Podcasts about Neurology

When someone we know or love starts to develop psychological issues, we don't often associate it with a form of dementia. However, this trait is one of the most common signs of frontotemporal dementia (FTD) — the most common neurodegenerative disease in people under the age of 65. In his new book, Mysteries of the Social Brain: Understanding Human Behavior Through Science, Dr. Bruce Miller highlights his experiences observing people with FTD and what they have taught him about what he calls the "social brain."Dr. Bruce Miller has been observing people with FTD for decades in the Memory and Aging Center at the University of San Francisco, where he is also Professor of Neurology and the Founding Director of the Global Brain Health Institute. He shares key insights on how to keep our "social brain" healthy and how it can even unlock our creative potential.

Dr. Justin Abbatemarco talks with Drs. Sumanth Reddy and Jeffrey Gelfand about the complexities of small vessel predominant primary CNS vasculitis, clinical features, and the impact of early intensive immunosuppressive therapy on remission.  Read the related article in Neurology® Neuroimmunology & Neuroinflammation.  Disclosures can be found at Neurology.org. 

In the second installment of this three-part series, Dr. Elizabeth Zollos discusses the use of magnetic resonance imaging (MRI) in multiple sclerosis diagnosis.  

In the first episode of the AAN President's Spotlight series, Dr. Jason Crowell speaks with the new AAN President, Dr. Natalia S. Rost, as she outlines her vision and key priorities for her two-year term. Show references:  https://www.aan.com/about-the-aan/presidents-spotlight

Distraction is making you anxious and sleepless. Here's how to fix it.   Adam Gazzaley, M.D., Ph.D. is the David Dolby Distinguished Professor of Neurology, Physiology and Psychiatry, and Founder & Executive Director of Neuroscape at UCSF. He co-authored the 2016 book “The Distracted Mind: Ancient Brains in a High-Tech World”.    In this episode we talk about: The impact of multitasking on our attention, relationships, emotions, anxiety, and memory The difference between top-down and bottom-up attention What it means to have cognitive control—and some practical tools for restoring your own cognitive control.  Controversial technologies that could eventually help us have a stronger brain The impact of music and rhythm on the mind And how to use technology for your brain's benefit   Join Dan's online community here Follow Dan on social: Instagram, TikTok Subscribe to our YouTube Channel  

Dr. Greg Cooper talks with Dr. David A. Wolk about limbic predominant age-related TDP-43 encephalopathy (LATE) discussing its clinical features, diagnostic criteria, and the importance of recognizing this condition in the context of Alzheimer disease. Read the related article.  Disclosures can be found at Neurology.org.   

In part two of this two-part series, Dr. Stacey Clardy and Dr. Elia Sechi discuss how to approach the management of patients in clinic when there is concern for a possible false positive on the radioimmunoprecipitation assay for the acetylcholine receptor antibody. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213498 

As artificial intelligence (AI) tools become increasingly mainstream, they can potentially transform neurology clinical practice by improving patient care and reducing clinician workload. Critically evaluating these AI tools for clinical practice is important for successful implementation. In this episode, Katie Grouse, MD, FAAN speaks with Peter Hadar, MD, MS, coauthor of the article “Clinical Applications of Artificial Intelligence in Neurology Practice” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Hadar is an instructor of neurology at Harvard Medical School and an attending physician at the Massachusetts General Hospital in Boston, Massachusetts. Additional Resources Read the article: Clinical Applications of Artificial Intelligence in Neurology Practice Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Guest: @PeterNHadar Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Peter Hadar about his article on clinical applications of artificial intelligence in neurology practice, which he wrote with Dr Lydia Moura. This article appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast, and please introduce yourself to our audience. Dr Hadar: Hi, thanks for having me on, Katie. My name is Dr Peter Hadar. I'm currently an instructor over at Mass General Hospital, Harvard Medical School, and I'm excited to talk more about AI and how it's going to change our world, hopefully for the better. Dr Grouse: We're so excited to have you. The application of AI in clinical practice is such an exciting and rapidly developing topic, and I'm so pleased to have you here to talk about your article, which I found to be absolutely fascinating. To start, I'd like to hear what you hope will be the key takeaway from your article with our listeners. Dr Hadar: Yeah, thank you. The main point of the article is that AI in medicine is a tool. It's a wonderful tool that we should be cautiously optimistic about. But the important thing is for doctors, providers to be advocates on their behalf and on behalf of their patients for the appropriate use of this tool, because there are promises and pitfalls just with any tool. And I think in the article we detail a couple ways that it can be used in diagnostics, in clinical documentation, in the workflow, all ways that can really help providers. But sometimes the devil is in the details. So, we get into that as well. Dr Grouse: How did you become interested in AI and its application, specifically in the practice of neurology? Dr Hadar: When I was a kid, as most neurologists are, I was- I nerded out on a lot of sci-fi books, and I was really into Isaac Asimov and some of his robotics, which kind of talks about the philosophy of AI and how AI will be integrated in the future. As I got into neurology, I started doing research neurology and a lot of folks, if you're familiar with AI and machine learning, statistics can overlap a lot with machine learning. So slowly but surely, I started using statistical methods, machine learning methods, in some of my neurology research and kind of what brought me to where I am today. Dr Grouse: And thinking about and talking about AI, could you briefly summarize a few important terms that we might be talking about, such as artificial intelligence, generative AI, machine learning, etcetera? Dr Hadar: It's a little difficult, because some of these terms are nebulous and some of these terms are used in the lay public differently than other folks would use it. But in general, artificial intelligence is kind of the ability of machines or computers to communicate independently. It's similar to as humans would do so. And there are kind of different levels of AI. There's this very hard AI where people are worried about with kind of terminator-full ability to replicate a human, effectively. And there are other forms of narrow AI, which are actually more of what we're talking about today, and where it's very kind of specific, task-based applications of machine learning in which even if it's very complex, the AI tools, the machine learning tools are able to give you a result. And just some other terms, I guess out there. You hear a lot about generative AI. There's a lot of these companies and different algorithms that incorporate generative AI, and that usually kind of creates something, kind of from scratch, based on a lot of data. So, it can create pictures, it can create new text if you just ask it. Other terms that can be used are natural language processing, which is a big part of some of the hospital records. When AI tools read hospital records and can summarize something, if it can translate things. So, it turns human speech into these results that you look for. And I guess other terms like large language models are something that also have come into prominence and they rely a lot on natural language processing, being able to understand human speech, interpret it and come up with the results that you want. Dr Grouse: Thank you, that's really helpful. Building on that, what are some of the current clinical applications of AI that we may already be using in our neurologic practice and may not even be aware that that's what that is? Dr Hadar: It depends on which medical record system you use, but a very common one are some of the clinical alerts that people might get, although some of them are pretty basic and they can say, you know, if the sodium is this level, you get an alert. But sometimes they do incorporate fancier machine learning tools to say, here's a red flag. You really should think about contacting the patient about this. And we can talk about it as well. It might encourage burnout with all the different flags. So, it's not a perfect tool. But these sorts of things, typically in the setting of alerts, are the most common use. Sorry, and another one is in folks who do stroke, there are a lot of stroke algorithms with imaging that can help detect where the strokes occur. And that's a heavy machine learning field of image processing, image analysis for rapid detection of stroke. Dr Grouse: That's really interesting. I think my understanding is that AI has been used specifically for radiology interpretation applications for some time now. Is that right? Dr Hadar: In some ways. Actually, my background is in neuroimaging analysis, and we've been doing a lot of it. I've been doing it for years. There's still a lot of room to go, but it's really getting there in some ways. My suspicion is that in the coming years, it's going to be similar to how anesthesiologists at one point were actively bagging people in the fifties, and then you develop machines that can kind of do it for you. At some point there's going to be a prelim radiology read that is not just done by the resident or fellow, but is done by the machine. And then another radiologist would double check it and make sure. And I think that's going to happen in our lifetime. Dr Grouse: Wow, that's absolutely fascinating. What are some potential applications of AI in neurologic practice that may be most high-yield to improve patient care, patient access, and even reduce physician burnout? Dr Hadar: These are separate sort of questions, but they're all sort of interlinked. I think one of the big aspects of patient care in the last few years, especially with the electronic medical record, is patients have become much more their own advocates and we focus a lot more on patient autonomy. So, they are reaching out to providers outside of appointments. This can kind of lead to physician burnout. You have to answer all these messages through the electronic medical record. And so having, effectively, digital twins of yourself, AI version of yourself, that can answer the questions for the patient on your off times is one of the things that can definitely help with patient care. In terms of access, I think another aspect is having integrated workflows. So, being able to schedule patients efficiently, effectively, where more difficult patients automatically get one-hour appointments, patients who have fewer medical difficulties might get shorter appointments. That's another big improvement. Then finally, in terms of physician burnout, having ambient intelligence where notes can be written on your behalf and you just need to double-check them after allows you to really have a much better relationship with the patients. You can actually talk with them one on one and just focus on kind of the holistic care of the patient. And I think that's- being less of a cog in the machine and focusing on your role as a healer would be actually very helpful with the implementation of some of these AI tools. Dr Grouse: You mentioned ambient technology and specifically ambient documentation. And certainly, this is an area that I feel a lot of excitement about from many physicians, a lot of anticipation to be able to have access to this technology. And you mentioned already some of the potential benefits. What are some of the potential… the big wins, but then also potential drawbacks of ambient documentation? Dr Hadar: Just to kind of summarize, the ambient intelligence idea is using kind of an environmental AI system that, without being very obtrusive, just is able to record, able to detect language and process it, usually into notes. So, effectively like an AI scribe that is not actually in the appointment. So, the clear one is that---and I've seen this as well in my practice---it's very difficult to really engage with the patient and truly listen to what they're saying and form that relationship when you're behind a computer and behind a desk. And having that one-on-one interaction where you just focus on the patient, learn everything, and basically someone else takes notes for you is a very helpful component of it. Some of the drawbacks, though, some of it has to do with the existing technology. It's still not at the stage where it can do everything. It can have errors in writing down the medication, writing down the exact doses. It can't really, at this point, detect some of the apprehensions and some of the nonverbal cues that patients and providers may kind of state. Then there's also the big one where a lot of these are still done by startups and other companies where privacy may be an issue, and a lot of patients may feel very uncomfortable with having ambient intelligence tools introduced into their clinical visit, having a machine basically come between the doctor and the patient. But I think that over time these apprehensions will lessen. A lot of the security will improve and be strengthened, and I think that it's going to be incorporated a lot more into clinical practice. Dr Grouse: Yeah, well, we'll all be really excited to see how that technology develops. It certainly seems like it has a lot of promise. You mentioned in your article a lot about how AI can be used to improve screening for patients for certain types of conditions, and that certainly seems like an obvious win. But as I was reading the article, I couldn't help but worry that, at least in the short term, these tools could translate into more work for busy neurologists and more demand for access, which is, you know, already, you know, big problems in our field. How can tools like these, such as, like, for instance, the AI fundoscopic screening for vascular cognitive risk factors help without adding to these existing burdens? Dr Hadar: It's a very good point. And I think it's one of the central points of why we wanted to write the article is that these AI in medicine, it's, it's a tool like any other. And just like when the electronic medical record came into being, a lot of folks thought that this was going to save a lot of time. And you know, some people would say that it actually worsened things in a way. And when you use these diagnostic screening tools, there is an improvement in efficiency, there is an improvement in patient care. But it's important that doctors, patients advocate for this to be value-based and not revenue-based, necessarily. And it doesn't mean that suddenly the appointments are shorter, that now physicians have to see twice as many patients and then patients just have less of a relationship with their provider. So, it's important to just be able to integrate these tools in an appropriate way in which the provider and the patient both benefit. Dr Grouse: You mentioned earlier about the digital twin. Certainly, in your article you mentioned, you know, that idea along with the idea of the potential of development of virtual chatbot visits or in-person visits with a robot neurologist. And I read all this with equal parts, I think excitement, but horror and and fear. Can you tell us more about what these concepts are, and how far are we from seeing technology like this in our clinics, and maybe even, what are the risks we need to be thinking about with these? Dr Hadar: Yeah. So, I mean, I definitely think that we will see implementation of some of these tools in our lifetime. I'm not sure if we're going to have a full walking, talking robot doing some of the clinical visits. But I do think that, especially as we start doing a lot more virtual visits, it is very easy to imagine that there will be some sort of video AI doctor that can serve as, effectively, a digital twin of me or someone else, that can see patients and diagnose them. The idea behind the digital twin is that it's kind of like an AI version of yourself. So, while you only see one patient, an AI twin can go and see two or three other patients. They could also, if the patients send you messages, can respond to those messages in a way that you would, based on your training and that sort of thing. So, it allows for the ability to be in multiple places at once. One of the risks of this is, I guess, overreliance on the technology, where if you just say, we're just going to have a chatbot do everything for us and then not look at the results, you really run the risk of the chatbot just recommending really bad things. And there is training to be had. Maybe in fifty years the chatbot will be at the same level as a physician, but there's still a lot of room for improvement. I personally, I think that my suspicion as to where things will go are for very simple visits in the future and in our lifetime. If someone is having a cold or something like that and it goes to their primary care physician, a chatbot or something like that may be of really beneficial use. And it'll help segment out the different groups of simple diagnosis, simple treatments can be seen by these robots, these AI, these machine learning tools; and some of the more complex ones, at least for the early implementation of this will be seen by more specialized providers like neurologists and subspecialist neurologists too. Dr Grouse: That certainly seems reasonable, and it does seem that the more simple algorithmic things are always where these technologies will start, but it'll be interesting to see where things can go with more complex areas. Now I wanted to switch gears a little bit in the article- and I thought this was really important because I see it as being certainly one of the bigger drawbacks of AI, is that despite the many benefits of artificial intelligence, AI can unfortunately perpetuate systemic bias. And I'm wondering if you could tell us a little bit more about how this happened? Dr Hadar: I know I'm beating a dead horse on this, but AI is a tool like any other. And the problem with it is that what you put in is very similar to what you get out. And there's this idea in computer science of “garbage in, garbage out”. If you include a lot of data that has a lot of systemic biases already in the data, you're going to get results that perpetuate these things. So, for instance, if in dermatologic practices, if you just had a data set that included people of one skin color or one race and you attempted to train a model that would be able to detect skin cancer lesions, that model may not be easily applicable to people of other races, other ethnicities, other skin colors. And that can be very damaging for care. And it can actually really, really hurt the treatments for a lot of the patients. So that is one of the, kind of, main components of the systemic biases in AI. The way we mitigate them is by being aware of it and actually implementing, I guess, really hard stops on a lot of these tools before they get into practice. Being sure, did your data set include this breakdown of sex and gender, of race and ethnicity? So that the stuff you have in the AI tool is not just a very narrow, focused application, but can be generalized to a large population, not just of one community, one ethnic group, racial group, one country, but can really be generalized throughout the world for many patients. Dr Grouse: The first step is being aware of it, and hopefully these models will be built thoughtfully to help mitigate this as much as possible. I wanted to ask as well, another concern about AI is the safety of private data. And I'm wondering, as we're starting to do things like use ambient documentation, AI scribe, and other types of technologies like this, what can we tell our patients who are concerned about the safety of their personal data collected via these programs, particularly when they're being stored or used with outside companies that aren't even in our own electronic medical records system? Dr Hadar: Yeah, it's a very good question, and I think it's one of the major limitations of the current implementation of AI into clinical practice, because we still don't really have great standards---medical standards, at least---for storing this data, how to analyze this data. And my suspicion is that at some point in the future, we're going to need to have a HIPAA compliance that's going to be updated for the 21st century, that will incorporate the appropriate use of these tools, the appropriate use of these data storage, of data storage beyond just PHI. Because there's a lot more that goes into it. I would say that the important thing for how to implement this, and for patients to be aware of, is being very clear and very open with informed consent. If you're using a company that isn't really transparent about their data security and their data sharing practices, that needs to be clearly stated to the patient. If their data is going to be shared with other people, reanalyzed in a different way, many patients will potentially consider not participating in an AI implementation in clinic. And I think the other key thing is that this should be, at least initially, an opt-in approach as opposed to an opt-out approach. So patients really have- can really decide and have an informed opinion about whether or not they want to participate in the AI implementation in medicine. Dr Grouse: Well, thank you so much for explaining that. And it does certainly sound like there's a lot of development that's going to happen in that space as we are learning more about this and the use of it becomes more prevalent. Now, I also wanted to ask, another good point that you made in your article---and I don't think comes up enough in this area, but likely will as we're using it more---AI has a cost, and some of that cost is just the high amount of data and computational processing needed to use it, as well as the effects on the environment from all this energy usage. Given this drawback of AI, how can we think about potential costs versus the benefits, the more widespread use of this technology? Or how should we be thinking about it? Dr Hadar: It's part of a balance of the costs and benefits, effectively, is that AI---and just to kind of name some of them, when you have these larger data centers that are storing all this data, it requires a lot of energy consumption. It requires actually a lot of water to cool these things because they get really hot. So, these are some of the key environmental factors. And at this point, it's not as extreme as it could be, but you can imagine, as the world transitions towards an AI future, these data centers will become huge, massive, require a lot of energy. And as long as we still use a lot of nonrenewable resources to power our world, our civilization, I think this is going to be very difficult. It's going to allow for more carbon in the atmosphere, potentially more climate change. So, being very clear about using sustainable practices for AI usage, whether it be having data centers specifically use renewable resources, have clear water management guidelines, that sort of thing will allow for AI to grow, but in a sustainable way that doesn't damage our planet. In terms of the financial costs… so, AI is not free. However, on a given computer, if you want to run some basic AI analysis, you can definitely do it on any laptop you have and sometimes even on your phone. But for some of these larger models, kind of the ones that we're talking about in the medical field, it really requires a lot of computational power. And this stuff can be very expensive and can get very expensive very quickly, as anyone who's used any of these web service providers can attest to. So, it's very important to be clear-eyed about problems with implementation because some of these costs can be very prohibitive. You can run thousands and you can quickly rack up a lot of money for some very basic analysis if you want to do it in a very rapid way, in a very effective way. Dr Grouse: That's a great overview. You know, something that I think we're all going to be having to think about a lot more as we're incorporating these technologies. So, important conversations I hope we're all having, and in our institutions as we're making these decisions. I wanted to ask, certainly, as some of our listeners who may be still in the training process are hearing you talk about this and are really excited about AI and implementation of technology in medicine, what would you recommend to people who want to pursue a career in this area as you have done? Dr Hadar: So, I think one of the important things for trainees to understand are, there are different ways that they can incorporate AI into their lives going forward as they become more seasoned doctors. There are clinical ways, there are research ways, there are educational ways. A lot of the research ways, I'm one of the researchers, you can definitely incorporate AI. You can learn online. You can learn through books about how to use machine learning tools to do your analysis, and it can be very helpful. But I think one of the things that is lacking is a clinician who can traverse both the AI and patient care fields and be able to introduce AI in a very effective way that really provides value to the patients and improves the care of patients. So that means if a hospital system that a trainee is eventually part of wants to implement ambient technology, it's important for physicians to understand the risks, the benefits, how they may need to adapt to this. And to really advocate and say, just because we have this ambient technology doesn't mean now we see fifty different patients, and then you're stuck with the same issue of a worse patient-provider relationship. One of the reasons I got into medicine was to have that patient-provider interaction to not only be kind of a cog in the hospital machine, but to really take on a role as a healer and a physician. And one of the benefits of these AI tools is that in putting the machine in medicine, you can also put the humanity back in medicine at times. And I think that's a key component that trainees need to take to heart. Dr Grouse: I really appreciate you going into that, and sounds like there's certainly need. Hoping some of our listeners today will consider careers in pursuing AI and other types of technologies in medicine. I really appreciate you coming to talk with us today. I think this is just such a fascinating topic and an area that everybody's really excited about, and hoping that we'll be seeing more of this in our lives and hopefully improving our clinical practice. Thank you so much for talking to us about your article on AI in clinical neurology. It was a fascinating topic and I learned a lot. Dr Hadar: Thank you very much. I really appreciate the conversation, and I hope that trainees, physicians, and others will gain a lot and really help our patients through this. Dr Grouse: So again, today I've been interviewing Dr Peter Hadar about his article on clinical applications of artificial intelligence in neurology practice, which he wrote with Dr Lydia Moura. This article appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

In part one of this two-part series, Dr. Stacey Clardy and Dr. Elia Sechi discuss the clinical scenarios where the commonly used assay for myasthenia gravis is most likely to produce false positive results in patients who do not actually have myasthenia gravis. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213498  

Learn how poetry can help your brain handle stress, process feelings, and spark insight.Summary: This episode of The Science of Happiness is part of our series Using Art As Medicine. We explore poetry, one of the oldest artforms, powers our brains, calms our nervous systems, and reduces anxiety by opening doors into our psyche. Whether you're reading or writing it, elements like rhythm, metaphor and rhyme improve memory, cognition and even self-esteem. This episode is made possible through the generous support of the John Templeton Foundation.How To Do This Practice: Find Your Moment: Notice the time of day when you feel closest to yourself. It might be early morning before the world wakes up, or another quiet pocket of time when your thoughts are unfiltered and your heart is open. Set the Scene: Create an atmosphere that supports you. Play music that matches your mood or inspires imagination. Let it be soft and inviting, not distracting, just enough to signal to your body that this is a sacred moment. Choose Your Tools: Use what feels natural. Journal, laptop, scrap paper, napkin, the format doesn't matter. What matters is that you're ready to begin. Write Without Interruption: Set a timer for 5 to 10 minutes. Let your pen or fingers move freely. Don't stop, don't edit, and don't worry about making sense, just see what comes. Welcome the Unsaid: Allow what's hidden, half-formed, or surprising to emerge.  Let It Be What It Is: When the timer ends, pause. Don't rush to interpret or fix your words. You've just made contact with something real, let that be enough. Scroll down for a transcription of this episode.YRSA DALEY-WARD is an award-winning poet and author. Her debut novel, The Catch, comes out June 3rd. Learn more about Yrsa here: https://yrsadaleyward.squarespace.com/Pre-order her book here: https://tinyurl.com/yanw6bb5DR. SUSAN MAGSAMEN is a Professor of Neurology at John Hopkins, and author of the New York Times bestseller, Your Brain On Art: How the Arts Transform Us. Learn more about Dr. Magsamen  here: https://tinyurl.com/33v8m5mdRead Dr. Magsamen's book here: https://tinyurl.com/426k87f2Related The Science of Happiness episodes:  Using Art As Medicine Series: https://tinyurl.com/k3mneupxHow Art Heals Us: https://tinyurl.com/yc77fkzuHow Awe Helps You Navigate Life's Challenges: https://tinyurl.com/2466rnm4Related Happiness Breaks:How To Awaken Your Creative Energy: https://tinyurl.com/4fknd8evMaking Space For You: https://tinyurl.com/yk6nfnfvA Self-Compassion Meditation For Burnout: https://tinyurl.com/485y3b4yTell us about your experience with poetry. Email us at happinesspod@berkeley.edu or follow on Instagram @HappinessPod.Help us share The Science of Happiness! Leave us a 5-star review on Apple Podcasts and share this link with someone who might like the show: https://tinyurl.com/2p9h5aapTranscription: https://tinyurl.com/y9r9dyzd

Dr. Stacey Clardy talks with Dr. Elia Sechi about the importance of understanding lab test results, the performance characteristics of assays, and the real-world implications of false positives in myasthenia gravis testing. Read the related article in Neurology®. Disclosures can be found at Neurology.org. 

Dr. Roy E. Strowd and Dr. Susannah Cornes discuss a teaching incentive initiative designed to support and reward faculty in academic neurology.  Show reference: https://www.neurology.org/doi/10.1212/NE9.0000000000200182 

Scientific Sense ® by Gill Eapen: Prof. Rodrigo Braga is Assistant Professor of Neurology at Northwestern University. His research interests include Brain networks, cognitive neuroscience and neurodegenerative diseases. Please subscribe to this channel:https://www.youtube.com/c/ScientificSense?sub_confirmation=1

In the first installment of this three-part series, Dr. Elizabeth Zollos explores how optical coherence tomography is advancing our understanding of multiple sclerosis and enhancing diagnostic accuracy.   

Neuro-ophthalmic deficits significantly impair quality of life by limiting participation in employment, educational, and recreational activities. Low-vision occupational therapy can improve cognition and mental health by helping patients adjust to visual disturbances. In this episode, Katie Grouse, MD, FAAN, speaks with Sachin Kedar, MD, FAAN, author of the article “Symptomatic Treatment of Neuro-ophthalmic Visual Disturbances” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Kedar is the Cyrus H Stoner professor of ophthalmology and a professor of neurology at Emory University School of Medicine in Atlanta, Georgia. Additional Resources Read the article: Symptomatic Treatment of Neuro-ophthalmic Visual Disturbances Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Guest: @AIIMS1992 Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Sachin Kedar about his article on symptomatic treatment of neuro-ophthalmic visual disturbances, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast, and please introduce yourself to our audience. Dr Kedar: Thank you, Katie. This is Sachin Kedar. I'm a neuro-ophthalmologist at Emory University, and I've been doing this for more than fifteen years now. I trained in both neurology and ophthalmology, with a fellowship in neuro-ophthalmology in between. It's a pleasure to be here. Dr Grouse: Well, we are so happy to have you, and I'm just so excited to be discussing this article with you, which I found to be a real treasure trove of useful clinical information on a topic that many find isn't covered enough in their neurologic training. I strongly recommend all of our listeners who work with patients with visual disturbances to check this out. I wanted to start by asking you what you hope will be the main takeaway from this article for our listeners? Dr Kedar: The most important takeaway from this article is, just keep vision on your radar when you are evaluating your patients with neurological disorders. Have a list of a few symptoms, do a basic screening vision, and ask patients about how their vision is impacting the quality of life. Things like activities of daily living, hobbies, whether they can cook, dress, ambulate, drive, read, interact with others. It is very important for us to do so because vision can be impacted by a lot of neurological diseases. Dr Grouse: What in the article do you think would come as the biggest surprise to our listeners? Dr Kedar: The fact that impairment of vision can magnify and amplify neurological deficits in a lot of what we think of as core neurological disorders should come as a surprise to most of the audience. Dr Grouse: On that note, I think it's probably helpful if you could remind us about the types of visual disturbances we should be thinking about and screening for in our patients? Dr Kedar: Patients who have neurological diseases can have a whole host of visual deficits. The simplest ones are deficits of central vision. They can have problems with their visual field. They can have abnormalities of color vision or even contrast sensitivity. A lot of our patients also complain of light sensitivity, eyes feeling tired when they're doing their usual stuff. Some of our patients can have double vision, they can have shaky vision, which leads to their sense of imbalance and maybe a fall risk to them. Dr Grouse: It's really helpful to think about all the different aspects in which vision can be affected, not just sort of the classic loss of vision. Now, your article also serves as a really important reminder, which you alluded to earlier, about how impactful visual disturbances can be on daily activities. Could you elaborate a little further on this, and particularly the various domains that can be affected when there are visual disturbances present? Dr Kedar: So, when I look at how visual disturbances affect quality of life, I look at two broad categories. One is activities of basic daily living. These would be things like, are you able to cook? Are you able to ambulate not just in your home, but in your neighborhood? Are you able to drive to your doctor's appointment or to visit with your family? Are you able to dress yourself appropriately? Are you able to visualize the clothing and choose them appropriately? And then the second category is recreational activities. Are you able to read? Are you able to watch television? Are you able to visit the theatre? Are you able to travel? Are you able to participate in group activities, be it with your family or be it with your social group? It is very important for us to ask our patients if they have problems doing any of this because it really can adversely impact the quality of life. Dr Grouse: I think, certainly with all the things we try to get through talking with our patients, this may not be something that we do spend a lot of time on. So, I think it's it is a good reminder that when we can, being able to ask about these are going to be really important and help us hit on a lot of other things we may not even realize or know to ask about. Now, I was really struck when I was reading your article by the meta-analysis that you had quoted that had showed 47% higher risk of developing dementia among the visually impaired compared to those without visual impairments. Should we be doing more in-depth visual testing on all of our patients with cognitive symptoms? Dr Kedar: This is actually the most interesting part of this article, and kind of hones in on the importance of vision in neurological disorders. Now I want to clarify that patients with visual disorders, it's not a causative influence on dementia, but if you have a patient with an underlying cognitive disorder, any kind of visual disturbance will significantly make it worse. And this has been shown in several studies, both in the neurologic and in the ophthalmological literature. So, I quoted one of the big meta-analysis over there, but studies have clearly shown that if you have these patients and treat them for their visual deficits, their cognitive indices can actually significantly improve. To answer your question, I would say a neurologist should include basic vision screening as part of every single evaluation. Now, I know it's a hard thing in, you know, these days when we are literally running on the hamster wheel, but I can assure you that it won't take you more than 2 to 3 minutes of your time to do this basic screening; in fact, you can have one of your assistants included as part of the vital signs assessment. What are these basic screening tools? Measure the visual acuity for both near and distance. Check and see if their visual field's off with the confrontation. Look at their eye movements. Are they able to move their eyes in all directions? Are the eyes stable when they're trying to fixate on a particular point? I think if you can do these basic things, you will have achieved quite a bit. Dr Grouse: That's really helpful, and thanks for going through some of the standard, or really, you know, solid basic foundation of visual testing we should be thinking about doing. I wanted to move on to some more details about the visual disturbances. You made an excellent point that there are many types of primary ophthalmologic conditions that can cause visual disturbances that we should keep in mind. So maybe not things that we think about a lot on a day-to-day basis, but, you know, are still there and very common. What are some of the most common ones, and when should we be referring them to see an ophthalmologist? Dr Kedar: So, it depends on the age group of your patient population. Now, the majority of us are adult neurologists, and so the kinds of ophthalmic conditions that we see in this population is going to be different from the pediatric age group. So in the adult population, we might see patients with uncorrected refractive error, presbyopia, patients who have cataracts creep on them, they may have glaucoma, they may have macular degeneration, and these tend to have a slightly higher incidence in the older age group. Now for those of us who are taking care of the younger population, uncorrected refractive errors, strabismus and amblyopia tend to be fairly common causes of visual deprivation in this age group. What I would encourage all of our neurologists is, make sure that your patients get a basic eye examination at least once a year. Just like you want them to go to their primary care and get an annual maintenance visit, everybody should go to the ophthalmologist or the optometrist and get a basic examination. And, if you're resourceful enough, have your patients bring a copy of that assessment. Whether it is normal or there's some abnormality, it is going to help you in the management. Dr Grouse: Absolutely. I think that's a great piece of advice, to think of it almost, like, them seeing their primary care doctor, which of course we offer encourage our patients to do, thinking of this as another very important piece of standard primary care. If a patient comes to you reporting difficulty reading due to possible visual disturbances, I'm curious, can you walk us through how you would approach this evaluation? Dr Kedar: It is not a very common presenting complaint of our patients, even in the neuro-ophthalmology clinic. It's a very rare patient that I see who comes and says, I cannot read or, I have difficulty reading. Most of the patients will come saying, oh, I cannot see. And then you have to dig in to find out, what does that actually mean? What can you not see? Is it a problem in your driving? Is it a problem in your reading? Or is it a problem that occurs at all times? Now you asked me, how do you approach this evaluation? One of the things that all of us, whether we are neurologists, ophthalmologists, or neuro-ophthalmologists, forget to do is to actually have the patient read a paragraph, a sentence, when they are in clinic. And that will give you a lot of ideas about what might actually be going wrong with the patient. Now, as far as how do I approach this evaluation, I will do a basic screening examination to make sure that their visual acuity is good for both distance and near. A lot of us tend to do either distance or near and we will miss the other parameter. You want to do a basic confrontation visual field to make sure that they do not have any subtle deficits that's impacting their ability to read. Examine the eye movements, do a fundoscopic examination. Now, once you've done this basic screening, as a neurologist, you already have some idea of whether your patient has a lesion along the visual pathways. If you suspect that this is a problem with, say, the visual pathways, ask your ophthalmology colleague to do a formal visual field assessment, and that'll pick up subtle deficits of central visual field. And lastly, don't forget higher visual function testing or cortical visual function testing. So basically, you're looking for neglect, phenomenon, or simultanagnosia, all of which tends to have an impact on reading. So, in the manuscript I have a schema of how you can approach a patient with reading difficulties, and in that ischemia you will see categories of where things can go wrong during the process of reading. And if you can approach your patient systematically through one of those domains, there's a fairly good chance that you'll be able to pick up a problem. Dr Grouse: Going a little further on to when you do identify problems with loss of central or peripheral vision, what are some strategies for symptomatic management of these types of visual disturbances? Dr Kedar: As a neurologist, if you pick up a problem with the vision, you have to send this patient to an eye care provider. The vast majority of people who have visual disturbances, it's from an eye disease. You know, as I alluded to earlier, it can be something as simple as uncorrected refractive error, and that can be fixed easily. A lot of patients in our older age group will have dry eye syndrome, which means they are unable to adequately lubricate the surface of the eye, and as a result, it degrades the quality of their vision. So, they tend to get intermittent episodes of blurred vision, or they tend to get glare. They tend to get various forms of optical aberration. Patients can have cataracts, patients can have glaucoma or macular degeneration. And in all of those instances, the goal is to treat the underlying disease, optimize the vision, and then see what the residual deficit is. By and large, if a patient has a problem with the central vision, then magnification will help them for activities that they perform at near; say, reading. Now for patients with peripheral vision problem, it's a different entity altogether. Again, once you've identified what the underlying cause is, your first goal is to treat it. So, for example, if your patient has glaucoma, which is affecting peripheral vision, you're going to treat glaucoma to make sure that the visual field does not progress. Now a lot of what happens after that is rehabilitation, and that is always geared towards the specific activities that are affected. Is it reading? Is it ambulating? Is it watching television? Is it driving? And then you can advise as a neurologist, you can advise your occupational therapist or low vision specialist and say, hey, my patient is not able to do this particular activity. Can we help them? Dr Grouse: Moving on from that, I wanted to also hit on your approach when patients have disorders of ocular motility. What are some things you can do for symptomatic management of that? Dr Kedar: So, patients with ocular motility can have two separate symptoms. Two, you know, two disabling symptoms, as they would call it. One is double vision and the other is oscillopsia, or the feeling or the visualization of the environment moving in response to your eyes not being able to stay still. Typically, you would see this in nystagmus. Now, let's start with diplopia. Diplopia is a fairly common presenting complaint for neurologists, ophthalmologists, and the neuro-ophthalmologist. The first aspect in the management of diplopia is to differentiate between monocular diplopia and binocular diplopia. Now, monocular diplopia is when the double vision persists even after covering one eye. And that is never a neurological issue. It's almost always an ophthalmic problem, which means the patient will then have to be assessed by an eye care provider to identify what's causing it. And again, refractive error, cataracts, opacities, they can do it. Now, if the patient is able to see single vision by covering one eye at a time, that's binocular diplopia. Now, in patients with binocular diplopia in the very early stages of the disease, the standard treatment regimen is just monocular occlusion. Cover one eye, the diplopia goes away, and then give it time to improve on its own. So, this is what we would typically do in a patient with, say, acute sixth nerve palsy or fourth nerve palsy or third nerve palsy, maybe expect spontaneous improvement in a few months. Now if the double vision does not improve and persists long term, then the neuro-ophthalmologist or the ophthalmologist will monitor the amount of deviation to see if it fluctuates or if it stays the same. So, what are the treatment options that we have in a patient who absolutely refuses any intervention or is not a candidate for any intervention? Monocular occlusion still remains the viable option. Now, patients who have stable ocular deviation can benefit from using prisms in their glasses, or they can be sent to a surgeon to have a strabismus surgery that can realign their eyes. So, again, a broad answer, but there are options available that we can use. Dr Grouse: Thank you for that overview. I think that's just really helpful to keep in mind as we're working with these patients and thinking about what their options are. And then finally, I wanted to touch on patients with higher-order vision processing and attention difficulties. What are some strategies for them? Dr Kedar: These are frankly the most difficult patients that I get to manage in my clinic, simply because there is no effective therapies for managing them. In fact, I think neurologists are far better at this than ophthalmologists or even neuro-ophthalmologists. In patients with attentional disorders, everything boils down to the underlying cause, whether you can treat it or whether it is a slowly progressive, you know, condition, such as from neurodegenerative diseases. And that tailors our goals towards therapy. The primary goal is for safety. A lot of these patients who have visual disturbances from vision processing or attention, they are at accident and fall risk. They have problems with social interactions. And, importantly, there is a gap of understanding of what's going on, not just from their side but also from the family's side. So, I tend to approach these patients from a safety perspective and social interaction perspective. Now, I have a table listed in the manuscript which will go into details of what the specific things are. But in a nutshell, if your patient has neglect in a specific part of the visual field, they have accident risk on that side. Simple things like walking through a doorway, they can hurt their shoulders or their knees when they bang into the wall on that side because they are unable to judge what's on the other side. Another example would be a patient who has simultanagnosia or a downgaze policy, such as from progressive super nuclear policy. They are unable to look down fast enough, or they are simply unable to look down and appreciate things that are on the floor, and so they can trip and fall. Walking downstairs is also not a huge risk because they are unable to judge distances as they walk down. A lot of what we see in these patients are things that we have to advise occupational therapists and help them improve these safety parameters at home. Another thing that we often forget is patients can inadvertently cause a social incident when they tend to ignore people on their affected side. So, if there is a family gathering, they tend to consistently ignore a group of people who are sitting on the affected side as opposed to the other side. And I've had more than a few patients who've come and said that, I may have offended some of my friends and family. In those instances, it's always helpful when they are in clinic to demonstrate to the family how this can be awkward and how this can be mitigated. So, having everybody sit on one side is a useful strategy. Advise your family and friends before a gathering that, hey, this may happen. And it is not because it is deliberate, but it's because of the medical condition. And that goes a lot, you know, further in helping our patients come out of social isolation because they are also afraid of offending people, you know. And they can also participate socially, and it can overall improve their quality of life. Dr Grouse: That's a really helpful tip, and something I'll keep in mind with my patients with neglect and visual field cuts. Thank you so much for coming to talk with us today. Your article has been so helpful, and I urge everybody listening today to take a look. Dr Kedar: Thank you, Katie. It was wonderful talking to you. Dr Grouse: I've been interviewing Dr Sachin Kedar about his article on symptomatic treatment of neuro-ophthalmic visual disturbances, which appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

On the latest NFL Players: Second Acts podcast, Super Bowl champion Ben Utecht joins Peanut and Roman. Ben reflects on the moments that led to his NFL career and credits Tony Dungy for giving him his shot in the league. He shares what it was like competing with Peyton Manning and tells a story that sums up what it was like playing with him. Ben opens up about the concussion he sustained during practice that aired on Hard Knocks and how that experience led him to become an advocate for brain health and a spokesman for the American Academy of Neurology. Then, Ben talks about how a foot infection led to the launch of his company, Sole Care Rx. He shares what he’s learned since becoming a CEO and the leadership lessons he took from Tony Dungy into business. Later, Ben shares how his passion for music led him to a career as a singer and songwriter, and how the people of Indianapolis got to experience him for his voice first before they saw him on the football field. The NFL Players: Second Acts podcast is a production of the NFL in partnership with iHeartMedia.See omnystudio.com/listener for privacy information.

Send us a textDoctor Carolyn Tran joins Neurologist Steven Toenjes to discuss migraines. Migraine is a complex brain disease affecting one in five women and one in ten men, with treatments ranging from traditional medications to cutting-edge therapies targeting specific pathways in the brain. The doctors talk about the causes - or lack thereof, the lack of treatment, and common misconceptions about what headaches should be classified as migraines. Dr. Toenjes explains the phases of migraine, including prodrome, aura, pain, and postdrome. Then the two doctors explore many treatment options, discussing the uses, benefits, and drawbacks of each class of treatment.Be a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on Apple PodcastsWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramX (Formerly Twitter)LinkedInWant to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

New research from UC San Francisco's Memory and Aging Center suggests that a decline in one region of the brain can cause other regions to “step in to help” – unlocking surprising capacities like deeper empathy or creativity. We talk to two UCSF doctors about why this has implications for any neurodegenerative disorder, including dementia. They join us to share their dementia-related discoveries. Their new book is “Mysteries of the Social Brain.” Guests: Dr. Bruce Miller, A.W. and Mary Margaret Clausen Distinguished Professor in Neurology, UCSF; Director of the UCSF Memory and Aging Center; founding director of the Global Brain Health Institute Dr. Virginia Sturm, professor in the Departments of Neurology and Psychiatry and Behavioral Sciences, UCSF Learn more about your ad choices. Visit megaphone.fm/adchoices

In part two of this two-part series, Dr. Jeff Ratliff and Dr. Per Borghammer explore the subcategories of Lewy body disease, focusing on the body-first subtype Show reference: https://www.nature.com/articles/s41593-025-01910-9 

Send us a textEpisode Summary: Dr. Michael Wheeler talks about neuroimmune interactions, exploring how the immune system and brain communicate, particularly through the blood-brain barrier and meninges; how chronic stress and inflammation can alter brain circuits, contributing to mood disorders like depression; how drugs like psilocybin and MDMA may reduce inflammation by modulating immune cells in the meninges, offering potential therapeutic benefits.About the guest: Michael Wheeler, PhD is an Assistant Professor of Neurology at Harvard Medical School. His lab studies how immune responses influence behavior, mood disorders, and addiction.Key Conversation Points:The blood-brain barrier (BBB) is not as impermeable as once thought, allowing immune signals like cytokines to influence brain function even in healthy states.Chronic stress can weaken the BBB, increasing inflammation and affecting mood-regulating circuits, potentially contributing to depression.Microglia, the brain's resident immune cells, help maintain neural circuits by pruning synapses and regulating metabolism.Psychedelics like psilocybin and MDMA can reduce inflammation by prompting immune cells (monocytes) to leave the meninges, potentially via vascular effects.These psychedelics may act in a context-specific “window,” requiring a dysregulated tissue state to exert anti-inflammatory effects, not as broad-spectrum anti-inflammatories.Neuroinflammation may underlie some treatment-resistant depression cases, suggesting immunotherapy could complement traditional psychiatric treatments.The brain encodes peripheral immune signals, like gut inflammation, in specific circuits, which can “remember” and recreate inflammatory responses.Aging may naturally increase blood-brain barrier leakiness, heightening the brain's susceptibility to peripheral inflammation.Future research aims to explore how psychedelics influence plasticity and their potential in treating inflammation-related diseases beyond psychiatry.Related episode:M&M 2: Psilocybin, LSD, Ketamine, Inflammation & Novel Support the showAll episodes, show notes, transcripts, and more at the M&M Substack Affiliates: KetoCitra—Ketone body BHB + potassium, calcium & magnesium, formulated with kidney health in mind. Use code MIND20 for 20% off any subscription (cancel anytime) Lumen device to optimize your metabolism for weight loss or athletic performance. Use code MIND for 10% off Readwise: Organize and share what you read. 60 days FREE through link Athletic Greens: Comprehensive & convenient daily nutrition. Free 1-year supply of vitamin D with purchase. MASA Chips—delicious tortilla chips made from organic corn and grass-fed beef tallow. No seed oils or artificial ingredients. Use code MIND for 20% off For all the ways you can support my efforts

Season 10 is on the horizon, but before we release our first episode, why not tune in to some of Isabel and Jade's favourite moments from season 9?  From leadership insights from top CEOs to navigating setbacks in R&D, there's plenty to discover in this season's batch of GOLD Medal Moments.   As well as the EMJ GOLD team, you'll hear from four former guests:  Charl van Zyl, CEO, Lundbeck Pharmaceuticals  Dr Dennise Broderick, President and Managing Director, Galen Pharma  Rebecca Vermeulen, recipient of the Healthcare Businesswomen's Association (HBA) STAR award for 2025  Christoph von der Goltz, Global Head of Medicine Central Nervous System and Emerging Areas, Boehringer Ingelheim 

Dr. Roy E. Strowd talks with Dr. Susannah Cornes about a teaching incentive initiative designed to support and reward faculty in academic neurology.  Read the related article in Neurology® Education.  Disclosures can be found at Neurology.org. 

In the second installment of this two-part series, Dr. Stacey Clardy and Dr. Janis Miyasaki discuss how she got involved with the AAN.  Show reference:  https://www.aan.com/news/aan-honors-leader-volunteer-2025-presidents-award  

Dr. Jin Hyung Lee is an electrical engineer focused on understanding the circuits of the human brain and how they relate to brain disorders. She is an associate professor of Neurology, Neurosurgery, Bioengineering, and Electrical Engineering at Stanford University. Her work with LVIS has led to the creation of NeuroMatch which focuses on mapping the brain to help with diagnosing brain disorders and creating new treatments for brain issues.    You can following the work of LVIS at: https://lviscorp.com/en/ Follow on YoutTube at: www.youtube.com/@LVISNeuroMatch Follow Dr. Jin on X @ljinhy   Mental Maps is brought to up by Arukah Well. Learn more at www.arukahwell.co    

If you’re worried about memory loss or have a family history of Alzheimer’s, this episode is a must-listen. Angela sits down with world-renowned neurologist and author Dr. Dale Bredesen to unpack the groundbreaking science behind Alzheimer’s prevention and reversal—even if you carry the APOE4 gene. With over 30 years of research, Dr. Bredesen shares how to optimise your brain health through metabolic flexibility, inflammation control, and personalised interventions. In this powerful and deeply personal episode, Angela also opens up about her own genetic risk and experience caring for her mum with Alzheimer’s. They explore why cognitive decline is not inevitable and how Dr. Bredesen’s new book, The Ageless Brain, is putting the power back into your hands. Whether you're 35 or 75, the steps to preserve your cognition start now—and the tools have never been more accessible. KEY TAKEAWAYS: Alzheimer’s Is Preventable and Reversible: Dr. Bredesen explains how addressing root causes like inflammation, metabolic dysfunction, and toxicity can stop and even reverse cognitive decline. Perimenopause and Brain Fog: Oestrogen loss affects brain energy metabolism, making perimenopausal women more vulnerable to cognitive decline. Your Brain Runs on Supply & Demand: Cognitive health depends on supporting your brain’s high energy needs while reducing inflammatory load and toxic exposure. Check Your Cognitive Biomarkers Early: Blood markers like P-Tau217, GFAP, and A-beta42 can reveal risk decades before symptoms appear. Lifestyle = Medicine: Sleep quality, insulin sensitivity, resistance training, brain stimulation, and even stress reduction all play a critical role. GLP-1s and Alzheimer’s Risk: While popular for weight loss, these drugs may negatively impact cognition in some people—especially APOE4 homozygotes. TIMESTAMPS AND KEY TOPICS:0:00 – Introduction 6:48 – Pathogens, toxins, and the real cause of Alzheimer’s 13:32 – Menopause, oestrogen, and female brain vulnerability 24:05 – Judy’s story: reversing cognitive decline for 13+ years 32:18 – Most common risky behaviours for brain degeneration 42:21 – Best exercises for insulin sensitivity and cognition 51:10 – Supplements that protect brain structure & function 54:22 – How to use The Ageless Brain as a practical guide 58:45 – Final thoughts + where to learn more from Dr. Bredesen VALUABLE RESOURCES Click here for discounts on all the products I personally use and recommend A BIG thank you to our sponsors who make the show possible: Get 20% off the Creatine I love at trycreate.co/ANGELA20, and use code ANGELA20 to save 20% on your firsts order. Brain Boost: Try Neuro Regenerate at lvluphealth.com/angela and use code ANGELA15 to save 15% ABOUT THE GUEST Dale Bredesen, M.D. is an expert in the mechanisms of neurodegenerative diseases such as Alzheimer's disease. He is a graduate of Caltech, and received his MD from Duke University Medical Center. His career has included serving as Chief Resident in Neurology at the University of California, San Francisco, and served as a NIH Postdoctoral Fellow. His faculty position included working at UCSF, UCLA, and the University of California, San Diego. He was the director of the Program on Aging at the Burnham Institute. He was the founding President and CEO of the Buck Institute. He has developed a new therapeutic approach to treating Alzheimer's disease. He is the author of The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Dr Dale Bredesen’s latest book: The Ageless Brain: How to Sharpen and Protect Your Mind for a Lifetime - https://amzn.eu/d/gdrjKQm https://www.apollohealthco.com/ https://www.instagram.com/drdalebredesen/ https://www.facebook.com/drdalebredesen/ ABOUT THE HOST Angela Foster is an award winning Nutritionist, Health & Performance Coach, Speaker and Host of the High Performance Health podcast. A former Corporate lawyer turned industry leader in biohacking and health optimisation for women, Angela has been featured in various media including Huff Post, Runners world, The Health Optimisation Summit, BrainTap, The Women’s Biohacking Conference, Livestrong & Natural Health Magazine. Angela is the creator of BioSyncing®️ a blueprint for ambitious entrepreneurial women to biohack their health so they can 10X how they show up in their business and their family without burning out. The High Performance Health Podcast is a top rated global podcast. Each week, Angela brings you a new insight, biohack or high performance habit to help you unlock optimal health, longevity and higher performance. Hit the follow button to make sure you get notified each time Angela releases a new episode. CONTACT DETAILS Instagram Facebook LinkedIn Affiliate Disclaimer: Note this description contains affiliate links that allow you to find the items mentioned in this video and support the channel at no cost to you. While this channel may earn minimal sums when the viewer uses the links, the viewer is under no obligation to use these links. Thank you for supporting the show! Disclaimer: The High Performance Health Podcast is for general information purposes only and do not constitute the practice of professional or coaching advice and no client relationship is formed. The use of information on this podcast, or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for medical or other professional advice, diagnosis, or treatment. Users should seek the assistance of their medical doctor or other health care professional for before taking any steps to implement any of the items discussed in this podcast. This Podcast has been brought to you by Disruptive Media. https://disruptivemedia.co.uk/

Grandpa Bill: is Going Deep on Hyperphantasia:Hyperphantasia, often described as having a "mind's eye on steroids," is a condition where individuals experience mental imagery that is exceptionally vivid, detailed, and often multisensory. It's not just about seeing pictures in your head; for hyperphants, these images can feel almost as real as actual perception. They might experience:Exceptional Vividness: Mental images possess a clarity and sharpness akin to real-world scenes. Colors are vibrant, textures are palpable, and details are readily accessible.Rich Detail: Hyperphants can often recall and generate images with intricate details, far beyond what most people experience. They might be able to "see" the individual leaves on a remembered tree or the specific patterns on a fabric.Multisensory Experiences: While visual imagery is the defining characteristic, hyperphantasia can extend to other senses. Individuals might experience vivid mental sounds (hyperacusis of the mind), smells (hyperosmia of the mind), tastes (hypergeusia of the mind), and even tactile sensations associated with their mental images.Effortless Generation and Manipulation: Creating and manipulating mental images often feels effortless and automatic for hyperphants. They can rotate objects in their mind, zoom in on details, and even create complex, dynamic scenes with relative ease.Strong Emotional Connection: The vividness of their mental imagery can lead to stronger emotional responses. Remembering a joyful event might evoke a more intense feeling of happiness, while recalling a negative experience could be more distressing.Enhanced Autobiographical Memory: Some research suggests a correlation between hyperphantasia and highly detailed autobiographical memory, as the past can be vividly relived through mental imagery.Potential for Creative Pursuits: The ability to vividly imagine can be a significant asset in creative fields like art, design, writing, and music.Distinguishing Hyperphantasia from Other Phenomena:Eidetic Imagery: While both involve vivid recall, eidetic imagery is primarily about retaining a near-perfect memory of a briefly viewed stimulus. Hyperphantasia is a more general and ongoing capacity for creating and manipulating vivid mental images, not necessarily tied to a recent external stimulus.Synesthesia: Synesthesia involves involuntary sensory crossovers (e.g., seeing colors with sounds). While a hyperphant might also experience synesthesia, the vividness of their voluntary imagery is a separate phenomenon.Lucid Dreaming: Lucid dreaming is the awareness that one is dreaming. While hyperphants might have vivid dream imagery, hyperphantasia is a waking-state phenomenon.#VisualDisturbances,#AlteredVision,#NeurologicalSymptoms,#BrainHealthAwareness,#TBI,#MigraineAura,#SeizureAwareness,#NeuroVisual,#SensoryProcessingIssues,#BrainInjuryRecovery,#CognitiveHealth,#Neurology,

How do you turn massive clinical imaging data into insights that change lives? What does it take to move from a psychology undergrad to a pioneering role in pediatric brain research? And how can coding, connectomics, and curiosity shape a meaningful clinical career in neuroscience? In this inspiring episode of Neurocareers: Doing the Impossible!, we sit down with Dr. Puck Reeders, Senior Neuroscience Research Scientist at the Brain Institute at Nicklaus Children's Hospital. From her early days in Curacao to building novel neuroimaging pipelines in one of the nation's oldest pediatric epilepsy programs, Dr. Reeders shares her unique career path—and how she helps decode complex brain networks to improve surgical outcomes for children with intractable epilepsy. We explore: How connectomics and diffusion imaging guide surgical planning Her innovative research on white matter networks and neuromodulation responses The steep but rewarding path from zero coding skills to advanced tractography Tips for transitioning from psychology to clinical neuroscience Career advice for anyone eager to enter research-focused medical settings Whether you're a student exploring future careers, a neuroscientist curious about clinical impact, or just fascinated by how science meets medicine—you'll walk away informed and inspired. Chapters: 00:00:00 - Insights from a Neuroscience Research Scientist 00:03:00 - Functional Mapping Techniques for Epilepsy 00:08:43 - Transitioning from Medical School to Psychology 00:13:10 - Research Gaps in Epilepsy 00:17:10 - Understanding Connectomics in Epilepsy Treatment 00:21:53 - Combining Imaging Techniques in Research 00:24:50 - Coding Challenges in Research 00:27:12 - Coding Journey in Neuroscience 00:28:51 - Learning to Code: A Personal Journey 00:32:39 - The Importance of Networking 00:34:30 - Art's Role in Science Communication 00:37:38 - Landing a Job Through Networking 00:41:22 - Research Opportunities in Connectomics 00:46:49 - Exploring Diverse Career Opportunities 00:51:38 - Job Search Tips and Strategies 00:54:39 - Tips for Job Applications and Interviews 00:59:46 - From Medicine to Neuroscience Research 01:02:06 - Clinical Research and Pediatric Epilepsy About the Podcast Guest: Dr. Puck Reeders is a Senior Neuroscience Research Scientist at the Brain Institute at Nicklaus Children's Hospital in Miami, Florida https://www.nicklauschildrens.org/home Her work focuses on investigating aberrant brain networks in children with intractable epilepsy, applying advanced neuroimaging techniques to improve clinical outcomes in pediatric neurology. Originally from the Netherlands and raised on the island of Curaçao, Dr. Reeders brings a global perspective to her research. She holds a Bachelor of Science in Psychology and Chemistry from the University of Miami, and a PhD in Cognitive Neuroscience from Florida International University, where she also completed her postdoctoral training in the Allen Neurocircuitry and Cognition Lab. Dr. Reeders has over nine years of experience working with functional MRI (fMRI) and diffusion-weighted imaging (DWI) in both adults and children. Her current research explores the structural connectomics of pediatric epilepsy, the development of clinical imaging pipelines to detect white matter abnormalities, cortical dysplasias, and automated SPECT subtractions—bringing together cutting-edge science with translational clinical impact. Her expertise spans: Neuroimaging and clinical pipeline development Data analysis and scientific coding Translational neuroscience and surgical planning support Research project design and academic mentoring Outside of the lab, Dr. Reeders shares insights into neuroscience careers and research life on her educational Instagram: @Drpucky You can also connect with her professionally on LinkedIn:  https://www.linkedin.com/in/puckreeders/  About the Podcast Host: The Neurocareers podcast is brought to you by The Institute of Neuroapproaches (https://www.neuroapproaches.org/) and its founder, Milena Korostenskaja, Ph.D. (Dr. K), a career coach for people in neuroscience and neurotechnologies. As a professional coach with a background in neurotech and Brain-Computer Interfaces, Dr. K understands the unique challenges and opportunities job applicants face in this field and can provide personalized coaching and support to help you succeed. Here's what you'll get with one-on-one coaching sessions from Dr. K: Identification and pursuit of career goals Guidance on job search strategies, resume, and cover letter development Neurotech / neuroscience job interview preparation and practice Networking strategies to connect with professionals in the field of neuroscience and neurotechnologies Ongoing support and guidance to help you stay on track and achieve your goals You can always schedule a free neurocareer consultation/coaching session with Dr. K at https://neuroapproaches.as.me/free-neurocareer-consultation Subscribe to our Nerocareers Newsletter to stay on top of all our cool neurocareers news at updates https://www.neuroapproaches.org/neurocareers-news

In part one of this two-part series, Dr. Jeff Ratliff and Dr. Per Borghammer examine the dichotomy that existed before his team began this project. Show reference: https://www.nature.com/articles/s41593-025-01910-9 

From the archive in recognition of May as Mental Health Awareness Month. Each year in the U.S. one in five adults will experience a mental illness. Physician assistant and co-owner of Meadowlark Psychiatric Services in North Liberty, Melissa Gentry, says that the first step in prevention is caring for oneself through diet and exercise. The next step is knowing when to reach out and ask for help. North Liberty is the headquarters of local media, regional financial and national transportation companies and home to solar energy and tech startups, and entrepreneurs getting their big ideas off the ground. Get to know your new business community.

In this episode of Huberman Lab Essentials, my guest is Dr. Karl Deisseroth, M.D., Ph.D., a clinical psychiatrist and professor of bioengineering and of psychiatry and behavioral sciences at Stanford University. We discuss his experiences as a clinician treating complex psychiatric conditions and his lab's pioneering work in developing transformative therapies for mental illness. He explains the complexities of mental illness and how emerging technologies—such as optogenetics and brain-machine interfaces—could revolutionize care. We also explore promising new therapies, including psychedelics and MDMA, for conditions like depression and PTSD. Read the episode show notes at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman David: https://davidprotein.com/huberman Eight Sleep: https://eightsleep.com/huberman Timestamps 00:00:00 Karl Deisseroth; Neurology vs Psychiatry 00:01:36 Speech; Blood Test?; Seeking Help 00:04:20 Feelings, Jargon; Psychiatric Treatment 00:09:40 Sponsor: David 00:10:55 Future Treatment; Vagus Nerve Stimulation, Depression, Optogenetics 00:19:40 Brain-Machine Interfaces 00:20:53 Sponsor: Eight Sleep 00:23:00 ADHD Symptoms, Lifestyle, Technology 00:29:34 Psychedelics, Depression Treatment, Risks 00:35:43 Sponsor: AG1 00:37:30 MDMA (Ecstasy), Trauma & Post-Traumatic Stress Disorder (PTSD) Treatment 00:40:33 Projections: A Story of Human Emotions Book, Optimism Disclaimer & Disclosures

Dr. Jeff Ratliff talks with Dr. Per Borghammer about the classification of Lewy body disease into brain-first and body-first subtypes, with a focus on the newly identified parasympathetic and sympathetic subtypes within the body-first category.  Read the related article in Nature.  Disclosures can be found at Neurology.org. 

In the first installment of this two-part series, Dr. Stacey Clardy engages in a thought-provoking conversation with Dr. Janis Miyasaki, asking her to share two invaluable pieces of wisdom. Show reference:  https://www.aan.com/news/aan-honors-leader-volunteer-2025-presidents-award 

In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles about early studies finding dopamine cellular therapies were safe and tolerable for patients with Parkinson's, use of GLP-1 agonists were associated with reduced dementia risks, and the FDA use of accelerated approvals for several neurology drugs are under scrutiny. 

Dr. Jeff Lambe talks about progressive multiple sclerosis.  Show references: https://journals.lww.com/co-neurology/abstract/2025/06000/re_defining_progression_in_multiple_sclerosis.4.aspx  https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(23)00281-8/abstract  https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70256-X/abstract  https://www.tandfonline.com/doi/full/10.1080/14737175.2022.2143265  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0288967  https://jamanetwork.com/journals/jamaneurology/article-abstract/2809772  https://www.nejm.org/doi/full/10.1056/NEJMoa2415988   

Dysfunction of the supranuclear ocular motor pathways typically causes highly localizable deficits. With sophisticated neuroimaging, it is critical to better understand structure-function relationships and precisely localize pathology within the brain. In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Gregory P. Van Stavern, MD, author of the article “Supranuclear Disorders of Eye Movements” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Van Stavern is the Robert C. Drews professor of ophthalmology and visual sciences at Washington University in St Louis, Missouri. Additional Resources Read the article: Internuclear and Supranuclear Disorders of Eye Movements Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Gregory Van Stavern, who recently authored an article on intranuclear and supranuclear disorders of eye movements for our latest Continuum issue on neuro-ophthalmology. Dr Van Stavern is the Robert C Drews professor of ophthalmology and visual sciences at Washington University in Saint Louis. Dr Van Stavern, welcome, and thank you for joining us today. Why don't you introduce yourself to our audience? Dr Van Stavern: Hi, my name is Gregory Van Stavern. I'm a neuro-ophthalmologist located in Saint Louis, and I'm pleased to be on this show today. Dr Jones: We appreciate you being here, and obviously, any discussion of the visual system is worthwhile. The visual system is important. It's how most of us and most of our patients navigate the world. Roughly 40% of the brain---you can correct me if I'm wrong---is in some way assigned to our visual system. But it's not just about the sensory experience, right? The afferent visual processing. We also have motor systems of control that align our vision and allow us to accurately direct our vision to visual targets of interest. The circuitry is complex, which I think is intimidating to many of us. It's much easier to see a diagram of that than to describe it on a podcast. But I think this is a good opportunity for us to talk about the ocular motor exam and how it helps us localize lesions and, and better understand diagnoses for certain disorders. So, let's get right to it, Dr Van Stavern. If you had from your article, which is outstanding, a single most important message for our listeners about recognizing or treating patients with ocular motor disorders, what would that message be? Dr Van Stavern: Well, I think if we can basically zoom out a little to the big picture, I think it really emphasizes the continuing importance of the examination. History as well, but the examination. I was reading an article the other day that was essentially downplaying the importance of the physical examination in the modern era with modern imaging techniques and technology. But for neurology, and especially neuro-ophthalmology, the history and the examination should still drive clinical decision-making. And doing a careful assessment of the ocular motor system should be able to tell you exactly where the lesion is located, because it's very easy to order a brain MRI, but the MRI is, like Forrest Gump might say, it's like a box of chocolates. You never know what you're going to find. You may find a lot of things, but because you've done the history and the examination, you can see if whatever lesion is uncovered by the MRI is the lesion that explains what's going on with the patient. So even today, even with the most modern imaging techniques we have, it is still really important to know what you're looking for. And that's where the oculomotor examination can be very helpful. Dr Jones: I did not have Forrest Gump on my bingo card today, Dr Van Stavern, but that's a really good analogy, right? If you order the MRI, you don't know what you're going to get. And then- and if you don't have a really well-formed question, then sometimes you get misleading information, right?  Dr Van Stavern: Exactly. Dr Jones: We'll get into some technology here in a minute, because I think that's relevant for this discussion. I think most of our listeners are going to agree with us that the exam is important in neuro-ophthalmology, and neurology broadly. So, I think you have some sympathetic listeners there. Again, the point of the exam is to localize and then lead to a diagnosis that we can help patients with. When you think about neurologic disorders where the ocular motor exam helps you get to the right diagnosis, obviously disorders of eye movements, but sometimes it's a clue to a broader neurologic syndrome. And you have some nice discussions in your article about the ocular motor clues to Parkinson disease or to progressive supranuclear palsy. Tell us a little more about that. In your practice, which neurologic disorders do you find the ocular motor exam being most helpful? Dr Van Stavern: Well, just a very brief digression. So, I started off being an ophthalmology resident, and I do two years of ophthalmology and then switch to neurology. And during neurology residency, I was debating which subspecialty to go into, and I realized that neuro-ophthalmology touches every other subspecialty in neurology. And it goes back to the fact that the visual system is so pervasive and widely distributed throughout the brain. So, if you have a neurologic disease, there is a very good chance it is going to affect vision, maybe in a minor way or a major way. That's why careful assessment of the visual system, and particularly the oculomotor system, is really helpful for many neurologic diseases. Neuromuscular disease, obviously, myasthenia gravis and certain myopathies affect the eye movements. Neurodegenerative diseases, in particular Parkinson's disease and parkinsonian conditions, often affect the eye movements. And in particular, when you're trying to differentiate, is this classic Parkinson's disease? Or is this progressive supranuclear palsy? Is it some broad spectrum multisystem atrophy? The differences between the eye movement disorders, even allowing for the fact that there's overlap, can really help point in one direction to the other, and again, prevent unnecessary testing, unnecessary treatment, and so on. Dr Jones: Very good. And I think, to follow on a thread from that concept with patients who have movement disorders, in my practice, seeing older patients who have a little bit of restriction of vertical gaze is not that uncommon. And it's more common in patients who have idiopathic Parkinson disease. And then we use that part of the exam to help us screen patients for other neurodegenerative syndromes like progressive nuclear- supranuclear palsy. So, do you have any tips for our listeners to- how to look at, maybe, vertical gaze and say, this is maybe a normal age-related degree of change. This is something that might suggest idiopathic Parkinson disease. Or maybe something a little more progressive and sinister like progressive super nuclear palsy? Dr Van Stavern: Well, I think part of the issue- and it's harder to do this without the visual aspect. One of my colleagues always likes to say for a neurologist, the eye movement exam begins and ends with the neurology benediction, just doing the sign of the cross and checking the eye movements. And that's a good place to start. But I think it's important to remember that all you're looking at is smooth pursuit and range of eye movements, and there's much more to the oculomotor examination than that. There's other aspects of eye movement. Looking at saccades can be really helpful; in particular, classically, saccadic movements are selectively abnormal in PSP versus Parkinson's with progressive supranuclear palsy. Saccades, which are essentially rapid movements of the eyes---up and down, in this case---are going to be affected in downward gaze. So, the patient is going to have more difficulty initiating downward saccades, slower saccades, and less range of movement of saccades in downgaze. Whereas in Parkinson's, it's classically upward eye movements and upgaze. So, I think that's something you won't be able to see if you're just doing, looking at, you know, your classic, look at your eye movements, which are just assessing, smooth pursuit. Looking carefully at the eye movements during fixation can be helpful. Another aspect of many parkinsonian conditions is saccadic intrusions, where there's quick movements or saccades of the eye that are interrupting fixation. Much, much more common in PSP than in Parkinson's disease. The saccadic intrusions are what we call square-wave jerks because of what they look like. Eye movement recordings are much larger amplitude in PSP and other multisystem atrophy diseases than with Parkinson's. And none of these are perfect differentiators, but the constellation of those findings, a patient with slow downwards saccades, very large amplitude, and frequent saccadic intrusions might point you more towards this being PSP rather than Parkinson's. Dr Jones: That's a great pearl, thinking about the saccades in addition to the smooth pursuit. So, thank you for that. And you mentioned eye movement measurements. I think it's simultaneously impressive and a little scary that my phone can tell when I'm looking at it within a few degrees of visual attention. So, I imagine there are automated tools to analyze eye movement. Tell us, what's the state of the art there, and what should our listeners be aware of in terms of tools that are available and what they can and can't do? Dr Van Stavern: Well, I could tell you, I mean, I see neuro-ophthalmic patients with eye movement disorders every day and we do not have any automated tools for eye movement. We have a ton of imaging techniques for imaging the optic nerve and the retina in different ways, but we don't routinely employ eye movement recording devices. The only time we usually do that is in somebody where we suspect they have a central or peripheral vestibular disease and we send them for vestibular testing, for eye movement recordings. There is interest in using- I know, again, sort of another digression, but if you're looking at the HINTS technique, which is described in the chapter to differentiate central from peripheral disease, which is a very easy, useful way to differentiate central from peripheral or peripheral vestibular disease. And again, in the acute setting, is this a stroke or not a stroke? Is it the brain or is it the inner ear? Part of the problem is that if you're deploying this widespread, the people who are doing it may not be sufficiently good enough at doing the test to differentiate, is a positive or negative test? And that's where some people have started introducing this into the emergency room, these eye movement recording devices, to give the- using, potentially, AI and algorithms to help the emergency room physicians say, all right, this looks like a stroke, we need to admit the patient, get an MRI and so on, versus, this is vestibular neuritis or an inner ear problem, treat them symptomatically, follow up as an outpatient. That has not yet been widely employed. It's a similar way that a lot of institutions are having fundus photography and OCT devices placed in the emergency room to aid the emergency room physician for patients who present with acute vision issues. So, I think that could be the future. It probably would be something that would be AI-assisted or AI-driven. But I can tell you at least at our institution and most of the ones I know of, it is not routinely employed yet. Dr Jones: So maybe on the horizon, AI kind of facilitated tools for eye movement disorder interpretation, but it's not ready for prime time yet. Is that a fair summary? Dr Van Stavern: In my opinion, yes. Dr Jones: Good to know. This has struck me every time I've read about ocular motor anatomy and ocular motor disorders, whether they're supranuclear or intranuclear disorders. The anatomy is complex, the circuitry is very complicated. Which means I learn it and then I forget it and then I relearn it. But some of the anatomy isn't even fully understood yet. This is a very complex real estate in the brainstem. Why do you think the neurophysiology and neuroanatomy is not fully clarified yet? And is there anything on the horizon that might clarify some of this anatomy? Dr Van Stavern: The very first time I encountered this topic as an ophthalmology resident and later as a neurology resident, I just couldn't understand how anyone could really understand all of the circuitry involved. And there is a lot of circuitry that is involved in us simply having clear, single binocular vision with the afferent and efferent system working in concert. Even in arch. In my chapter, when you look at the anatomy and physiology of the smooth pursuit system or the vertical gaze pathways, there's a lot of, I'll admit it, there's a lot of hand waving and we don't completely understand it. I think a lot of it has to do with, in the old days, a lot of the anatomy was based on lesions, you know, lesion this area either experimentally or clinically. And that's how you would determine, this is what this region of the brain is responsible for. Although we've gotten more sophisticated with better imaging, with functional connectivity MRI and so on, all of those have limitations. And that's why I still don't think we completely understand all the way this information is integrated and synthesized, and, to get even more big level and esoteric, how this makes its way into our conscious mind. And that has to do with self-awareness and consciousness, which is a whole other kettle of fish. It's just really complicated. I think when I'm at least talking to other neurologists and residents, I try to keep it as simple as possible from a clinical standpoint. If you see someone with an eye movement problem, try to see if you can localize it to which level you're dealing with. Is it a muscle problem? Is it neuromuscular junction? Is it nerve? Is it nucleus? Is it supranuclear? If you can put it at even one of those two levels, you have eliminated huge territories of neurologic real estate, and that will definitely help you target and tailor your workup. So, again, you're not costing the patient in the healthcare system hundreds of thousands of dollars. Dr Jones: Great points in there. And I think, you know, if we can't get it down to the rostral interstitial nucleus of the medial longitudinal fasciculus, if we can get it to the brainstem, I think that's obviously- that's helpful in its own right. And I imagine, Dr Van Stavern, managing patients with persistent ocular motor disorders is a challenge. We take foveation for granted, right, when we can create these single cortical images. And I imagine it's important for daily function and difficult for patients who lose that ability to maintain their ocular alignment. What are some of the clinical tools that you use in your practice that our listeners should be aware of to help patients that have a persistent supranuclear disorder of ocular movement? Dr Van Stavern: Well, I think you tailor your treatment to the symptoms, and if it's directly due to underlying condition, obviously you treat the underlying condition. If they have sixth nerve palsy because of a skull base tumor, obviously you treat the skull base tumor. But from a practical standpoint, I think it depends on what the symptom is, what's causing it, and how much it's affecting their quality of life. And everyone is really different. Some patients have higher levels of tolerance for blurred vision and double vision. For things- for patients who have double vision, depending upon the underlying cause we can sometimes use prisms and glasses. Prisms are simply- a lot of people just think prism is this, like, mystical word that means a lot. It's simply just an optical device that bends light. So, it essentially bends light to allow the eyes- basically, the image to fall on the fovea in both eyes. And whether the prisms help or not is partly dependent upon how large the misalignment is. If somebody has a large degree of misalignment, you're not going to fix that with prism. The amount of prism you'd need to bend the light enough to land on the fovea in both eyes would cause so much blur and distortion that it would essentially be a glorified patch. So, for small ranges of misalignment, prisms are often very helpful, that we can paste over glasses or grind into glasses. For larger degrees of misalignment that- let's say it is due to some skull base tumor or brain stem lesion that is not going to get better, then eye muscle surgery is a very effective option. We usually like to give people a long enough period of time to make sure there's no change before proceeding with eye muscle surgery. Dr Jones: Very helpful. So, prisms will help to a limited extent with misalignment, and then surgery is always an option if it's persistent. That's a good pearl for, I think, our listeners to take away. Dr Van Stavern: And even in those circumstances, even prisms and eye muscle surgery, the goal is primarily to cause single binocular vision and primary gaze at near. Even in those cases, even with the best results, patients are still going to have double vision, eccentric gaze. For most people, that's not a big issue, but we have had a few patients… I had a couple of patients who were truck drivers who were really bothered by the fact that when they look to the left, let's say because it's a 4th nerve palsy on the right, they have double vision. I had a patient who was a golfer who was really, really unhappy with that. Most people are okay with that, but it all depends upon the individual patient and what they use their vision for. Dr Jones: That's a great point. There's not enough neurologists in the world. I know for a fact there are not enough neuro-ophthalmologists in the world, right? There's just not many people that have that dual expertise. You mentioned that you started with ophthalmology and then did neurology training. What do you think the pipeline looks like for neuro-ophthalmology? Do you see growing interest in this among trainees, or unchanged? What are your thoughts about that? Dr Van Stavern: No, that's a continuing discussion we're having within our own field about how to attract more residents into neuro-ophthalmology. And there's been a huge shift. In the past, this was primarily ophthalmology-driven. Most neuro-ophthalmologists were trained in ophthalmology initially before doing a fellowship. The last twenty years, it switched. Now there's an almost 50/50 division between neurologists and ophthalmologists, as more neurologists have become more interested. This is probably a topic more for the ophthalmology equivalent of Continuum. One of the perceptions is this is not a surgical subspecialty, so a lot of ophthalmology residents are disincentivized to pursue it. So, we have tried to change that. You can do neuro-ophthalmology and do eye muscle surgery or general ophthalmology. I think it really depends upon whether you have exposure to a neuro-ophthalmologist during your neurology residency. If you do not have any exposure to neuro-ophthalmology, this field will always seem mysterious, a huge black box, something intimidating, and something that is not appealing to a neurologist. I and most of my colleagues make sure to include neurology residents in our clinic so they at least have exposure to it. Dr Jones: That's a great point. If you never see it, it's hard to envision yourself in that practice. So, a little bit of a self-fulfilling prophecy. If you don't have neuro-ophthalmologists, it's hard to expose that practice to trainees. Dr Van Stavern: And we're also trying; I mean, we make sure to include medical students, bring them to our meetings, present research to try to get them interested in this field at a very early stage. Dr Jones: Dr Van Stavern, great discussion, very helpful. I want to thank you for joining us today. I want to thank you for not just a great podcast, but also just a wonderful article on ocular motor disorders, supranuclear and intranuclear. I learned a lot, and hopefully our listeners did too. Dr Van Stavern: Well, thanks. I really appreciate doing this. And I love Continuum. I learn something new every time I get another issue. Dr Jones: Well, thanks for reading it. And I'll tell you as the editor of Continuum, I learn a lot reading these articles. So, it's really a joy to get to read, up to the minute, cutting-edge clinical content for neurology. Again, we've been speaking with Dr Gregory Van Stavern, author of a fantastic article on intranuclear and supranuclear disorders of eye movements in Continuum's most recent issue on neuro-ophthalmology. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

We all want to age well, so let's learn from those who already have. Emily Rogalski, Rosalind Franklin professor and Director of the Healthy Aging & Alzheimer's Research Care Center at the University of Chicago, delves into the secrets. Dr. Rogalski is the Rosalind Franklin Professor of Neurology and the Director of the Healthy Aging […]

Dr. Dale Bredesen, a renowned expert in the field of neurodegenerative diseases, is on a mission to reshape the way we think about aging and brain health. He challenges conventional perceptions about aging, emphasizing the importance of maintaining a "brain span" that matches one's lifespan. Often posing thought-provoking questions about longevity, Dr. Bredesen highlights the undesirability of living to an advanced age if it means suffering from dementia. His work, driven by ongoing research and encapsulated in his latest book, aims to shift the narrative from expecting cognitive decline with age to implementing proactive strategies for preserving brain function. Timestamps: 05:24 Brain Health Over Longevity 07:53 Exercise, Memory, and APOE4 Gene Impact 10:26 Optimizing Cognition: Early Detection's Role 14:56 Herpes and Toxins Linked to Cognitive Decline 17:38 Neurotransmitters, Choline, and Stress Impact 20:43 Tau's Role in Brain Health 24:57 Understanding Cognitive Health Markers 26:43 Misdiagnosed Alzheimer's Story 30:51 Optimal Diet and Fasting Guidelines 33:35 Expanding Exercise Benefits in Neurology 39:11 Early Detection in Alzheimer's Prevention

Dr. Justin Abbatemarco discuss autoimmune encephalitis with a focus on outcomes.  Show reference:  https://www.neurology.org/doi/10.1212/WNL.0000000000210109  https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(23)00463-5/abstract 

To get the word out during National Stroke Awareness Month, this week on FOX Rehabilitation's Live Better Longer podcast, we speak with Neurologist and Associate Professor of Neurology and Neurosurgery at the University of Tennessee Health Sciences Center, Dr. Violiza Inoah, MD. This year's focus of Stroke Awareness Month is the Hispanic Community, where stroke is the fourth leading cause of death in Hispanic men and the third leading cause of death in Hispanic women. Dr. Inoah discusses what factors into these distressing stats and what steps need to be taken to improve them. The overall takeaway in Stroke Awareness education is to act quickly. If you or a loved one ever experiences any stroke symptoms (slurred speech, balance issues, losing sight in one or both eyes, difficulty raising both arms, facial drooping), call 911 immediately! As you'll soon hear, your hospital's medical staff will jump into action immediately, as every second counts.

To get the word out during National Stroke Awareness Month, this week on FOX Rehabilitation's Live Better Longer podcast, we speak with Neurologist and Associate Professor of Neurology and Neurosurgery at the University of Tennessee Health Sciences Center, Dr. Violiza Inoah, MD. This year's focus of Stroke Awareness Month is the Hispanic Community, where stroke is the fourth leading cause of death in Hispanic men and the third leading cause of death in Hispanic women. Dr. Inoah discusses what factors into these distressing stats and what steps need to be taken to improve them. The overall takeaway in Stroke Awareness education is to act quickly. If you or a loved one ever experiences any stroke symptoms (slurred speech, balance issues, losing sight in one or both eyes, difficulty raising both arms, facial drooping), call 911 immediately! As you'll soon hear, your hospital's medical staff will jump into action immediately, as every second counts.

Dr. Stacey Clardy talks with Dr. Janis Miyasaki about her journey into neurology, the integration of palliative care into neurologic practice, and the critical importance of patient-centered care. Read more about the 2025 AAN President's Award.  Disclosures can be found at Neurology.org. 

In part two of this two-part series, Dr. Dan Ackerman and Dr. Trey Bateman discuss handling patient requests for blood-based biomarkers for Alzheimer disease and interpreting test results.

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Aye presents a case of behavior change, headaches, and blurry vision to Vale. Neurology DDx Schema Aye Chan Moe Thant (@AyeThant94) Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only… Read More »Episode 395: Neurology VMR – Behavior change, headaches, and blurry vision

Dr. Jessica Ailani and Dr. Kathleen Digre discuss the evolution of spontaneous intracranial hypotension (SIH) diagnosis and treatment over the past decade.

Dr. Jessica Ailani talks with Dr. Kathleen Digre about the evolution of spontaneous intracranial hypotension (SIH) diagnosis and treatment over the past decade. Disclosures can be found at Neurology.org. 

In part one of this two-part series, Dr. Dan Ackerman and Dr. Trey Bateman discuss current biomarkers for Alzheimer disease and how do you use them in clinic. 

"Sometimes life directs you somewhere you didn't plan on going, and you realize everything happens for a reason." - Dr. Trupti Gokani I was absolutely fascinated by my conversation with Dr. Trupti Gokani, an award-winning neurologist who has brilliantly bridged Western medicine with ancient Ayurvedic wisdom. Her journey began during her first year of medical school when debilitating insomnia led her to discover Ayurveda after conventional medicine failed her. What's remarkable is how she's developed a three-brain optimization approach (head, gut, and microbiome) that addresses the root causes of chronic conditions instead of just managing symptoms. We explored the three Ayurvedic body types—Vata (air/space), Pitta (fire/water), and Kapha (earth/water)—and how understanding your unique constitution can transform your approach to diet, stress, and health challenges. This conversation offers powerful insights for women feeling disconnected from their bodies or struggling with stress-related conditions like migraines, digestive issues, or autoimmune disorders.   What you'll learn: How Dr. Gokani discovered Ayurvedic medicine after conventional approaches failed to help her insomnia The three Ayurvedic body types (Vata, Pitta, Kapha) and how to identify yours Why understanding your constitution is foundational to personalized health How chronic stress manifests differently based on your body type The connection between gut health, emotions, and neurological symptoms Simple Ayurvedic techniques that can complement modern medical treatments How choosing the right foods for your type can significantly improve symptoms Love the Podcast? Here's what to do: Make My Day & Share Your Thoughts! Subscribe to the podcast & leave me a review Text a screenshot to 813-565-2627 Expect a personal reply because your voice is so important to me. Join 55,000+ followers who make this podcast thrive. Want to listen to the show completely ad-free?  Go to subscribetojj.com Enjoy the VIP experience for just $4.99/month or $49.99/year (save 17%!) Click “TRY FREE” and start your ad-free journey today! Full show notes (including all links mentioned): https://jjvirgin.com/trupti Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Justin Abbatemarco discusses updates around MOGAD treatments.  Show references: https://jamanetwork.com/journals/jamaneurology/article-abstract/2822964  https://jnnp.bmj.com/content/95/11/1054 

It's time to rewire for wellness—your brain holds the blueprint for healing, and Dr. Steven Resnick is here to show you how! In this powerful episode of The Manifested Podcast, Kathleen Cameron sits down with neurologist Dr. Steven Resnick to explore how subconscious beliefs and identity shape our physical health. Discover how neurology and manifestation intersect—and how rewiring your mind could be the key to lasting wellness. Don't miss Dr. Resnick's holistic take on healing that goes far beyond traditional medicine.   In this episode: Your brain loves habits — even the unhealthy ones. Change takes awareness. Shifting your mindset can lead to real health breakthroughs. Positive self-talk and mindfulness help rewire old patterns. Beliefs and words can impact healing — even in medicine. Dr. Resnick shares how being present boosts well-being.   About The Guest: Dr. Steven Resnick is the Medical Director of the Mount Sinai Comprehensive Stroke Center. Board-certified in Neurology and Vascular Neurology, Dr. Resnick is an attending Neurologist with direct supervision of internal medicine and medical students at Mount Sinai Hospital. Dr. Resnick has co-authored a textbook entitled Practical Neuroimaging in Stroke and has published articles in the Journal of the Peripheral Nervous System, the Journal of Neurology, and the Journal of Neurology, Neurosurgery, and Psychiatry. He has lectured extensively on stroke prevention, acute ischemic stroke, practical Neuroimaging in cerebrovascular disease, and other related topics. Clinical research includes studies of drug therapies to treat Neuromuscular diseases.   Connect with Dr. Resnick Website: https://drstevenresnick.com/ Instagram: https://www.instagram.com/dr.stevenresnick Facebook: https://www.facebook.com/DrStevenResnick/ Podcast: https://drstevenresnick.com/the-healthy-mind-podcast/   Shop Iylia Premium Non-Alcoholics: https://iylia.com/   Subscribe To The Manifested Podcast With Kathleen Cameron: Apple Podcast | YouTube | Spotify Connect With The Kathleen Cameron: Facebook | Instagram | LinkedIn | Youtube | TikTok | Kathleencameronofficial.com   Unlock Your Dreams with House of ManifestationA community where you take control of your destiny, manifest your desires, and create a life filled with abundance and purpose? Look no further than the House of Manifestation, where your transformation begins: https://houseofmanifestation.com/ About Kathleen Cameron: Kathleen Cameron, Chief Wealth Creator, 8-figure entrepreneur, and record-breaking author. In just 2 years, she built a 10 Million dollar business and continues to share her knowledge and expertise with all of whom she connects with.  With her determination, unwavering faith, and powers of manifestation, she has helped over 100,000 people attract more love, money, and success into their lives. Her innovative approaches to Manifestation and utilizing the Laws of Attraction have led to the creation of one of the top global success networks, Diamond Academy Coaching, thousands of students have been able to experience quantum growth. The force behind her magnetic field has catapulted many students into a life beyond their wildest dreams and she is just getting started. Kathleen helps others step into their true potential and become the best version of themselves with their goals met. Kathleen graduated with two undergraduate degrees from the University of Windsor and the University of Toronto with a master's degree in nursing leadership. Her book, “Becoming The One", published by Hasmark Publishing, launched in August 2021 became an International Best Seller in five countries on the first day.    This Podcast Is Produced, Engineered & Edited By: Simplified Impact

Could our healthcare system be making us sicker rather than healthier? In the UK, autism diagnoses have increased by a staggering 787% between 1998 and 2018, and one in five people now has some form of mental health disorder. But what if some of our health struggles aren't diseases to be cured, but normal human experiences being medicalised? This week, I'm joined by Dr Suzanne O'Sullivan, a consultant in clinical neurophysiology and neurology at The National Hospital for Neurology and Neurosurgery, who specialises in the investigation of complex epilepsy and also has an active interest in psychogenic disorders.  Her latest book, The Age of Diagnosis: Sickness, Health, and Why Medicine Has Gone Too Far, aims to challenge long-held assumptions about medical progress and change the way we think about our health.  In this thought-provoking conversation, we explore: Why giving someone a diagnosis is never neutral – it can fundamentally change how a person views themselves, their body and their future possibilities How the definition of autism has dramatically expanded over the past few decades from its original concept of "extreme autistic aloneness" to now potentially including 1 in 20 children in Northern Ireland Why screening for diseases like prostate cancer can lead to unnecessary treatment The potential problems of genetic testing - when results are misinterpreted or used without proper context, especially with tests that aren't clinical grade Why early detection and treatment aren't always better, particularly when it turns healthy people into patients decades before they might develop symptoms The profound story of how Suzanne diagnosed a rare genetic condition in a 15-year-old girl, only to question whether she had actually done the right thing by medicalising someone who believed herself to be healthy This is a nuanced, compassionate discussion that challenges many of the widely held assumptions in modern healthcare and I would urge you to listen with an open mind. Throughout our conversation, Suzanne emphasises that she's not arguing against the existence of these conditions or suggesting everyone should refuse diagnosis. Rather, she encourages both patients and doctors to consider whether medicalising our struggles is always the right approach. I hope you enjoy listening.   Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore.  For other podcast platforms go to https://fblm.supercast.com.   Thanks to our sponsors: https://thriva.co https://drinkag1.com/livemore https://vivobarefoot.com/livemore https://airbnb.co.uk/host   Show notes https://drchatterjee.com/553   DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.