah. So we've gotten a mix of some questions from our readers, a few that we're going to highlight in here. But I want to think of really those of us, whether they've been a listener and reader of Brain and Life, and now brainhealth.com as a resource, or if you're newly joining this podcast, so that everyone can leave today with some things that they can do for their life and for their brain health.
One thing I wanted to start off. Let me pause, Adam, for edit. I'm just confirming, Benham, I am pronouncing right?

Dr. Sabayan:
Yes, perfect. Yeah.

Dr. Correa:
Okay, good. So one thing I wanted to start out with, and for those who've listened before, maybe have been following online, we've defined and described brain health previously, but how do you describe it and explain it to individuals in your community or someone you're seeing about what does brain health mean and what does it mean for the entire family?

Dr. Sabayan:
Thank you so much for asking this question. This is really fundamental to what we do and what we are aiming to achieve. So when you think about brain health, brain health means the level of brain structural and functional integrity that would help us to achieve maximum joy in our physical wellbeing, in our social wellbeing, and also in our mental wellbeing.
When we think about brain health, we are really thinking about multiple factors playing a role to really enjoy our life and achieve the maximum connection with our environment, with our family, with our society. So that's why brain health is such a fundamental thing for our wellbeing and is probably the main driver for the wellbeing of an individual as a whole.

Dr. Correa:
But we're seeing so much news about so many different things that people can do. And before we get to the specifics or certain situations, if two parents or an individual who lives in a household wants to begin today, and maybe with just a simple way of considering and taking stock of what's going on for them or their family without creating an overwhelming checklist, where would you start?

Dr. Sabayan:
This is a really important question, and I think this is something that we are actively learning about. So when we think about preserving our brain health and promoting our brain health in the unit of family, I think there are some factors that we need to take into account and implement.
But really, before that, I think we need to really encourage each other as a community as a whole to think about brain health, because more frequently than not, we are not thinking about that. We are so busy with our life. We are so busy with what we do on a daily basis in our personal life and our work that brain health usually is not necessarily active in our radar.
But when we get to the really practical aspects of providing a brain health-oriented environment at home, I think the most important thing is to make sure that we are not exposing ourself to risk factors, and we are really promoting connection of our brain with healthy habits and connection with the environment around us.
What do I mean by that? I think we know that diets that are pro-inflammatory, diets that would accelerate atherosclerosis are not really good for brain structural and functional integrity. And this is really starting from early childhood. I think this is very important. We also know that sedentary lifestyle, which can have different forms and format, is not really good for your brain. Kids with so much screen time all the way to adults, long period of time working or using laptop or other kind of screens types are not really enjoying their brain health and they are not really protecting their brain health.
We know that physical activity itself, probably this is the most important thing for our brain health, physical activity, just moving, activating our muscles, making sure that these neural muscle connection are really ongoing is probably most important intervention that everyone can do in their life course. And we know that this is really a lifespan, life course thing. And on top of that, really connection with our world around us.
So in the time that social media is really dominating our life and our activities, making sure that we would get connected with our neighbors, we would make sure that our kids would have play time with other kids, they go to the playground, making sure that our friendships are not just through connection through Facebook or other social medias. I think these are really key things to make sure that we would protect brain vascular health through prevention of cardiovascular risk factors and healthy lifestyle, but also making sure that this is in the context of healthy connection with the rest of the world and preserving our attention to become very narrow and to become very unhealthy on negative things.

Dr. Peters:
I think you really spoke to several things around the connection and also about being active and not really focusing on, I guess, the gadgets that we have in our hand. And I just think about, I was at a play recently and so many people were just up holding their phones and recording it. So how do we get those gadgets out of people's hands and get them more connecting together? What is sort of that first step in how to do it? How do you do that?

Dr. Sabayan:
When we think about brain health, I think there's ABC to that, and A of that is awareness. So we are frequently unaware that whatever I'm doing now, it might not be good for my mental health or my physical health, et cetera. I think this is something that we really need to talk about. So the platforms like this and in every possible opportunities, I'm talking about this for my own colleagues, neurologists, but also public, that we need to think about the examples and the situation that we can get really more connected and really get distance from this.
The other way that we can think about that is really these devices, they also come with some numbers. So how much screen time did you have? At least if you are using them, also let's ask them to give us some feedback on how much are we using them. At the end of the day, I don't think we can totally get disconnected. But when I was a PhD student, my mentor told me that the best quality that you can have for organization of your work and life to make sure that you make different folders and don't open all of them at the same time.
So if you think about that, I'm at the play, I'm at the concert, I'm at watching a game. Perhaps at this point, at this moment, I need to really enjoy and focus on this rather than being distracted with other things. And I think this is something that really takes practice. I'm guilty as charged too in these situations, but it really takes a lot of conversation, discussion at home, making sure that we are educating each other, we are reminding each other, but also we are realistic about that, that everything now from our banking account to our social media to our MyChart, they all go to these devices. So we cannot be disconnected, but maybe we can really define some outlines and boundaries for how we are connected with them or we are disconnected with them.

Dr. Correa:
So Katy, let's put this into practice and think of some people. I think maybe a good way of thinking about it would be like a whole household or family. So maybe two parents, a 47-year-old, a 49-year-old, one of the parents with a family history of Alzheimer's, whatever their genders might be. Who else should we put in this household?

Dr. Peters:
Oh, well, what about a grandparent? I think that could be a good, maybe a grandparent living down the block. Maybe they had a stroke about a couple years ago of 2024, is now independent, occasionally has some headaches, maybe has some slowing of their cognition. So, grandparent.

Dr. Correa:
Yeah. We want to think of brain health through all different life stages. Let's include a younger than teenage child, maybe an 11-year-old who's in school.

Dr. Peters:
And everybody's going off to college right now, so we need someone, maybe an 18-year-old preparing for college. Maybe they just went. There's a lot of people. I know my nurse just sent her oldest to college, so that's sort of at top of mind.

Dr. Correa:
And Katy and I both live with pets, and they're a big part of our own brain health, but I won't quiz you on the veterinary questions about brain health for our pets. We just know that if they bring joy to your life, they also bring some positivity and benefit. So let's start then thinking of, in that pre-adolescent stage, we got a question from Jesse from California who wrote to us, "I love doing puzzles and reading. Am I on the right path? Are puzzles and reading enough for developing a brain for everyone in my family? How should we think about the combination of learning something new, physical play, creativity, adequate sleep, and social connection?"

Dr. Sabayan:
Perfect question. So I think when we are thinking about younger age, enrichment of the environments with things that would stimulate our cognitive function and thinking, I think are very key to building up the very good foundation for brain health for the rest of the life. Of course, a formal education is really key to that and basic. But there's a very good amount of data shows us that learning new language and learning music, or any other skills that would help you to form new patterns and help you to have more flexibility with the way that you are thinking, but also it helps you to find an organization in a way that you are processing the information are very important for really stimulating that cognitive function, making more neural connection and having a very strong structural and connectivity within your brain.
And that's such a great question because it talks about not just doing one thing, but also combination of things. So let's take example of physical activity. We know that physical activity and going to gym and doing all sorts of sports and activities are really good and healthy, but we also know that they are most effective and most influential when they are coupled with social connection. So why not going to the gym with my buddy, that we also enjoy the coffee and drink a tea afterwards? So why not implementing our physical activity routines with gardening that also comes with some purpose and some output and all those kind of things?
I think when we are really thinking about younger age population, we really need to think about all the ways that we will prevent exposure to risk factors. And this is bad diet, sedentary lifestyle, too much screen time, TBI, traumatic brain injury, exposure to all sorts of contact injuries, but also enriching their life with all sorts of exposure, that could be music, new language, new friendship, gardening, new skills. And I think this is really helpful to think about that in that framework of physical, environmental, and social health altogether.

Dr. Peters:
So that makes me think of our recent episode with Shawn and Genein Letford. I'm sure you listen to it. Shawn is like a super kid and is all about brain health and all about activity and all about music. So I think it's trickling down to him. I think eventually Shawn is going to get older, and he's going to become a college-bound teen. I don't know if his mom's ready for that.
So I really think, thinking about these teens right now, there's so much going on. It's a major transition to go to college. College can disrupt sleep, meals, all that exercise that you just talked about, stress management. You now have new social interactions that are outside of your family or maybe outside of your old classmates that you had more in those preparatory stages. And then also now there's access to things that may be bad for your brain, like alcohol and cannabis and vaping and other substances. What choices have the greatest immediate and long-term effects on our brain health for that population, for those teens or college-bound people?

Dr. Sabayan:
There's a really good amount of data showing that. When we transition from younger age and teen to adulthood, two things happen. On one hand, you are getting more and more exposed to things that would be not healthy for your brain, whether that's alcohol, whether that's smoking, whether that's also physical injuries, et cetera. At the same time, our resilience also is getting plateaued. That means that we used to be able to have a little bit more resilient in handling the damages, but then that would kind of get plateaued.
So that's why, when you're thinking about early 20s and 30s and getting to 40s, we need to do two things at the same time. We need to make sure that we are not exposing ourselves to all those risk factors, but also we need to make sure that we would stimulate our life and lifestyle in a way that we would be more aware of the repair of the damage might be more difficult through the time.
In that setting, and again, young adulthood comes with a lot of energy, it comes with a lot of adventurous events, which is really great. And probably we cannot really prescribe that you should not do this and that. But again, A of the ABC is awareness, just becoming aware that things that you are getting yourself exposed to are not necessarily good for you, not at this age, but also the older age. And this is really the key moment of time to be aware of that. Whether that would work or not, I'm not sure about that, but I think it's important to have the conversation, to have the discussion and just provide some awareness.
So when we think about prevention, I think there are things that, what we call a primary prevention, but there are some primordial prevention. An example would be really TBI, right? Obviously, as a person, we would not want to expose ourselves to it, but also there should be some structural and regulatory and some frameworks to help us to avoid that as much as possible. The same with salt in the diet, with the alcohol use in a younger age, or being exposed to cannabis and other materials.
I think this would be a really tough task to kind of tell our young adulthood individuals that these are things that might not be helpful for you. I'm not at that age or my kids are not that age, thankfully, to really put emphasis on that and share from my own experience. But I can say that maybe awareness and education. And maybe it doesn't have to be just the parents. It could be also the society as a whole, our medias, our social media. The schools and environment could be also promoting all these healthier behaviors.

Dr. Correa:
Like what you were saying before, Katy, it makes me think of Genein and Shawn Letford because also there's of course all the education and emphasis on awareness on so many of the choices that we make day to day and how they might impact us, or even awareness of the things that we're doing each day and how that helps us with recovery. So whether I'm trying to learn something new and study and prepare for something and seeing how my sleep patterns might impact me in the following days.
We want our teenagers and college-bound, our collegiate students to be aware of these things, but some of that level of self-awareness about diet, activity, the choices we're making about meals and sleep probably also needs to happen at that younger age and really across the family. So it's great to see more examples and hear examples from parents of how they're incorporating that into the family discussion.
And I love that you're a particular highlight, because we know that traumatic brain injury or physical trauma is a major potential risk factor for so many other things later and a key way that many individuals at that teenage group might end up having something that leads to a neurologic condition or results in an injury leading one. So would you say that maybe a helmet for those who are on a scooter or bike or so on would be the thing you'd want a teenager to carry with them? Or is there something else that you think practically we want to give or have teenagers carrying with them and how parents might be able to support that need without relying on fear?

Dr. Sabayan:
Definitely. I mean, things like helmets and making sure that our playgrounds and areas that we go to are safe and well-thought about TBI, but also really regulation is also key. I think we need to really, in every voice that we would have in any town hall, we need to make sure that we would make our legislatures, our executive branch aware that, "Hey, my street, there's this intersection and there was this amount of car accidents." Or, "I have seen teenagers in our neighborhood or in our district, they don't wear helmet."
I think these should be really bidirectional. So of course it should be like a grassroot and from within the families, but also there should be an environment. We are encouraging, for example, physical activity, and biking is one of the healthiest habit you can have. I have lived in the Netherlands for six years. And I think because I had to be on bike, even if we moved from one house to the other with just bike, you are really by default getting more engaged in physical activity on your daily basis, but there were also wonderful path for biking.
So these are really two directional things. And I think it really highlights our role, not just as clinicians, not just as neurologists, but also as public health advocacy group to think about brain from time zero when you are developing a mall, when you are thinking about a stadium and a concert venue, et cetera. So I think we should not just leave it up to the families. We should also really hardly advocate for whatever makes our environment healthy. We know that green space by itself is really important for getting more active, but also reducing a stress and inflammation and all those kind of things. I feel like we need to really push for it as much as possible to have the regulation and the right environment for healthy habits, brain health habits, especially for younger age individuals.

Dr. Peters:
I love that, how you're discussing that, because it's really about what can we do around us to make it accessible to do those things. We know that Daniel can run from place to place, but I hadn't really thought about it sort of making it easier to bike to work for people, making it more accessible. I'm just thinking about even at my own institution right now, people are bused everywhere because the parking lot is so far away. What if there were options for more bike paths? So I think that's a great idea. So kudos to you and to wear your helmet.

Dr. Correa:
Now let's dive a little bit more into probably what you're seeing closer day to day. Let's take these parrots of either gender in middle life, maybe one with a family history. So one parent asks, "My mother had Alzheimer's disease. Am I destined to develop it too? What can I do to stay sharp?" How do you explain the difference among family history, genetic risk, and/or maybe something that might be inevitable, or is it inevitable?

Dr. Sabayan:
Yeah, thank you, Daniel, for asking that. So this is something that, as you said... So we have a preventive neurology clinic. And the preventive neurology clinic earlier, it was just about secondary prevention of a stroke. And then through the time, I'm seeing more and more individuals coming in their middle age, and they're asking, "My father had a stroke, my mother had dementia or combination or my siblings. What can I do now to not go to that route?"
I think the very first thing that I would explain to them, and I think this has been really helpful for me and for them to hear that is that thank you for being here. You have the A of awareness already, so that is really a very strong and important step that you are thinking. The second thing is you need to have a structure for risk prevention. So there are things that we need to do as clinician. What I would do in a very first step in this situation, I would try to explore that question a little bit further.
So they're going to say that I don't want to have a stroke or I don't want to have dementia, but I start asking, "What do you think about your memory? Have you ever had any transient neurological symptoms? How's your mood? How's your anxiety level?" And all those kind of things. So I think you need to make sure that in a very first step that there's nothing brewing and there are no evidence of subclinical neurological conditions that would affect the brain. I think this is one fundamental thing.
And the next thing, you would really go to these lifestyle modification and highlighting things that are very important for an individual to not develop a stroke and dementia. So now we have this framework by Lancet Group that they put out 14 modifiable risk factors out there for prevention of dementia. So this is a really life course, very nice life course. If you look at those figures that explain how much you can reduce risk of dementia, that middle age group has the highest weight there. So that means that you need to start early, you need to start in really middle age and younger age. So this is the next thing I would highlight that you are in the right path, and you're in the right age and to think about that.
Then I would go to details. So these 14 risk factors. By the way, one thing that I think is really amazing to happen for me is... I'm a little biased there because I'm a vascular neurologist. So many things that we can prevent stroke with, they are also good for prevention of dementia and cognitive decline. I think this is something that we always think about. So we say 40 to 50% of dementias are preventable. But the same risk factors you can also prevent 80 to 90% of a stroke, which is really good. So then I will go to a specific risk factors, whether they have it or not.
One other thing that I learned in my practice and my connection with my patients and those who come to my clinic is that I really need to team up with the primary care providers to make sure that we are covering our bases, and we are making sure that the healthy lifestyle and the habits are coupled with continuous medical care through the established guidelines, through the established screening patterns, and is fortified by additional healthy lifestyle behaviors. Frequently than not, even those people who are very health aware, so they come to my clinic, and then we realize that for a couple of years, they were supposed to have some sort of a screening or they needed to have the A1C or cholesterol profile and it has not been checked. So this is important to make sure that we are really going a step by step medical conditions, any neurological concerns, and then really promoting lifestyle behaviors.
The other thing that I would highlight is that what happened to your parents doesn't have to be your destiny and it is not going to be your destiny. Of course, it takes a lot of energy and commitment and work, but last thing you want to have for your brain health is to have this like a constant low-grade anxiety that would always burn your brain, that "I'm going to have dementia, I'm going to have a stroke." No, actually you are in a situation that you can prevent it and you are the captain of the ship now and you can be really leading the process.
So these are the conversations that I have for these individuals. And of course we would really customize based on their need, based on their family history. Frequently than not, these days people come to my clinic with some labs measured for dementia risk, over-the-counter genetic testing for ApoE gene, et cetera. So that would take the whole other conversation how to move from data to real life changes. And this is really something we are actively learning about it every week.

Dr. Correa:
So I want to get to some of those specifics. But before we get to whether or not they have maybe some genetic tests that have been done or they're asking about them, if this individual's in their 40s or 50s, they're coming to you with some vitals numbers and some other lab tests, which numbers and habits do you feel like deserve the most attention, or do you focus that based off of what their concerns and symptoms are? Is it blood pressure, blood sugar, cholesterol, smoking, sleep, hearing, mood, social connection? Is there some place you start with? Because it already still feels like a long list.

Dr. Sabayan:
So that's why I learned that I can do it all myself. And another thing that I learned is that, and I'm hoping that with all the great things happening at American Neurology, so our primary care providers are trained to think about cancer screening and cardiovascular risk reduction. By training and by default, they were not taught to think about brain health. And there are good overlap on risk factors when it comes to hypertension, diabetes, hyperlipidemia, smoking. But how about hearing? How about vision? How about TBI prevention and all those kind of things?
So what I would do, because as you say, this is a really long list, I want to make sure that there are things that are covered by primary care provider. I'm not going to reinvent the wheel, but I'm going to put emphasis on things that are not necessarily routinely checked or discussed at the primary care level. And hearing, vision, cognitive function itself, mood and behavior and anxiety and those behavioral changes are really major things that I will focus on. And of course, I'm a neurologist, so I'm going to ask about transient neurological symptoms and anything that would really reflect the fact that if there's a brewing neurological condition.
Sleep is the one that I think we cannot emphasis enough. I think our primary care providers are getting better at checking that, but still I think there's a lot needs to be done. And this is another area that I feel like as a neurologist, as a preventive neurologist, I need to focus on, I need to ask a little more question. Frequently than not, we are hearing some concerns for REM behavior disorders, or any other conditions like a lack of a sleep or a different pattern of a sleep could be a reflection of that. So I really try to really go over those that are covered by primary care provider and other colleagues, and then really hyper-focus on really specific preventive neurology aspects of it.

Dr. Peters:
So I love that you're really talking about preventative aspects, and I do agree that you need to have all your senses in front of you. So when my patients come in and they're having problems with their speaking, but they have bad hearing or bad vision, I was like, let's also work on those other senses to keep you up. But now we do have these fancy new blood tests and how do we integrate them. Because I think our patients are, we can give them the easy things of testing your hearing and your vision, but what about the new blood tests, like the new Alzheimer's blood tests and ApoE? Who should be tested and how should we communicate it? Particularly in this scenario, this parent that supposedly has a risk factor or has a family member with prior Alzheimer's, they're seeing headlines about ApoE4, about the pTau-217 blood test. Who should get this testing?

Dr. Sabayan:
So I think the science is so rapidly evolving. You don't believe that how many articles, including... This morning I was just listening to a neurology podcast about Alzheimer's Association Conference. So kudos to that great interviewer. This is a really rapidly evolving area. So what I think we know right now is that if individuals don't have any objective symptoms or evidence of cognitive decline, these tests are not necessarily made for them. So if there are some subtle cognitive decline and documented, I think checking p-217, we do that here at our center. We do amyloid PET, et cetera. That's how we should do that as of now.
There are two to three primary prevention trials going on that they are looking whether if you have some sort of amyloid buildup or tau buildup, whether you would be benefiting from removal of that. I don't think we are yet there. But also it's important to know that when we check something that we don't have an action plan for it, it can be just a source of anxiety and it cannot be really productive. So that's why sometimes when I'm asked, I would say, "Let's go through the steps and see whether you would really benefit from checking those labs."
When they come to me with those labs already done, we say, "Okay, let's take pause, go one step back, and see whether there is any evidence of cognitive impairment or any cognitive issues before we would be able to interpret them." I think I would keep my mind and eyes very open for whatever comes for future in terms of prognostication and in terms of future risk. One thing that I'm sure is that lifestyle modification, multi-domain lifestyle modification, including improving your cardiovascular health, cognitive training, and it has different forms, engaging your brain and recruiting your brain, and avoiding things like TBI and improving your senses are protective for you no matter what is your p-217 or your ApoE4 status is.
And of course, when we learn more about these things, we would think about that. And I also educate them that, as of now, we are talking about some false positivity or false negativity. So if you have a lower level or negative level, probably you should not be rest assured that I'm not going to get it. Or if you are positive, you should not be too worried that I will definitely get it. So this is a very nuanced area. I think so many of our colleagues now are experiencing that. And that's why this is the inception of the concept of preventive neurology. Now we have tools in hand that decades earlier might reflect something would happen in future. And this is something that preventive oncology and cardiology have gone through. And I think we need to learn more about that and just be honest with our patients, "I don't know. I'm actively learning about that, but as of now, this is my recommendation."

Dr. Correa:
Now, let's talk about this both preventative and/or living well with an established condition and how the brain health plan might change for someone who already has a neurologic diagnosis. And we were mentioning before, we have a local grandparent who had a small stroke a few years ago. She's 72. So beyond taking prescribed medications, what do you think should be part of a strong post-stroke plan in their management, but also thinking about both preventative neurology and living as well as possible with their brain health?

Dr. Sabayan:
Yeah. So with all these wonderful advancement in acute neurological care, now we have more and more individuals who survive from a stroke and other acute neurological conditions. And frequently than not, I think we are not equipped about tell them what next. We know that post-stroke cognitive decline, post-stroke depression, post-stroke social isolation are very common, and they are associated with higher rate of recurrent stroke and post-stroke dementia.
One thing that I would really do in my daily practice is that, of course, I'm going to focus on antiplatelet, anticoagulation, and cholesterol medication, et cetera, but also really asking about their mood, about their cognition and about social connection. So really encouraging the family members and other people, just make sure that it is as important as taking your cholesterol medication to also not getting socially isolated, not letting your physical disability, your language disability, your sensory or vision, social disability would be a major barrier for not getting back to the routines that you had.
It is very difficult to achieve, but the fact that we would talk about that as neurologists, as clinician, I think really goes a long way for people because that would give the feeling that it is not just those medications. You need to really think about and work on other stuff. Social isolation, more than depression screening, and making sure that they remain physically active within the boundaries of their disabilities from a stroke, I think this is the most important thing.
But also I think we should really invest in research and understanding of how we can keep the stroke survivors and those with acute neurological condition to not go to the route of cognitive decline. I think cognitive decline is the ultimate phenotype of many neurological conditions. And what happened is that we always tend to think about short-term outcomes while I think trials and research and advocacy should also think about long-term outcomes. More and more people survive in neurological conditions, and more and more people are at risk of having these long-term consequences.

Dr. Correa:
And so extending that discussion after a stroke, we got a question from Jeff in West Virginia who asked, and he stated to us that he's mostly back to normal, but sometimes has headaches or feels slower, but he lives far from a neurologist. So he worries about spending time and money on something that may not be simply just part of his recovery. So how should a survivor of a stroke or maybe other neurologic conditions distinguish between symptoms requiring 911 or if they have remote access to care, and when things warrant prompt attention versus waiting to a routine visit?

Dr. Sabayan:
Excellent question. And thanks, Jeff, for bringing that up because this is not limited to you. I'm sure many other patients would have that feeling. So having mild headaches, some fogginess, slowness, slow gaits and processing of information are pretty common after a stroke, especially first few months, because there's a hit to the network of all the neurons and connection, even if you had a good recovery. So that might not be 100%.
I can't emphasis enough that how much we should promote these acronym of BFAST. And let's talk about that. So BFAST is a very good framework when you develop new neurological conditions, you need to seek medical attention. And we know that those who had a stroke in the past are at a higher risk of having a stroke in future. So if you have none of specific symptoms that you discussed with your neurologist or primary care provider and doesn't seem to be really something new and they have been kind of low grade and constant, probably you don't need to be worried about it right away.
But if you have acute changes in your balance, in your vision, eye, in your face, in your arms, in your speech and movement, that's time to call 911. And this is BFAST that I think is very important to be aware of that, balance, eye, face, arm, speech, time to call 911.

Dr. Correa:
I think that's a good resource. And we'll make sure to also include information about that in the show notes. And I guess just always I throw in, if there is some function that you previously had or could do, and now today along with a headache or some other symptoms, you're not able to complete that task, and it's a new change, it's not already been established as part of a seizure or a headache condition or something that you have, whether or not it falls exactly into BFAST or some other description, then that requires medical attention.

Dr. Peters:
Absolutely. I think of also clumsiness, new onset of clumsiness is something that recently happened to one of my colleagues and ended up having a left parietal stroke. So, you never know.

Dr. Correa:
Absolutely. So Benham, I wanted to wrap up and think of bringing the whole family together to think of a brain healthy day. And Michelle from Nevada wrote to us and expressed she enjoyed our brain healthy day from AM to PM episode and resources online, and asks, "What's new in your routine? What do you tell someone who's there in your office that has a whole family? How can the family begin with small enough changes and actions to think of a brain healthy day for the individuals in the team and their family?"

Dr. Sabayan:
Yeah. This is from early in the morning, but also before that, and that's an adequate amount of sleep. I think we are living in a very fast-paced society. We tend to forget that one-third of our life is during asleep and this is where you need to really recover. Your brain needs to have some breathing. So let's make sure that you would have adequate sleep overnight.
And then I think that during the day, one way or another, one shape or another, we need to include some sort of physical activity and avoiding sedentary lifestyle within our daily activities, whether that's going to the gym, or whether going to park next to our house, have a nice walk, whether biking to work, whether having a treadmill at home, I think this needs to be part of our habit. We don't have to exhaust ourselves to the very extreme level, but this constant moving and activation of the neuromuscular junction is really important.
The other thing is just to be aware of what you are eating. I think it is now very clear that Mediterranean diets or mine version of it, which is associated with ingredients that would lower your inflammation are associated not only with heart health, but also brain health. These will be another thing that I will keep in mind. And then one other thing that I would not forget about that we are humans, and humans are by nature social animals. And you need to find meaningful connections in your, maybe not the everyday, but also in a week or a month, having some sort of social connection that you feel like it gives you joy and it helps you to be connected with others. This is the nature of our being, and I think this is important that do not lose track of that.

Dr. Correa:
Well, thank you so much, Benham, for joining us and for everything that you're doing to bring awareness to the community and be alongside individuals as they're thinking about their brains and preventative neurology. And I guess after this episode, we should probably all disconnect from the screens.

Dr. Peters:
I agree.

Dr. Correa:
Call someone we love, maybe reach out to one of those collegiate family members that we have, share with them our love and connect with someone socially.

Dr. Sabayan:
Yeah, thank you so much for having me. This is awesome. Thank you for doing this.

Dr. Peters:
Thank you for doing this. My brain already feels healthier.
Thank you for joining us today on the Brain Health Podcast. Follow and subscribe so you don't miss our weekly episodes.

Dr. Correa:
Also, for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. And you can send these in by email to podcast@brainhealth.com, or leave us a message at (612) 928-6206.
I'm Dr. Daniel Correa connecting with you from New York City, and you can find me on social media @neurodrcorrea.

Dr. Peters:
And I am Dr. Katy Peters, joining you from Durham, North Carolina, and online @katypetersmdphd.

Dr. Correa:
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Dr. Peters:
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