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Maria Thomas: Hello, and welcome everyone. We will be starting very soon. Thank you for joining us this afternoon, and this evening. Thanks again to those who are joining. We'll be starting very soon. We'll give it just another minute. Thank you all again for joining. We'll be starting very soon.Thanks, folks for joining this afternoon, and this evening we'll be starting in just a moment. We see the room filling up. We're excited that you're all with us this afternoon.Great. I think we can probably get underway.My name is Maria Thomas. I am the CEO of Sunday health, and before we get started with our webinar this afternoon. I wanted to go over a few administrative details and also share with you a little bit about Sunday health.First of all, we are on zoom, and we will be taking questions. So if you have questions, you can put them into the Q. And A. We will try to reserve plenty of time at the end to take go through questions. We did receive quite a few questions upfront. So we've tried to build in answers to the preliminary questions through the presentation, and hopefully we'll answer some of your questions that way.If you need assistance in any part of this webinar, you can put your question in chat. The chat will come through to us at Sunday health, but everybody will not be able to see it.Also, if you want to submit a question anonymously. There's an option to do that in Zoom by checking the send anonymously box while you're in the QA Area. And finally, if you would like to show closed captions, you can turn on the closed captions by clicking the CC Button at the bottom of your zoom screen.So thank you for joining us. We are Sunday health, and we are a medical practice focused on modern cognitive care. I use the word modern for a variety of reasons, but one of which is that we'd like to start our care before symptoms actually start. So we're really focused on early preventative early testing and preventative care. But of course, we can provide care throughout the diagnostic and prognostic journey.We are currently practicing in DC, Maryland and Virginia. We do have, I think, a national and international audience this evening, so feel free to ask your questions, but know that we are right now licensed to practice in DC, Maryland and Virginia.Today we have 2 fantastic speakers who will be talking about the science backed tips for taking care of your brain, and that is a big piece of what Sunday health is about. We really are trying to promote brain health. And, as I mentioned, early testing and also preventative steps that we can take very early to take care of our brain and not to wait too late to be dealing with cognitive issues. So I'm thrilled to be joined by Sarah Borschelt, who's one of our geriatric nurse practitioners at Sunday health, and also and also Julie Fratantoni, Dr. Julie Fratantoni, who's a PhD neuroscientist who until recently was working with the University of Texas at Dallas in their center for brain health.Dr. Fratantoni recently left the University of Texas to really strike out on her own building and dedicating herself to building brain health resources to help people with a number of the questions that you may have today, but also a number of the tips that we're going to go over today. So I'm thrilled to be joined by both Sarah and Julie. The way this is going to work is Sarah's going to present a few slides. Just kind of going over some of the basics that we wanted to share with you today, defining, cognitive aging and some other basics, and then we're going to open it up to kind of a more of a discussion with Sarah and Julie, and that's where we'll try to answer some of the questions that we received up front, and also, of course, take your questions as they come along. So thanks again for joining, and I'm going to hand it off to Sarah.

Sarah Borchelt, MSN: Wonderful. Thank you, Maria. Hi, my name is Sarah Borschelt. Again. I'm a nurse practitioner with around 10 years of experience, and for the past year I've gotten to work with Sunday health. And so I'm just going to start us off with a little bit of a definition. So we have some working guidelines here of what is cognition.And simply put cognition is our thinking abilities. But it's very complex, as I'm sure you can imagine. And and in healthcare, we define it as having 5 different domains or areas of cognitive abilities, and so that includes memory both short term and long term memory. But it also includes attention, language, executive function, and visual spatial capacity. And so what are these things? Attention is our ability to stay focused to pay attention over a long period of time, but also to selectively choose what we're paying attention to in the midst of distractions.Language is our ability to speak, to read, to comprehend what's being spoken to us. Executive function is more higher level thinking, so abstract thinking, planning, decision, making solving problems and visual spatial is kind of our navigation. So thinking of getting from point A to Point B packing a car, navigating depth and space.And so that's just kind of a quick summary. But it is actually natural to see some cognitive changes over time, and that is something where we want to define what is normal in that, and maybe what's not normal. And so you can see that this is a very basic plot of our cognitive abilities over time. And we all start with some basics we start with what we're born with. We can't change that. Our genetics, we have our environment which plays a role in our in our cognitive abilities and the development of them, and also our life experiences.And over time the ideal for all of us would be that we don't see any changes. And that's optimal aging, of course, but it's not uncommon to see some slight changes in our thinking abilities. And that's what we call typical aging when we go beyond that into more of an impairment or more of a notable decline. In our cognition we are into the realm of actual pathology, which is either mild cognitive impairment or dementia, and it's important to distinguish the 2 of them. So mild cognitive impairment is the change in cognitive function that is causing an impairment in your thinking abilities.Any one of the ones we just spoke about or multiple. But it's not impairing your functional abilities day to day. Someone is still functioning well, and taking care of themselves, getting out and about taking care of their house, probably, but dementia is when you have notable cognitive impairment in addition to a functional decline. And so that's where that's where we have to have a pretty comprehensive assessment to determine if someone has dementia, and it is important to note. I'll just touch on this briefly, that dementia is a syndrome meaning. It's a way of describing different symptoms that people have. But there are different diagnoses within dementia. So you've heard of Alzheimer's disease. Then there's multiple different other dementias frontotemporal dementia lewy body dementia. So I wanted to highlight that just because we want to think of dementia more as an umbrella term. And then there are more specifics within that.

Sarah Borchelt, MSN: So what are some normal things that we can see? Meaning if you see these changes in yourself or your loved one? It's it's not a huge red flag that what we call the tip of the tongue phenomenon. So that's having more trouble finding the right word or the right name. The name you just learned, and you can't remember it, but eventually it does come back to you. The word or the name. That's an important distinction.Paying attention might be a little bit harder, whether it be a long movie or a long book. Complex activities aren't as easy as they were before you find it maybe a little slower or a little harder, and then multitasking, keeping many things going at once just isn't as easy as it used to be.But what is not normal. These are some of the things that we really want to pay attention to. And first and foremost, memory changes are not normal. And so what can those look like? How can you notice a memory change? One example is asking someone the same question, multiple times in a conversation or within a day, or maybe one day to the next day, because one's not remembering the answer or getting lost, especially in a place that is familiar to you.

Julie Fratantoni, PhD: Hi! Everyone super excited to be here. Like Maria mentioned, I have spent the last 5 years at the University of Texas, at Dallas, where I helped to launch and lead a large scale longitudinal study that was about defining, measuring, and improving brain health across the lifespan. So did a lot of work with online training, coaching and assessments that were designed to measure and track potential.My passion is really to break down neuroscience, make it easy to understand. And I love helping people learn about brain, healthy habits and small things that you can do in your day to day life. And so one thing I want to touch on is the Lancet Commission that came out earlier this year this summer. If you're not familiar with the Lancet, it is one of the top medical journals.And the Lancet Commission is basically our group of multidisciplinary experts that come together with the goal of addressing major global health challenges. And so they did this one for dementia, prevention, intervention, and care, and came up with these different things so essentially looking at what are the top things that you can do risk factors for dementia. And what can you do about them? And the good news is that you can do just the way that you live. Your lifestyle day to day can greatly impact your level of risk. And what they found is that nearly 45% of dementia cases are preventable. So that's nearly half of dementia cases are preventable just from some simple lifestyle factors. So I want to go through and touch on these different factors that they covered in this commission.So the first one being in early life that your quality of education definitely matters and can help set you up for success. But since most of us are no longer, you know, super young and in elementary school, or we don't have control over that. Want you to know that you still the way that you engage your brain day to day. And that continued learning is important throughout your entire life.

It is kind of a use it or lose it thing. You want to continue to be curious and learn and take on new challenges.Okay, we'll move to the items in midlife. So the first one is addressing hearing impairment. This one's really important. If you have unaddressed hearing impairment, you're going to miss out on speech signals which can impact the quality of your social connection and relationships. And we know that social isolation is actually listed later, we'll talk about, but that those connections are some of the most protective factors. As you age for your health so definitely want to make sure that you're getting your hearing checked, and if there is impairment that you're going to correct that.Okay, high cholesterol, you know. That's something you want to always work with your doctor. To address depression again, your mood. Really matters. And so you want to prioritize your mental health as a part of your brain health, and also know that all of your brain, healthy practices, things like sleep, exercise, nutrition, morning sun, all these things can help with mood and with managing something like depression. But again, have your care team that you work with when it comes to reducing risk around traumatic brain injury. Wearing helmets is a really important thing. So whether you're riding a bike or contact sports, or whatever you're doing, always always wear your helmet. Physical inactivity is a big one. So we know that exercise increases things like Bdnf, which is like miracle growth for your neurons. So it's really neuroprotective specifically in areas like the hippocampus that is responsible for memory. So staying physically active is important, and this doesn't have to be, you know, joining a crossfit gym, or training for a marathon. This can simply be taking walks every day, you know, a 10 min walk this is, this can be gardening, this can be playing with your grandkids. This is just any form of physical movement finding things that you enjoy, that you like doing.Okay diabetes you want to detect and treat any diabetes. Work with your doctor there. Reducing smoking is another big one that increases risk. So I know that one recommendation that I have. If you're familiar, or have heard of Dr. Judd Brewer, he is a master of using mindfulness to beat addiction, and he has excellent resources. So recommend you check out his Ted Talk. He's incredible. Same with managing your blood pressure, obesity wanting to stay on top of that, and then with alcohol, we know the research is really clear. There's really no amount of alcohol that is good for the brain.And then let's move on to the later in life ones. So any uncorrected visual impairment. So you definitely want to again get your eyes checked and get glasses or contacts if you need to. The social social isolation is a huge one. So this doesn't mean this is definitely more about quality over quantity. So having, you know, 1, 2, 3 close friends, deep relationships, people that you trust and that you can count on that. You can, you know, solve problems with to have that support is huge. And then this last one air pollution actually has been connected. There have been studies that have found air pollution correlates with diseases like Alzheimer's and Parkinson's. So, you know, having an air filter, or, you know, just being mindful if you are in a polluted environment.Okay, that's it for those.

Julie Fratantoni, PhD: I'll pass it back to Sarah.

‍Sarah Borchelt, MSN: Wonderful. Thank you, Julie. So we do want to touch briefly tonight on the role of genetics and family history as it pertains to developing dementia. This is a very complex topic, and so I'm going to hit the highlights tonight. And then try to hit some of the main points, but not go into too much detail.So genetic mutations are changes in the gene structure that happen over time, and there are some known genetic changes or mutations that directly contribute to the development of Alzheimer's disease. The difference between this and something which is more commonly talked about now called the Apoe 4 allele is that the Apoe 4 is a genetic variant. And this is meaning that there's a change in the normal gene structure that you were born with. You were given this from birth, and they have found that having one copy of the E. 4 allele, they call it, or the variant increases your risks about 25% of developing Alzheimer's having 2 copies meaning you got one from each parent increases your risk much much higher than than 25%.And then family history is also considered a risk factor that we can't change. All of these are risk factors that we cannot change, but is worth knowing about, and family history includes both your nuclear direct family, but also maybe more extended family. And I think it's important to note that a lot of times dementia wasn't diagnosed in older generations, but there were cognitive decline signs of cognitive decline. So that's something to pay attention to in your family, because there is a known correlation between the more family members that have dementia in your family, the greater the risk there is, and ultimately as kind of the theme of our conversation tonight. The point of highlighting this is one for knowledge, but also to empower you, that if these are, if these are things in your life that you know you're dealing with. What are the how do we focus on the modifiable, the risk factors that we can change like Julie just talked about and really emphasizing a focus on those.And so the next area that is really important to touch on is the new blood tests that exist in the realm of cognitive care and dementia. And this is actually a pretty exciting development. I guess you could say in recent years for dementia care and that's because this hasn't really existed up to this point, as far as something measurable in the blood that can point to an underlying diagnosis of dementia.

I'm keeping this pretty high level tonight, just because it again, it's another very complicated topic. But one of our cognitive neurologists did a wonderful podcast on this recently, which we're going to put the link to in the chat. If you want to get some more detailed information on this topic.So simply put a blood test, or what we call a blood-based biomarker, is a measurable level of something in your body that indicates something's either normal or not normal. And there are now multiple different biomarkers for dementia that indicate something else might be going on that we may or may not see in a person's behavior or day to day life. And so we consider this one of our diagnostic tools. But it can't be right now. We're not using it as a standalone tool for diagnosing dementia, because there has to be many other components like we talked about a little earlier of what's going on in someone's life and their health to to imply a diagnosis. So I think it's it's exciting. There's a lot to come. There's a lot of developments that are happening. But again, just know that this is this is not something that we're gonna rely on as a standalone.

‍Maria Thomas: Thank you so much, Sarah and Julie, and appreciate everyone's questions in the Q. And A. And also in the chat we are standing by for additional questions, and I see that there are a couple. Yes, we can put the study link up again in the Q. And A. Kelly if you wouldn't mind doing that.So as I mentioned, up front, we are going to sort of shift into a little bit more of a discussion now that includes going over. The many questions that were submitted in advance, and we try to look at those questions and kind of group them into themes. A couple of topics really emerged at the at the top of that list, and we will kick off with the topic of lifestyle choices, and how lifestyle choices can help to keep your brain healthy when we say lifestyle choices. We're referring mostly to those 14 factors that Dr. Fratantoni mentioned from the Lancet Commission study. But we'll just bump it back to a few of these questions that we bucketed into this group.

For example, can a person be too old, like late seventies, early eighties, to help with their brain, so that their quality of life is maintained? Can one improve memory using nutrition or exercise. Can language, learning help with delaying cognitive decline? What would be your top recommendations for lifestyle habits that could be done in 30 min or less? So these are a sampling of the many questions we received, and I'm going to ask Julie to comment on all of these.

‍Julie Fratantoni, PhD: Yeah, these are such great questions. So when it comes to how can you be? Well, first I want to address, can a person be too old to help their brain. And the answer, I believe, based on research. And my experience is, no, it's never too early, and it's never too late. We know that the brain has the capacity for neuroplasticity and change your entire life.So it's never too old, and or you're never too old. And when it comes to how you can engage. I started. I spoke to this a little bit earlier, but want to really emphasize the importance of curiosity and learning throughout your entire life.And I also want to emphasize this idea of purpose and passion and connecting to that. So when I say learning, a lot of people think you know. Okay, well, should I learn a foreign language? Should I learn a musical instrument? Should I sign up for that? And the answer is if you want to. Yes, if that is life giving to you, if it's something you're passionate about, if it's something that you enjoy, then absolutely. Yes, if you already have a packed schedule, and are stressed and overwhelmed and burnt out and doing, you know, doing everything. Adding another thing like that to your plate is probably not going to be helpful. So it's also knowing kind of the right level of engagement for you, and that is going to look different in each different phase of your life.

So just want to say that, you know readjusting that level of challenge is going to change often, and then also, really the important aspect of it is not forcing yourself to learn something just because you think it's good for you, but really doing it, the most benefit comes from the things that you are genuinely curious about. And it's really those instances where learning doesn't feel like learning, you can kind of lose yourself in those activities. You want more of that. That's really helpful. I sort of touched on this one earlier, too, about improving memory using nutrition and exercise. And so absolutely, we know, exercise increases the number of synapses in your hippocampus. That brain area that's really key for memory and learning helps enhance long-term memory formation.So really great, and food, of course, can support your brain. So you know your leafy greens, your fatty fish high in Omega 3s. A lot of, you know, highly processed or fast food or fried food can increase inflammation in the body can disrupt gut health. Things like that contribute to brain fog difficulty with focus. It's harder to pay attention harder to encode. So what you eat in your daily movement really does matter, and it can make quite a big difference, and then I'll just wrap up because I really like this question of lifestyle habits that can be done in 30 min or less. So this is how I would break it down.If you only had 30 min a day I wouldn't even bulk it into one chunk. I would split it up, and so I would do in the morning. First thing I would do 5 min of some type of journaling, gratitude, practice, breathing, meditation, pick what you enjoy the most but 5 min of that just 5 min, and then I would also do a 10 min walk outside getting sun. This is going to help regulate your Circadian rhythm. So you get better sleep, which is essential. It's going to help with mood, alertness during the day. And you're also getting that movement and you're getting out in nature. So major habit stack with that 10 min walk, and then I would say, so. That's only 15 min so far in the middle of your day. Take a 5 min brain break, so truly disconnecting from people and technology and just allowing your brain to rest. It's really important. And then, 10 min after dinner, take a walk.Even bonus points if you can take that walk with a friend, a family member, or if you can't physically join someone, call them on the phone and walk and talk. So you're getting the benefits again of the movement you're seeing kind of after eating dinner. That's really helpful for digestion and glucose metabolism. And then adding the social component is that social support connection is really helpful, great for your mental health as well. So that's how I would break it down. So 5 min of some type of gratitude practice in the morning, 10 min walk, 5 min break in the middle of the day, and then another 10 min walk after dinner.

Maria Thomas: Thank you so much, Julie. Those are great suggestions. The next area that we tried to group some questions into has to do with cognitive testing. And I'm going to summarize one question that represents actually many questions we received and that is, are there assessments that should be done on a somewhat regular basis, as one ages for early identification of dementia, Alzheimer's symptoms, etc. Similar to how there are other routine medical screenings like mammograms, colonoscopies, and so forth. And so before I turn it over to Sarah, I just want to take a moment to say that question, or those types of questions really speaks to the Sunday health care model. If you look at our website on our homepage, we really are trying to elevate this idea of the importance of getting screened early, to establish a baseline of your brain health somehow, in our society we have all come to learn that once you turn 50. It's time to start getting colonoscopies, or if you're a woman, you get regular mammograms, but we most of us forgot about our brain, and it is very important to establish a brain health baseline and Sunday health absolutely embraces that concept. And so I'm going to ask Sarah to maybe speak a little bit more about what cognitive testing is, and the importance of getting that brain health baseline.

‍Sarah Borchelt, MSN: Awesome. Thank you, Maria. Yeah, I like this question because I think there again, kind of like the definition of dementia. There's kind of an umbrella term of cognitive testing. But then we want to talk about what does that include? Because it can be an intimidating thing for people, and so cognitive testing, on the whole, is simply looking at what is your cognitive function. But there are in a subset of that there is cognitive screeners, and those may be things that you may have heard of drawing the clock or answering these 3 questions at your doctor's office.

This isn't being as done as commonly the research shows in doctor's offices regularly these days, but there are certain tests that can be done in a screening fashion that could. If there's changes on the on those tests or the results aren't considered normal, they might be indicators that a more comprehensive assessment of cognition should be done.So what are some of those screeners? The one that we use here at Sunday Health is called the Moca, the Montreal cognitive assessment. And then there's also something called the Mmse. The Mini mental status exam. So these include looking at those various domains of cognition that we talked about earlier in order to recognize or try to find if there's something that may be a little off base that we wouldn't have noticed otherwise. And what is the importance of that, even if there's nothing wrong. Like, Maria said, we can establish a baseline to come back to and compare to. And I would say, even if you're not noticing concerns or problems, and you feel totally normal. Going in and requesting a cognitive screening test is is very important for your own data, but also for your healthcare provider to have that in your record. And then if normal doing it, maybe every year, if not normal. The next step beyond that would be based on what the results were and what else may be going on with your health. So it's hard to speak to that exactly. But, if there's significant signs of significant issues, we would recommend a more comprehensive assessment, and that includes looking at your medical health, looking at your social, your lifestyle factors that we've talked about in depth, talking about your stressors, your family history, what medications are you taking?How's your mood. And that's what I mean by comprehensive is really trying to come around you as a whole person and think about what else could be affecting these cognitive changes that the screener identified. And so that would then be kind of the impetus for further, if needed, further evaluation of the biomarkers we talked about and things like that. So simply put cognitive testing includes screening tests which would be an engaging thing like with your healthcare provider, or someone trained to do the test, but also more of a conversation around what's going on with your overall health and things like that.

‍Maria Thomas: Thank you so much, Sarah, I just want to comment. I do see some questions coming in both on Chat and in the Q. And A that are quite specific and have to do with very specific medical situations. For most of those, I think we would prefer that you email us, or we can take it offline one on one, because each of these situations is very specific, and we would likely need to know more. But thank you for your questions and keep them coming. If you have general questions about cognitive testing, cognitive assessments, any of those things.

I am going to direct this one to you. The question was, What is the impact of poor sleep on cognitive function? And are there tips for getting better uninterrupted sleep? And maybe, as part of answering the question you could just touch on why sleep is so important for the brain.

‍Julie Fratantoni, PhD: Absolutely. Sleep is the closest thing to a magic pill there is, there is none, but sleep comes pretty darn close, it improves. It's when every single brain and body system resets, it is the time that the glymphatic system comes through and clears out all the toxins that have built up throughout the day. So when we miss out on sleep, we miss out on that cleaning process and the impact of poor sleep on cognitive function. So your frontal lobe is like your brain, CEO, and it's responsible for all of your executive functions, your planning, judgment, decision, making problem, solving organization, and many more flexible thinking.And so your frontal lobe is actually the most vulnerable part to lack of sleep. So we all have experienced this on some level, that if we're super sleep deprived or really tired, or had just a bad night's sleep, your your mood is down. You're more cranky. You're not able to focus and keep attention. And just thinking clearly is harder. And it's not the time to make big decisions right? If you're having, if you're sleep deprived. So just want to touch on. Those are a few of the big, big impact. There's so much more I could go into there. But those are some big ones, and as far as tips for getting better sleep or more uninterrupted sleep, there are so many things that you can do throughout your day that can help.The habits you have during the day impact how well you sleep at night, and how well you sleep at night definitely impacts what you do during the day or your abilities during the day. And the nice thing is, you can kind of intervene in either place and start to just break the cycle and see improvements when it comes specifically to sleep. I think having a really great wind down routine is important. I think a lot of us are just go go or screen screens, whether that's from your computer to then to the TV or to your phone, or to your ipad, or whatever it is. And so really giving yourself a period of time, whether that's, you know, 30 min, if that's what you can do, or an hour before bed to be screen free and to kind of dim the lights use lamps instead of bright, harsh overhead lights, and that can really help to signal to your body that it's evening. It's time to wind down. It's time to prepare for sleep, and then to do a relaxing activity, like reading or journaling, or take a hot bath, or sip on some tea and catch up with someone.

So having that wind down routine is really important, and then setting up your sleep environment can also really make a difference. So getting blackout shades, you know, wearing earplugs or getting white noise if you're in a noisy environment and then setting the temperature to be really cool between 65 and 68 degrees is pretty optimal. So those are a few tips that you can. Small adjustments you can make. One other thing is take any screens and electronics out of your bedroom. That's one really easy one that can help. Because those little, even if they're off, the chargers have little glowing lights, and your brain is very sensitive to light, and that can impact your sleep quality so I could go on and on, but I'll leave it at that.

‍Maria Thomas: That's a good one, and so hard for so many of us. There's a question that came through ahead of the webinar that also has come up in the chat or the Q. And A. And that question is about how someone can help a loved one who is showing signs of cognitive decline, and may be resistant to acknowledge it. I did pop in the chat, a link to a short video that we have on our blog that one of our dementia neurologists put together with some tips for that very situation. But, Sarah, maybe you can comment a little bit further, elaborate a little bit more on that question.

‍Sarah Borchelt, MSN: Yes, it's a great question and a challenging one, because there is no singular answer to this. It is going to be an individualized thing based on the person, I think, from clinical experience and time, in this world of taking care of people with cognitive changes and dementia myself, there's both the emotional side of this and support and the practical side.And so, first just acknowledging that people who are experiencing cognitive changes themselves can still be fairly sensitive to the reality that they know something is wrong, even if they can't name that something is wrong. And similarly, family members around them may may be struggling with acknowledging that as well, simply for the nature of the fear that comes with that. And so I think, from that side of things, acknowledging how much support cognitive change and dementia needs from both within the family and outside of the family emotionally and practically, is very important.

And how do you provide that? I think one of my favorite tips is just using the I statements. So instead of coming at someone and saying, you've been doing this? Just say I've noticed this. I'm concerned about this. What do you have any concerns? Or have you noticed anything? And creating a dialogue instead of having just a statement.Choosing how, when, where to have that conversation is important, especially if people are over taxed or stressed already by cognitive changes. Having it be a private kind of quiet, sensitive conversation, I think, is helpful.It's it can be worthwhile, you know, within that conversation, emphasizing that there there are a lot of benefits to cognitive screening and testing that kind of like we spoke about a little earlier that aren't necessarily just getting a diagnosis. It's the opportunity to possibly identify things that we could intervene on, whether that be vitamin deficiencies or thyroid changes or medications that are causing these problems, that we could actually make changes with your healthcare provider on so emphasizing to them that you know what if if we did look into this with a provider, with your doctor, there may be things that we could impact now and also recognizing. And this comes down to some individual discernment of how much you say this in the conversation, but recognizing that if something is going on earlier intervention is always better like, Julie said. We can do a lot to help the brain over time. And there, there's even studies that show that movement and introducing therapies with people who have known dementia can help their function on a day to day basis.And so I think I would phrase it more along the lines of "Hey, maybe we can just get some more information about what's going on and what we can do to help" and really use non threatening terms like that in order to maybe encourage them in that direction. And then, I think, just continuing the conversation over time, just because we know how important it is to identify these things early. So not not giving up, not getting super discouraged if it's turned down right away, expect that that's probably the normal. With any sort of I guess you could say intervention or hard conversation like this, it's not always received well the first time.

So yeah, Dr. Sanders' Video, that Maria linked in the chat is wonderful and touches on a lot of these points. But from my experience, acknowledging upfront kind of going in with an expectation that this may not that you may need to have this conversation a couple of times can be helpful, so that that it helps allude the or evade the defensive reaction that can happen. So that's just personal experience. Thank you.

‍Maria Thomas: We still have a few minutes left. I do want to cover a couple of administrative details, so we don't run up against the clock. But if if there are lingering questions, feel free to put them into the Q. And A. I wanted to let everybody know that you will receive a recording of this webinar, and also a summary, a kind of one page summary of this discussion. Following the webinar. So thanks again for joining us, and you'll be receiving that via email.If you're interested in following up specifically about anything you've heard today from Sunday health or from Dr. Frantoni. We're going to give you that information now. So Dr. Julie Fratantoni, as we mentioned, has recently left the University of Texas at Dallas to build a independent practice focused on brain health resources. And you can find her here at her substack or at her website.And then for Sunday health, we can be reached either by phone at this number or via email. hello@sundayhealth.com. And just to review again, Sunday health is a care delivery practice, an actual medical practice. We are licensed to provide care in DC, Maryland, and Virginia we are currently accepting new patients. Very little wait time. And so if you are interested in making an appointment with us. You can call us. You can email us. We do accept medicare part B, that's traditional Medicare. We are expecting soon, probably within the next few months to also be in network with a number of commercial insurance providers. So at the moment Medicare part B and also self pay options are available.If there are any lingering questions, we're happy to take one or 2 more questions while we still have a few minutes or any final comments from the group. Sarah or Julie?If not, I want to thank everyone for joining us this afternoon and this evening, and please check the Sunday health website periodically, we are offering future webinars, and we will let you know about those. So thanks again for joining us.