Brain Boost or Bust? Unpacking the Latest Dementia Prevention Study

In this episode, we dive into the fascinating world of cognitive health with Dr. Mitchell Clionsky, a board-certified clinical neuropsychologist specializing in memory disorders assessment. Our host, Darleen Mahoney, explores a recent study on lifestyle interventions for cognitive health, presented at the Alzheimer's Association International Conference.

Dr. Clionsky offers a critical analysis of the Pointer Study, which examined the effects of lifestyle changes on cognitive function in older adults. We discuss the study's methodology, results, and limitations, providing listeners with a balanced view of the research. The conversation then shifts to practical aspects of cognitive health, including the impact of diet, alcohol consumption, and even marijuana use on brain function.

Whether you're curious about the latest research in dementia prevention or looking for actionable advice on maintaining cognitive health, this episode delivers valuable insights. Tune in to hear Dr. Clionsky's expert take on what really matters when it comes to keeping your brain sharp as you age.

Visit: www.braindoc.com

Link to Psychology Today Article: Do Lifestyle Changes Improve How We Think? by Dr. Clionsky

SeniorLivingGuide.com Podcast sponsored by TerraBella Senior Living

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Transcript

Darleen Mahoney [0:01 - 0:52]: Today we are joined on the podcast by Dr. Mitchell Clionsky. He is a board-certified clinical neuropsychologist and he is licensed in Massachusetts and Connecticut. He specializes in the assessment of memory disorders, other neurological diseases, mild traumatic brain injury and ADHD. He co authored with his wife the book dementia prevention, using your head to save your brain. Dr. Clionsky has been on our podcast several times and he is amazing. I'm super excited to have him back today as I am excited to congratulate him on his article that was actually released today on Psychology Today and it is titled do lifestyle changes improve how we think? And I'm going to include that link in the podcast description as well. Thank you so much for joining us today, Dr. Clionsky. 

Mitch Clionsky [0:53 - 0:57]: As always, Darlene, a real pleasure. I enjoy being on your podcast so much. 

Darleen Mahoney [0:57 - 1:15]: Yeah, absolutely. You have always brought so much incredible information to our listeners and I'm glad you're going to share even more today. You had shared with me about a study called the Poynter Study that you're pretty excited about. And actually your article in Psychology Today is based on that. 

Mitch Clionsky [1:17 - 3:21]: Exactly. So this was published, actually was presented at the Alzheimer's Association International Conference this year back on July 30. Simultaneously, the article that the presentation was based on was published in the Journal of the American Medical Association, I think in their neurology section. So it was a big deal. It's a study that spanned two years and involved 2111 subjects. People ages 60 to 80. 80. Or maybe it's a little older than that. Yeah, I think. I think it may be a little older than that. But these are all people who we tried to look at or they tried to look at because it's five different centers across the country that were involved in this study. So it was a very large undertaking because they started with 13,000 people and sort of winnowed it down to the final 2,000 people. And what they did with them was they looked at intervening in this group to increase their lifestyle advantages to avoid dementia. Things like a MIND diet, which is a Mediterranean diet that is similar. There's two different diets, the MIND Diet and the DASH diet. And the DASH diet has to do with circulation and cardiovascular health. It's called the MIND Diet. Combined with exercise on a regular basis, combined with some cognitive retraining several times a week using computerized programs, combined with group meetings once or twice a month over the course of two years, and a real emphasis on getting people up and moving and eating better and living their lives. In more connected kinds of ways. And they had this very structured, very intensive kind of program for half of the people in this group. 

Darleen Mahoney [3:22 - 3:22]: Yeah. 

Mitch Clionsky [3:22 - 6:21]: The other half, they gave them some advice of general nature. You know, it's good to have this kind of a diet and it's good to stay active and you ought to exercise. The kinds of things that you very often will see that people get from their primary care doctor when they go in for an annual physical. So these were the two groups that they followed over two years, and they followed them primarily, at least in this version of the study that was published, looking at how well they thought, using a composite of four different types of tests, looking at memory and processing speed and executive functions, which have to do with planning and organization and with looking at their attention. And rather than look at the individual components to that, what they did was they grouped them together in one composite measure. So this is sort of like, you know, you think about intelligence. Intelligence is composed of a number of specific abilities. There's vocabulary, there's general knowledge, there's the ability to see how puzzles are put together. There's being able to remember digits, numbers forwards and backwards. There's some decoding tasks, and they can take those and combine them into an overall score, which we call IQ Intelligence quotient. Most people out there, one way or the other, pretty familiar with an IQ score anyway, so they developed a type of general cognitive measure, and they gave these tests for those cognitive measures every six months. So at the start of the study, six months later, a year, year and a half, and finally at the end of the study, two years later, so that was the primary intervention. They had a second group, same general number of people. I did explain this. So you have the intensive group and you have the group that just got advice, and then they took a look at what their scores were like over these two year periods. So the headline for all of this is change your lifestyle, improve how you eat, improve your exercise, improve your interactions, and. And your thinking will improve. So I saw the headline, I read the initial research printout, I thought, wow, this is really great, because I am all about dementia prevention. That's really what our mission has been for the last several years is what can we do to stop people from developing Alzheimer's disease, vascular dementia, Lewy body dementia, all these different types of neurological declines. Well, if you can improve their memory and their thinking ability, theoretically, you're going to delay dementia, and that's a real win. 

Darleen Mahoney [6:22 - 6:22]: Right? 

Mitch Clionsky [6:22 - 7:23]: So now all of the research, most of the research on this has been we call correlational. They look at large data sets, thousands or hundreds of thousands of people, and they say, you know, this group did a better job of avoiding dementia. And this is why it differs. Because these people exercised more or the people ate better, or these people had closer relationships, or they had their sleep apnea treated, or they changed the types of the amount of alcohol they were drinking. They managed their diabetes. So I thought, wow, this is really cool if we can show this because this is really a proof of concept. Then I started reading a little more closely and then I started thinking about it a little more and I got to the conclusion that, you know, all that glitters is not gold. This may not be what we thought it was. And let me tell you why. 

Darleen Mahoney [7:23 - 7:25]: Yes, because now I'm super curious. 

Mitch Clionsky [7:26 - 7:29]: Okay, that's the teaser. May not be what you thought it was. 

Darleen Mahoney [7:29 - 7:30]: Okay. 

Mitch Clionsky [7:31 - 10:56]: Number one, the people selected for this study may not be as representative of most people as you think. For one thing, you had to already be at risk for cognitive decline. That's not bad. Most people getting up into their 70s and 80s are at cognitive decline risk anyway. But you had to be at more risk. You had to be a couch potato who didn't eat a good diet and either were part of minority group because they have a higher rate of dementia if you're in a racial minority, or you had to have first degree relatives who had dementia, or you had to have a medical condition like uncontrolled high blood pressure, diabetes that put you at greater risk. So basically you had to be someone who may not be the typical person that you know in that age group. But that's okay. You know, it's at least we're avoiding people who are already suffering from dementia. So you couldn't get a real low score on the initial testing. And we didn't want people who are already leading really healthy diets and exercise patterns because they're already doing it. So this was the choices. You always have to make choices when you're doing research as to who you include and who you exclude. So this was a fairly reasonable place to start. The composite of the tests is a little bit murky also because it makes it hard to break down. They did some breakdowns. Seems like executive functions, not memory itself. But the ability to flexibly go back and forth and to think through problems actually may have improved the best. But one of the problems is you have a multi domain intervention. In other words, you don't have a group that just exercised more. You don't have a group that just ate differently you don't have a group that just did cognitive training. They've done studies like that before and generally they found, you know, it doesn't make a huge difference. By and large, probably the most important data coming out has been that exercise, as they say, high tide floats all boats. Exercise improves things for almost everybody in every way. So that's the one thing that we've seen over the years. Diet. Well, everyone wants to eat better. In fact, if you look at anything on the Internet, it's always eat this or don't eat that to improve your mind. But when they really drill down on it, if you take people according to their type of diet and you go from the very worst in terms of what science tells us, up to the very best, and you split those into five groups, from very poor up to the very best. The very best does better than the very worst. So stay out of that. Fast food line is what I tell my patients. Problem was the very best actually didn't do better on other testing than the intermediate, normal, typical American, eat a lot of different things kind of diet. So diet itself is really overrated. 

Darleen Mahoney [10:56 - 11:22]: I find that very interesting because I feel like when we talk about dementia prevention, that diet is one of the biggest ones that we talk about. You know, especially the food that we eat primarily in this country differs so much from other countries that may not have as much dementia in their food intake and what they eat specifically. So, yeah, so it's. To me, I find that really surprising. 

Mitch Clionsky [11:22 - 11:27]: It is surprising. It's one of the reasons why there's not a single chapter in our book on what to eat. 

Darleen Mahoney [11:28 - 11:29]: Oh, wow, okay. 

Mitch Clionsky [11:29 - 11:42]: There is a chapter on weight control in relation to your body size. So obviously I think everyone believes that it's probably true. Eating a lot of sugar and a lot of processed things, not good for you. 

Darleen Mahoney [11:42 - 11:42]: Yeah. 

Mitch Clionsky [11:43 - 12:09]: But can you really save your brain just by eating more blueberries, more leafy vegetables, switching from one kind of oil to olive oil? It's all helpful, but it won't make the difference. So we sort of stayed clear of that whole because it keeps changing. You read one study, it tells you this is the thing to eat. The next study says that to eat. 

Darleen Mahoney [12:10 - 12:14]: So it's probably not more what to eat, it's more what not to eat. 

Mitch Clionsky [12:14 - 12:16]: What not to eat and how much to eat. 

Darleen Mahoney [12:16 - 12:27]: Right? Yes. Like anything that's see process. To me, I always go back to, if you can't pronounce it, do you want to stick it in your body? I mean, honestly. 

Mitch Clionsky [12:28 - 12:41]: Well, if that's the case, you probably won't want to have any vitamins. Vitamins. Because now you're staring me. May be difficult to pronounce. There's a lot of things that you. 

Darleen Mahoney [12:41 - 13:04]: Can'T actually pronounce, but you know what I mean. When you look on the back of a package and you're reading it and it's like the, the, the word is like 14 letters in. You're just like. But this is a fruit bar. It's a fruit bar. Why is a fruit bar have I something in it that is like 14 letters in that nobody can pronounce what is that? 

Mitch Clionsky [13:04 - 13:42]: And probably to keep it stable longer on the shelf or to make it look more attractive. So I'm sure. So this is the great debate. You can get mired in this forever. And all the people that I know, including family members, are really, will be. This is what I eat. So I got one really close friend who's now gone vegan. I've got a family member who's now doing carnivore and came to visit and brought us duck fat and beef tallow, which are both sitting in my closet because I'm not going to eat them. Yeah, but you know, my rule is diversity. 

Darleen Mahoney [13:43 - 13:44]: Yeah, yeah. 

Mitch Clionsky [13:44 - 16:50]: So anyway, but, but anyway, they didn't, they can't separate out all the, the elements. This is a conglomerate of interventions. Really. What differed was the intensity of the interventions. So what did it show? Well, it showed that the people who had this intense intervention thought better. At least they scored better. Let's say they scored better on these tests consistently as you went out two years. Now, the amount of change is expressed in the article as percentages. Not percentages, but 0.24 standard deviations from a Z score. So most people look at this and they say, ah, what the heck is that? Anyway, I translated this into something that makes more sense, which is most people are familiar with IQ scores. So an IQ score, the average score for the general population is 100 points. And we know that the standard deviation, the amount of things that vary normally around this are a 15 point unit, which means that if you go from 85, which is 100 minus 15, or up to 115, which is 100 plus 15, that covers more than two thirds of the general population. It's a bell shaped curve. So as you go farther away from that average, fewer and fewer people are involved. But most people think if you get an IQ of 100, you're the average person in American society and that's fine. You certainly are able to do most things and Learn most things. If you translate this difference into an IQ score, you go from a starting point of 100 over two years to having an IQ of about 107. Okay, now that's pretty good. Anything that boosts thinking ability to that degree, we say, hmm, that's a good intervention. But here's the rub. The group that didn't get the strong intervention that was just advised about what they should do, their IQ type of number went up to about 106. So there's like a one point difference between the intensive group and the group that got advice. And so the question is, how meaningful is that single point difference? Now the authors of the study will take that difference and tell you that it means that your brain is a year or two younger than it was before. Which I guess means if you're spending two years in the study, it's sort of where you started. You haven't aged two years. From a practical point of view though, I'm not sure that really makes a difference. And when you compare it with the group that didn't get the intensive intervention, that difference really disappears. 

Darleen Mahoney [16:51 - 17:02]: Right. And so I do have the question. So they educated people on what they should do, but there was no follow through on if they followed the advice of the education, Is that correct? 

Mitch Clionsky [17:02 - 17:42]: It's unclear. They say this is going to be published in a subsequent article. So I don't know exactly how they tested. How much are you exercising now? What are you eating? Whether they did a good job of that or not a good job that's absent from the article that was just published. They say they're going to extend the study for two years and publish this subsequently. So it's a good question. I just don't know what the answer is at this point. So we got two groups that got better. The problem with that is there's something called practice effect, which is you get better in some cases by taking the same test over and over. You sort of learn what's going to happen. 

Darleen Mahoney [17:43 - 17:43]: Right. 

Mitch Clionsky [17:43 - 18:17]: And both groups here got better. How much of that was due to the practice effect? The reason we don't know that is that they skipped a step in their design, which is there was no control group. A control group would get no additional advice. They would simply get tested every six months. And because there was no intervention, no advice or any kind of supervision, we could tell what the effects of practice were because that's all they got was practice by taking the tests. 

Darleen Mahoney [18:18 - 18:19]: Okay. 

Mitch Clionsky [18:19 - 18:57]: And I don't know why they didn't do this, because these are smart people. There's like 30 people on this study. They come from very well regarded institutions. And adding a group of people who just took the practice, who just took the test every six months, and you don't even need a thousand of them, you need a couple hundred just to tell you what the effect is, would have answered this question and resolved at least that doubt that this was due to just repeatedly taking the same test. Until that's resolved, I have real questions about how much of a difference are we really getting? 

Darleen Mahoney [18:58 - 19:06]: Okay, I, I was gonna say, I feel like most studies have a control group. That's pretty standard in a study, from my understanding. 

Mitch Clionsky [19:06 - 20:07]: Yes. In fact, it's one of the first things you're taught in graduate school in methodology class is that they have a really well developed study. You want a control group right? Now it's possible to have a control group plus groups that have different intensities. That's. That just tells you how much adding intensity helps you. And they say that they corrected for some of the practice effects. Statistically, I don't know. I'm still left wondering. Now, along with this study, there was an editorial by another physician who was looking at the difference in the cost factor. In other words, you got one group that meets every month, a couple times it's got supervised exercise. They really control their diet. They go to meetings, they do all kinds of things to support this. And they're only like a little bit better than the group that just got advice. If this is really a meaningful intervention, why don't we just give advice? 

Darleen Mahoney [20:08 - 20:08]: Right. 

Mitch Clionsky [20:09 - 20:12]: Why go to the expense. Why go to the trouble of doing this other stuff? 

Darleen Mahoney [20:13 - 20:49]: Right, right. And you think to follow all of the protocols, the exercise, the food, all of the different things in that controlled environment, for someone to completely alter their life in the real world with all of those different things, that's, that's a, that's a program. Yeah. Unless you start out young and you. That's your lifestyle, it has to be a lifestyle. It can't be something that is specifically intended for intervention. 

Mitch Clionsky [20:50 - 21:24]: Well, there's two people I find that are really good at doing those things. One are people who are motivated just because they want to embrace every positive aspect of their health. And the other group are my patients who are already developing cognitive impairment and are scared to death and want to do everything they can to avoid it getting worse. And they're motivated. They will latch on to changes that otherwise they had not embraced for years because they see the future. They. They don't like it, and they want to do Everything they can. 

Darleen Mahoney [21:24 - 21:29]: There's nothing to lose. I mean, to live absolutely nothing to lose. So. 

Mitch Clionsky [21:30 - 21:35]: And that's the beauty of dementia prevention is the worst that comes out is that you're healthier. 

Darleen Mahoney [21:35 - 22:06]: Right, right. Because even in our previous podcast about dementia prevention, we talked about a variety of different things, you know, including the sleep apnea, which can be something that is completely overlooked by people that are not getting the sleep that they should be getting, that don't even realize they have sleep apnea. We talked about hearing loss. We talked about all the different things that can be attributors that people are walking around in everyday life that are not addressing some of those issues. 

Mitch Clionsky [22:07 - 22:31]: And we have no idea from this study who has sleep apnea, what their hearing levels are, what other kinds of activities they're involved in. The hope is that with a large enough sample that all of that equals out. And again, if they'd had a control group, it would have been easy to come to a better conclusion. So there's work to do. 

Darleen Mahoney [22:32 - 22:54]: Yeah, Like a full, full physical on all of those different things. So you know, exactly what everyone's, you know, who has high blood pressure, who has, you know, any kind of ailments, who has, I mean, literally like a full blown physical on each person to know. Exactly. So that you're comparing apples to apples, not apples to oranges. 

Mitch Clionsky [22:54 - 22:56]: How much do they drink? We don't know. 

Darleen Mahoney [22:56 - 22:57]: Oh, yeah. 

Mitch Clionsky [22:57 - 23:38]: So there's a lot of stuff there. And, you know, again, this is difficult science. It's expensive. They ran this, I think, from 2020 to 2022. So they also ran into the COVID pandemic, which made collection of data more difficult. So there's a lot of science that got sidelined then because of, you know, the exigencies of modern life. So there's a lot of stuff here. I'm glad they did the study. I just wish in there, I hope in their next two years of following these people that they decide at some point to now start some people as a control group so they can go back and ask, answer some of those original questions. 

Darleen Mahoney [23:38 - 23:50]: Yeah. Make some adjustments. I did want to ask you, I know you mentioned the alcohol, and I don't know that we've talked about this before. Maybe we have, and I don't recall. So what is the effect as just a signal on alcohol with increased risk? 

Mitch Clionsky [23:51 - 23:55]: It's a complicated question. So let me try to dissect it a little bit. 

Darleen Mahoney [23:55 - 23:56]: Break it down. 

Mitch Clionsky [23:56 - 25:24]: Okay. If you, if you want to take the Debbie Downer approach, you cite the literature that shows that any amount of alcohol is a problem for our brains. Alcohol kills blood, kills brain cells. And if you look at MRI scans of people who don't drink at all versus those who even drink moderately, and I'll explain what that is, you see that the brains of teetotalers look better than the brains of drinkers. Excessive alcohol, I think everyone agrees, is a bad thing, especially binge drinking, so that you're having four or five or more drinks at a time. But the question is, for everyday drinkers or people who are, you know, drinking a couple times or more a week, what's the right level? So a couple things here. Number one, the general rule and what I usually use with my patients is if they do not have true cognitive impairment yet, then for a woman, it's generally about one drink a day. And for men, it's one to two. If they already are suffering from mild cognitive impairment or dementia, I really advise them not to drink because I don't think they've got much in the way of bench strength on their basketball team. You know, their first string gets exhausted. There's no one sitting there to come in to help them out. They can't afford to lose any more brain cells. 

Darleen Mahoney [25:25 - 25:25]: Okay? 

Mitch Clionsky [25:25 - 26:05]: The other question is, what's a drink? So there's an equation for that. And it's surprising to many people. We know that a shot of liquor is a drink. Basically an ounce and a quarter of alcohol, hard spirits, anywhere from proof of 65% up to, you know, 80% in some cases. But a beer, 12 ounces, 16 ounce American beer, 4.5% alcohol content is the same as a shot. Okay, 3 to 4 ounces of wine, 12%. Wine is the same as a shot, is the same as a beer. 

Darleen Mahoney [26:06 - 26:06]: Oh, wow. 

Mitch Clionsky [26:06 - 27:09]: So people say, I only drink wine. And I say to them, well, how much do you drink? Oh, glass. And I say, tell me about your glass. And a lot of times the glass that they tell me about is a lot larger than 3 to 4 ounces. The same way that when people talk about pouring shot of liquor, I always ask them, well, do you use a shot glass or do you pour like your neuropsychologist pours? And they always laugh about that because I say, you know, here's the thing. When you're free pouring, it looks like it's just a drink, right? Do yourself a favor, free pour yourself a drink, then get a shot glass and, and strain out the, the, the ice and see how much you're actually pouring. You may be surprised, right? And you Want to make an adjustment if you have that feedback as to what to drink, because what's only light beer? I say, oh, so instead of 4.5%, it's only 4.2% alcohol. It's the same amount of alcohol, just fewer calories. 

Darleen Mahoney [27:09 - 27:11]: Yeah. It's the carbs. Right? 

Mitch Clionsky [27:11 - 27:13]: Basically, that's what they're getting rid of. 

Darleen Mahoney [27:13 - 27:14]: Yeah, the carbs, yeah. Yeah. 

Mitch Clionsky [27:15 - 27:28]: So it's, you know, it's one of those things that by paying attention to and deciding, do I really want to do this? And how much of it do I want to do, you're probably going to make better health decisions. 

Darleen Mahoney [27:28 - 27:58]: Yeah, no, I. I agree with that. I just. I know that we talk. I don't think that we have talked about in a past podcast the alcohol side, or maybe we touched on it, but not really dug into it. The other thing I wanted to ask you, and this is completely off topic, but as the use of marijuana continues to grow in this country on a consistent and daily basis, as it's becoming more and more socially acceptable, is that a concern that we're really going to see the effects of that in dementia risk? 

Mitch Clionsky [27:59 - 30:23]: I'm concerned about it, yeah. I don't think it's been factored in yet, partly because we have not had the controlled experience because of its illegality, and because for years and years, people who wanted to do studies on this could not get a hold of marijuana that was grown in a controlled way. At one point, there was only one place, I think was the University of Mississippi that grew all of the marijuana for research in the United States. And it was extremely difficult to get permission to do studies. So that's one factor. The other is the factor of strength. People always say, do you smoke marijuana or use cannabis products? They'll say, well, yeah. And I say, how often? Well, most evenings or I use it for sleep. I said, great. What strength are you using? They'll say, well, it's 5 milligrams. They got me. I said, yeah, but that's not the answer. The answer to the question is what strength, what percentage thc, Right. And they don't know. I said, here's why this is important. Back in my day, I go way back. So this was in the 70s. Return with us now to those days of yesteryear. So back in the 70s, the typical marijuana that was being either grown in someone's backyard or in a field in California or being brought over from Mexico on average was 4% THC. The current marijuana being grown that's sold in dispensaries starts at 16% THC and goes up to 30% traditionally and even beyond that for some types. And that's the problem is we have brains that are 50 years older using marijuana that is somewhere between four to maybe seven times stronger. And the math is really difficult to do at that point. We do know because we have studies on short term use, that in the first six to eight hours after someone consumes marijuana through smoking or vaping that their processing speed declines, that their attention paying Billy is impaired. Which is one of the reasons why you don't want to get a buzz on and then get into your car and drive. 

Darleen Mahoney [30:23 - 30:24]: Right. 

Mitch Clionsky [30:25 - 30:53]: But the longer. I can tell you anecdotally that when patients of mine who I discovered were smoking on a very frequent basis decided to quit in some cases we have seen improvements in their cognition that were otherwise unexpected. So for some people I think it makes a difference. But I can't cite you a study or percentage as to what that adds to your risk of becoming demented. 

Darleen Mahoney [30:54 - 31:25]: That is the study I think we're probably going to see coming down the pipeline real soon. I do know that clearly it's the younger people, the younger generations, 20s and 30s that are probably more of the daily users because it's more of their generation that's made it more of a. I want to say more of an acceptable kind of. But everyone is smoking it. It's not just specifically with them, I guess, but just the younger generations. I think it's. I just have concerns that it's going to start being something they're going to have to deal with as they get older. 

Mitch Clionsky [31:25 - 32:15]: I didn't used to ask this question from my patients who are so I. Last year I saw 750 patients. Almost all of them were over the age of 65. I started asking the question, I started getting some interesting answers which is, yeah, you know, I've been getting high for out My life is just now legal. So I feel I can talk about it to people who said, well, my friend said that this would help me to sleep. So I started getting them from the dispensary to people who said, well, I quit years ago, but now that it's legal and I'm retired, why not? So more than you would think. I don't know about the middle group of people between the ages of 30 and 60, but there's a lot of older people, at least up here in Massachusetts who are still getting high. 

Darleen Mahoney [32:16 - 32:51]: I think everybody's doing it. Absolutely. I just felt, I just was, I guess mentioning or just thoughts on that it, you know, as it started becoming legal, it was more attractive to the younger, you know, 20s and 30s that were of that age range, becoming more of the frequent users that were jumping on board the train. But I. Clearly everyone is, as it's becoming more legal and more acceptable, that it's. It's becoming more attractive and it's available in dispensaries and you can get. You can get, what do you call it, prescriptions for it from doctors and things like that. So, yeah, it would be an interesting. 

Mitch Clionsky [32:51 - 32:54]: Poll question for your podcast, wouldn't it? 

Darleen Mahoney [32:54 - 32:56]: Yeah, absolutely. Yeah. 

Mitch Clionsky [32:56 - 33:00]: Is it legal in your state and do you use it how often? 

Darleen Mahoney [33:00 - 33:00]: Yeah. 

Mitch Clionsky [33:00 - 33:03]: What's your age? That would be fascinating data. 

Darleen Mahoney [33:03 - 33:16]: Yeah. I think you've got a project maybe for you, so. Oh, it's so great having you. Is there anything that we didn't talk about that you wanted to mention? 

Mitch Clionsky [33:16 - 33:36]: Oh, there's lots of stuff happening. It's a really exciting time. I'm really excited about. I was also wanting to talk about some of the supplements that are out there in the market. Maybe we could do that a different time because I have a jaundiced view of some of them as well. So I'll be happy to share that and the reasons for that jaundice view. 

Darleen Mahoney [33:37 - 35:01]: Yeah, I absolutely want to do another podcast with you on that topic as well, because I know that there's the prescription and then there's over the counter that claim to help you with that clear brain fog, prevent dementia, all the different things. And you may not be able to pronounce some of those items in there either, when you look at the back of those pill bottles. But which ones, you know, follow through on what they say, which ones you might as well just not bother, you know. So I think it is important to become educated on those, not waste your money. But I think that is a really important subject because everybody gets bombarded with those. And then we'll also talk about if you're doing any type of social media, they will find you and they will hunt you down until you buy their product. So it's becoming aware of that as well. So, yeah, great. Yeah, absolutely. Thank you so much for joining us today, Dr. Kliansky. And I will tell you, if you've enjoyed this podcast and you enjoyed the information here, the links to everything that we talked about will be in the description. So look that up, including Dr. Klonski's book that he authored with his wife. We have talked about that in other podcasts. That link will be in there as well. For dementia prevention, how to save your brain. So thank you so much for joining us. If you enjoy this podcast, we are available anywhere you listen and enjoy podcasts such as Spotify, Apple Podcasts, GoodPods, Podchaser. So many different options. Thank you for listening.