The One You Feed - What to Remember When You’re Forgetting: Living Well with Memory Loss | Dr. Zaldy Tan

Episode Date: October 20, 2026

In this episode, Dr. Zaldy Tan explores how to live well with memory loss and what an Alzheimer’s diagnosis means for individuals and the people who love them. Drawing on his own experience caring for family members with Alzheimer’s, he discusses the questions many of us carry about forgetfulness, aging, and the fear of losing our independence. Together, they discuss how to stay connected as memory changes, make important decisions early, and approach caregiving with compassion—including for yourself. His new book is What to Remember When You Are Forgetting: How to Live and Thrive with Memory Loss, Alzheimer's, and Other Dementias Free Guide: Outsmart the Hidden Saboteurs of Self-Control. What’s been holding you back lately? In this free guide, Eric shares the six common saboteurs that quietly derail our best intentions—like autopilot behavior, self-doubt, and emotional escapism—and offers practical strategies to help you regain control and move forward. Download your free copy at oneyoufeed.net/ebook. Key Takeaways: How to distinguish everyday forgetfulness from changes that warrant a closer look What Alzheimer’s blood tests and genetic testing can—and can’t—tell us Why addressing health risks in midlife matters for long-term brain health How honest conversations about a diagnosis can help preserve friendships and meaningful activities Why familiar routines and reassurance can help when reasoning with someone with dementia doesn’t How caregivers can prepare for changing needs and find support before reaching exhaustion To learn more, click here! If you enjoyed this conversation with Zaldy Tan, check out these other episodes: Eating for Brain Health with Lisa Mosconi The Science of Emotions: How Your Brain Predicts Your Feelings with Lisa Feldman Barrett This episode is sponsored by: Ka’Chava is your daily all-in-one shake, with protein, fiber, greens, superfoods, vitamins, minerals, omega-3s, probiotics, and more. Go to KaChava.com and use code FEED for 15% off your first order. David Protein bars deliver up to 28g of protein for just 150 calories—without sacrificing taste! For a limited time, our listeners can receive this special deal: buy 4 cartons and get the 5th free when you go to www.davidprotein.com/FEED Learn more about your ad choices. Visit megaphone.fm/adchoices

You do have that window of time where life is still vibrant and you still enjoy your friends and you can still travel, as you mentioned, and, you know, go to your favorite restaurants. Those are things that you shouldn't squander by denial. And those are things that I think are important in the early stages of this illness. Welcome to the one you feed. Throughout time, great thinkers have recognized the importance of the thoughts we have, Quotes like garbage in, garbage out, or you are what you think, ring true. And yet, for many of us, our thoughts don't strengthen or empower us.

We tend toward negativity, self-pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf. Dr. Zaldi Tan opens his book with a story about two people who got the same Alzheimer's diagnosis around the same time.

One kept traveling, kept seeing friends, kept living. The other more or less gave up. Same disease, same stage. Dr. Tan has spent his career as a memory specialist watching that fork in the road, and in this conversation, he explains what separates the two paths. I lost my father to Alzheimer's and was deep in the care of Ginny's mother who also had it, as well as I worry about my own future, so I brought a lot of questions to this one, including ones about how difficult it is to care give. His book is What to Remember When You're Forgetting. I'm Eric Zimmer, and this is the one you feed. Welcome aboard via rail.

Please sit and enjoy. Please sit and sit. Play. Post. Taste. View and enjoy. Via rail. Love the way.

Hi, Zaldi. Welcome to the show. Glad to be here, Eric. Thanks for having me. I'm really excited to talk with you about a really important book that you've written. It's called What to Remember When You Are Forgetting, How to Live and Thrive with Memory, memory loss, Alzheimer's, and other dementias. And as I said to you in the pre-show conversation, this topic is very near to my heart. I lost my father from Alzheimer's. Ginny lost her mother from

Alzheimer's. We've been involved in her mother's care really deeply. So this space we've spent a lot of time in. And as an aging person, it's also on my mind. And so I'm really excited to talk with you. But before we get into that, we'll start the way we do on every show, which is with the parable. In the parable, there's a grandparent who's talking with their grandchild, and they say, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love. And the other's a bad wolf, which represents things like greed and hatred and fear. And the grandchild stops. They think about it for a second.

They look up at their grandparent. They say, well, which one wins? And the grandparent says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. Well, Eric, that parable really appeals to me both personally and professionally. I think I've always felt like we're all a combination of positive and negative qualities, positive and negative experiences. And we try our best to be the better person, right? have the positives kind of be more dominant over the negative.

But there are times when the negative shows up. And we try our best to contain it and to not let it take over. And I think that always that check and balance is a healthy thing. But realizing the complexity of the human being being a combination of both positive and negative qualities are important. Professionally, especially as it pertains to the book, it also appeals to me. because when you get dementia and you've experienced this in your family, as you've said, you have less control over which wolf shows up on a day-to-day basis, right?

Just because you have dementia doesn't mean that you lose any of these qualities, positive and negative. But your day-to-day experience, I think, will be dictated by sort of internal triggers and external triggers. The internal triggers, maybe you wake up and in your mind, especially in the moderate to late stage, that someone's trying to poison me, or my wife is cheating on me. And that's the internal trigger, but there might be an external trigger as well.

Maybe she's wearing makeup and you'd be like, why is she wearing makeup? You know, so sometimes these kinds of things trigger you. And the caregiver really has a lot of control over which wolf shows up that day, right? By redirecting, by concentrating on a positive, by not feeding that wolf. if it's fear, jealousy, anger, by just making sure that they don't add to that wolf feeding that wolf, because that's going to show up and it's going to wreck havoc on that person's day and the caregivers as well. So that parable appeals to me because it shows us that, you know, no matter who we are, whether we have dementia or other illnesses, we are a combination of these traits.

And in terms of dementia caregiving, there is a lot of control that the caregiver can exert. as to which wolf shows up that day. I love that. There's so many things that you sit in there that resonate with my experience and also resonate with what I think about when I think about dementia, which is this beginning to lose, the way I would call it is filters or internal tamping down mechanisms or inhibition mechanisms or that that obviously seems to sort of go.

I think the question of how much we are day to day already, even without dementia, a combination of these internal and external triggers is a very interesting thing. But it does seem there's a degree of choice that erodes. I think about the degrees of choice we have a lot. I'm a recovering heroin addict and I think about the degrees of choice I have today in relation to that to the degree of choice I had 30 years ago. They feel very different. And I think there's a similar, parallel to dementia, which is that the choice you have about what shows up here in your brain and what you do with that, it seems that you have less of that. Would you say that that seems accurate with what you've seen? Absolutely, Eric. You know what? I hate to make the comparison

between someone older with dementia with the child because they're not children, they're adults. They have a whole lived experience. But if you think about the children having sort of lower control or less control over their impulses, that's, you know, a way to think about dementia, right? When our frontal lobes, our executive function tells us, you know, I have this impulse to do X, but it's inappropriate or it's not the right time. I'm going to not do it, right? So that is a frontal lobe function.

With dementia, specific dementia is like frontotemporal dementia affects the frontal loaves specifically. That's why very early in the disease, people get disinhibited and they have behavior. behavioral personality issues. But even with Alzheimer's or vascular dementia, eventually it will affect their frontal lobe and they will have less control over the impulses. So if they're feeling bad, they're going to make you feel it. And if they're happy, they will be, you know, they'll be very happy and boundlessly happy. So it's a good way to think about it.

And again, manipulating or controlling the external environment is really the best way to bring them back to the center. Yeah, it's so tricky. All right, I want to go about this. I kind of, I'm so excited I want to dive in all over the place, but I want to go about this mildly systematically. And I want to start with just a couple of minutes on the different types of dementia that are out there.

Now, I've heard you say somewhere, maybe I read it in the book, that there's potentially up to 100 different types of dementia. We're not going to lay out 100 of them. But I think there's three or four kind of major categories. And I'm wondering if you could just walk us through what those are to sort of set up the stage of what we'll be talking through. Yeah. So you're right. There are many, many different types of dementia because there's a lot of different things can happen in the brain as you get older.

And each one manifests slightly differently. But, you know, Eric, the best way I can explain it is that think of your mind as an orchestra, right? It's there's a string section, there's a percussion, you know, and all of these different parts of the orchestra work well together to, you know, produce music, right? So if there is a string that's broken in a violin section or someone is not in sync in the percussion section, the whole music is going to be a ruin, right? I make that analogy because the types of dementia manifests depending, the way that it manifests depends on which section of the orchestra is broken. So in Alzheimer's, the section of the brain or the part of the cognition that's most affected is memory.

So how will people with Alzheimer's manifest short-term memory problem? So a lot of times, they will not have personality changes early on. they will not have any problems walking, talking, you know, driving, but then they will have short-term memory problems. Frontotemporal dementia is another common type of dementia, and this one affects younger people in their 40s, 50s, early 60s, and one affects impulse control, the front part of the brain, which is irresponsible for controlling our impulses, and also responsible for motivation, right? motivation to shower, to, you know, get up in the morning and go about your day. So that's more

frontal frontal frontal frontal dementia. But also the frontal lobe is also responsible for language, right? So it can also affect not just personality and inhibitory impulses, but also your ability to understand and express yourself in language. And then the other type of dementia that's common, it's called Louis body dementia. Louis body dementia, is a cousin of Parkinson's disease, meaning it's the same protein that accumulates in the brain of Lewy body as it is in Parkinson's called Alpha Cnuclin. But if Parkinson's is more of a motor symptom, you know, the shaking and the stiffness and the drooling, and then Louie body is more of a cognitive. So people can start having visual hallucinations. People can start having some

acting out of the dreams when they're sleeping called the REM behavior disorder. And then the last common type of dementia is vascular dementia. So vascular dementia is basically think about strokes, right? Think about small strokes, strategically placed that can manifest in any of these things that I've described, depending on which area of the brain was affected. I'm sorry vascular dementia is so interesting and so complex because sometimes it can look like Alzheimer's, sometimes it looks like gluey body or frontal, depending on which area of the brain is affected. But those are sort of the foremost common types of dementia that people will likely encounter.

So science changes fast, and it's been, I don't know how long since Ginny's mom was diagnosed with Alzheimer's and we went through all this. At that point, Alzheimer's diagnosis was considered sort of a diagnosis by exclusion, meaning clearly there are cognitive problems happening. We've looked at the other types of dementia that are out there. We've ruled those out. So we've you now just say, hey, this is what you got. And you could have an autopsy after your life where you look in your brain and you confirm, hey, that was right. But has that changed?

Like, what is the diagnostic process? I hear about biomarkers. I hear about different things these days that are starting to come about. But I just don't know where the science actually sits with that stuff. Yeah, just by the way you describe it, Eric, I could almost certainly say that that didn't happen in the last five or ten years. years because things have changed. You're right dramatically. And you mentioned biomarkers. What is a biomarker? Biomarker is just a protein or other compound that can tell you whether a disease is

occurring, right? So that's the broad definition of biomarker. But it pertains to Alzheimer's disease. These refer to the abnormal proteins that form in the brains of people with Alzheimer's disease, mainly amyloid and tau. These two proteins are known to accumulate in the brains of people with Alzheimer's disease a good 10 or even 20 years before the first sign of a memory problem. So think about the cholesterol plaques in your arteries, right? We know that beyond our teenage years, people even in their early 20s already have plaques in their arteries, right?

But it doesn't mean that they're going to get a heart attack, but you accumulate that risk over time. So in a similar token, when you start accumulating these abnormal proteins in your brain, your risk of developing Alzheimer's disease goes up exponentially. So for the longest time, we thought of Alzheimer's disease as a mental health or even a psychiatric diagnosis. In fact, the DSM, which is the Bible of psychiatry, is the first criteria that was developed diagnosing what Alzheimer's disease is, right? And mainly from the cognitive symptoms. Forget debtfulness, lack of ability to plan and sequence things, paying attention is a problem. So those are more cognitive symptoms.

But now more and more, we are defining it as a neurologic disease that have specific markers, as I mentioned, amyloid and tau. You know, 10 years ago, Eric, we couldn't really measure amyloid and tau in vivo, when the person's living. It would have to be an autopsy, right? And then we do a brain section. We look for amyloid and tau. But now, there are ways to measure amyloid and tau in vivo, meaning while the person is living.

So it could be done through an amyloid PET scan, wherein we inject this antibody that can bind to the amyloid, and then it lights up in the PET scan. We can also get a seribus spinal fluid through a spinal tap and measure the amounts of amyloid and tau that are there swimming around in the seribus spinal fluid. or we could also get now purple blood like you do for your primary doctor. And we can measure how much amyloid and tower in the brain in order to determine whether this person is at risk of developing Alzheimer's disease. So how accurate are these?

And again, I'm one of those people that had a vague working knowledge of the science eight years ago. So you have to forgive me. But I know one of the problems with drugs to treat Alzheimer's seemed to be that. that accumulation of plaque seems to be part of what is an Alzheimer's thing, but you can have people who have accumulations of plaque and symptoms. So what does the fact that I get a biomarker back that says, hey, your levels of this are higher than we would expect at your age, how diagnostically useful is it? And then I guess the question comes from that that I've always wondered, it's the same thing

with certain gene tests that you can take that tell you whether you have multiple copies of APOE, maybe, I don't know, I'm probably getting it all mixed up, then I've been like, well, do I really want to know? Like, if I know what would I do, what can I do differently? So I guess question one is, how accurate it's the diagnosis? Would you recommend a 56-year-old who has a history of Alzheimer's get them? And then B, what do we start doing with that information? Yeah, you ask really, really important and pertinent questions that I hear very often. amongst my patients and their families.

So the accuracy of the genetic test, the APOE, you mentioned, is very accurate, right? So there's no problem with accuracy there. With genetic testing, basically whether you have one or two copies of the APOE4, as you know, you get one copy of your genes from your father and then the other copy from your mother. So if you have two copies, it elevates your risk of developing Alzheimer's in the future quite substantially. Now, the genetic testing is not something we routinely check, even in people who have Alzheimer's disease, unless they're undergoing monoclon antibody therapy because it matters because of the complication rates differ depending on the number of E4 you have.

But if someone, for example, has memory problems. Genetic testing is not the first thing we recommend unless it happens to someone who is young, meaning in their 40s, 50s or early 60s, because there might be a genetic component to it. which can then be passed on to the next generation. Most people want to know whether it's something that they can pass on to their children. Now, biomarker, if you look at the literature, it's very accurate, you know, in the 90s, sensitivity, specificity in the 90s. The problem is real-life data. So when this was first-leased and approved the FDA, we were all very excited.

Because if you have a test that's 90-something percent accurate, you know, any, anyone who has a memory problem or memory change or even just want to know whether they have, you know, the beginnings of Alzheimer's can just check it and then know whether they are in the clear or they're not. But the problem is there is accumulating data from real world experience, meaning outside the experiments that are being done to get FDA approval, that the accuracy may not be as high. And there could be false positive and false negatives. So the recommendation, Eric, is that these blood by,

markers, while they're helpful, should really be limited only in people who have memory problems. Okay. Because there's something called pre-test probability. So if your pre-test probability is high, the likelihood that you're going to have a false positive, false negative is significantly lower. But if you have no symptom at all and you get this test, the probability that you're going to have a false positive or false negative is going to be quite a bit higher. So these tests are available, but we recommend that these only be checked in people who are symptomatic,

meaning they already have the symptom and it will help us as another data point to determine whether these changes are just normal age-related memory changes or whether this is, in fact, the start of Alzheimer's disease. Okay, so you've teed up the second biggest question. Maybe this might be the biggest question you get from people who are my age, 56, or 65, what is normal? I mean, how do I know whether changes in my memory, my working cognition, my, all of this is normal? Or how do I know that like, oh, something's going wrong here? Is that your most asked question? It's got to be up there. Yes, in parties and in social circles.

You're probably tired. You're probably very tired of answering this one, but it's an important one. Unfortunately, they probably are not very satisfied with my answer because it really depends, right, on your baseline. So let's say you're doing a party for 20 friends and you're piling a barbecue and you have to pick up, you know, all these things and prepare your house for barbecue and then you suddenly are not able to do it. Now, the question is, were you able to do it, you know, years ago and has things changed? Or were you never a party planner and suddenly you're planning a party and you're overwhelmed? So that may not be normal. So baseline is key.

I also get Eric a lot of the complaints from adult children saying, my mom can't figure out her smartphone. I don't know what's going on. And then you ask them, has she been a techie? Has she been able to, you know, program her cable box? And it's like, no, he hates technology. And now she's older and now she's having problems. And as you know, our phones, in fact, the iPhone's going to be released.

Your iPhones are going to be released today. They get more complicated because there's more apps, more stuff to do. Even dishwashers, even washing machines get a lot more complicated because there's a lot more features. Yeah. So again, just because someone's having a problem with technology doesn't mean that they're having dementia. But is this different from their baseline?

And how much is the delta, right? And again, there is definitely overlap in very early stages of Alzheimer's disease and normal aging, which makes it a bit more challenging, right? So that's why you need someone who is a very objective and astute observer. Typically your partner or your adult children or very close friends who sees you regularly and say, you know, this is very different from your baseline. You know, and if there's any doubt, of course, when they see memory specialists like me, we can do more objective testing and neurology examinations that can detect that in an earlier way.

Welcome aboard via rail. Please sit and enjoy. Please sit and sip. Play. Post. Taste. View and enjoy. Via rail.

Love the way. So with certain things, early detection is everything. Right? I mean, if I have cancer, stage one, it's going to be a far better situation for me than stage four. let's say I wanted to be hyper vigilant. Welcome aboard via rail. Please sit and enjoy. Please sit and sip.

Play. Post. Taste. View and enjoy. Via rail. Love the way. Like, you know what? I do notice that I forget words.

I'm like, what is that? I know there's a word there. I can't grab it. Oh, recent podcast guests. I don't remember as well as I used to, which, you know, then the question becomes, well, is that because you've done 900 of them? But I want to be vigilant here. How important is early detection?

What does early detection buy me? What would knowing at 60 that we are in early stages of MCI, like, let's say very early, versus five years later? Like, how do you think about that? Yeah, a great question. You know, so it depends. I always think about prevention. valuable if there's something you can do about it yes right because if you for example if everyone checks their APO E4 allele status even a baby you know a

newborn you can check their APO E4 status but why would you right you can't change your genes and and for example with April E4 not all people with April E4 will get Alzheimer's disease yeah and you don't need an April E4 to get Alzheimer's disease so that's a kind of test that I wouldn't unless it's being done for a specific purpose. Now with biomarkers, early detection is possible, right? But what are you detecting? Early detection for biomarkers is detecting the start of the pathology.

It doesn't detect the disease. As you mentioned earlier, there are people whose brains are studied with amyloid and they never get Alzheimer's disease. because now that we are able to get rid of amyloid in people with early disease and disease still progress tells us that there are other factors at play in developing Alzheimer's disease. So that means that even if you detect it very early, there is currently no good way to absolutely prevent someone from progressing, right? But in a sense, we should be assuming that all of us are at risk for Alzheimer's because we are, whether you have amyloid in your brain or not, right?

Because, you know, it takes 10 or 20 years for amyloid to develop. So if you were in your 50s or early 60s, you have, you know, 30 years to develop amyloid and Alzheimer's disease. So you have a very long runway, as I always say. So I always say that, you know, we have to assume that we're all at risk. So we shouldn't live as if we could escape this disease. So we should instead think of it as what can I do at my age, whether you're 20, 30, 40, 50 or 60 to reduce my risk of developing this or pushing it further down the road so that something else will get me. Right. Because at some point, something will get us. But you just don't want to spend the last five, 10 years of your life without a memory and being dependent on others for your day-to-day.

needs. Before we dive back into the conversation, let me ask you something. What's one thing that has been holding you back lately? You know that it's there. You've tried to push past it, but somehow it keeps getting in the way. You're not alone in this, and I've identified six major saboteurs of self-control, things like autopilot behavior, self-doubt, emotional escapism, that quietly derail our best intentions. But here's the good news. You can out. You can outsmart them. And I've put together a free guide to help you spot these hidden obstacles and give you simple, actionable strategies that you can use to regain control. Download the free guide now at one you feed.net slash ebook and take the first step towards getting back on track.

What I'd like to do is I'd like to spend a few more minutes here and then I'd like to pivot the second half of the conversation because this book is about living with Alzheimer's. It's designed for people who have it. So I don't want to make the whole thing about what about those of us who don't have it, but might get it. But I want to ask a couple more questions there and then move on. And I guess the general one is my like don't get Alzheimer's plan, as such as it is, has largely been eat well, you know, don't eat a ton of sugar, don't eat a lot of processed foods, keep my cholesterol, and my blood pressure, all that stuff in the right spot, exercise regularly, do something,

things with my mind that stimulate it to do other things and sleep, you know, try and optimize for sleep. Is that the general roadmap for Alzheimer's or dementia prevention? Or is there more to it that I'm not thinking of? Yeah. So you hit the nail on prevention right now as we know it, right? Midlife is the age of vulnerability, it's the time of vulnerability. The midlife is when, you know, our blood pressure starts to rise, our LDL starts to rise. our sleep gets a bit less, you know, optimal. We become less physically active and we, you know, accumulate some extra weight. All of these things that you pointed out are important to address,

not just for brain health, but also for cardiovascular health and for overall health, right? So right now we know that reducing the risk for Alzheimer's disease and other dimensions is really addressing these risk factors, some of which you mentioned. There are 14 risk factors. One good place to look at is something called the Lancet Commission. The Lancet is a British Journal, wherein they looked at the evidence of factors that can contribute to the risk of dementia, and they outlined all of them, and they, you know, presented the evidence.

And so these factors, we should do our best to mitigate them. Again, not all of them could be modifiable. Family history, age. If you had traumatic brain injury in the past, that you can't overtly. So there are things that are irreversible, but there are a lot of things, the majority of things, that you can mitigate. So definitely start with that. One exciting thing, Eric, that's going on is there are three randomized control trials that

are going on. Where in the medications that are currently being given for Alzheimer's disease to get rid of the amyloid are being given or tested in people who have biomarkers of the disease, meaning they have amyloid in town their brain, but they don't yet. have the memory problems. Remember, I said it takes 10 or 20 years for these things to develop. So basically they screen people perhaps about family history or at higher risk of developing Alzheimer's. And then they measure the amyloid and tau either in their brain or in their blood.

And they find that these people, while they are walking and talking and working like all of us, they already have amyloid and tau in their brain. So giving these monocon antibody to these people who we call preclinical or pre-symptomatic. and then they get rid of the amyloid in their brain, and then they will follow these people long-tunally to see if they will, in fact, not get the memory problems and functional loss associated with Alzheimer's disease. So those are really pivotal and important studies for those of us, as you said, who don't yet have the disease but are at risk for it. And it's worth looking out for. And the exciting thing is that, you know, within the next one or two years, we will see the initial results.

This is not the final results, but the initial signals will be. seen in the next one or two years. So it's very soon and it's worth looking out for. Excellent. All right. Let's transition because one of the things I loved about your book is it is aimed at people who have gotten a diagnosis. And I'm going to circle kind of back to where we started a little bit, which is you tell a lot of moving stories throughout the book. But in the beginning, there's a very quick recap of a couple of stories of two people both diagnosed with, I don't know whether they were with MCI with Alzheimer's, but they were diagnosed. And one person was living their best life and out there traveling the world, doing all the other stuff.

The other person had basically, in sort of a way, given up. I may be oversimplifying that. I'll let you add the color. And it's clear from that beginning that, you know, the person who is out there, you know, going for it with life is the path that seems to make most sense best outcome. Part of my question, though, is when we started, we talked about how people who start to have Alzheimer's are less able to make choices. And so I originally read that story and I was like, oh, it's clear. I want to be person A, not person B. But then as you were saying that, I was like, but what if I am sort of more like person B because I can't control my brain as well as I used to?

I don't even know if that was a question. I'm going to let you respond to that half. Corey. I understand exactly what you're saying. It's, is it a choice or not a choice, right? How you react to certain diagnosis. Yeah. I will argue, Eric, that it is a choice, right?

So in the very early stage, MCI or mild Alzheimer's disease, you still have all your faculties in time, right, except for memory. So at that point, you will need to decide, what am I going to handle this? And it's similar to how we handle any problem, serious problem, right? So do we just deny it, just bury under the rug and pretend that there's nothing going on and I will go on my usual, you know, way and not change anything in my life until I can't do it anymore? Or do I make active and conscious choices in my life and inform people who are important to me about my diagnosis?

Because at some point, I may not be able to do that anymore. Do I reorder my life's priorities based on this diagnosis or do I just pretend that it doesn't exist? So those are the choices that people can consciously make, right? And it also reflects how you generally approach problems in your life. Are you a more like a person that denies things or gives up on things easily when things get more difficult? Or are you the type of person who's honest and will face the problems head on? I argue in the book that it is best to address these challenges head-on, especially because that window of opportunity to do that does close eventually, and then somebody else will have to do it

for you. So the things that are important in the early stage, things like assigning someone who can make decisions for you later on in life, arranging your finances so that there's no argument among your errors as to who gets the house, how. the finances are handled, who's going to write the checks for my caregivers if I need one in the future, where I choose to live in case I'm so functionally compromised that I am not able to go to the bathroom by myself or feed myself. Those are important questions to answer in scenarios to consider what they look at. And unfortunately, after about three to five years

of this disease, the person may not be able to handle the complexity of these decisions well enough to be able to contribute to the discussion. And I find this quite sad because the person who is most impacted by these decisions are not able to participate. And I also feel sad for the families who are kind of left holding the bag of making these important decisions, not knowing what the person would have wanted and then living with a guilt if the outcome is less than optimal. So I think those are important things. And of course, the positive side of things is that you do have that window of time where life is still vibrant and you still enjoy your friends and you can still travel, as you mentioned, and, you know, go to your favorite restaurants. Those are things that you

shouldn't squander by denial. And those are things that I think are important in the early stages of this illness. Welcome aboard via rail. Please sit and enjoy. Please sit and sip. Play. Post. Taste. View and enjoy. Via rail. Love the way. Getting a diagnosis like that is pretty jarring. I mean, we all know the general path of the future, right? It is one of decline. So to be completely surprised by it seems like maybe I've been paying close attention. But that's a scary one, right?

How do you see people work with the psychological aspects of that? Right. Like, because now all of a sudden I'm afraid, I'm worried, I'm reading, you know, am I starting to read everything that doesn't go, that I don't do as well as I thought I should do it as a sign that I'm failing? Like, are there psychologists? is an ignorant question who focus on this. Like, oh, you've been given a diagnosis.

I know how to help you work with your mind. Yeah, great question. And you're right. How the person reacts to this depends on how they react generally to challenges in life, right? In the early stage, I can tell you there's a lot of isolation. So people tend to withdraw from their social circles. If they like to play golf, suddenly it's like, I don't feel like playing golf anymore. I don't like it.

When they make up excuses not to go because not because they don't enjoy golf or seeing their friends, but they are worried that they're going to be found out that they're having memory problems. They're embarrassed, right? So that's one aspect of it. In fact, I tell people who are in the early stages that they should see a therapist, a psychologist to help them come to terms with aging and the loss that they are experiencing because the loss of your memory is a loss.

It's a real loss that you have to acknowledge and try to come to terms with because if you don't, then just like I mentioned in the book, you will live in denial and then you'll lose that opportunity to have the most precious times that you have in your life to do the things that you want to do and also make. So what I find Eric is that people who are very smart, very independent have the most difficulty because they learn to depend on themselves rather than others. And for them relying on others for their personal needs, for their, you know, for their day-to-day existence is a fate worse than death. And it's very, very difficult for them. And so I don't know what to say, but except that, you know, we have to try to find people to trust and to be able to confine it and to have honest conversations. And if you don't have that in your life, you have to find it, right? Because again, when we're talking about Alzheimer's or just aging in general, this is not an individual sport. It's a team sport, right?

Because eventually you're going to need a village to help you get through this. It's not a disease that you can handle on your own. You need to assign someone who can take care of your finances. You have to have someone make decisions about your future health care. You need to make sure that your social circles are such that you can still have, socialization, even if you get to the mild, moderate, or late stages, because socialization is so important. You don't want to be isolated just because you have this condition. So there's a lot of preparations that need to be done, and the earlier, the better. As you were talking, I was thinking

about my father. And for several years, he lives in the villages in Florida. So he's in sort of a, probably an ideal environment in many ways for that sort of thing. So he had good friends. He played golf with all the time. And they all knew he had Alzheimer's. And they kept him golfing pretty late into the game. I mean, far later than he would have been able to go golf by himself or with a random, you know, sign up and go out for a random foursome. Like they knew and they took my dad out. And they kept doing that. And I think that was, I mean, you could see that as a sign of being open about what's happening so that the people around you have the capacity to be able to support you and help you.

Think of Ginny's mother also. I mean, she was a very proud woman, but enough people knew that she had people who continued to visit her up till near the very end, you know, friends of hers that she'd had for years and years who initially no one should know, you know, Southern woman. But that ability for the people that are close to know what's happening. allowed in both those cases there to be far more socialization, I think, and positivity in that way than there would have been otherwise. You know, Eric, in the book, I mentioned something about Alzheimer's Garden.

And I made an analogy between dementia and maintaining your garden, right? I always tell people sometimes you have to have your pruning shears ready, you know, when you get this diagnosis. Not all, you will not keep all your friends. Right. There are friends that are just not the right temperament or their right kind of mindset that they will be able to pick you up to wait at the golf course and drop you off and patiently say, you know, oh yeah, that's interesting after you told the same story for the time, right? There are just some friends who are very smart, very fun, you know, and I say, you know, just like in your garden, there are flowers that you enjoy during the springtime and summer. but in the winter they're gone, right?

And there are perennials who may not be as fragrant or beautiful or you don't get as much enjoyment from them during the spring. But guess what? They're going to be there every season. That's a beautiful analogy. I love that. That is really good. Yeah. Yeah.

Another thing I want to mention is that just like staying on that gardening, I tell caregivers, even in the hands of the best gardeners, there are a lot of things that are not in your control, the weather, pests, diseases that can afflict your flowers. So you do your best by maintaining your garden and taking care of it, but just know that there are things that are beyond your control. So don't be surprised or frustrated if things don't go your way, even if you are doing your best, right? You did your best.

You created the best garden that you have for the season and the limitations of the geography where you live. But don't get frustrated and appreciate it for what it is and be proud of yourself for what you've done. And don't second guess yourself saying, oh, I should have put more pesticides or I should have taken the flowers in my home when the first frost came. Those are beyond your control. So always think of it as, you know, you have some control, but you don't have total control of dementia caregiving. Yeah, yeah, that is incredibly true. What do we know about progression? I think in the book you break it into early, you know, middle and then sort of last stages.

Is that a pretty typical way that Alzheimer's people break up the disease, early, middle, late kind of thing? That's a simplest way to do it, early, middle, and late. But again, because these are long phases, right? You could be in each phase for three, four, five years. So sometimes there's overlap between the early days. the middle, middle to late. But I think it's a good way to kind of sense with general stage your loved one is in so you can prepare for the next stage. There's also something called a fast scale, which is a more granular way of looking at the stages. It has criteria like, is the person

able to dress themselves? Are they able to toilet themselves? Are they able to speak full sentences, things like that? And that's available online. I also included in the book. It's called a fast. seven stages, and within each stage, there are sub-stages to add to the granularity. And that's helpful sometimes to people who want more detail as to which stage they feel their loved one is in. But in practice, I usually say, you're a loved one. It's in middle stages. Let's talk about this. In the late stages, let's talk about that. So I'd like to talk about, I'm going to guess this is kind of more mid-to-late stage-esque. And it's really around some caregiving things that I came up against it. I'm curious, you know, as an expert, what you might

recommend. So one of the things that this happened, I saw this both in the memory care unit that my father was in, which again is going to be later stage, but I saw it happen with Ginny's mom also. And Ginny's mom was like someone out of Game of Thrones. And what I mean by that, it was winter is coming. She lived in Atlanta, but the thought of winter terrified her. She was certain she was going to be isolated. She was going to be alone. No one would be able to reach her. She was going to starve to death. Like it would just keep coming back to these things. And I would try and debate it with her, which never worked very well. You know, for every scenario she would come up with, I'd be like, Well, but here's what we would do then, in which case she would come up with an increasingly elaborate scenario.

So you've mentioned in passing earlier, like some people will think my wife is cheating on me. At the memory care facility, I remember a man who was convinced his wife never visited him, even though she came every single day. So like, what things can we as caregivers do to help comfort people when they have these, I guess you call them a delusion, reason doesn't seem to work. Like, what does? Yeah. Delusions for your audience is false beliefs, right? Which is different from hallucinations, which are seeing things that aren't there.

And delusions can run the gamut of, yes, you're not visiting me. My son hasn't called me for three months. What's going on? Is he okay? Or my wife is cheating on me or my caregivers are poisoning me, right? Yeah. It runs the gamut of severity and seriousness. Now, obviously, if it's the serious thing, like my caregivers are poisoning me, and therefore

I'm not going to eat or drink and they get dehydrated, that's definitely a psychiatric emergency and they need to be seen because some of them need to get intravenous fluids and feeding in order to prevent them from getting ill and dying. Now, with the things that you mentioned, which are more subtle, you know, this is. nonetheless quite distressing, right? Yeah, they're very distressed. Yeah, because that's the reality. That's the reality where they live in.

Interesting thing about delusions in dementia, they're not bizarre. Bizarre delusions are what shows up in schizophrenia, for example, like the FBI planted something in my head, and people are listening to my conversations. You know, those are more bizarre delusions. Now, the delusions in Alzheimer's disease and other dementias are mood congruent. If they're feeling sad, then they feel like nobody cares for me or my wife doesn't love me anymore. And then there goes the infidelity and all that stuff. So what I tell my patience is that while there is no absolute way to make those things go away,

there are things you can do to minimize them. So, for example, the calling thing. if the visiting or calling comes consistently, not haphazardly, different days of the week. Let's say, you know, Wednesdays at 5 p.m. afterward, you know, I will visit my mom in the nursing home. I will have a big calendar and I will tell the caregivers, whenever he looks for me, point to the calendar and saying, today's Monday, your son will be visiting on Wednesday in a couple of days. What will you tell him? What do you want to prepare for his visit?

So always put that in a predictable way so that someone can have a point of reference of when something is happening. Is that predictability a good idea in general? Yes. People with dementia deal best with structure. So, you know, well-meaning children will say, oh, why don't mom stay with you for a week? And then she's going to stay with me for another week and then put with our brother the next week. And I tell them, unfortunately, while that's very well-meaning and very sweet, it's not the best thing for the person with dementia because they thrive in routine and familiarity.

So they like to sleep in their own bed. They like to be in their own place. And, you know, I've had people fall, you know, tragically when they are in another house, in their children's house because they feel like the bathroom is right there on right. And they don't realize it's a stairway, right? So those are kind of things that I would recommend. Now, with delusions of infidelity, you have to know that some of this come from the unpredictability of when the spouse will be gone. For example, if the spouse and the person with a mention living together and the spouse

goes to the grocery store to pick up something. And the person doesn't have a point of reference of how long the spouse has been gone. In their minds, the spouse has been gone, you know, five hours to pick up something, a milk. So that's suspicious, right, for them. But if you say, okay, the day, it's 10 o'clock, I'll be back at 11 o'clock and you put in a whiteboard somewhere where 10 o'clock, you know, wife going to the supermarket and then they reference them. See, I wrote down here that it's almost feels artificial. It's like, why do I have to do that? I'm not doing anything bad. But just understand that their reality is different because their sense of time is not the same as ours because

their short-term memory is not as good as it should be. You said something there that was really interesting, mood congruent. So in psychology, there's this idea that gets batted about a lot. Is it the thoughts that I have that cause my mood, or do I have a mood that then all the thoughts filter through? And it seems pretty obvious to me it's both. So if it's mood congruent, is an approach to boost their mood in some other way that hopefully then the thoughts that the thoughts will become more mood congruent? Is that a strategy? Oh, absolutely. In fact,

when someone comes in and saying, you know, my loved one is agitated. Agitated is sort of a very unspecific term, right? Someone that's not cooperating, spitting out their medication, trying to hit or scratch your caregiver. That's agitation. But agitation is the final common result of anything. It could be hallucination, delusion, but it could also be depression. So I always tell my patients and their caregiver, someone with dementia doesn't get depressed like you and I will. You know, if you and I get depression, typically we don't want to get out of bed. We may push the plate away when someone offers us food. But with people with dementia, they may not be able to do that. They are not allowed to stay in bed the whole day. They're not allowed to not shower for a week.

They're not allowed to skip a meal, right, by their caregiver. And so they act out in different ways. So I always say that if someone is sad and they look sad or if they have clinical depression, that needs to be addressed, right? So for sadness and not depression, if they're just sad because, you know, it's Christmas time perhaps and they're seeing the decorations and that reminds, and there's an internal trigger there that reminds them of a sad time when they lost their son around Christmas time, for example, then that is something that you need to distract them. Don't have Christmas stuff.

no matter how festive it is, if it reminds them of something not good in their lives, don't do it. You know, pretend that it's not Christmas. If it's a trigger that is a bad memory, then try not to bring it up over and over again. If they're convinced, for example, that their mom is still living, you don't have to remind them that their mom has died five years or ten years ago. You just have to go play along with it. So trying to steer this mood into a better direction is really important. in order to avoid sort of the consequence of them acting out and becoming more agitated.

And of course, if they have clinical depression, antidepressants are very effective in reducing the symptoms of depression and the delusions that are associated with the depression can also be mitigated by starting them on an effective medication. In your book, you talk about 3Ds. You talk about dementia, which we had been talking about. We just hit depression. You talk about delirium. We were just talking about delusions, but delirium is something different.

Yeah, delirium is very different. Delirium is a state wherein there is inattention, meaning you're talking to someone and their eyes are drifting somewhere or they're looking at random things. And this is a transient state of confusion, right? Transient, meaning it doesn't last forever. But it can last days, weeks, or months, and that is potentially troublesome. And delirium is typically caused. by either a metabolic problem like electrolyte abnormalities or dehydration or an infection like a

urinary tract infection and you know anyone can get delirious Eric so you know we've seen young people who get drunk or who are on substances and they're delirious right they're hallucinating they're seeing things that aren't there they're confused there's belligerent that's delirium but with older people especially those with dementia you don't need to be on or an alcohol to have that, even the urinary track infection or an electrolyte imbalance can cause that. And it's the same experience. It's terrifying, right?

Yes. Having been through a couple with my mom a couple times in Jenny's mom, a urinary track infection, they are completely out of their mind. I mean, it is stunning. You're like, this cannot possibly be an infection. But, yeah, it's amazing. Yeah. And the good thing to know is that it can be.

treated, right? It can be avoided, it can be treated. So if for a urinary tract infection, for example, just, of course, the person with dementia is not going to tell you, oh, I'm burning in my urine, you know, but you feel that they're wincing when they're urinating and you know that they're uncomfortable, you can get your analysis to see if they're brewing a urinary tract infection and they can be starting antibiotic and avoid all that. Make sure to have proper hydration so that whatever, you know, bacteria is there is flushed out. And really, those are some things. that you could do to avoid having these crises. Before we wrap up, I want you to think about this.

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brutal. I mean, it can be really, really difficult. Do you have a couple of, I even, I even I even hate to say tips because tips sounds like, you know, it way undersells the severity of what it can be like. But do you have a couple of things we could give listeners who are in that caregiving role of ways that they can begin to support themselves under, you know, very significant burden? You know, I always tell people think about best case, worst case scenario. You mentioned that certain people are like the winter's coming, right? Like worst case scenario. And there are people who are like, everything will be fine. It'll sort itself out.

I think you have to think and prepare for both scenarios. You don't want to be a doom and gloom, but you also don't want to be a poliana saying everything will be fine. So if you're a caregiver or someone with dementia in the early stage, you have to have that conversation either with the person with dementia or perhaps your siblings or whoever else in your family, your parent, your other parent, to say, what happens if mom gets X, right? Becomes unable to take care of herself or gets delusions or gets sick and has to go to the hospital.

So prepare for that and think about the things that you need to do to be prepared for that worst case scenario. Hopefully it never happens. But if it does, at least you have thought through it and you have some preparations for it. The other thing is to think about support system. I always think of any problem as scaffolding, right? You need scaffolds because you can't say, oh, my mom is taking care of my dad. She's excellent.

We don't need anyone else. That thing could go away, right? She could fall or she might have a problem herself. She has to go to surgery or whatever. What happens, right? So if you're depending on that one scaffold, it takes very little. for that whole thing to collapse. So you always have to have plan A, plan B, plan C,

so that if something gives up, you have another way to fill those gaps. And those scaffolds are really community-based services, right? Depending on where you are. Typically, there are ways to get help, whether it be caregiving or respite care or medical care that you need. You get to know which hospitals are in your area, right?

So if there's a crisis and you have a choice, go to the hospital where you can get better care when someone's not just going to be tied down to their bed because they're understaffed or be medicated and zonked out because the nurses can't be bothered, right? If in case you need temporary or permanent placement for your loved one, get to know what in your area are available for this kind of service, whether it be assisted living or senior housing or even nursing homes.

And a lot of people like, No, nursing homes, never, ever. I hate those places. But, hey, if someone factory their hip and they need two or three people to help them to get to the bathroom, what choice do you? Right. So don't always think about the best case scenario, but always be prepared also for the worst case scenario. And one last thing, Eric, is that make sure you take care of yourself. Because once the caregiver throws in the towel, game over, right?

the person who suffers the most is the loved one who is the one that's most vulnerable. So don't expend all your energy and resources to the point of exhaustion and then give up, right? Instead, prepare for it, space it out. Don't let the perfect be the enemy of the good and, you know, make sure you have respite care and other community supports to help you get through this marathon, not a sprint. I think some of what you're saying there is really important. Our health care system, there's all kinds of problems with it. There's all kinds of problems with our community supports and all of that.

And there are resources out there that my experience has been, as I looked more for them, there was more than I thought there might be. You know, we found things from my mom in Colorado. We moved her to Colorado to be near my sister. She'd have dementia. She passed recently. But we found things that were available in Colorado. I should say, let me rephrase that.

My sister, God bless her, found things that were available in Colorado that I don't know that we had in Ohio or I didn't look closely enough. But she was very good. She was very resourceful at turning over resources that I was like, well, I had no idea. You know? And again, so it's easy to lament that there's not enough. but it's also very much worth making sure we take advantage of what is there. Absolutely. And the worst time to be doing that is when there's a crisis.

You know, the best time to do that is before a crisis happens. And that's why preparation is key. If you wait for it for when that serious illness happens and you're gathered around, you know, the hospital bed and saying, what are we going to do with mom? Where's that going to go? That's not the best time to do it. You have to know before that happens. Yep.

Well, thank you so much, Zaldi, for coming on the show. I appreciate it. I appreciate this book. I think it's really useful to people if either they have mild cognitive impairment or their family. This book is a really great resource. So thank you so much. Thank you for having me, Eric. It's such a pleasure. Thank you so much for listening to the show. If you found this conversation helpful, inspiring, or thought-provoking, I'd love for you to share it with a friend. Sharing from one person to another is the lifeblood of what we do. We don't have a big budget, and I'm certainly not a celebrity, but we have something even better, and that's you. Just hit the share button on your podcast app or send a quick text with the episode link to someone who might enjoy it. Your support

means the world, and together we can spread wisdom one episode at a time. Thank you for being part of the one you feed community.