Move It or Lose It | Episode 140 | Dr. Anthony Feinstein: How is Your Brain Treating You?

Podcast: Move It or Lose it – The Podcast
Host: Kathy Chester
Guest: Dr. Anthony Feinstein, Professor of Psychiatry, Neuropsychiatry expert
Date: November 19, 2025

Episode Overview

In this engaging episode, host Kathy Chester reconnects with Dr. Anthony Feinstein, renowned neuropsychiatrist and author, to delve into the cognitive and emotional challenges faced by people living with Multiple Sclerosis (MS) and other neurodegenerative diseases. Together, they break down the latest advances in brain imaging, cognitive rehabilitation, stress management, and discuss Dr. Feinstein's powerful new book on moral courage among journalists. Throughout, Kathy mixes personal experience and practical advice, keeping the conversation accessible and motivating for listeners dealing with similar health journeys.

Key Discussion Points & Insights

1. Dr. Feinstein’s Background (00:40–03:10)

• Born in South Africa, medical school and psychiatry PhD in London, then emigrated to Toronto (00:56–02:40).
• Director of a major neuropsychiatry clinic at the University of Toronto since 1993.

2. Why Focus on MS and Cognitive Research? (03:15–04:20)

• Fascination sparked by the advent of MRI technology revealing MS brain lesions unseen in earlier times.
• "It was having this new tool called MRI which really was a game changer." (B, 04:09)

3. Advances in MRI & Understanding of MS (05:09–07:41)

• MRI strength went from 0.15 Tesla to 3 Tesla, vastly improving lesion detection.
• Ability to measure not just lesions but subtle changes and atrophy (brain shrinkage).
• “We now know that there’s gray matter disease in people with MS as well.” (B, 07:16)
• Gray matter pathology is increasingly recognized as crucial for cognition.

4. Cognitive Symptoms in MS: Myths and Realities (07:41–09:34)

• Cognitive changes can occur early in MS, not just in older patients.
• Challenges the myth that cognition is spared in youthful MS.
• High prevalence: ~40-45% in relapsing-remitting, 60-70% in secondary-progressive, higher in primary-progressive.

5. The Need for Baseline Cognitive Assessment (08:37–09:34)

• Strong recommendation for all MS patients to have initial neuropsychological testing to document cognition and monitor changes over time.

6. Impact of Stress on MS Cognition (10:24–11:46)

• Stress can worsen symptoms and lesions, per UCLA study with stress reduction therapy (10:37–10:56).
• Emotional stress is distracting; reducing stress can benefit cognitive function.
• "If you can correct the stress...those kind of cognitive challenges you face can improve." (B, 11:46)

7. Therapeutic and Coping Strategies for Cognition (12:24–13:31)

• Evidence supports psychotherapy for anxiety/stress and cognitive issues.
• Dr. Feinstein’s clinic now offers computer-based cognitive rehabilitation therapy:
  • 5-week programs with two 45-minute sessions weekly (13:13–13:25)
  • Programs target specific impairments (memory, processing speed, etc.)
  • “We now have interventions which we think can subtly improve your cognition.” (B, 13:26)

8. Challenges in Making Cognitive Rehab Accessible (13:36–16:33)

• Resources limit ability to provide therapy for everyone—priority for those most likely to benefit.
• REACOM, a German program, used both in-clinic and virtually.
• Notable: Uncertainty remains if improvements in the program translate to daily life (16:33).

9. Pandemic Effects on Cognition & Clinical Practice (18:27–21:29)

• No clear global increase in cognitive decline post-pandemic, but some individuals worsened, especially those with severe COVID or long COVID.
• Biggest change: Shift to telehealth/remote practice and empty hospital corridors.
• Social and intellectual engagement suffered during lockdowns, threatening cognitive reserve.

10. Depression, Anxiety, and Access to Psychotherapy (22:02–24:13)

• Dr. Feinstein clarifies the distinction: “Anxiety is not the same as depression. It’s different.” (B, 22:28)
• Treatment options: psychotherapy (especially CBT, mindfulness-based therapy), or medications.
• Rise of computerized CBT when therapists are inaccessible; “Some of those programs can be very effective as well.” (B, 23:57)

11. Cannabis Use in MS: Benefits & Pitfalls (24:36–26:16)

• About one third of Dr. Feinstein’s clinic patients use cannabis.
• Patients describe benefits for pain, spasticity, sleep, anxiety—but THC can worsen cognition.
• Encourages patients with cognitive problems to consider stopping THC.
• “When you stop cannabis…your cognition can improve.” (B, 26:09)

12. Recognition of Cognition and Mood in Neurology (27:52–29:25)

• Huge change over two decades: neurologists now recognize cognitive and mood symptoms as central to MS management.
• “Now…there’s a very broad recognition that this [cognition and mood] is absolutely pivotal to good clinical management.” (B, 28:36)

Dr. Feinstein’s Book: Moral Courage: The Front Line (30:10–39:14)

Book Theme & Motivation

• Focuses on journalists reporting in countries with poor press freedom (Russia, Bangladesh, Iran, Zimbabwe, India).
• Explores “moral courage”—the willingness to risk personal safety for truth and societal good.
• “If you keep quiet, if you don’t say something, you compromise yourself morally.” (B, 33:04)

Standout Story

• Gwen Lister, Namibian journalist, stood against apartheid despite extreme risk (35:24).

Broader Societal Relevance

• Press faces global challenges, from overt repression (Bangladesh, Russia) to intimidation in democracies like India (37:03–39:13).
• Moral injury: The psychic distress of witnessing or enabling moral transgressions by remaining silent.

Closing Advice: Keeping the Brain Active (39:34–40:39)

“You want to boost your cognitive reserve, and you do it by keeping your brain active…through intellectual activity, social activity, and physical activity.” (B, 39:36)

• Read, join a library, listen to podcasts/audiobooks, do puzzles.
• Engage in social activity, exercise (even from a wheelchair—“sitting cardio”).
• Avoid excessive passive activities (like TV watching).

Notable Quotes & Moments

• On MRI’s impact:
  “It was having this new tool called MRI which really was a game changer.” (B, 04:09)

• On cognitive symptoms in MS:
  “Cognitive problems can begin very early in the disease…that’s why it’s very important that you have access to someone who can test you.” (B, 08:37)

• On stress and cognition:
  “Stress problematic for the disease. Absolutely.” (B, 10:58)
  “If you can correct the stress…those kind of cognitive challenges you face can improve.” (B, 11:46)

• On rehab innovation:
  “We now have interventions which we think can subtly improve your cognition.” (B, 13:26)

• On cannabis use:
  "The good news is that when you stop cannabis...your cognition can improve." (B, 26:09)

• On moral courage:
  “If you keep quiet, if you don’t say something, you compromise yourself morally.” (B, 33:04)

• On advice for those struggling cognitively:
  “You want to keep your brain active. That’s the best medicine.” (B, 39:36)

Important Timestamps

• 00:40-03:10 – Dr. Feinstein’s background and early career
• 03:15-04:20 – What drew Dr. Feinstein to MS cognitive research
• 05:09-07:41 – Advances in MRI and lesion/atrophy assessment
• 07:41-09:34 – Prevalence and early onset of cognitive symptoms in MS
• 10:24–11:46 – Stress, emotional impact, and cognition
• 12:24–13:31 – Cognitive rehabilitation therapy details
• 18:27–21:29 – Impact of COVID-19/pandemic on practice and cognition
• 22:02–24:13 – Differentiating depression and anxiety in MS; therapy options
• 24:36-26:16 – Cannabis benefits and risks in MS
• 30:10-39:14 – Discussion of Dr. Feinstein’s new book on moral courage
• 39:34–40:39 – Dr. Feinstein’s top advice for MS cognitive health

Overall Tone & Takeaways

The conversation is warm, relatable, and informative—combining rigorous expertise with empathy, and ending with hope and practical motivation for listeners navigating the cognitive ups and downs of MS. Dr. Feinstein’s insights offer validation, up-to-date science, and a sense of community for patients and caregivers alike.

Resource Links

• Dr. Feinstein’s books: Mind, Mood & Memory and Moral Courage: The Front Line
• REACOM cognitive rehabilitation program (for information and purchase options)
• MS cognitive and mood resources (CBT, mindfulness, online therapy options)