Full Transcript Brain Fog and Medication Clues 0:02 If you're over 60, dealing with brain 0:02 If you're over 60, dealing with brain fog, memory slips, balance problems, or 0:05 fog, memory slips, balance problems, or 0:05 fog, memory slips, balance problems, or a sudden change in personality, here's 0:08 a sudden change in personality, here's 0:08 a sudden change in personality, here's what I would do differently today. I 0:10 what I would do differently today. I 0:10 what I would do differently today. I would stop asking, "Is this just aging?" 0:13 would stop asking, "Is this just aging?" 0:13 would stop asking, "Is this just aging?" and start asking, "What medications 0:16 and start asking, "What medications 0:16 and start asking, "What medications quietly changed your brain?" Because 0:18 quietly changed your brain?" Because 0:18 quietly changed your brain?" Because what I've seen again and again is that 0:21 what I've seen again and again is that 0:21 what I've seen again and again is that many people labeled with early dementia 0:24 many people labeled with early dementia 0:24 many people labeled with early dementia weren't degenerating. They were 0:26 weren't degenerating. They were 0:26 weren't degenerating. They were reacting. reacting to prescriptions that 0:29 reacting. reacting to prescriptions that 0:29 reacting. reacting to prescriptions that were meant to help them. And this 0:31 were meant to help them. And this 0:31 were meant to help them. And this matters now, not years from now, because 0:34 matters now, not years from now, because 0:34 matters now, not years from now, because once that label sticks, medications tend 0:37 once that label sticks, medications tend 0:37 once that label sticks, medications tend to pile up, the narrative hardens, and 0:41 to pile up, the narrative hardens, and 0:41 to pile up, the narrative hardens, and the window to reverse course quietly 0:43 the window to reverse course quietly 0:43 the window to reverse course quietly closes. So the real question becomes, 0:47 closes. So the real question becomes, 0:47 closes. So the real question becomes, what if the problem was never your brain 0:49 what if the problem was never your brain 0:49 what if the problem was never your brain in the first place?
Introduction and Why This Matters 1:12 I'm Dr. Fred Bloom, a holistic and 1:12 I'm Dr. Fred Bloom, a holistic and integrated physician in Maryland. If you 1:14 integrated physician in Maryland. If you 1:14 integrated physician in Maryland. If you haven't done so already, I invite you to 1:16 haven't done so already, I invite you to 1:16 haven't done so already, I invite you to like and subscribe to the channel if 1:18 like and subscribe to the channel if 1:18 like and subscribe to the channel if this kind of content is helpful. Sign up 1:21 this kind of content is helpful. Sign up 1:21 this kind of content is helpful. Sign up for the newsletter if you want deeper 1:22 for the newsletter if you want deeper 1:22 for the newsletter if you want deeper explanations like this delivered 1:24 explanations like this delivered 1:24 explanations like this delivered directly to you. Now, let's slow this 1:26 directly to you. Now, let's slow this 1:26 directly to you. Now, let's slow this down and talk about why this topic 1:29 down and talk about why this topic 1:29 down and talk about why this topic matters so much. Cognitive decline is 1:31 matters so much. Cognitive decline is 1:31 matters so much. Cognitive decline is one of the most frightening experiences 1:34 one of the most frightening experiences 1:34 one of the most frightening experiences people face. Not because of pain, but 1:37 people face. Not because of pain, but 1:37 people face. Not because of pain, but because of identity, memory, clarity, 1:41 because of identity, memory, clarity, 1:41 because of identity, memory, clarity, independence, personality, and the quiet 1:44 independence, personality, and the quiet 1:44 independence, personality, and the quiet fear of losing yourself. What often gets 1:47 fear of losing yourself. What often gets 1:47 fear of losing yourself. What often gets missed is that the brain is exquisitly 1:50 missed is that the brain is exquisitly 1:50 missed is that the brain is exquisitly sensitive to chemistry, especially as we 1:53 sensitive to chemistry, especially as we 1:53 sensitive to chemistry, especially as we age. Many medications were tested in 1:56 age. Many medications were tested in 1:56 age. Many medications were tested in younger populations over relatively 1:58 younger populations over relatively 1:58 younger populations over relatively short time frames without seriously 2:01 short time frames without seriously 2:01 short time frames without seriously asking what happens to the brain after 2:03 asking what happens to the brain after 2:03 asking what happens to the brain after years of exposure, particularly in a 2:06 years of exposure, particularly in a 2:06 years of exposure, particularly in a body that detoxifies more slowly. 2:08 body that detoxifies more slowly. 2:08 body that detoxifies more slowly. Patients are often told this medication
How Medications Can Affect Cognition 2:11 Patients are often told this medication 2:11 Patients are often told this medication doesn't cross the bloodb brain barrier 2:13 doesn't cross the bloodb brain barrier 2:14 doesn't cross the bloodb brain barrier or that side effect is rare or you've 2:17 or that side effect is rare or you've 2:17 or that side effect is rare or you've been on it too long for it to be the 2:19 been on it too long for it to be the 2:19 been on it too long for it to be the cause. But real life doesn't work like 2:22 cause. But real life doesn't work like 2:22 cause. But real life doesn't work like textbooks. What I see instead are people 2:25 textbooks. What I see instead are people 2:25 textbooks. What I see instead are people who slowly lose clarity, confidence, and 2:28 who slowly lose clarity, confidence, and 2:28 who slowly lose clarity, confidence, and function without anyone stepping back to 2:32 function without anyone stepping back to 2:32 function without anyone stepping back to connect the dots. They're told their 2:34 connect the dots. They're told their 2:34 connect the dots. They're told their labs look fine. their imaging is 2:37 labs look fine. their imaging is 2:37 labs look fine. their imaging is unremarkable and that this is simply 2:40 unremarkable and that this is simply 2:40 unremarkable and that this is simply what aging looks like. If you've ever 2:42 what aging looks like. If you've ever 2:42 what aging looks like. If you've ever felt confused, frustrated, dismissed, or 2:45 felt confused, frustrated, dismissed, or 2:45 felt confused, frustrated, dismissed, or quietly worried that something deeper is 2:48 quietly worried that something deeper is 2:48 quietly worried that something deeper is being missed, you're not alone, and 2:50 being missed, you're not alone, and 2:50 being missed, you're not alone, and you're not imagining it. Earlier in my 2:53 you're not imagining it. Earlier in my 2:53 you're not imagining it. Earlier in my career, I trusted medication lists more 2:56 career, I trusted medication lists more 2:56 career, I trusted medication lists more than patterns. If a drug was commonly 2:58 than patterns. If a drug was commonly 2:58 than patterns. If a drug was commonly prescribed, FDA approved, and considered 3:02 prescribed, FDA approved, and considered 3:02 prescribed, FDA approved, and considered standard of care, I assumed the problem 3:04 standard of care, I assumed the problem 3:04 standard of care, I assumed the problem had to be somewhere else. What I didn't 3:06 had to be somewhere else. What I didn't 3:06 had to be somewhere else. What I didn't fully appreciate then was how cumulative 3:10 fully appreciate then was how cumulative 3:10 fully appreciate then was how cumulative effects matter far more than isolated 3:13 effects matter far more than isolated 3:13 effects matter far more than isolated side effects. Experience changed that. 3:16 side effects. Experience changed that. 3:16 side effects. Experience changed that. Over time, I began noticing patterns 3:18 Over time, I began noticing patterns 3:18 Over time, I began noticing patterns that became impossible to ignore. 3:21 that became impossible to ignore. 3:21 that became impossible to ignore. Cognitive decline that started after 3:23 Cognitive decline that started after 3:23 Cognitive decline that started after medication change. Memory issues that 3:26 medication change. Memory issues that 3:26 medication change. Memory issues that worsened despite normal brain imaging. 3:29 worsened despite normal brain imaging. 3:29 worsened despite normal brain imaging. People labeled with early dementia who 3:31 People labeled with early dementia who 3:31 People labeled with early dementia who improved not dramatically, not 3:33 improved not dramatically, not 3:33 improved not dramatically, not overnight, but meaningfully when certain 3:36 overnight, but meaningfully when certain 3:36 overnight, but meaningfully when certain medications were reduced or removed 3:39 medications were reduced or removed 3:39 medications were reduced or removed carefully. That's when my thinking 3:41 carefully. That's when my thinking 3:41 carefully. That's when my thinking shifted. Now when someone comes in with 3:44 shifted. Now when someone comes in with 3:44 shifted. Now when someone comes in with brain fog, confusion, falls, emotional 3:47 brain fog, confusion, falls, emotional 3:47 brain fog, confusion, falls, emotional flattening or early cognitive decline, 3:50 flattening or early cognitive decline, 3:50 flattening or early cognitive decline, my first question is very different. 3:52 my first question is very different. 3:52 my first question is very different. What has your nervous system been 3:54 What has your nervous system been 3:54 What has your nervous system been exposed to every single day for years? 3:57 exposed to every single day for years? 3:57 exposed to every single day for years? And this is where I want to be very 3:59 And this is where I want to be very 3:59 And this is where I want to be very careful and very respectful because 4:02 careful and very respectful because 4:02 careful and very respectful because naming examples can help people orient 4:04 naming examples can help people orient 4:04 naming examples can help people orient themselves, but it needs to be done 4:06 themselves, but it needs to be done 4:06 themselves, but it needs to be done gently. I'm not naming these medications 4:08 gently. I'm not naming these medications 4:08 gently. I'm not naming these medications to scare you, and I'm certainly not 4:10 to scare you, and I'm certainly not 4:10 to scare you, and I'm certainly not saying they're bad, wrong, or never 4:12 saying they're bad, wrong, or never 4:12 saying they're bad, wrong, or never appropriate. Many of them can be very 4:15 appropriate. Many of them can be very 4:15 appropriate. Many of them can be very helpful, and some are lifesaving. But 4:18 helpful, and some are lifesaving. But 4:18 helpful, and some are lifesaving. But what experience has taught me is that
Common Drug Classes to Watch 4:20 what experience has taught me is that 4:20 what experience has taught me is that they are not neurologically neutral, 4:23 they are not neurologically neutral, 4:23 they are not neurologically neutral, especially with long-term use, aging 4:26 especially with long-term use, aging 4:26 especially with long-term use, aging brains, or when several are combined. 4:29 brains, or when several are combined. 4:29 brains, or when several are combined. One group I pay close attention to are 4:31 One group I pay close attention to are 4:31 One group I pay close attention to are medications with antiolinergic effects. 4:34 medications with antiolinergic effects. 4:34 medications with antiolinergic effects. These interfere with acetylcholine which 4:37 These interfere with acetylcholine which 4:37 These interfere with acetylcholine which is critical for memory attention and 4:39 is critical for memory attention and 4:39 is critical for memory attention and learning. Examples people often 4:41 learning. Examples people often 4:41 learning. Examples people often recognize include benadryil bladder 4:43 recognize include benadryil bladder 4:43 recognize include benadryil bladder medications like oxutinine and older 4:46 medications like oxutinine and older 4:46 medications like oxutinine and older medications such as amatryptalene that 4:48 medications such as amatryptalene that 4:48 medications such as amatryptalene that are sometimes used for pain, mood or 4:50 are sometimes used for pain, mood or 4:50 are sometimes used for pain, mood or sleep. Used briefly, these may be fine. 4:53 sleep. Used briefly, these may be fine. 4:53 sleep. Used briefly, these may be fine. Used nightly for years, I've often see 4:56 Used nightly for years, I've often see 4:56 Used nightly for years, I've often see them quietly cloud cognition. Another 4:59 them quietly cloud cognition. Another 4:59 them quietly cloud cognition. Another group are bzzoazipines and seditive 5:01 group are bzzoazipines and seditive 5:01 group are bzzoazipines and seditive medications. These enhance calming 5:04 medications. These enhance calming 5:04 medications. These enhance calming signals in the brain which can feel 5:06 signals in the brain which can feel 5:06 signals in the brain which can feel relieving at first but over time may 5:09 relieving at first but over time may 5:09 relieving at first but over time may suppress alertness and memory formation. 5:11 suppress alertness and memory formation. 5:11 suppress alertness and memory formation. Common examples include Adavan, Xanax, 5:14 Common examples include Adavan, Xanax, 5:14 Common examples include Adavan, Xanax, Clonopin and sleep medications like 5:16 Clonopin and sleep medications like 5:16 Clonopin and sleep medications like ambient. Clinically I've seen 5:18 ambient. Clinically I've seen 5:18 ambient. Clinically I've seen associations with slow thinking, balance 5:20 associations with slow thinking, balance 5:20 associations with slow thinking, balance problems, emotional flattening and 5:23 problems, emotional flattening and 5:23 problems, emotional flattening and increased fall risk, especially with 5:26 increased fall risk, especially with 5:26 increased fall risk, especially with long-term use. Then there are 5:28 long-term use. Then there are 5:28 long-term use. Then there are over-the-counter sleep aids which often 5:30 over-the-counter sleep aids which often 5:30 over-the-counter sleep aids which often surprise people. Products like Tylenol 5:32 surprise people. Products like Tylenol 5:32 surprise people. Products like Tylenol PM or Advil PM feel harmless because 5:36 PM or Advil PM feel harmless because 5:36 PM or Advil PM feel harmless because they're familiar and easy to buy, but 5:38 they're familiar and easy to buy, but 5:38 they're familiar and easy to buy, but many contain the same antiolinergic 5:41 many contain the same antiolinergic 5:41 many contain the same antiolinergic ingredients that affect memory and 5:42 ingredients that affect memory and 5:42 ingredients that affect memory and clarity. I also pay attention to certain 5:44 clarity. I also pay attention to certain 5:44 clarity. I also pay attention to certain anti-depressants and antiscychotic 5:46 anti-depressants and antiscychotic 5:46 anti-depressants and antiscychotic medications, not because they're wrong, 5:49 medications, not because they're wrong, 5:49 medications, not because they're wrong, but because context matters. For 5:51 but because context matters. For 5:51 but because context matters. For example, peroxitine has anticolinergic 5:54 example, peroxitine has anticolinergic 5:54 example, peroxitine has anticolinergic properties and some medications 5:57 properties and some medications 5:57 properties and some medications originally prescribed for mood or 5:59 originally prescribed for mood or 5:59 originally prescribed for mood or agitation are later used simply to help 6:01 agitation are later used simply to help 6:01 agitation are later used simply to help someone's sleep. Over time, that can 6:03 someone's sleep. Over time, that can 6:03 someone's sleep. Over time, that can come at a cognitive cost. And finally, 6:06 come at a cognitive cost. And finally, 6:06 come at a cognitive cost. And finally, opioid pain medications. Drugs like 6:09 opioid pain medications. Drugs like 6:09 opioid pain medications. Drugs like oxycodone, hydrocodone, or morphine can 6:13 oxycodone, hydrocodone, or morphine can 6:13 oxycodone, hydrocodone, or morphine can be appropriate in specific situations, 6:16 be appropriate in specific situations, 6:16 be appropriate in specific situations, but with chronic use, especially in 6:18 but with chronic use, especially in 6:18 but with chronic use, especially in older adults, I often see brain fog, 6:22 older adults, I often see brain fog, 6:22 older adults, I often see brain fog, slow processing, and increased fall 6:24 slow processing, and increased fall 6:24 slow processing, and increased fall risk. What's important to understand is 6:27 risk. What's important to understand is 6:27 risk. What's important to understand is that it's often not one medication. It's
Polypharmacy and Neurological Burden 6:30 that it's often not one medication. It's 6:30 that it's often not one medication. It's the combination. a sleep aid and a 6:33 the combination. a sleep aid and a 6:33 the combination. a sleep aid and a bladder medication and something for 6:34 bladder medication and something for 6:34 bladder medication and something for anxiety and something for blood 6:36 anxiety and something for blood 6:36 anxiety and something for blood pressure. Each reasonable on its own, 6:39 pressure. Each reasonable on its own, 6:39 pressure. Each reasonable on its own, but together they can overwhelm a 6:42 but together they can overwhelm a 6:42 but together they can overwhelm a vulnerable nervous system. I want to be 6:44 vulnerable nervous system. I want to be 6:44 vulnerable nervous system. I want to be very clear here. I am not saying these 6:47 very clear here. I am not saying these 6:47 very clear here. I am not saying these medications cause dementia. And I am not 6:50 medications cause dementia. And I am not 6:50 medications cause dementia. And I am not saying anyone should stop medications 6:52 saying anyone should stop medications 6:52 saying anyone should stop medications abruptly. What I am saying is that I've 6:55 abruptly. What I am saying is that I've 6:55 abruptly. What I am saying is that I've seen many patients whose cognition 6:57 seen many patients whose cognition 6:57 seen many patients whose cognition changed after long-term exposure to 7:00 changed after long-term exposure to 7:00 changed after long-term exposure to medications like these and whose clarity 7:02 medications like these and whose clarity 7:02 medications like these and whose clarity improved when the total neurological 7:05 improved when the total neurological 7:05 improved when the total neurological burden was reduced thoughtfully and 7:07 burden was reduced thoughtfully and 7:07 burden was reduced thoughtfully and safely. This isn't about blame. It's 7:10 safely. This isn't about blame. It's 7:10 safely. This isn't about blame. It's about better questions. Questions like, 7:13 about better questions. Questions like, 7:14 about better questions. Questions like, why am I still on this? Is this still 7:16 why am I still on this? Is this still 7:16 why am I still on this? Is this still necessary? And could this be affecting 7:19 necessary? And could this be affecting 7:19 necessary? And could this be affecting my brain? This gets missed not because 7:22 my brain? This gets missed not because 7:22 my brain? This gets missed not because doctors don't care, but because the 7:24 doctors don't care, but because the 7:24 doctors don't care, but because the system isn't designed for this level of 7:26 system isn't designed for this level of 7:26 system isn't designed for this level of integration. 7:28 integration. 7:28 integration. Medicine is time pressured, siloed, and 7:31 Medicine is time pressured, siloed, and 7:31 Medicine is time pressured, siloed, and protocol-driven. One physician 7:33 protocol-driven. One physician 7:33 protocol-driven. One physician prescribes for sleep, another for 7:35 prescribes for sleep, another for 7:35 prescribes for sleep, another for bladder symptoms, another for mood, 7:37 bladder symptoms, another for mood, 7:37 bladder symptoms, another for mood, another for blood pressure, and each 7:39 another for blood pressure, and each 7:40 another for blood pressure, and each decision makes sense in isolation. 7:43 decision makes sense in isolation. 7:43 decision makes sense in isolation. But no one owns the total neurological 7:45 But no one owns the total neurological 7:45 But no one owns the total neurological burden. There's also an over reliance on 7:48 burden. There's also an over reliance on 7:48 burden. There's also an over reliance on imaging and reference ranges. If the MRI 7:51 imaging and reference ranges. If the MRI 7:51 imaging and reference ranges. If the MRI looks clean, the assumption is that the 7:53 looks clean, the assumption is that the 7:54 looks clean, the assumption is that the brain must be fine, but function often 7:56 brain must be fine, but function often 7:56 brain must be fine, but function often declines long before structure does. And 7:59 declines long before structure does. And 7:59 declines long before structure does. And when symptoms worsen, the reflex is 8:01 when symptoms worsen, the reflex is 8:02 when symptoms worsen, the reflex is often to add another medication. That's 8:04 often to add another medication. That's 8:04 often to add another medication. That's how people end up on five, 10, sometimes 8:08 how people end up on five, 10, sometimes 8:08 how people end up on five, 10, sometimes 15 prescriptions, all interacting with 8:11 15 prescriptions, all interacting with 8:11 15 prescriptions, all interacting with the same nervous system. When you see 8:14 the same nervous system. When you see 8:14 the same nervous system. When you see this earlier, everything changes. You 8:17 this earlier, everything changes. You 8:17 this earlier, everything changes. You stop changing labels and start restoring
Reassessing Cognitive Decline 8:20 stop changing labels and start restoring 8:20 stop changing labels and start restoring physiology. The focus shifts from habit 8:24 physiology. The focus shifts from habit 8:24 physiology. The focus shifts from habit to necessity, from stacking to 8:27 to necessity, from stacking to 8:27 to necessity, from stacking to sequencing, and from suppression to 8:30 sequencing, and from suppression to 8:30 sequencing, and from suppression to nervous system recovery. Often the first 8:32 nervous system recovery. Often the first 8:32 nervous system recovery. Often the first improvements aren't memory at all. 8:34 improvements aren't memory at all. 8:34 improvements aren't memory at all. They're better balance, clearer speech, 8:37 They're better balance, clearer speech, 8:37 They're better balance, clearer speech, improved emotional presence, fewer 8:40 improved emotional presence, fewer 8:40 improved emotional presence, fewer falls, better sleep architecture, and a 8:43 falls, better sleep architecture, and a 8:43 falls, better sleep architecture, and a return of engagement with life. Those 8:46 return of engagement with life. Those 8:46 return of engagement with life. Those are neurological wins. And sometimes 8:49 are neurological wins. And sometimes 8:50 are neurological wins. And sometimes quietly, steadily, clarity follows. Not 8:54 quietly, steadily, clarity follows. Not 8:54 quietly, steadily, clarity follows. Not because we added something, but because 8:57 because we added something, but because 8:57 because we added something, but because we removed what didn't belong. This 8:59 we removed what didn't belong. This 8:59 we removed what didn't belong. This doesn't apply to everyone, and nuance 9:02 doesn't apply to everyone, and nuance 9:02 doesn't apply to everyone, and nuance matters. Some medications are essential. 9:05 matters. Some medications are essential. 9:05 matters. Some medications are essential. Some should never be stopped without 9:07 Some should never be stopped without 9:07 Some should never be stopped without guidance. Some are absolutely 9:10 guidance. Some are absolutely 9:10 guidance. Some are absolutely appropriate. 9:11 appropriate. 9:11 appropriate. This is not anti- medicine. It's pro 9:14 This is not anti- medicine. It's pro 9:14 This is not anti- medicine. It's pro discernment. This perspective matters 9:17 discernment. This perspective matters 9:17 discernment. This perspective matters most if cognitive changes begin after 9:19 most if cognitive changes begin after 9:20 most if cognitive changes begin after medications were started or increased. 9:22 medications were started or increased. 9:22 medications were started or increased. If symptoms fluctuate rather than 9:25 If symptoms fluctuate rather than 9:25 If symptoms fluctuate rather than steadily decline, if imaging doesn't 9:27 steadily decline, if imaging doesn't 9:27 steadily decline, if imaging doesn't match lived experience, or if the 9:29 match lived experience, or if the 9:30 match lived experience, or if the decline feels too fast or simply out of 9:32 decline feels too fast or simply out of 9:32 decline feels too fast or simply out of character. Every medication deserves 9:35 character. Every medication deserves 9:35 character. Every medication deserves periodic re-evaluation, 9:37 periodic re-evaluation, 9:37 periodic re-evaluation, especially when the brain is involved. 9:39 especially when the brain is involved. 9:39 especially when the brain is involved. If there's one thing experience has 9:41 If there's one thing experience has 9:41 If there's one thing experience has taught me, it's this. Not all cognitive 9:44 taught me, it's this. Not all cognitive 9:44 taught me, it's this. Not all cognitive decline is degeneration. 9:47 decline is degeneration. 9:47 decline is degeneration. Some of it is reversible signal 9:49 Some of it is reversible signal 9:49 Some of it is reversible signal distortion. And when we slow down, 9:53 distortion. And when we slow down, 9:53 distortion. And when we slow down, listen carefully, and respect the 9:55 listen carefully, and respect the 9:55 listen carefully, and respect the nervous system, people often regain more 9:58 nervous system, people often regain more 9:58 nervous system, people often regain more than anyone expected. So, I'll leave you 10:01 than anyone expected. So, I'll leave you 10:01 than anyone expected. So, I'll leave you with a few questions. Has anyone ever 10:04 with a few questions. Has anyone ever 10:04 with a few questions. Has anyone ever reviewed your medications through the 10:05 reviewed your medications through the 10:05 reviewed your medications through the lens of brain function? Did your 10:08 lens of brain function? Did your 10:08 lens of brain function? Did your symptoms begin after something was added 10:10 symptoms begin after something was added 10:10 symptoms begin after something was added rather than before? And would you want a 10:14 rather than before? And would you want a 10:14 rather than before? And would you want a deeper breakdown of how specific drug 10:16 deeper breakdown of how specific drug 10:16 deeper breakdown of how specific drug classes affect cognition? If this 10:19 classes affect cognition? If this 10:19 classes affect cognition? If this resonates, I'd love to hear your 10:20 resonates, I'd love to hear your 10:20 resonates, I'd love to hear your experience in the comments. Your story 10:23 experience in the comments. Your story 10:23 experience in the comments. Your story may help someone else connect the dots 10:25 may help someone else connect the dots 10:25 may help someone else connect the dots sooner.
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