← The Neuro Experience
Loading summary
Transcript98 lines
- [00:00]
Louise Nicola
What has changed over the last 10 years? In imaging the Brain, when I see
- [00:05]
Dr. Mistry
a scan on a patient, it tells me your past in a one scan. And if we have an opportunity to get a second scan, then I can tell you what your future looks like. One day I put up a scan and I said, okay, this guy's probably between 50 and 60. And I looked at the age he was 78 years old, and I said, wow, this guy is doing something right.
- [00:28]
Louise Nicola
Dr. Mistry.
- [00:29]
Dr. Mistry
Louisa, neuroimaging is very exciting. I probably, I have around 300,000 plus exams under my belt. So over the past 20 years, I've developed protocols where I feel that it can really help us age more healthier.
- [00:42]
Louise Nicola
You are utilizing AI in neuroimaging. I want to know what AI can do.
- [00:47]
Dr. Mistry
This is volumetric mri. This is the AI going in and outlining these areas in a precise manner. I looked at a patient, she was in their 50s, she was forgetting things. She had had an MRI that was normal. So we said, let's come back in a. And her hippocampal volume loss was 2.2%.
- [01:09]
Louise Nicola
Oh my gosh.
- [01:11]
Dr. Mistry
Which, if I was doing the measurements, I would never pick up.
- [01:14]
Louise Nicola
I'm Louise Nicola and this is the neuro experience. Dr. Mistry, you've spent most of your life as a medical doctor, right? You're doing what you were trained to do when you take a brain scan, let's just say an mri, you scan it, you look at the results and then you report it. What has changed over the last 10 years when it comes to what you found in Imaging the brain?
- [01:45]
Dr. Mistry
Louisa Neuroimaging is very exciting. And I say that when I see a scan on a patient, it tells me what you've done up to this point, really tells me your past in one scan. The reason I say that is that on neuroimaging, not only are we seeing brain volume, but also the health of your calvarium in terms of your bone health, in terms of your vasculature. It gives us a nice snapshot. If we have an opportunity to get a second scan where we have, let's say, one ear in between and something like a volumetric mri, then I can tell you what your future looks like because then I know your cognitive degeneration trajectory. What does your curve look like, you know, when you draw a line, the slope of the line. We need two points. So as soon as we have two points, it gives us an idea where is this patient going? And I believe that information is absolutely invaluable and When I first started in radiology, here I am in radiology resident. I'm so excited. I've read all these anatomy books and I started looking at these scans and I started seeing 30 and 40 year olds having brains and brain volumes of 50 year olds, 60 year olds. And I said, wow, that's not what I learned in my books. And I started asking the guy, and I would ask my attendings, I would say, is this normal? Isn't this like, shouldn't we be questioning this? Shouldn't we be reporting this? And we would read them out as no acute disease, which is a cute term, but it doesn't say anything else. And so this started this questioning journey. And so for the past 20 years, I would say probably I have around 300,000 plus exams under my belt. I started seeing patterns of what makes people age, particularly what makes their brain age. And usually when I put up a scan, while just looking at the scan, I can usually tell the age of the patient, right? So I usually don't even look at their age. I just put up the scan and I say, okay, I know that guy's 50, that guy's 60. But what surprised me and, you know, the aha moment here was one day I put up a scan and I said, okay, this guy's probably between 50 and 60. And I looked at the age and he was 78 years old. And I said, wow. I said, this guy is doing something right. And I looked at the history and tried to find out. And, you know, he was a farmer, you know, living a very, very natural lifestyle and things like that. And then that just begged the question that what can we learn from these outliers that we can apply? And that started this quest. So over the past 20 years, I've developed protocols, put in, you know, several buckets where I feel that these interventions can really help us age more healthier.
- [05:08]
Louise Nicola
Oh, my gosh. I love this because it's the same. It's almost identical to the story that I had when I was doing EEG scans and picking up on mild cognitive impairment. And, you know, I haven't, I don't have, you know, 300,000. I've probably got around, I know 20,000 scans under my belt where I was tasked with the mission of just pick, like scanning all these brains and detecting mci. And I couldn't understand why most of these patients were women. And that started my questioning journey. But I think before we move on, I think it'd be good to actually talk about what scans we're talking about, because there's so many different brain scans, right? You're specifically talking about an mri. But when we talk about brain scans, clinically, we can check the functionality of the brain, which is an eeg, we can do an fmri, but what does the MRI actually show?
- [06:01]
Dr. Mistry
So when we talk about brain scans, like you said, there are many different types of scans. And besides the ones you mentioned, we can do a CAT scan of the head either without or with contrast. We can do an MRI of the brain more recently with AI tools. What we're able to do is what is known as volumetric mri, which is a thin section mri. What the AI software is able to do is take those thin sections and measure the volume of the key components in the brain that are important for different functions. For example, the hippocampal formation related to memory, the cerebellum related balance, the motor cortex, the sensory cortex, which is related to other pathologies. So what we're able to do now, and it's an exciting time in history, is that we have this technology to pick up subtle changes in these brain volumes that we could never do before. And we cannot do without with the human eye. But AI, when it's under the proper supervision, there's a lot of quality control that goes into this. It's just not all automated. There's a lot of input from our end and what we're doing. But when it's done correctly and it's in the right hands, you get tremendous information. And when you do it serially, you can figure out this curve or the slope of neurodegeneration.
- [07:36]
Louise Nicola
Oh, my God, that's beautiful. Because you can actually. So what you're saying is we can go into, like you said, certain parts of the brain, like the hippocampus, which is what I speak about a lot. And you can measure, when you say measure, the trajectory of its atrophy or trajectory of its change, isn't that. Don't you have to do that over a given time, like every six months, just to see the rate of change?
- [07:58]
Dr. Mistry
So we can see some change over six months, preferably a year. But even then, you know, year one year is not a long time. And when, if you look at traditionally where people used to just eyeball the scan and take some rough measurements, there is no way you had the precision or sensitivity to even notice any change. We are now able to pick up changes in like 1 to 2% range, which is phenomenal. And that's where we want to be, because I can then figure out the trajectory and we can See that? Are the interventions working? Does that person need to be more aggressive in terms of their lifestyle modifications? And so it's just giving us these fantastic tools to work with.
- [08:53]
Louise Nicola
Okay, so what we're going to do is I want you to take this brain, this is Zoe, and I want you to explain to us the car analogy that you use to describe the brain. And you've described it to me before. Here you go.
- [09:09]
Dr. Mistry
So, Louise, I do this on stage and for my residents. And I believe that when we talk about our central nervous system, most people just point to their brain, and rightfully so, because that's, that's sort of the epicenter of central nervous system or main control center. But I like to use a car analogy and I say that we are all a finely tuned F1 automobile, right? And so the first piece of this, even before we can talk about the brain here, I believe the first piece we need to address is the fuel system and the fuel pump that supplies this thing. And so if you think of ourselves as a car, the first thing is you could have a beautiful car. You have a 700 horsepower Ferrari, but if it has no fuel or a leaky fuel system, there's no point. Doesn't matter how much horsepower it has. And hence the fuel system in our car is our cardiovascular system. Right? The fuel pump is the heart. And what's exciting about this, and we're at a time that now we've understood that the heart is not a static, right? It's, it's malleable, it has plasticity. We can train the heart. We talk about the Norwegian 4x4 protocol in being able to train the heart, change the myocardium and optimize the myocardium. So exciting times.
- [10:46]
Louise Nicola
There is something I see over and over again with the women I work with. They're doing everything right. Training, eating well, optimizing sleep. And they still feel off. Low energy, brain fog, mood fluctuations. And a lot of the time it comes back to something really simple. They're evidently deficient in key nutrients such as iron, folate, zinc, vitamin D, B vitamins, especially if they're menstruating. And most supplements just don't account for that. They're built on male default models, or they chase symptoms instead of fixing the foundation. That's why I started using daily basis. It's a cycle aligned multivitamin powder. Two formulas, one for each phase of your cycle. Replenish in the first half, especially around your period, to restore what you're losing and balance in the second half to Support mood, inflammation and gut health. It's one stick a day. You mix it with water, that's it. For me, the biggest shift has been consistency in how I feel. More stable energy in the first half of my cycle and in the second half, better focus, better mood, and I'm sleeping better. It's foundational. Not a stack, not a quick fix, just one thing a day that covers what most people are missing. They're doing a really special offer for the neuro experience audience. You can use coding euro for 50% off off your first month. That is codingeuro for 50% off. The link is below in the show notes. Did you know that the heart actually has around 40,000 neurons?
- [12:23]
Dr. Mistry
There is an institute called heart Math.
- [12:25]
Louise Nicola
Yes, right.
- [12:25]
Dr. Mistry
And they talk about the. The heart brain axis.
- [12:29]
Louise Nicola
Oh, it's amazing.
- [12:30]
Dr. Mistry
And where you talk about heart coherence leading to brain coherence and this whole science coming out of that and phenomenal, phenomenal research coming out of there. But going back to our analogy, so we have our fuel pump, which is our heart, and then the fuel system, which is the fuel lines, which is our arteries. Interestingly, the arteries, the endothelium of the arteries is also a live system. Just as the heart is also constantly evolving the arteries, the endothelial wall is a live system. That means your daily lifestyle changes your movement, everything you do, your HIIT TR the 4 by 4, it changes the endothelium as well. So this becomes a huge issue because you may have a great engine or a great brain, but if the fuel system is not there, if your arterial network and your endothelial health is not there, that's when you run into issues with strokes, improper perfusion of the brain. So that's the first step is optimizing the fuel system. Okay. The second part is the engine. Okay. And that's the physical engine block or the brain itself. And there are many components we can talk about here. However, the key components is one is the overall brain volume. And so we talk about the total brain volume, which is important because it gives us an idea of how people are aging. The second aspect is different parts of the brain that have to do with different functions. Right. We know that the motor cortex and the sensory cortex are important. And so we want to know the volume there. Beyond that, two other components that are critical is you can even split that
- [14:19]
Louise Nicola
and show the hippocampus.
- [14:20]
Dr. Mistry
We can split it. Let's see if we can do that. But is going to be hippocampal is in the medial part of our temporal Lobe. So we have four lobes, the frontal, parietal, temporal, and then we have the cerebellum and the occipital lo lobes. The medial part of our temporal lobe, okay, that is somewhere in here actually, is this area called the hippocampal formation, which is our memory center. The volume of that is something that we can track and assess neurodegenerative disease. Okay, and the other piece that's important is this green area here. This is our cerebellum, which is has to do with coordination and balance. Okay. That's important too, because certain disease processes, certain drugs, impact the cerebellum directly and cause cerebellar atrophy. Okay, so we have our fuel system, we have our engine. What's important is it's not just about the engine, but it's also about the engine output or the horsepower. So we talk about networks in the brain. So you may have a great engine block, a great brain, but it doesn't tell us about the networks inside. And so when we look at functional mri, that is another form of mri, which tells us how those individuals networks function and are activated. And so that's important. You may have a great engine, you may have a 700 horsepower engine, but it's only putting out 400 horsepower because internally the efficiency is not there. And the last piece is how this engine transmits everything to the rest of the body. Okay. We talk about our nerve root tracts, that's our transmission. Okay. Of a drive shaft. The main tract is our corticospinal tract is basically the motor cortex communicating with the rest of the body. That's how we move things. Right. But then there are tracks that lead up, that bring sensory information. Then there are tracks within our system that communicate from the anterior part of the brain to the posterior part of the brain, between the brain. And so all these play a role in the transmission of the brain. So when we look at it this way, it gives us a much more of a cohesive, much more of a holistic framework of thinking about the nervous system.
- [16:47]
Louise Nicola
Oh, wow, I loved that analogy. And there's so many questions, especially as it relates to the, the blood vessels, because you mentioned it's the most vascular, rich organ in the entire body. And it's made up of, you've got capillaries, which are the one cell thick little blood vessels. You've got the arteries which have muscles around them, and then you've got the veins. So we're going to get into that, but before we do, I want to talk about what we're here to talk about, which is neurodegeneration and how do we pick up on early signs of neurodegeneration, specifically Alzheimer's disease. And something that I've pounded to the audience is that Alzheimer's disease is not a one time stamp. When you are 70, 75 years old, you don't just get that diagnosis. It is generally when you get the diagnosis of Alzheimer's disease or let's just say any of the dementias, we know that it has been going on and going on for about 20 years. 20 years prior to that diagnosis, or maybe even 30 years prior to that diagnosis is the starting point of your neurodegenerative journey, which is unfortunate. And we'll talk about this landmark study, clinical and biomarker changes in Dominantly Inherited Alzheimer's Disease. So these are basically, this was a New England Journal of Medicine study which basically showed in 2012 the evidence to neurodegeneration. Meaning, like here are the biomarkers that we can detect 20 years prior to you getting a diagnosis. So why don't you give us a bit of an overview of what is Alzheimer's disease in your perspective and how do we pick up on early signs of it?
- [18:26]
Dr. Mistry
Louisa, apart from a lot of the content that you talk about in terms of cognitive testing and whatnot that's used for Alzheimer's, from my perspective as a neuroimager, what are tools we have to pick up early changes in terms of this neurodegeneration? As we know Alzheimer's, there are many different forms of Alzheimer's, right? We have Alzheimer's, we have also vascular related dementia. When we talk about Alzheimer's specifically, we know that there are certain proteins that are involved, like beta amyloid and tau. And so part of the imaging approach to this has been, is that can we pick up these changes early and what can we do and what are the tools that we have? So this is one of the scans that is used and this is a, what is known as a beta, it's a amyloid PET scan. And basically it's a PET marker. And so what PET is Positron Emission Tomography. And basically it's a substance that's injected in your vein and it collects and is avid for that beta amyloid protein. Now there are also scans like this for tau, but more common is the beta amyloid. Now what's interesting is that there is, this is the normal size and you can see there is some normal physiologic uptake in the white matter. And on the right Side we see an Alzheimer's patient where you see all this red area is this abnormal uptake of this beta amyloid tag.
- [20:27]
Louise Nicola
One of the best ways to improve brain energy metabolism is to make sure that you have adequate ketones circulating in your body. This is why I ingest ketone iq. I'm obsessed with ketones. They're one of the brain's most efficient energy sources, especially as we age and glucose handling changes. I use it for deep work or for long days when I want to focus without caffeine or crashes. But I also use it just in my day to day to make sure that I am neurologically adequately fueled. If you haven't tried ketones, you, you must, these ones taste great and you can get 30% off your subscription@ketone.com neuro/get a free gift with your second shipment. So, so when I'm looking at this brain, I'm looking. So the, the one on the left where it says normal, what does the plus six mean?
- [21:21]
Dr. Mistry
So those are just sort of like image image parameters and like that, that has to do with just like the kind of like settings there. I would, you know, I wouldn't worry about that. Yeah.
- [21:32]
Louise Nicola
So that brain doesn have the normal one, doesn't have too much amyloid in it.
- [21:37]
Dr. Mistry
Right. There is always some little bit of physiologic uptake in the white matter. You know, that's, that's expected. And, but you can see in the cortex of the brain which is the most important, that's where the gray matter is. Right. There is not a whole lot of amyloid accumulation. So the red part is where the amyloid density is. Right. So on the right side we see all this activity in the cortex of the brain, in the frontal lobes here in the parallel parietal lobes. And so what we've seen in, in terms of assessing and picking these changes up early, that even biopsies have shown that even in cadavers where even in 30 year olds we've seen amyloid plaque in a 30 year old, in a 30 year old.
- [22:24]
Louise Nicola
How is that possible?
- [22:27]
Dr. Mistry
Well, we know that amyloid is, is basically our brain is flushing out amyloid every night. Right. Like through the glymphatic system. Right. And but if that is processes impaired, you're not sleeping enough, you're stressed, you're, you're, you're under, you know, tremendous trauma or you know, and you're in a low socioeconomic area where you know, kind of, you don't have access to kind of proper nutrition and whatnot, then this degenerative process can start early. And we know that our brain matures between 25 to 30, but then after that is how are you maintaining that nervous system? And if the lifestyle factors and all these other issues that we talk about are not optimal, this deposition can start as early as in your late 20s to 30s.
- [23:23]
Louise Nicola
And also CTE, like concussions at a young age can obviously impair the clearance of amyloid too.
- [23:30]
Dr. Mistry
Absolutely.
- [23:31]
Louise Nicola
Okay, so I want to get on to AI and I want to know what AI can do now. We're living in this world, it's 2026, AI is everywhere. And a lot of people just think that AI is chatgpt, but you are utilizing AI in neuroimaging. And I think it's just the start. I think AI is going to be phenomenal. There's an AI tool that you use to measure changes in the memory center of the brain, which we mentioned, the hippocampus. And I want to see you've brought something in. So what can AI do in this aspect?
- [24:05]
Dr. Mistry
So, Louisa, AI, from my perspective as a neuroimager is a great augment to who we are as a physician. You know, we are using AI technology in many different ways, not just imaging. And you know, for example, a lot of physicians, you know, before, if you go five years ago, would or you would step into a room and because of billing and whatnot, would be so busy typing everything because they had to, you know, put in all the notes and everything like that to submit for reimbursements. Now a lot of them can walk into a room. You have AI in the back, listening, charting and everything like that. Now they can be more human. From my perspective, AI is allowing doctors to be more human. I think that's a big perspective shift. Instead of us being afraid of AI replacing us, I believe it augments us as physicians as far as imaging is concerned. We're able to do things with AI and offer imaging services with AI that we could never do before. And so one of them is what I'm going to show right now. So this is a, what is known as a volumetric mri. Basically what that is is a thin section mri. Now this is a what we call as a coronal section. It is basically taking a slice of our brain in the coronal plane. And what we're seeing here is all these color coded areas. This is the AI going in, identifying these areas and outlining them in a precise manner so that it can take volumes. So not only of the cerebral cortex, the central gray nuclei, which are like what we call our basal ganglia areas. And more importantly, there are structures we measure that have to do with memory. And so this is what is known as a neural quant scan. That's one of the vendors that we use. And what they do is they, again, map all these areas. But one of the key areas that is mapped here is the hippocampal formation. And that's what's in the yellow here.
- [26:28]
Louise Nicola
I can see one of them is filling out the spaces, and the other one, there's a lot of space there.
- [26:33]
Dr. Mistry
Right? So the left one in the healthy brain, you can see, is a robust hippocampal formation. It's maintained its volume. The black area next to it, which is where the cerebrospinal fluid is in the ventricle, there's just minimal space there. And it's kind of the. That temporal horn that's in that area is small and the way it should be. Now, let's go over to the right side. This is an Alzheimer's patient. That same hippocampal formation, and this is kind of like an exaggerated view, but that same hippocampal formation you can see, see, is much smaller. It's taking up less space. Okay? So it equates to less kind of memory function in this individual. And then the space that was there is now taken up by the dilatation of that ventricle in that area.
- [27:22]
Louise Nicola
And the fourth ventricle, it's very like. You can see how big it is. Like, even look at these ventricles up here.
- [27:27]
Dr. Mistry
And then the other ventricles are large as well, because of the overall loss of brain volume in the total loss of brain volume as well. So what's interesting, Louisa, is that we are. Once we get serial scans, we are able to pick up minute differences in volume of the hippocampus. Okay? So like I said, when we have one study, it tells me what you've been doing up to this point. But having two or more studies tells me your trajectory where you're going to the normal hippocampal atrophy. Okay. When you. There are many different numbers. Some people say 0.5%, some people say 1% yearly. 1.5%, 1%, 1.5%. Those are the different numbers depending on our standards. Actually, for the studies we do, our thresholds are a lot lower. Okay. But what we see is that. I'll give you an example. Just yesterday, okay, I looked at a patient, and she was in their 50s. She had a scan in 2025, because she had. She was forgetting Things. She had issues with memory. She has a family history of dementia, and she requested. Her neurologist said, I need the scan. Okay. She had. Had an MRI that was normal. Okay. Because the mri. The normal mri really doesn't do any volumetric imaging. Nothing is wrong with her. Nothing is wrong with her brain. Kind of like a general MRI sense. Okay. She doesn't have strokes. She doesn't have anything like that. She gets the volumetric scan. Her hippocampal volume. That's the yellow area that we talked about here, was in the lower limits of normal. Okay. So still normal.
- [29:17]
Louise Nicola
This is based on a normative database.
- [29:19]
Dr. Mistry
This is on a normative database.
- [29:20]
Louise Nicola
Do you use Loretta? What's your normative database?
- [29:23]
Dr. Mistry
We. We use multiple ones. I'm not sure if we use Loretta specifically. Okay. I know that Neuroquant uses several different databases. You know, and so. But Neuroquant is the. Is the vendor that we use.
- [29:38]
Louise Nicola
Yeah.
- [29:40]
Dr. Mistry
So her hippocampal volume was in the lower limits of normal. And we said, okay, you know, for everything that counts, that's a normal study. And she could have. We could say, go home. And, you know, it's. It's a normal scan. But we said, you know what? Because she's complaining, and let's just be more diligent about this. So we said, let's come back in a year. And so she. Yesterday she had come back, and her hippocampal volume loss from 2025 to 2026 was 2.2%.
- [30:16]
Louise Nicola
Oh, my gosh.
- [30:18]
Dr. Mistry
That's a change which, if I was doing the measurements, I would never pick up. It looks almost identical. Identical. Okay. Identical in terms of just us looking at it, but the AI, when we did the numbers. And again, there's a lot of quality control going into this because we want to make sure the scan is not artificially giving us a false positive and whatnot. We're checking for all that. Okay. And that's why I would say that you don't just let AI do the processing and get an output. It requires us to be very diligent, but controlling for everything. She had a 2.2% loss of volume. Okay. Now, depending on what the. What the normal rate of decline you use, let's say 0.5% or 1%. That's still in her 50s. In her 50s. That's still advanced. Okay. So normal scan. She still has a normal scan, two normal scans, but her rate of decline is very abnormal. And so now she has an opportunity.
- [31:21]
Louise Nicola
Yeah.
- [31:22]
Dr. Mistry
Okay. To be very aggressive. Okay. And then we, that's what we put in the report. We said, look, it's a normal scan, but the rate of decline is clearly abnormal. Okay? Hence the value.
- [31:35]
Louise Nicola
One of the simplest longevity upgrades is reducing daily toxin exposure. That's why I switched to Caraway. Because their ceramic cookware is non toxic, because it has no pfas, no forever chemicals. And I use it every single day. It's one of those quiet changes that adds up over time. So if you haven't really looked into the science of your cookware and how you're cooking your food, you need to check out Caraway. Head to Caraway.com SL Neuro to get 20% off anything on their website. Caraway.com Neuro 20% off. This is the best cookware on the market. Let's talk about longevity because I think there is a misunderstanding. Longevity isn't about living longer, it's about living better and having the energy to actually do it. And one thing I've noticed on my journey is that health is fragmented. I mean, you've got different doctors, different labs, different apps, but no one's actually looking at the full picture. That is where Kinsin comes in. It is a platform built specifically for women that connects your medical records, labs and wearable data in one place. So incredible, right? So your provider can actually see what's going on. And from there you get personalized recommendations, whether that's supplements testing or clinician guided longevity support. The biggest thing that stood out for me is when you go on their website, they have a quiz. So I was able to connect my own data and it was the first time everything actually made sense together. My hormones, my metabolism, my energy, all in context. And importantly, because it's built for women's biology, this means it is fitted for you. Kinsey is world class in their care. They've got cutting edge treatments which are so accessible to every woman, not just few. If you want to have a look at their things that they've got on offer, meanwhile, I just want you to know I am personally taking their glutathione from them. I order the glutathione and I administer it myself, which I really love because glutathione is a powerful antioxidant. If you want to check this out, go to kinson.com neuro do their free quiz and get personalized recommendations guided by real healthcare providers. And guess what? You will get 20% off your subscription order if you use code NEURO, that is code NEURO for 20% off at checkout. Now this rate of Decline could be for a number of different factors. You know, we can think of. Well, you said she's got a family history, so maybe. Does she possess any of the genetic risk factors? Maybe APOE 4 that's probably aiding in the atrophy. Let's look at her lifestyle. We have to figure out why she's atrophying. But I want to bring up something you said. 2.2%. Right now we're going to bring up my most favorite study ever, which is a 2011 study. 2010, actually. Erickson et al. I've brought it up probably every single podcast I've done. Exercise training increases size of hippocampus and improves memory. We have seen with this phenomenal study that just by exercising, at minimum 30 minutes a day, you can grow the hippocampus by 2%, the volume of the hippocampus. So one of the interventions that this woman can get into is exercising. Literally.
- [35:00]
Dr. Mistry
Absolutely. I love that study. Louisa too. And one of the key drivers here is apart. Remember we talked about those, that four part car model. Okay. Apart from exercising, not only influencing the heart health and the endothelial health, it also aids in BDNF increase, which is then increasing the volume of that hippocampus.
- [35:27]
Louise Nicola
I want to understand this woman a bit more because not everyone is getting these MRIs with the AI. Most people, most people actually don't even get an MRI, to be honest. Right. I think in the US if you've got a, let's just say a migraine, five migraines in a given week, okay, great, you qualify for MRI. But how many people are actually going in at 52 years old complaining of, you know, short term memory loss? Because honestly, sometimes I, I'm not 52, I'm in my 30s. I get short term memory loss, albeit it might be because of sleep deprivation, hydration or stress. But I'm not walking in saying, hey, can I have an mri? And so people are not even going in to get an mri, let alone getting an MRI with volumetrics. So there's a problem here. There's a disconnect in the health care system.
- [36:18]
Dr. Mistry
And I think that that's where a lot of this education is required, that people need to be aware that they are AI tools available. I think we need people to take a comprehensive, proactive approach to this problem. And as you know, it's a huge issue. Dementia is a huge issue. But you don't want to wait till you have that diagnosis when things don't feel right. Like as to this woman right she was very proactive about it. She said, I have a family history, I want to be tested, you know, with not just an mri, but something that's, you know, more precise. And she, I guess heard about the scan and she requested her neurologist to order it. So for people listening to this out there, I would say that if this applies to you, that is a conversation you can have with your physician and if it requires, you know, you to get a consult with a neurologist, have this conversation, have a discussion, discussion. And if it's something that makes sense, maybe you want to get a baseline volumetric mri.
- [37:28]
Louise Nicola
So let's just say they get the baseline volumetric MRI and they're atrophing, right. In different areas of the brain, it can be multiple different points at a rate of 2%, what does somebody do?
- [37:43]
Dr. Mistry
So hence I mentioned that four part model. I think you have to address all those components. Yeah, okay. We talked about heart health, we talked about endothelial health, you know, and then we get into mechanisms that improve your BDNF and then your brain volumes. Right. Apart from exercise, we know that even things like meditation, mindfulness. Okay. And all the research like, like Eric Davidson and colleagues have done talks about how all of those factors also play into increased BDNF levels and increasing brain volumes. So these are all things that come into play. But I would say you have to address this as a four part model and be comprehensive about this.
- [38:39]
Louise Nicola
So you've mentioned something as well, by the way, on that. I think, you know, I've spoken a lot on various different podcasts around, like, how do we improve the health of your brain from lifestyle factors alone. You know, you want to be sleeping well, obviously you want to be exercising, as we mentioned, diet, which we can control for. And then you said earlier in the podcast medications that are actually atrophying the cerebellum. Not a lot of people think about medications that are actually damaging their brain.
- [39:10]
Dr. Mistry
So there's a whole list of medications, but the ones that stand out the most are certain seizure related medications. Okay. Yes. And Dilantin. And so it's a tough situation because these people need that medication to control the seizures. But then the medication itself is leading to atrophy, particularly cerebellar atrophy. So it's, it's a fine balance.
- [39:44]
Louise Nicola
Okay, so let's just say somebody in their 30s are on Keppra. My father's on Keppra, by the way. And what, what, what would they notice? What type of changes would they notice in themselves?
- [39:57]
Dr. Mistry
So One is that it depends on their cognitive reserve. You know, when. When people are in their 30s and 40s, they may not see any changes. Right. But beyond that, you know, you start seeing changes in sort of coordination. Okay. You maybe miss a step, you have coordination, you know, climbing up a stairway. And so this loss of balance, loss of coordination, that's where the cerebellum, you know, really functions. Once you start seeing that, then you want to do more formal testing to see if this is a truly a cerebellar issue.
- [40:36]
Louise Nicola
Okay. I want to talk now about the vascular piece and a prevention window because you measure intimal thickness, which is what you've mentioned. Okay. Intimal thickness, essentially how well blood is getting to the brain. Nobody has heard of this before. Can you talk to me more about what that is?
- [40:52]
Dr. Mistry
So this is our fuel pump and fuel system aspect. Right. Like that first aspect we talked about. Right. And I want to show this picture.
- [41:01]
Louise Nicola
Oh, I love this. It kind of the jugular vein.
- [41:05]
Dr. Mistry
And so again, like, so for most people looking at this, need some orientation. So basically, this is an ultrasound, and the probe is placed on the neck. Okay. And so this is the outside of the neck, and we are going more deeper. So this is sort of like your skin and subcutaneous tissue. And this is a jugular vein that is in your neck. And deep to that jugular vein is our carotid artery. And you can see the carotid artery has this wall. Okay. And so the. The wall of the carotid artery, when you go from the inside out, there is this intimal layer and then the medial layer. When we do this in a. In a very specific way and with a specific transducer, we call that CIMT scan, which is carotid intima medial thickness scanning. What is interesting is that, you know, we talk about. We talked about that other study where we start seeing amyloid deposition early. Okay. In almost. In late 20s to 30s, depending on lifestyle. The vascular endothelial changes, they have traced it back almost in the teens. That depending on how your lifestyle was, even in your teens, you can start seeing these intimal changes. Okay. So it even precedes the brain changes. And that's why I'm so passionate about this, because I think that this is such an opportunity, because it's such a inexpensive scan for somebody to get a CIMT scan. But it gives you an idea. And what we're able to do with AI is measure the. The thickness of this wall, and it tells us the health of the endothelial Lining, which is very, very key because it will. When you know the health of your endothelial lining, it gives you a chance to intervene. And particularly if you get serial scans, it tells you if your CIMT numbers, if your intima medial thickening is increasing or decreasing, is your lifestyle interventions working? If you're doing a four by four for, are you making changes or are, you know, so if you're in going in the wrong direction, you need to be more aggressive about this. But it's a, it's a relatively easy scan. Painless, people can get it and gives you a great picture and gives you a chance to be proactive.
- [43:32]
Louise Nicola
It's like getting the carotid artery scanned and just seeing if there's any plaque in there.
- [43:38]
Dr. Mistry
It's. But it's not just plaque. You know, you can have. It's interesting because, you know, when I was in the radiology resident, I was, we could scan ourselves, you know, and I used to take pictures. And when I was seeing my doctor who's sort of a longevity physician, and I said, oh, I have clean, clean carotids. And he would say, no, we need to do a CIMT scan because a clean carotid doesn't mean anything. We need to know the thickness because that's what's going to tell us where you stand in terms of your endothelial health. And so I said, oh, okay, I see, I see what you're saying. And at that time I, I didn't pay much attention. Mentioned when I looked into the research, I'm like, he's right, he's right. We can actually the, the thickness tells us a lot about our vascular health.
- [44:16]
Louise Nicola
Have you heard about jugular vein stenosis from poor posture, which is limiting the amount of blood flow to the brain? What do you think about this? I don't know if it's actually a real thing.
- [44:30]
Dr. Mistry
So jugular veins stenosis from poor posture. I know poor posture can lead to many different things, you know, in our body. The jugular vein, though, is very, very malleable in a terms of.
- [44:46]
Louise Nicola
Even when it's like we're talking here, if everyone's watching. Yeah. With Zoe at the back around here. Right.
- [44:52]
Dr. Mistry
So the jugular veins runs alongside our neck here. You know, the jugular vein, even if you narrow it down, it still has a pretty good flow within it. So to change your posture to a degree that it kind of impedes flow in your jugular vein, it's, it's hard to say. I have not heard any specific studies regarding that.
- [45:14]
Louise Nicola
You know, it was a, it was a popular influencer with no medical training whatsoever who's trying to sell a $100,000 program.
- [45:23]
Dr. Mistry
Okay.
- [45:23]
Louise Nicola
Yeah.
- [45:23]
Dr. Mistry
All right.
- [45:24]
Louise Nicola
Brian Johnson. And he did this huge Instagram reel saying, you know, guys, I, I fixed my posture which improved, improved my jugular vein because I was getting, you know, less blood flow to the brain. Now I don't have any headaches and I thought, what the hell.
- [45:39]
Dr. Mistry
One of the things we see is something called Eagle's syndrome. So there is a Eagle's syndrome and there is a specific kind of ligament that calcifies and what it does is narrows down that jugular vein. Okay. But even when people have a, that type of changes where their jugular vein is pinched because of that ligament in their neck, even then with those patients, when we look at the kind of intracerebral flow, we don't see any changes even when they have severe stenosis of the jugular vein. So I would say that if that's not doing it, you know, some postural changes, I'm not sure how much impact it's going to have on your cerebral blood flow.
- [46:24]
Louise Nicola
Oh, you know, the people that you said that came in and they are, are 30 years old, but they've got 50 year old brains. Right. Or let's take for example, a, the 50 year old comes in and she or he does the scan and you can see a lot of atrophy when you look at this. Right. How much do you take cholesterol into perspective here? Because when it comes to cholesterol and looking at your lipid panel, you can go to your doctor and he'll give you a lipid panel which tests, you know, triglycerides, hdl, ldl. Maybe if you're really special, you'll get something called an apob. There is so much happening now on social media. Right. There's a huge divide between the people who think that having a high LDL does not matter when it comes to brain health. And I think for all cause dementia and for Alzheimer's disease specifically, you want to maintain brain, you know, low lipid levels. There's, you know, multiple studies that have actually been shown to say if you can have an LDL less than, you know, which is really remarkable, less than 60, but it doesn't have to be less than 80. That's, you know, indicative of good long term brain health as well. With an APOB of less than 90. Right. Because once we reach higher, you know, LDL levels and APOB, we can start to, you know, maybe interfere with how the Brain's functioning and clogging up the arteries in the brain. So when you look at these, these people, do you cross reference them with their lipid panels at all the fuel
- [47:58]
Dr. Mistry
system or the cardiovascular system? I think that is step one.
- [48:02]
Louise Nicola
Yeah.
- [48:02]
Dr. Mistry
And, and it's so vital because, you know, part of maintaining this brain health is, is reducing your risk of stroke. Okay. And so cardiovascular health mirrors your brain health. Right. So maintaining that endothelial health, the health of your arteries, so vital. And part of that, you know, we talked about this kind of intima medial thickening. Okay. Because one is that it's so important to reduce your risk of stroke. Okay. But at the same time, when you do that, you're also improving your brain health at the same time. And as far as lipid control, I believe is absolutely key. And I think that everyone should do whatever it takes to get the lipids under control. Now whether you become super aggressive, try to get it under your LDL under 70 or 80, that's I think up to individuals. But I think that certainly if your numbers are out of range and you have a family history of heart disease. Okay. I know the argument is that the, the high LDL doesn't necessarily mean it's a, it's a bad thing if that LDL is not oxidized. But on the overall, okay, when people have high ldl, they're also not the most healthy individuals, which means they have a high level of inflammation. So along with that, in elevated ldl, they do also have inflammation. And that's a bad recipe there because you have increased ldl, you have high level of inflammation, you're going to have high levels of oxidized ldl, then you set up this scenario where you're going to have accumulation in your vessels, you
- [49:59]
Louise Nicola
know, and how do you feel about statins?
- [50:03]
Dr. Mistry
So it's interesting, I would say, if you ask me this question 10 years ago, I would say stay away, stay away, stay away. Right. But what I've found is that in scenarios where people have a strong family history, okay. That I think statins do play a role. And apart from that, what I've seen is that low grade, low level statins and play a role in this vessel wall inflammation, which is it? So there are a lot of studies on there. And so even if you are not taking statins for, to specifically being aggressive with statins to lower your overall particle number and LDL number just from decreasing the vessel wall inflammation by taking a low dose statin, I believe there is some, some role there.
- [51:06]
Louise Nicola
I, I am Very much on the bandwagon of statins are preventative, they don't affect you in the slightest. We've seen a 30 reduction in some really wonderful research and studies to show a 30 reduction in Alzheimer's disease from statin use. So I don't know why we have, why there's so much controversy around it. Okay, so moving on. Have you seen an intervention window where, and you've tracked this, where somebody comes in, they're at a certain age, and you see certain areas of their brain from the MRI with volumetrics, they go through, they complete an intervention, they come back and you've seen changes in that.
- [51:47]
Dr. Mistry
That's a great question, Louisa. And so what you're asking is that after people have positive interventions in terms of lifestyle, let's say better sleep and whatnot, have we seen a increase in the brain volumes? Okay. And so a lot of these patients who, having these sort of follow ups within, with lifestyle changes, a lot of them go to kind of like these more lifestyle centers and longevity centers and, and so they're getting these elective scans. Right. And so not all of those patients are coming to us. But what I can say is that from the patients that we've seen in terms of like, who are working with neurologists who are coming to us for those referrals, we've seen patients that initially had the, the rate of neurodegeneration of, let's say, like that other patient, like 2.2% or 2% or 3% and they have, with, with lifestyle changes and, and you know, lipid control, control as we just talked about, have leveled off their rate of neurodegeneration, maybe. So from year to year, maybe they, there is no change in the, in their brain volume, which I think it's a, it's a big achievement. Think about it. Because if you're, if your normal rate of decline is, let's say a point 5% or 1% and you have zero change, that means you've done something to maintain that brain volume from year one to year two. You know, so we have seen that, that when patients have become aggressive that they have maintained their volume from year to year and that initial drop, they have flattened that curve. So that is very encouraging.
- [53:35]
Louise Nicola
I really love that because I'm, I'm telling people interventions are all that matter. Right? There is nothing that you can do. There is no cure for Alzheimer's disease, but there are medications actually. So if you are. Which I still don't, I, I don't promote either. But let's say you do have mild cognitive impairment, right? The pre dementia state. And I always say that you're on this trajectory, right? So now you've been given, you're on the treadmill, you've been given the MCI diagnosis, which means that maybe Alzheimer's disease is going to come knocking on the door in 20 years, but we can make it knock on the door in 30 years. Right, just by slowing the progression. How? What role does medications play, specifically these IV medications? Lecanemab, aducanumab, like all of these monoclonal antibodies that you go in, it's an IV infusion. What are they actually doing in the brain?
- [54:36]
Dr. Mistry
So one of the, the. A lot of these antibodies are targeted towards, and there's a lot research going on and targeting this beta amyloid that we talked about. Right. So we know that the beta amyloid correlates with increased rate of neurodegeneration. And so we talked about, we showed that scan where it kind of like that beta amyloid kind of deposits in that periphery of the brain. And what's interesting is that the beta amyloid not only plays a role in kind of like the neurodegeneration, but also impacts the blood vessels in that area. And that is one thing also that we see. And what's imaging wise is that not only do we see the cortical volume loss, but we see the vessels there being impacted. And so a lot of times there is a term we called amyloid angiopathy, where the beta amyloid causes the blood vessels to degenerate and creates this amyloid angiopathy. And so these patients wind up getting these microbleeds and all over their cortex from that amyloid deposition. And so micro hemorrhages. Micro. Micro hemorrhages. And on our scans they look like these little dots that are all spread. Okay. And one of the risk factors is that eventually you get enough of a conglomeration of this beta amyloid and this amyloid angiopa, the changes in the cortex that it ultimately can lead to a focal parenchymal hemorrhage or a massive hemorrhage. And that can be very devastating. So this protein deposition, you know, it is an issue. Okay. And so not only from neuronal loss, but from vascular changes. And so a lot of this work with this antibodies is trying to, to curtail or control those effects.
- [56:41]
Louise Nicola
Yeah, I think I. I don't think that they are. I just, you know, let's not get there in the first place. Let's not get to the position where you have to think about that. Let's start intervening in our 20s. Definitely intervening in your 30s and 40s with all of the lifestyle interventions that we've mentioned. Right. So you don't have to get to that. That spot. I have a few more questions. Someone's listening right now. They've got a parent who has mild cognitive impairment, or maybe they think they've got Alzheimer's disease and they want to advocate for them and they want to get one of these brain scans. What do they do?
- [57:21]
Dr. Mistry
Louisa? You know, every time I talk about this, people always approach me and say, hey, you know, can I come. Can I come to you? And can you scan me? You know, and what I tell them is this, is that on these scans we just. It's not just the hippocampal formation that we're imaging. We're imaging the whole brain. A lot of times we. We don't just see that one particular area, but we also find, like, incidental tumors. We find many things that may need follow up.
- [57:51]
Louise Nicola
Wait a second. How do you find an incidental tumor?
- [57:53]
Dr. Mistry
So, you know, there are sometimes people coming in just for these volumes scans, but that does not mean that they cannot have other brain tumors, you know, in different parts of the brain. And so sometimes they're coming in for just this kind of like MCI evaluation or, or, you know, memory impairment evaluation. And we'll do the scan, and it's actually a brain tumor that was causing edema, that was leading to the memory issues. You know, and so what I tell people is this, is that, you know, you don't want to take that responsibility on yourself to get the scan, meaning that there has to be a neurologist or a primary care physician who is ready to back you up or who's, who's. Who's taking care of you, because God forbid you get a scan and there is a tumor there. Now who do I call to take care of you? You know, and, and, and that becomes an issue for us. Okay? So the best approach is that you go through, get, get the evaluations in terms of the cognitive tests, let's say the genetic tests. And if you can make a case to get this exam, approach your physician, approach your neurologist and say, hey, this is, you know, I would like to get evaluated, but have somebody that can one follow up on that study and if need be, act on the, the hippocampal findings we talked about. But if, God forbid, there is a brain tumor, then there's somebody there that, that can, you know, address that as
- [59:43]
Louise Nicola
well, but being proactive. Yes, yes. And asking for what you want and asking for what you need. Absolutely, yes. Okay, so my last question is of everything you've seen in brain scans over your entire career. What is the one thing that separates the people whose brains age well from the peoples whose brains age don't? And why is nobody telling people about this?
- [60:07]
Dr. Mistry
Great question. And I'm going to share a very brief personal story about this. So I would say 10 years ago, you know, doing great in my career, you know, great family, great house, you know, driven, you know, all brands of cars and everything like that. And but I would say kind of cognitively or in terms of my mental status, I still had this low grade anxiety and it was bothering me. I said, you know, outwardly I have all the trappings of success and everything you can think of. And that's when, you know, I read this book, it's called Altered Traits. I don't know if you've heard about that book. And so you have the clinicians in there and the researchers you have, they talk about the, what meditation does to your brain. And to answer your question, I would say that apart from everything we've talked about, you know, the four part model, you know, kind of the vascular health, brain health, brain function and then the nerve root tracts, a key parameter or key determinant of brain health is your, what is your baseline anxiety level? And right now, you know, at that stage, I would say 10 years ago, I was playing ping pong between two parts, right? I was either thinking about some regrets of the past or some anxieties or some anticipation of the future, right? Just kind of constantly on the go, right? You're thinking about things that didn't go right, and then always anticipating things, things, you know, that are going to happen. And you know, even the anticipation, you have a little bit of anxiety about it. And then what I found out, you know, the research shows that that that chronic level of anxiety has been linked to one longevity in terms of your telomere length and whatnot, but that it truly impacts your brain as well. And these studies on these Tibetan monks showed that these monks had one, some of the best preservation of brain volumes one, number two, that in terms of neural circuits, right, they were able to downgrade their sort of stress response. And so that as they built up their practice, they were able to downgrade their stress response during the day so that their stress network, their amygdala, the parts of the brain that, that plays a role in reactivity, was down regulated. And so they Actually were living a stress free life where they were more present. They were not in this kind of mode of regrets of the past or anxieties of the future. And that got me very intrigued and I said I have to work on myself. So 10 years ago I really dug deep into this research and I said I want to make those changes, you know, real for me. And so I went on this, I decided to do this eight day silence program. It's in India, it was in India. But to do this program there was this prep that I had to go to. It was almost 12 to 18 month prep that is needed to go into this. And I was, I'm just, you know, I was been very kind of gung ho about things. So I said, you know what, I'm just going to whatever it needed will do it. So in 12 months I kind of completed all the prerequisites, all that and I'm here qualified when go to India. Eight days silence. No cell phones, no social media, no books, no tv, nothing. No contact with family, just total silence for eight days. And I tell you what, I would say the first five days extremely painful. I could not, I wanted to jump ship right away. End of the sixth day, going into the seventh day, this stillness descended in me, which I cannot I given my, you know, just talking about it, the hairs on my arm stand up because it was so profound. Where I, I was like, wow, this is the first time I'm experiencing the here and now. And why I share this story is that I believe that in this day and age we're under so much noise, you just watch the news, social media, you know, tracking our own emails and everything like that, that we're constantly playing this ping pong between regrets of the past, anxieties of the future, anticipation of the future. How many of us actually are remain in the here and now and experience this moment. You're not experiencing life. And I came out of that, those eight days and it reset my level of anxiety. You know, I just, and I do a maintenance practice now for about 20 minutes in the morning. And so the overall principle, the takeaway for people is when I speak about this on stage, I said you have a choice between stillness versus illness. And when you remain in this state of stillness, you're not reactive, you can respond. You have this gap between when somebody tells you something, you have this space, this white space to respond from, versus if you're in this reactive anxiety mode, you're in illness. And so the choice is that, and I think that has been the Biggest driver for my health. And research has shown that that has helped, you know, in terms of preserving brain volume and preserving, you know, kind of like cognitive health. Wow.
- [66:18]
Louise Nicola
I don't think I'd ever be able to do a silent retreat, but, you know, meditation is. It's very hard for me. I've never. I just get up and I go every single morning. I don't meditate in the morning. I don't really have any sound therapeutic morning rituals. Would I like to meditate? Yes. A form of meditation for me is sitting down. I do sit in silence, but It's. Maybe the TV's on or maybe I'm listening, I don't know, to something else or doing so I don't know how to explain it, but to me, to calm my brain down, I have to be watching something like maybe like some sort of dumb content. Right on. Not dumb content on Instagram, but maybe a TV show that calms me down. But I always wonder about what meditation is doing because I've just seen a lot of the research taking place now with binaural beats and 40 Hz binaural beats, clearing out amyloid in mouse models. So I wonder how this plays with brainwave activity, getting it into that, you know, gamma frequency brainwave. And how if I can get. If we can get that oscillating at the perfect speed, then can that have better brain coherence and calm down anxiety and clear out amyloid? I'm not sure, but I'm going to definitely be getting on board with meditation now that you've mentioned that. And I actually want to read that book, Altered Traits.
- [67:42]
Dr. Mistry
Yeah, I think it changed it really altered traits. It really altered my viewpoint because what they said was that it's not about changing your state, it's about changing your trait, which means it's changing who you are biologically. And which I think is. When I saw that, that I said that this is going to have a permanent change in my system. And it did. You know, even that one week intervention changed who I was fundamentally as a person in terms of being reactive. And it just gave me this level of stillness where, you know, now I just have this gap when somebody says something to me, I don't respond right away. I just think and I take my time and sometimes I don't even need to respond, but it gives me the space. And I think that's huge because we know that lowering that chronic state of anxiety has tremendous value in terms of how we age biologically, in terms of our body age, but also how Our brain ages.
- [68:58]
Louise Nicola
It's funny you said that just to close out when you said you don't respond immediately. I've started using this little thing that locks me out of my phone, right? Locks me out of my apps. I didn't realize it can also lock you out of your messages. And so for a certain period of time, because, let me tell you, I've got my, you know, it's my work phone and it's my personal phone, and I'm in a group text with my closest girlfriends, and I'm. Sometimes I open it. There's around 50 texts in there. And it gives me anxiety. So now I lock myself out of my phone for several hours per day. Right. And I just don't get back to any messages, like, especially. Right. Like right now. But even when I'm not doing anything, if I'm doing mundane tasks and I do have the ability to respond, I just lock myself out of them. So then I have a moment. Moment without getting any text messages. And it's. Honestly, it's changed my life.
- [69:47]
Dr. Mistry
It's huge. That white space is so vital. It's so vital.
- [69:51]
Louise Nicola
Well, Dr. Mistry, thank you for coming on here and showing us your brain scans and teaching us all about MRIs and neuroimaging.
- [69:59]
Dr. Mistry
Pleasure being here, Louisa. You know, I would say with technology advancing, okay, we want to not be a slave to technology, but we want to leverage all this technology and AI technology to really augment who we are as humans. And I think if we can leverage technology that way, that's the best way forward.