Dr. Alexander Peralta is a pharmacist and a physician as well as the Chief Operating Officer for Peralta Enterprises. He is also President of Palliative Medicine Consulting Services and Chief Medical Officer and Director of Palliative Care Services for Compass Hospice in Dallas and Director of Palliative Care for Prestonwood and Denton Rehabilitation and Nursing Centers.
Frank Samson: I'm very excited about our guest today. Dr. Alexander Peralta is a pharmacist and a physician as well as the Chief Operating Officer for Peralta Enterprises. He's also President of Palliative Medicine Consulting Services and Chief Medical Officer and Director of Palliative Care Services for Compass Hospice in Dallas and Director of Palliative Care for Prestonwood and Denton Rehabilitation and Nursing Centers. Dr. Peralta has presented at international, national, state and local symposia and has authored multiple publications. Dr. Peralta, thank you so much for joining us on The Aging Boomers.
Dr. Peralta: Frank, it's a privilege and an honor to be on your show. I'm very excited to be part of this program.
Frank: Great, well I appreciate it. I did do a little research and I know you talk quite a bit at various events and I’ve read speeches that you've given. You talk about a term that some people might be familiar with, but I would have to guess most aren't neuroplasticity, if I pronounced it right. Can you tell us a little bit more about what is neuroplasticity?
Dr. Peralta: Yes, Frank. Really, neuroplasticity is a term that's been around in medicine for several years. Actually, as a pain specialist, we knew about neuroplasticityin terms of how drugs worked in the brain and what caused them to stop working; however, neuroplasticity now is very high on the radar screen for neuroscience. It's referred as a gray plasticity, cortical plasticity or cortical remapping which refers to changes that occur in the organization of the brain as a result of an experience. The term plasticity was coined by Jerzy Konorski. The concept of neuroplasticity implies that there are certain areas of the brain that are dynamically rewiring in response to changes in the environment. It also challenges the notion that the brain function is fixed in certain regions, which it is not. The brain, in a way, is very plastic and has the ability to rewire itself, especially like when someone has a stroke. What really allows people who've had a major stroke to get better is how the brain literally rewires one side of the brain to the other side of the brain, actually moving certain functions, neuroconnections and cognitive abilities.
Frank: The brain, of course, is pretty complicated. Maybe not to you, but I think to the average person. I guess there are various functions, of course, and cognitive areas of the brain. Would you say, all the areas of the brain change over time? What I mean is do all of them or just certain areas change as we age?
Dr. Peralta: Definitely Frank. According to the theory in neuroplasticity just to kind of add one more thing, it's thinking, learning, and acting that actually change in both the brain and physical structure, the anatomy and the functional organization, and the physiology of the brain from top to bottom. This natural ability to form new connections in order to compensate for an injury or a change in one’s environment is what we talk about. There’s a great book called The Brain that Changes Itself by Norman Doidge. He talks about how the brain works. Something I think is very important are areas of the brain and brain function. For example, memory. Memory is part of the brain’s function, the ability to retain and recall past and present information. The cognitive area of the brain that's affected there is the temporal and frontal lobes. When we look at language, you know, the brain function, the process involved in producing and understanding spoken and written communications.
The cognitive area in the brain is called the parietal lobe and then there's executive function, which is the capacity to control and apply one’s own mental skills. That cognitive area of the brain in the frontal lobe, it's kind of like, in that particular area, how well you reconcile your checkbook - that kind of thing. Then, there's the motor functions, which are multi faceted. The ability to produce body movement through interaction to the brain, the nerves, and the muscle. That's what gets us around and gets us to do things. That cognitive area is interconnected throughout the brain and the cerebellum and parietal lobe edge where it intersects with the frontal lobe and the major motor and sensory strips of the brain.
The last one I think is very important is the visual, spatial skills - the brain function process involving discrimination and perception, attention and tracking objects visually. That's in the area of the brain that is the occipital area in the temporal lobe. The occipital is the back of the brain and temporals are the side areas. When there's an injury or when there's trauma, these are the areas that are affected. In the future, our therapies will be very, very focused and very targeted so that and this is common in part of somebody who maybe has had a fall and a traumatic brain injury or someone who's had a stroke or someone who has progressive…we used to call it neurodegenerative degeneration, but the Institute of Medicine has created a great word called cognitive aging. That sounds better, than dementia, but I think cognitive aging is a new word that the Institute of Medicine in the April issue of JAMA in 2015 that talks about how most of us age and how things happen to us that is a lifelong process, gradually ongoing and changes. Everybody has their own different changes that occur depending on our previous experiences.
Frank: You mentioned something, it wasn't on my list to ask you, but I hope you don't mind me asking you. When you said cognitive aging, there's a name that many physicians give to someone who maybe is not diagnosed with dementia yet, but they use a term called MCI or Mild Cognitive Impairment. How do you define MCI versus what you're saying, cognitive aging?
Dr. Peralta: I'll give you the definition that the Institute of Medicine has. Minimal Cognitive Impairment is now considered the beginning of Alzheimers. It used to be that you didn't have it, but now the literature states clearly and the evidence shows that it is part of that diagnosis of Alzheimer’s. I have personal experience. I took care of my mom who died in 2000. She had vascular dementia and Alzheimer’s disease with late onset. That's what has driven me over the last probably 15 years to know more about this, but the definition by the Institute of Medicine from their report says that if cognitive aging is a lifelong process of gradual and ongoing, yet highly variable changes in cognitive function, it occurs, people get older. That happens to all of us. Some cognitive function decrease predicatively, such as memory and reaction time, where some of the other functions are maintained may even increase such as wisdom and knowledge. We all have hope on that end.
The report really addresses the emerging concepts of cognitive aging that are important in public health and more importantly, what you're doing here today, educating the public, educating people to understand better and maintain this cognitive reserve or cognitive health, so that we can stay functional, but more importantly, we can enjoy the quality of life that we've been given.
Frank: Okay, great. I've had people on the show previously talking about exercise and how important that is, but we're mainly talking about physical exercise. Of course, many say that helps the brain and all of that. I guess, what comes to mind, I guess, as it relates to the brain, can you really teach an old brain new tricks? With exercise the experts say it's never too late. You can be 70, 80 years old maybe you haven't exercised in a while, but you could start to strengthen things again even though maybe you weren't someone who exercised much. Is that the same with the brain?
Dr. Peralta: Absolutely, and it's a combination of both cognitive exercises or mental exercises as well as physical exercises. You know, several years ago the Alzheimer's Project had a wonderful two-part series, and one of the videos that showed how really certain areas of the brain are stimulated and addressed certain types of neurohormones called endotropins. These endotropins really help in nourishing brain cells so then they become important. What they did is they looked at ... they exercised these transgenic mice which they were able to give Alzheimers disease or a dead animal with plaques and those that exercised really were able to keep a lot of their conditional responses, while those that didn't became very sedentary and demented. That's how we do certain testing, but also we get test drugs and see how they work through these mice studies, these transgenic mice.
The exercise is pivotal. I'm kind of looking at all of us as we age, I'm a baby boomer - I'm 72. What can I do? From my perspective it's walking and exercising and staying active, but the physical exercise is very important. I'm not telling people, you have to check with your doctor to make sure you're physically able to do this, but walking is the easiest thing that you can do to help ... Walking, start with quarter of a mile, or two blocks and then increase it every month or so, so that you challenge yourself physically and then, of course, as you and your previous shows have mentioned to people, all these different types of mental exercises are also very important, that can be protective.
Just to give you an example of it: I'm from the old school and I grew up and dancing was kind of neat to do so dancing actually is one of the top things you can do to be exercised. I'm not talking about fast dancing, although if you can tango and square dance that's good. Just like those Dancing with the Stars things, but just to stay active because it allows you to use those things in the brain that we talked about, visual spatial skills, motor skills, sensory skills, cognitive skills. All of that is important to help you really improve what we call cognitive reserve. That's what you're trying to do.
Frank: Yes. As long as you brought up dance and just overall brain fitness. I know our listeners would love to hear more on how…what would be the best way to keep the mind sharp? There are a lot of companies, because of the aging population, a lot of games out there to play, various fitness games. How does one know whether one can work better than another and what should they believe and what shouldn't they believe?
Dr. Peralta: There's six ways. One of them that's come up on the radar screen quite a bit is coffee and certain types of extracts from coffee. This is very important. There are certain products you can find on the internet that contain these extracts. These are good, but coffee is found to actually be very important in being able to help the brain as well. The other thing I think that's very important is looking at just caffeine as a drug that consistently shows positive effects. A little bit is okay, but not a lot. It does help with attention and memory and learning. You have to be careful. A little is good, but I would not go out there and drink a couple of espressos! That can really affect somebody's heart rate.
Frank: Somebody that has a couple cups of coffee in the morning, maybe one more in the afternoon, would you say that falls within the guidelines?
Dr. Peralta: Absolutely. I would only caution the afternoon coffee because there's a lot of research on what I'm going to talk about next -- which is sleep. Caffeine affects people differently ... Some people can have coffee before they go to sleep and some people can have a cup of coffee and be awake all night long so be careful with the afternoon cup of coffee if you're drinking it caffeinated. The best thing is to drink decaffeinated. Yes, you still get a little bit of caffeine. A couple, absolutely, a couple of cups of coffee a day leads to really a way in which we can heighten our attentiveness.
The other thing that I really promote because we talk about eating right and exercising your body and exercising your mind, but sleep is pivotal. Sleep is the Swiss Army Knife of memory, learning that what sleep does is consolidate our memories, encoding them in certain connections between neurons that make it easier to recover information. It also strips away unimportant details so that you can remember what's really more useful to you. It solidifies skills you've learned during the day and of course, this is kind of interesting because most of us are reading and we're trying to learn and then we fall asleep. Yeah, but you really keep that information. It doesn't help if you put your head on the book. You've got to read the book or you've got to read the material.
The other thing that I think is most important about sleep is that it flushes out harmful toxins that accumulate during a 24 hour period of time, which possibly could increase your risk for Alzheimer’s disease. I know that there's a lot of people that have a type of obstructive sleep apneas and interruptive sleep, so be sure that you treat that and you go to a professional to get this treated. It also builds up stores of reserve energy for times when you really need to think hard and this is, to me, in what I've read and what I've researched, is very, very important because sometimes we have to really think hard;
especially if we've had some situation where we have a family member who is ill or you become ill or you get a new diagnosis or you've had a trauma or you have progressive disease, then this is really one to protect your brain. Sleep also develops the ability to focus and avoid distractions the next day so you know when you have enough sleep, you know how clear and how crystal your brain is, but when you have interruptive sleep or you don't get enough sleep, that really affects your thinking and over a long period of time, it could cause loss of neurons. Then, of course, eating right. Making sure that you eat right, exercise your body and of course, exercise your mind.
Frank: I do have a question for you on the sleep part.
Dr. Peralta: Sure.
Frank: Is this dependent on the particular person and their age as far as the amount of sleep they need? I mean, you hear people say hey, I just need four hours of sleep a night and I'm sharp as can be. Is that a fallacy?
Dr. Peralta: No, that's absolutely correct. I think there are some researchers that actually looked at this. Art Markman is Physiology Professor at University of Texas in Austin and he talks about the importance of sleep. All of us go through four stages of sleep. We go through light sleep and also deep sleep, but everybody talks about that rapid eye movement sleep so you can have sleep that's non REM, (rapid eye movement), and sleep that is REM. There's a lot of theories, but most of us need about three to four cycles of REM and each of those cycles are about 90 minutes, so you're absolutely right. Some people can sleep four to six hours and they're good because they get into that real deep sleep, get their three or four REM cycles and they're good.
For me, it's seven and a half to eight hours. There is actually a way of you testing that. If you buy one of those apparatuses that you can put on your wrist and it can actual measure how many hours you actually sleep. The number is between seven and a half and eight and a quarter hours so eight hours and fifteen minutes. That's about normal for most people. What happens is if you have interrupted sleep throughout the night, then it affects you the next day where you don't feel like you've really slept at all and I'm going to leave that to the experts that do all these studies. Let’s just say that sleep is so important in brain health.
Frank: Got it. Okay, I had interrupted you. You were going to talk about eating.
Dr. Peralta: Well yes, healthy food and exercise, of course, all of us know that we want to make sure that we have a variety of vegetables and fruit and whole grains and all these nuts. I'll have to share with you, my breakfast is muesli and then I put over all kinds of Brazilian nuts, almonds and blueberries. Whatever it is, those are a good antioxidants that really help the brain in not developing those free radicals that can be dangerous to us. Then, of course, exercising as much as you can. The last thing I want to mention is social interaction, being interactive socially.
A lot of studies have shown that even though a person may carry a lot of this disease in their brain, as long as they're interacting socially, and I think it's one of the things that's so great about what you do and your affiliates do, is to tell the people that interaction and support groups can help take care of demented patients for the last 16 years because I saw what happened to my mom. I've really got compassion fatigue syndrome trying to do it all, my wife and I, by ourselves so you need to seek help and you need to sometimes make sure that the person who is the caregiver, who is the pillar of taking care of that patient, takes care of themselves. If they get sick, then the whole house falls apart, it craters. It's very important that whatever spouse is buffering for that particular person who has cognitive aging, that they stay healthy as well. It's very important that it becomes more of a family thing. Everybody needs to support the ones who are caring for someone who has dementia or another type of neurological degenerative disease.
The social interaction is very, very important because there are studies done with some nuns outin Iowa. All these nuns donate their brains (upon their death) and those nuns that were active, teaching, even though they had more disease than one who didn't have as much disease in their brain post mortem, did not have dementia. The other part is the challenge of doing something new everyday by challenging yourself. Every month you need to pick something new to do so that you can stay fresh. What I do every two years, I write an article or I pick up something new. I will share with you something personal. They say that it helps if you play an instrument or you're in the choir or you're learning something. I always said, "God didn't give me that talent, he gave it to my daughters, he gave it to my wife, all my family, but I didn't get the talent," so this year I'm learning how to play the piano. That's been something really new for me.
Frank: That's great.
Dr. Peralta: The other thing that I'll mention, and I hope this is not an advertisement in any way, but just the fact of iPhones, our phones changed operating systems and you know how hectic that is. Right?
Dr. Peralta: You change the system and I have to relearn something. Oh, I hate this. No. That's really good for your brain.
Frank: That's great. Good. You've got to challenge the brain.
Dr. Peralta: Yeah, absolutely. You have to challenge the brain, because if you do not use it you will lose it and the the adage that we had of “... oh, we'll just go some place and sit in a rocker and just take it easy. I've worked hard all my life...” In neuroscience we called that pruning. You brain literally gets pruned so you need to keep those connections open.
Frank: When you were talking about the social interaction and how important that is, but then you see studies that 90 some odd percent of people want to live at home the rest of their life. That may not be the best if they're alone and sitting in front of the TV all day long. Is that right?
Dr. Peralta: That's a real conundrum …in the daily work that I do because yes, obviously. There's no place like home Especially if you’re sick and things of that sort, but there has to be a way in which there is social interaction, physical interaction, mental type of skills and functions that are being used because otherwise, one can slowly lose some of those things. It gets to the point where sometimes they forget how to turn the stove on and off or be able to cook a meal or even know that they need to eat so that becomes very important. Yes, home is a great environment if there's somebody there that can also provide all those very important elements that nourish a brain and nourish the individual so they can maintain a certain quality of life that they certainly deserve.
Frank: Time went really quickly. I had a number of other questions to ask you, but unfortunately, we're out of time and I want to invite you right now, to come back because there's so much to talk about. I could talk to you all day long about this stuff. Thank you. I did want to make sure that you share with people, if people wanted to learn more about what you're doing, speaking engagements, etc, is there a site where they can go to learn more about what you're doing, Doctor?
Dr. Peralta: You know I do palliative care in two areas, but I would highly recommend your Alzheimer's Association. I do work with them and I'm one of their speakers on an off and on basis and the local branch of the Geriatric Society. We have a Gerontological Association in Dallas. Just look for those because there are a lot of very good people providing some great programs that are educational. The whole focus here is to make it practical and also something that you can adapt to do that will help you.
Frank Samson: Great! Dr. Alexander Peralta, thank you so much for joining us. It was fascinating, very informative and as I said, we will have you back. Lots more to talk about so thank you so much for joining us. I just want to thank everybody out there for joining us as well on The Aging Boomers. Just be safe out there and we'll talk to you all soon.