Dr. Jennifer Reynolds Discusses ADHD, Memory, and The NEAT Center of Austin

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your board certified urologic host, here with my cohost Donna Lee.

Donna Lee: 

I thought you’re trying to say your bored. You’re just, you’re board certified.

Dr. Mistry: 

That’s right.

Donna Lee: 

We’re not ever bored on our show.

Dr. Mistry: 

No, I’m never bored.

Donna Lee: 

Ok, good.

Dr. Mistry: 

I think the show goes too quick. It’s too hard to get bored.

Donna Lee: 

It does. That’s right. Everybody, thanks for tuning in. We appreciate it. Happy Sunday, everybody.

Dr. Mistry: 

When I tell people that I’m doing this, this show and podcast, and that I have this huge family in this practice, the first thing they ask is how do I, how can I do it? Like how can I get it all done? I jokingly think that I have ADHD, but I think I just use that…

Donna Lee: 

You just use that to get out of things?

Dr. Mistry: 

I think I just used the word, I think I just use the word. The truth is I have an amazing wife who takes care of 95% of my life.

Donna Lee: 

That is true.

Dr. Mistry: 

And an amazing staff here at the office.

Donna Lee: 

Back at the office.

Dr. Mistry: 

Yeah, that’s right.

Donna Lee: 

And me!

Dr. Mistry: 

When we talk about men’s health…that’s what I just said, staff at the office!

Donna Lee: 

You forgot to separate me into some other fun categories.

Dr. Mistry: 

Oh my goodness.

Donna Lee: 

Your board certified cohost.

Dr. Mistry: 

Oh my goodness.

Donna Lee: 

Continue!

Dr. Mistry: 

Would somebody please tell somebody to bring out the pedestal?

Donna Lee: 

Speaking of ADHD…

Dr. Mistry: 

You know, from the beginning of my desire to do this show, you could only talk about testosterone, erectile dysfunction, and large prostate, prostate cancer, and all the amazing things that we do, without getting to some of the psychological things. And so, you know, over the course of this show, we do plan on talking about things like alcoholism and depression and anxiety disorder. But I’m seeing so many patients with other neuro-cognitive kind of conditions. And I started thinking about “What am I worried about myself?” I’m in my 40’s. I went to school for many years and I feel like my success as a professional is dependent on a lot of the motivation. But I worry about my memory, and I worry about ADHD and hyperactivity. So, we have a wonderful guest today, Dr. Jennifer Reynolds. She’s the CEO of the NEAT Center of Austin. That’s the Neuropsychological Evaluation and Therapeutic Center of Austin. Thanks a lot for joining us again.

Dr. Reynolds: 

You’re welcome. Thank you for having me. And if that name didn’t give you ADHD, I don’t know what will, it’s a long one.

Dr. Mistry: 

It’s okay. I think the NEAT Center’s awesome.

Donna Lee: 

I like the “NEAT” part.

Dr. Mistry: 

I love, it’s so neat.

Dr. Reynolds: 

It’s neat. It’s a neat acronym.

Dr. Mistry: 

So, neuropsychology is a field that’s known to me, because I went through medical school. We use neuropsychology evaluations often in children when we’re trying to diagnose them with behavioral or issues related to how they’re progressing in school.

Dr. Reynolds: 

Right.

Dr. Mistry: 

And then we know about neuropsychological evaluations in older patients when I’m trying to diagnose memory, dementia, but there’s this whole big middle, right?

Dr. Reynolds: 

Sure. I think that when people think of a neuropsychologist, they think mostly ADHD assessments, or you know, autism spectrum disorders. But what I’ve found in my practice and I’m in Northwest Austin, is that I’ve had an increase of middle-aged–I say middle aged 40 to 60 year old men–coming in worried about cognitive decline and memory issues. And what goes hand in hand with that is a lot of times I see some ADHD issues, meaning inattention, inability to concentrate, impulsivity. All of these things that need to be parsed out from say dementia or you know, early onset Alzheimer’s. There’s something that happens in the neurotransmission of a man’s brain between 40 and 55 specifically with dopamine and testosterone that can affect memory and cognitive ability, the personality of the man, problem solving, reasoning, emotions. And all of these things can be examined by a neuropsychologist with very thorough assessments, valid, reliable assessments. These aren’t things that are self report where I ask you 10 questions and you say true or false with, you know, our Likert scale of 1 to 10. This is 6 hours of testing. But what it does is it goes in and out of the brain very specifically to figure out what lobes are functioning best, what lobes maybe need a little more working out so to speak–you use it or you lose it. And is this, you know, an ADHD issue that’s being exacerbated by low testosterone? Or perhaps it is an early onset dementia, Alzheimer’s memory problem.

Dr. Mistry: 

So if I were to classify how the medical profession outside of psychology and psychiatry thinks of ADHD, I think that there would be a general skepticism…

Dr. Reynolds: 

There is.

Dr. Mistry: 

…that it’s probably, it’s over-diagnosed…

Dr. Reynolds: 

Absolutely.

Dr. Mistry: 

…and inappropriately diagnosed. Because there’s something nice about taking Ritalin, you know, this, this idea of taking Ritalin or some kind of stimulant that might kinda make me focus more and make me better at my life. You know, there are movies about kind of like pills that’ll just make me better at my job.

Dr. Reynolds: 

“Prozac Nation.”

Dr. Mistry: 

Maybe walk me through, let’s say a person’s interaction, if you can think of an example of how somebody would respond as an ADHD person or somebody who’s just kind of a normal person who’s not paying attention.

Dr. Reynolds: 

Sure. And I think that’s a really wonderful question because from young to old, I get the same, you know, blanket diagnosis of ADHD that comes in my office and they need validation of that because the diagnosis usually comes from a general practitioner who says, “Well, let’s try this cocktail of Adderall or Vyvanse. And if that works, then you have it.” ADHD is a blanket term that I’m not really fond of. What it really means is a cognitive redistribution of thinking. So people with attention deficit aren’t always hyper and jumping off walls, and they’re not always inattentive and daydreaming. There’s a lot, there’s a myriad of things that go on, which is the thought emotional process. For example, when you say, give me an example of what it may look like in a day to day life…so somebody with quote unquote “ADHD” may have a to do list, right, at their house and they got 10 things to do: change the light bulbs, you know, take out the trash. And before you know it, you’ve got 1/16th of everything done and not a whole thing of anything done.

Donna Lee: 

Is that hitting home, Dr. Mistry?

Dr. Reynolds: 

And it can be frustrating because…

Dr. Mistry: 

I have a whole Google Drive called “Nothing But To-Do Lists.”

Dr. Reynolds: 

Right. You know, even I to-do list for my to-do list. So you know, and it can get more frustrating when you have changes in dopamine and testosterone because it’s going to be exacerbated. There’s going to be, you know, there can be issues with your relationships because you don’t seem to be paying attention. And by the way, men, it’s not your fault. I mean, it’s dopamine’s fault. You can blame it. So just kind of parsing out and figuring out what is going on in the brain at that age is really important. I mean, our executive functioning cortex, the frontal cortex, is done developing and we’re in mid-life and try to figure out now you know, the brain, just like any other organ in the body, you know, needs certain things at certain times in life.

Dr. Mistry: 

Well, what would be the kind of behavior person might exhibit if they don’t really have ADHD but are just maybe not “focused?”

Dr. Reynolds: 

Procrastination is a big one that I see a lot of times in both men and women. You know, just the inability to overcome inertia, right? So you know, there’s something important to do. And instead of doing that important thing, you’ll sit there and look on Amazon prime for a new phone cover, for your phone, for 5 hours.

Dr. Mistry: 

That’s not ADHD. That’s just not wanting to get up and take the garbage out.

Dr. Reynolds: 

It is though! Believe it or not, that is a component and attendant of attention deficit. So what happens is you have an ability psychologically to go to a cognitive fugue state, and you distract from what you need to do because you’re overwhelmed by that which you need to do. So you see a lot of procrastination. And then you see guilt coming from the fact that you procrastinated; loss of focus, so even when you do start on that important task, the mind will wander, the mind will drift. You’ll get tired. I mean, physically, this is something that is converted. I mean, you become tired. You know, it’s exhausting just to think about having to think. So when you start thinking you’re tired. So all of these things start occurring and people start wondering, “Well, am I losing my mind? Am I losing my memory? Am I going to be Grandma Rose in 4 years, who doesn’t know who my kids are?” You know, that sort of thing. And that’s terrifying. It’s terrifying for anybody. So I think it’s very important on many levels, but certainly on the memory aspect and ADHD aspect to have it thoroughly evaluated for peace of mind. No pun intended

Dr. Mistry: 

For sure. And I think that, you know, people don’t want to go through extended evaluations. People just want this idea that there’s going to be a pill that fixes it. And then when you put them on the pill, they’re like, well, is there a way to do this without a pill?

Dr. Reynolds: 

Catch 22!

Dr. Mistry: 

So maybe talk to me about techniques or ways that we can address ADHD without the use of medications.

Dr. Reynolds: 

Well, I think, and that’s again, great statement. Great question. I think the problem is historically, the way that we’ve gone about treating ADHD is through amphetamines. And we build tolerance to those very quickly within the brain, so they don’t work as well when you’re older. However, that being said, once you’ve had a thorough assessment and you know you’ve had a thorough neuro-psych assessment when it’s, you know, 5 hours long. And by the way, it’s kind of fun. We get to play with blocks and other stuff. But, you know, once you’ve had that assessment, then you find learning mnemonics based on the lobes of your brain and what I figure out they’re doing and what they’re not doing. So if there’s under-compensation, there’s mnemonics that you know, I can teach and psycho-educate on that will help compensate, because the brain, you know, is the same like any muscle–use it or lose it. So these “flaccid” is a good word, maybe in this clinic. So flaccid parts of the brain…

Dr. Mistry: 

We don’t say “flaccid.”

Dr. Reynolds: 

Okay, so weaker muscles in the brain areas–you’re welcome–so just stimulating, we say stimulating, right? So stimulating those parts of the brain, are more likely to make them more efficient by, you know, reconnecting. Again, neuroplasticity is an amazing thing. But again, you’ve got to figure out where that needs to happen. And in order to do that, you need a thorough assessment.

Dr. Mistry: 

Well, you know, there’ve been several topics on this show that have really struck home to me. Hyper-masculinity was one. Humility was a second. But now ADHD, I don’t know Donna Lee.

Donna Lee: 

So fitting…I feel like you’re just connecting so well today, so thank you.

Dr. Mistry: 

You want, you want to tell people, you want to tell people how to get ahold of us?

Donna Lee: 

Yeah. As you can get ahold of Dr. Reynolds through neatcenteraustin.com, correct?

Dr. Reynolds: 

Correct.

Donna Lee: 

Neatcenteraustin.com. But you can reach out to us during the week (512) 238-0762. You can send us an email to armormenshealth@gmail.com, any question you have for us or even Dr. Reynolds, armormenshealth@gmail.com. Our website is armormenshealth.com. We have four amazing locations in the Austin area and in Dripping Springs, and it looks like we will be right back with more from Dr. Reynolds. We’ll be right back.

: 

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.

: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host here as always with my cohost, Donna Lee.

Donna Lee: 

That’s right. Hello. Welcome back everybody. Happy Sunday.

Dr. Mistry: 

So, we’re again joined by a wonderful guest. Dr. Jennifer Reynolds. She’s the CEO of the Neuropsychological Evaluation And Therapeutic Center of Austin–neatcenteraustin.com. Thanks a lot for joining us again, Jennifer.

Dr. Reynolds: 

Of course. Thanks for having me.

Dr. Mistry: 

So, Donna, you’ve been around for awhile. You think my memory is pretty good?

Donna Lee: 

Uhhh, except when it comes to texting me back. You’ll text my husband back, but he forgets to text me back.

Dr. Mistry: 

Well, he’s a lot more fun than you are. There’s usually not a lot of work.

Donna Lee: 

I think the question is for your wife, Krista. We should ask her. We should call her up and see how his memory is.

Dr. Mistry: 

Oh man, please. I don’t think she likes my memory or my texting, like return.

Donna Lee: 

Oh, Okay. We can help you with that through Dr. Reynolds and the NEAT Center of Austin.

Dr. Mistry: 

So we tell a lot of people low testosterone, even nutrition to point and constant cognitive engagement or constantly doing something can help them with their memory.

Dr. Reynolds: 

Sure.

Dr. Mistry: 

I mean, for me personally, this idea of losing my memory is something that’s such a frightening thing.

Dr. Reynolds: 

Absolutely. It’s terrifying.

Dr. Mistry: 

Because my memory and my cognitive capability is such an important part of who I am professionally. And so I’m worried about it, but I feel like it’s kind of out of my control. So I can’t do anything to like hold onto my memory or to know when there’s a problem. So I’d love to hear your thoughts on what kinds of things that we can do to prevent memory loss or to even kind of stem the tide? What kind of risk factors we should look for getting advanced testing and what can we expect as we’re aging?

Dr. Reynolds: 

Sure. Well, I mean, obviously there’s a genetic component right to Alzheimer’s and early onset dementia. So looking at, you know, a family pattern and a history is going to be important. And if you see, you know, a marked, you know, acute and chronic memory issues within the family, you really need to think about getting tested in your mid to late 40’s and 50’s, because if there is memory loss from cerebral brain, you know, shrinkage–which does happen in men more than women, the brain starts shrinking and you start losing areas that would functionally be capable of neurotransmission for memory.

Dr. Mistry: 

And I feel that sometimes this, this onset occurs earlier and earlier in subsequent generations.

Dr. Reynolds: 

It is. It is. And I think that’s because of all the technology and everything that’s going on. We don’t do a lot anymore to work the hippocampus, the memory center in the brain. So before the senses, you know, we’re used to to enjoy life, go outside, play, go outside, ride a bike, walk around. Now we’d get on a phone. Well the senses are what are tied in, you know, to our memory centers. So we’re not using our senses as much. We’re not, you know, creating that constant communication system loop between the hippocampus and the frontal cortex and solidifying memories in both long and short term.

Dr. Mistry: 

Something as simple as remembering addresses, or remembering phone numbers.

Dr. Reynolds: 

Exactly. We don’t have to do that anymore. That’s right.

Dr. Mistry: 

I know my phone number, my wife’s phone number, and maybe one of my children’s phones, if they’re lucky. But you know, I’m not keeping 40 phone numbers and 40 addresses in my head like I used to.

Dr. Reynolds: 

Right, right. And I mean in a way it’s, you know, it can be good. It’s a double-edged sword: garbage in, garbage out. So there’s some stuff maybe that we were taxing the brain a little too much with, you know, useless information. But I think you’re right, for the most part, memorizing all those phone numbers and what memorizing all those, you know math calculations that kids don’t have to have any more. They have a handout for it, a calculator. What it does is it works as sort of a bench press, right, for the hippocampus, for the memory center of the brain. So the fact that we’re not doing that as much is showing literally through MRIs and fMRIs, we’re seeing a shrinkage in the hippocampus, in the limbic system loop that works that memory center. So you are seeing earlier-onset dementia and you know, Alzheimer’s.

Dr. Mistry: 

And you like me kind of agree with the use of some supplements like fish oil and gingko biloba. I think that we both agree that constant cerebral or mental or cognitive kind of exercises with things just to keep us engaged that don’t involve watching our phones all the time is probably important. What are some other ways that we can try to keep our memory, going and when should we start worrying that we’re losing a step and get tested?

Dr. Reynolds: 

Well that’s a good question. There’s a lot of different things. You know, there are apps out there–I hate to use this since we’re, you know, talking about not using our phones–but there are apps that work on the memory center. You know, there are brain apps that are just brain games that you get on there and they’re memory puzzles and you flip a card and then you flip another and if they match…So all of these, although they seem slightly pedantic, you know, or a little rudimentary, are actually really helping work that deeper area of the brain where the hippocampus is. You know, and one point that I do want to make though is the fear based factor of memory loss. It is terrifying to think that you’re losing your memory. So just to normalize some memory functions that do show some decline, that doesn’t mean you have dementia, are things like misplacing your keys more often, or forgetting that your wife told you or your husband told you to pick something up that day. Again, this can be parsed out with having a busy life and the busier you get, the more cortisol you release from stress and the less your memory starts working. So is it that or is it, you know, I’m literally starting to lose longterm memory? I mean, things that have been stored that should still be there for retrieval are not only difficult to retrieve, but start getting impossible to retrieve because they’re no longer there. That’s when the concern really comes in. So if you start doing things differently than you’ve done historically as a pattern of behavior and it seems out of norm for you, then that’s time to maybe worry and get a neuropsychological evaluation. Because although we can’t stop Alzheimer’s, there’s not a cure, there is a way to slow the progression down. You know, there’s drugs like Aricept and Namenda and I’ll leave that, you know, you’re the MD. But there are things that can sort of slow that down as well as the brain workouts that we’re talking about.

Dr. Mistry: 

I think there’s more than that. If you can identify yourself or a family member at being at risk for dementia or Alzheimer’s, continued memory loss, you can start setting up your life in a way that helps people.

Dr. Reynolds: 

Absolutely.

Dr. Mistry: 

You can put constant reminders of people, of things. You can have more pictures than you would have normally. You think about what people do in a memory center for people that are so far gone that they can’t even remember their own name, and try to bring it closer into your life. So these constant reminders of who you are, who people are, what you’re supposed to remember. I think this is important.

Dr. Reynolds: 

It is. It’s very important. And you know, sense association is important, when you start seeing that you know your memory is declining. So if a certain smell reminds you of a certain person, have a picture paired with that sense, take it, you know–sniff that scent every morning and look at that person. And what you’re doing is you’re rewiring or hardwiring those neurons and that hippocampus to formulate and maintain a longterm memory. Because that’s really the terrifying thing. Not losing your keys today, but losing it, you know, awareness of who your child is.

Dr. Mistry: 

It’s such a great point because I think so often we forget about common sense type approaches to problems.

Dr. Reynolds: 

Absolutely.

Dr. Mistry: 

You know, as physicians, we know patients that are put in a hospital setting, unfamiliar, you know, they have what’s called a sun-downing effect. You know, when that’s when the sun goes down and they’re in an unfamiliar place, oftentimes cognitive function diminishes substantially and quickly. So why wouldn’t it be the case that surrounding yourself with familiar things, constant reminders. Something as simple as make sure that everybody that comes to you, even if you’ve known them for a long time, make sure they introduce themselves again, just to kind of just make sure that you’re reminded constantly. And I think these kinds of things, if you’re at risk for memory loss, can have a real big impact.

Dr. Reynolds: 

Absolutely. I think we need to be a lot more proactive when it comes to cognitive decline versus reactive. You know, what we see is the decline has already, you know, hit the bell curve and we’re on the downward slope. So now it’s a reactivity issue versus being prophylactically proactive about it. You know, set things up before it starts happening. If you have diabetes and you’re insulin dependent, you’re not going to forget to take your insulin. So if you’ve got memory issues, you need to not forget to do your memory puzzles every day.

Dr. Mistry: 

Yeah. And if you have balance issues, you’re going to put rails on in the bathroom, you’re going to make different changes. You’re going to have, you know, less loose fitting carpet to keep yourself from falling. So this is great. So if you or a loved one are concerned about, we talked about ADHD earlier and now we’re talking about memory loss and concerns about dementia. They go through what’s called a neuropsychological evaluation and that’s what you do at your center.

Dr. Reynolds: 

What most people think of an evaluation is they get a questionnaire handed to them in their doctor’s office that says, you know, “Did you forget your keys? Do you often forget things you misplace things, yes or no?” So what’s different about a neuropsychological evaluation is that it’s very specific, valid, and reliable testing. For example, the executive functioning tests that I administer. And every part of the test has been normed and created to look at certain parts of the brain in a valid and reliable way. It’s very consistent. So when they come to me specifically for memory, Wechsler memory skills are amazing because it’s not just about how’s your memory, it’s about how’s your declarative knowledge? How’s your crystallized knowledge? How’s your fluid knowledge? All of these are different memory funded things, if you will. And we need to see if memory is declining, where is memory declining because that’s important. It’s going to be important for setting up your environment so as to stop the progression, right and sort of get that neuroplasticity working and try to hardwire that again if you’re losing it.

Dr. Mistry: 

And it may not be done just once. I mean I tell people over and over again that you know, you test, you just get a snapshot of where you are today.

Dr. Reynolds: 

That’s right.

Dr. Mistry: 

You may need additional testing, you know, 2 or 3 years down the line to see if what we’re doing is working.

Dr. Reynolds: 

Absolutely. You establish a baseline and you go from there to see if the, you know, the treatment plan is effective and that’s basic science. But that’s what works.

Dr. Mistry: 

Well, Jennifer, thank you so much for coming on and talking about something that’s very frightening to so many people. This idea of losing your memory and losing yourself. You’re at the neatcenteraustin.com, that’s the website. (512) 540-4767. Thanks a lot for joining us.

Dr. Reynolds: 

Thank you so much for having me.

Donna Lee: 

That was fun. So now I have to stop yelling at my husband for being on his stupid brain app.

Dr. Reynolds: 

Well, yes.

Dr. Mistry: 

We don’t want him beating you. You take that phone away from him because he needs to forget.

Donna Lee: 

Wow. Well, on that note, we’ll be right back.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.