Introduction to Dr. Ashanthi Gajaweera

Kerry 0:28

All right. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have Dr. Ashanti Gajaweera. Welcome to the podcast. You can correct me if I said it wrong.

Ashanthi 0:41

No, it's Gajaweera, but you said it almost perfectly.

Kerry 0:44

Okay. Thank you. And we will call you Dr. G from Okay. So Dr. G, tell us who you are and what you do.

Ashanthi 0:52

Thank you so much for having me here. I'm a neurologist. I practice in Rochester, New York. I see patients virtually throughout New York State, maybe one day in Florida too. And my practice, HealthSpan Neurology, is focused on dementia prevention.

Why Dr. G shifted from traditional neurology to dementia prevention

Kerry 1:09

Such an important thing, as you obviously well know, but, and especially in Florida, we have a little bit of an older population and dementia is prevalent here, of course. So you spent over 20 years in traditional neurology. What were you seeing over and over again with patients that made you wanna make a change?

Can dementia really be prevented?

Ashanthi 1:27

Yeah, so I've been in clinical medicine for a long time and practiced within a more traditional model of care for over 23 years and had the privilege of working with over 10,000 patients, many of whom had neurodegenerative diseases. And time again, I see patients asking and myself wondering,"What could we have done to have prevented this? And, for years, I gave people very generic advice that I think most physicians are still doing, which is not wrong, it's just not adequate. And it's eat better, sleep better, get plenty of exercise. And I think those, that's the right, that's the right general inclination. It's just not very empowering or motivating. And I looked further into the research and studies that have been done in over the past 10 years in particular of information and on a daily basis studies that are telling us that dementia is preventable. At least half of dementia cases are preventable probably as much as 90% of dementia cases are preventable if we start early and are proactive. And I think that, within medicine, our intentions are always very patient focused and in terms of responding to patient needs, but it, the way our model of care is built is around addressing symptoms and addressing disease. And w- with dementia, by the time you're addressing a symptom, you've waited 30 years too late because we know that the changes in the brain that occur with dementia didn't start overnight. In most cases, in the majority of late onset dementia with diagnosis in the 70s or 80s, those people those brains started to change in their 40s, 50s, 60s, and that's really the window of opportunity to affect change. And once I saw that, frankly, it was really hard to go back. I tried instituting that into a more traditional practice and realized this is just not possible within the framework of a routine practice. And so I started my own practice, built almost entirely around this model of care. And along the way, I realized that women's brain health is incredibly important as well. So I became a menopause society certified practitioner and I don't know any other neurologist who prescribes hormone therapy but I feel well equipped to do that and, taken classes and experience in doing that now. And so I'm I'm outside the traditional neurology framework and I'm 50, I'm gonna be 55 soon. So personally speaking, it's really exciting for me to be doing something so far off the edge in a way. If you know any neurologists we like things to be just and I'm outside my comfort zone and it's really good for me and good for my brain. And if not now, then when. So that's what I'm doing.

Kerry 4:28

Yeah. I what you're doing is amazing. And unfortunately, you mentioned that, about this broken system. Can you elaborate on that, especially when it comes to brain health and dementia?

Ashanthi 4:38

I think that it's, our medical system is built out of necessity to address symptoms and disease, and that works when we've all had, we've all lived because of it. We've all benefited from it, right? So in terms of when there's an emergency, when there's cancer, when there's some type of cardiopulmonary or car- cardiac arrest, you need emergent medical care. I'm not saying that's not important, but for something like dementia I think perhaps one way to f- frame it is dementia doesn't start overnight, and because of that, we really need to affect change well in advance, and our system isn't preventative in the sense of looking at dementia, because it is so complicated. Our brain is incredibly adaptable and resilient. Our brain is constantly learning. Your brain at the beginning of this podcast is different from your brain at the end of this podcast. That's incredible, right? I- if you, when you go to sleep and when you wake up in the morning, your brain has changed structurally. And to do that takes so much energy and so much electrical energy frankly, and because our medical system is in silos, neurologists, for example, generally don't, like I said, we don't manage hormone man- management. We don't manage cardiac issues, we don't manage lipids, we don't manage diabetes or endocrine issues, all of those things, but we need to have an awareness of all of those in order to that window of opportunity that starts 20 to 30 years before problems occur because if we stay in the siloed medical system that we have, then the brain suffers because you can't just affect the brain by thinking of brain health. You have to affect brain health by thinking of the brain as being downstream of whole body health.

Kerry 6:42

That's definitely an interesting way to put it. I did not realize, my brain is gonna look different after the podcast, but I'm excited.

Why Alzheimer’s changes may begin decades before symptoms

Ashanthi 6:48

So, you know, I I actually studies have shown, I think it was if you, for example, look at and you put them through a math course for two weeks versus doing another type of cognitives task, but without formal training, their brains look different. This is controlled studies, but the, but their brains look different. If you just in terms of the amount of if you exercise a chemical called BDNF those, the amounts of that change after 30 minutes of exercise. You can really affect dynamic changes in your brain. We think of our brains as really I think we think of, a beating heart and a your lungs expanding and breathing, but we don't really We think of our brains as inert and just this lump but it is this pumping, thriving, buzzing organ that, we all learn in medical school and it's a fact, two to 3% of your body weight, but takes 20% of your body's energy, and that's all electrochemical energy. And if we appreciate how much energy our brain requires, then everything we need to do to maximize brain health, I think becomes more optimistic rather than seeing this as an inevitable decline or as a inevitable del- deterioration. We can see our brains as these thriving, buzzing organ that we can affect change on very actively.

Kerry 8:21

Interesting. Yeah. What you mentioned the Alzheimer's begins in your 40s and 50s, and that's the time to intervene. Why don't we catch it earlier? Is there just the symptoms aren't presenting or

What “preventative neurology” actually looks like

Ashanthi 8:33

Yeah. It goes back to your brain being incredibly adaptive and resilient, right? The way the brain is adaptive and resilient is two, twofold, but structurally there's neuroplasticity, which means you have formation of different connections and collateral networks in your brain. So your brain is just, it's, a hundred billion neurons and over a hundred trillion synapses connecting these neurons. And if there's a loss of neurons or a loss of synapses, there are collaterals or other through ways that those signals can take. So that'll happen for a very long time. And then the other is neurogenesis or new neurons. And, till 10, 15 years ago, we didn't really even know that was possible. We now know you can actually create neurons into your 90s, which blows my mind. And so that's So your brain is very capable of compensating for hits, right? Because that's just the nature of the brain is it's really good at compensating for loss. It's extremely adaptable. So for example, during menopause almost all women, will see a change in estrogen in the brain. It's by definition your estrogen levels plummet, and then your brain, which is full of estrogen receptors doesn't see estrogen anymore. So that's when you might experience brain fog, sleep disturbances, hot flashes, mood swings. We think of those things as hormonal changes, and they are, but the symptoms themselves, so many of them, the most common symptoms of menopause are actually neurologic symptoms because of what your brain is experiencing. And so in response to that, though, why don't women just fall off the cliff completely? Most women and I feel like I'm a testament to that. I'm about four years post-menopause right now, and most women will see a recovery of cognition or a recovery in sleep because your brain adapts. So we now know that, for example, through Lisa Mosconi's work at Cornell, that the you see a decline in the res- estrogen, and in response, you see an increase in estrogen receptors. So your brain is adapting, right? It didn't get all the estrogen it needed in order to function as well and in order to utilize glucose as well. So what does it do because estrogen is important, it makes more estrogen receptors, so it gets everything that it can so that it can function normally. That's just one example of why we don't see symptoms early. And we build this cognitive reserve, which is why we wanna keep learning, why we wanna keep staying socially active, socially engaged, have good mindset, build the stimulus, the positive stimulus, so that your brain is forced to maintain that resilience as long as possible. So even if that decline is occurring, you've built enough resilience that it's not going to manifest symptomatically.

Kerry 11:51

So you've built this practice around preventative neurology. What is, what does that mean, and how is that different from most people when they see a neurologist?

Ashanthi 12:00

Yeah just like we were saying before, when you generally see a neurologist, you come in with a symptom."I have numbness, I have brain fog, I have migraines, I have seizures, or I'm not able to walk, or my walking is impaired, I'm falling."Those are examples of the symptoms that many people will see a neurologist for. And I still do, I do neurologic consultation, I still see patients for that. Patients come to me typically when they feel there is a concern about dementia, either because of a family history or because they just are people who wanna be really proactive about their health and they know the statistics of dementia risk, which are pretty astounding. It's the lifetime, projected lifetime risk of dementia after the age of 55, if you live long enough, it's 42%. That's crazy. So when you think about that, those are the people that come to see me. So I I do evaluate any concerns that they're having if they're having trouble walking or, and brain fog and things like that and any symptoms. But what I do is a very sort of systematic assessment first of their risk and I use what I've made up my own model just to frame it for myself and it's called the A, B, C, D, E system. And so A is ancestry and genetics. So I do think that genetics is really important, so I do check most people for genetic risk. And then B is biomarkers, which is anything like brain imaging serum biomarkers if indicated body composition, cardiac testing VO2 max testing, all of those things that we know have a good correlate in terms of association with dementia risk. And then C is cognition and mindset. We do cognitive testing, and then mindset is around that feature of optimism that I was talking about in terms of, how, what your mental health and your mindset, how they frame your response to stimulus. And I think that's really key. And then D is daily habits, and that's everything like we think about in terms of lifestyle medicine. And then E is environmental, which is everything from toxins and hearing loss to vaccinations and our social environment, our cult- cultural environment. So going through that whole framework and then assessing risk figuring out where your risks are most malleable, like where do we have the best ways to optimize your risk and then putting together a framework of care that works for you because I could give you, we all know this in medicine, we can give patients a list of 90 things to do and they're gonna do none of them, 20 things and you're not, they're gonna do none of them. Five things per visit is about the max that you could probably ask a patient to do, and so getting to know my patients and then figuring out what's gonna work for them. It's really fun actually. In the world of neurology one of the things I think I do really well, I know this sounds like a strange thing to say, but in family medicine you do the same, is it has to be a comfort with sitting in a space of suffering and ill ease, right? That's essential to being a neurologist or clinician in general. So in a sense, this is really fun for me because I'm it doesn't mean that I don't enjoy working with those people, but this is a, this is really a shift in framework to more of a a framework of optimism and empowerment. So that's what the whole program that I do is motivated by, is making people educated and optimistic and empowered for their brain health. We do it over a six month, it's a six month program generally, and it's three visits in person and by telemedicine as well, and about six hours of time together. And it's a lot of time. You get to know me pretty well and vice versa. But it's really fun. And I think it's really made some significant change in people's lives and impacts, so yeah.

Kerry 16:15

You said some things that have surprised me that you have in your framework there. So one would be body composition. So tell me more about that. Why is that a risk or benefit or anything in preventing neurologic disease?

Ashanthi 16:28

Yeah, so it's huge. And the main reason is metabolic health, right? So if we think of the risk of diabetes, for example, in dementia, so 80% of patients with Alzheimer's have diabetes. So there's obviously an association if you think of it that way. And then if we look at the statistics of time of onset or diagnosis of diabetes, we see that the earlier you're diagnosed with diabetes the greater likelihood you will have of dementia. So if you're diagnosed with diabetes at age 55, it's about 50% risk of dementia versus if you're diagnosed with diabetes at onset at age 80, it's about 10%. So the longer you have diabetes, the longer the higher your risk of dementia. And I'm 55, and I, if I'm not careful, could very easily be pre- pre-diabetic. So what that means for my personal health, for example, is then I don't wanna not just be, just not be diagnosed with diabetes. I don't wanna even be close to pre-diabetic, right? And so we know that body composition is an excellent way of maintaining metabolic health by knowing and controlling your visceral fat, by building your lean muscle, your skeletal muscle, by being aware of those numbers, then you can take actionable steps to really focus your work. So I'm a relatively slender person who exercised maybe three to four days a week about, I'm just giving you an example about 10 years ago, but when I took my, did my body composition, I realized I'm exercising and I'm relatively slender, I eat very healthy, but I was skinny fat if you looked at my visceral fat, right? So that's a really important indicator of me preventing pre-diabetes from myself in order to minimize my dementia risk. So that's an example and it's very elucidating to patients because many people who think they exercise on a regular basis for three, four days a week, once we do body composition, we'll realize we could and should, depending on your risk profile all, all together, we should and probably to maximize your body composition in a more healthy metabolic way.

Why VO2 max and exercise matter for brain health

Kerry 19:18

Yeah. I s- to preach to my patients or explain their body composition with the visceral fat, stating that it's, the more inflammatory one, and I'm sure you're gonna bring up inflammation in the dementia risk. But yeah, I love using the body composition as well. Maybe not targeting it at neurologic health, but maybe that would be another, kicker,"Hey, reduce your visceral fat and you may have less risk of dementia." So I think that's a great plus to motivate the patients to improve it, right? Yeah. You also mentioned VO2Max, which I don't know if all of our listeners know what that is, but you test that as well in your office?

Ashanthi 19:55

I do for the, it's, I don't force anybody to do anything. And some people are like,"Yeah, there's no way I'm doing that. But I think it's really beneficial because, it goes back to that, there's really good studies showing VO2 max and lifespan and health span. So aside from that, if you look at it from the energy standpoint of the brain So I think all of this comes down to how energy greedy our brains are. And as we age our energy efficiency declines. So if you want your energy efficiency, meaning those little batteries, the mitochondria to work as well as possible, you need to start improving that from as early in age as possible. And it is a VO2 max is about the most motivating way that you can show somebody how energy efficient their cellular makeup is, right? I think it's a nice way to say, how strong is your battery? And with age, our battery is going to decline because it's had so many charging cycles, right? Just like we think of any rechargeable battery. It's had so many charging cycles, but if you can maximize its efficiency, then you can eat a few more charging cycles out of it. And I think a VO2Max does just such a good job at showing us that, and it's really changeable, right? So body composition takes years to really sometimes see dramatic changes. It's very motivating to get you to do something, but sometimes it's, it can be a little bit discouraging, especially depending on your own body shape and genetic makeup. You might not get the body composition you want, but you can see significant gains in VO2Max, and I think that can be very motivating for people. And I feel, I think it is incredibly powerful in shaping brain health and brain energy efficiency.

Kerry 22:03

Another thing you mentioned was vaccination. Do you ha- I don't know where you're going with that one, other than there was some new literature out about the shingles vaccine, but

Ashanthi 22:11

that's the main one, but there's thoughts about some others, but shingles is the main one. And it's just an example more than anything that there's external factors that we should be considering that traditionally we really haven't even thought of as part of neurolog- or as part of a long-term brain health. As a neurologist, I think, through training, I saw many cases of HSV encephalitis, and it's a devastating illness to observe. And it also makes you think how many mild like HSV encephalitis are occurring that just don't come to fruition, hemorrhagic changes in the brain and seizures, how many cases of milder encephalitic viral illnesses are occurring that might then linger and harbor in the brain to cause inflammation, so I'm not saying that va- vaccines are We know that all vaccines are preventative or supportive in terms of preventing dementia, but there is pretty good evidence for shingle, the shingles vaccine and in general for trying to And like back to the inflammatory and the immune response to supporting your immune health, I think that's a huge part of it.

Kerry 23:40

Yeah. I, okay, so you were saying that maybe not the vaccine itself, but preventing those mild or potential, we don't know they're happening viral illnesses that could be causing inflammation in the brain that could have had at some point Obviously preventing those could be helpful to reduce inflammation in the brain. So a vaccine would help prevent it, right?

Menopause, estrogen, and women’s brain health

Ashanthi 24:00

Yeah. So it's one of those simple things. So I think it's something like sh- if we, if the study that looked at the shingles vaccine, it reduced the risk of dementia. I think it was like 20 years later in the folks that got the get the vaccine, something like 40%. So that's a tr- sig- significant really easy thing in terms of getting the shingles vaccine. One, shingles is terrible and chronic post-herpetic neuralgia is absolutely awful. But then in terms of just it's a relatively simple thing and I'm surprised when it's an easy thing to recommend to people is just to get your shingles vaccine.

Kerry 24:44

Yeah. Yeah. It is a doozy of one. That's what I always say, you're gonna maybe have some flu-like symptoms, but I think most people, once they have witnessed someone else having shingles, they're like,"Oh my gosh, I'm getting something." Yeah. What So one of the most fascinating parts of your work you already brought up was the menopause and brain health connection. So you described the menopause as a neurologic transition, right? And the estrogen receptors go increase because the estrogen is down. Does this create you alluded to that already, but it creates a higher risk of Alzheimer's disease in women. Is that correct?

Ashanthi 25:18

Yeah. So statistically, epidemiologically speaking women c- comprise two two thirds of dementia cases. So that in itself is pretty astounding. Now, some of that has to do with the fact that we do live a little bit longer than men, but even when you account for that change in in, in demographic as we age women still are prob- for every two men with dementia, there's three women with dementia. So we still have a higher likelihood of dementia, even accounting for age. And we also know that the changes that occur in the brain, so for example, the things we really are very familiar with in terms of amyloid and tau changes, amyloid plaques and tau tangle buildup, we see those changes occurring 20 to 30 years before a diagnosis. So that coincides with the change with menopause for most women. So the diagnosis, average age is around 78, 80. If you then work 30 years back, boom, that's right around menopause for many, perimenopause for many women. And then looking at imaging studies we see that there's significant changes in gray matter volume. We see that there's an increase in white matter hyperintensities. These are the changes in the myelin and the connectivity between, in, between neurons. We see decreased energy in parts of the brain that overlap with the changes that we see with Alzheimer's. So the brain changes quite dramatically structurally as well as physiologically pre, peri and post-menopause. So for women, it's this and this change doesn't occur when we look at men of the same age. So there's the pre-menopausal brain looks similar to a men's brain. Perimenopausal brains have a dramatic change, for example, in energy, white matter changes, and gray matter volume. And then postmenopause, a lot of these things improve. They don't go back to the premenopausal state, but they even out so they're not as bad as the depths of perimenopause.

Kerry 27:44

So even if you don't treat with estrogen, the, it can improve?

Ashanthi 27:48

Yeah. So the the studies were done on women without exogenous without using hormonal therapy. We don't know So in terms of helpful, so I'll just try to answer that as best as we can. And this is just fraught full of controversy, or depends on your your i'm gonna stick to the evidence. So the observational studies are pretty good that alone is protective for dementia, but these are observational studies. In randomized control studies it is very age dependent. So estrogen, especially when delivered with progesterone and in these older forms of estrogen like Prempro which I know your prior guests have talked about those have shown, have been shown to increase risk of dementia, but those studies didn't look at the target age of younger women that we're usually looking at now in terms of starting estrogen and menopausal hormone therapy through their perimenopausal symptoms, which is more typically between the ages of, in the 40s through 50s, rather than those studies that were done looking at women more in the a- later ages. I think the average age was 63. So the way I approach it is really symptom-based. If a woman is having hot flashes sleep disturbances, and certainly if there's brain fog, I first try to really address lifestyle changes that might help with those symptoms, because oftentimes, we can at least affect some positive change. But for many women, hormone therapy through menopause or perimenopause is extremely helpful in controlling symptoms, and with better more stable mood, with less brain fog, you are going to feel more optimistic, and that cycle is going to improve, and you will be on a better trajectory towards better brain health long-term. So I do treat with hormone therapy in the right individual based on their risks, their age, not necessarily targeting dementia prevention, but targeting how we manage your symptoms now in order to optimize your future brain health.

Kerry 30:18

Do you have any anecdotal stories of how that has helped some of your patients?

Ashanthi 30:23

Yeah. So I think that if in their late 40s start to get hot flashes, and they didn't actually think their hot flashes were too severe. They didn't really think their cognitive brain fog was too severe. What they really found was that the world was just really annoying, and it was through COVID, so the world was really annoying, but this persisted and with the family history of dementia, they sought specialized attention from me in terms of addressing this. And once we really got down to it in terms of looking at, I tried to do with someone like this, I would try to do a sleep log, saw that their sleep was actually quite disrupted that their energy level was quite poor they had mild sleep apnea and their outlook and motivation was really This was a fairly a person who'd never had depression or anxiety before, but was manifesting with symptoms of significant anxiety. And then starting hormone therapy, Along with other things, but hormone therapy allowed them to sleep, So that improvement in sleep sets the foundation for everything else. And so this person's brain imaging, for example, showed some white matter changes, and they didn't have a strong migraine history, they didn't have hypertension matter changes, which I think might have been due to hot flashes that were occurring at night because we know in studies that an increase in hot flashes, especially nocturnal hot flashes, leads to an increase in white matter changes. And so that imaging also persuaded me to say,"I think that hormone therapy might be helpful for you, and this improvement, the most dramatic improvement was in terms of sleep. And then the sleep set the stage for better cognitive resilience and feeling better through the day, so that you then have more energy to actually exercise through the day, you're more optimistic because you exercise and you got that done in the morning and now the day is better. So it, it's just one thing leads to another. And I think that I think for years, I myself told women"You have so much on your plate." Obviously, it's just a lot. I don't know if it's menopause, but it's, there's, you're going through so much. And I think that both of those things can be true, right? It can be a physiologic state, but it can also be that women, we have a lot on our plate right now. And so putting those things together, your plate's not gonna get any lighter, but maybe you can just build a little more strength to, to hold that plate up with hormone therapy. So in this person, just getting back to them, they're feeling pretty good and that allowed them to take a more proactive outlook at their overall health and wellbeing rather than feeling like I'm on this downward spiral. I turned 50 and now, it's doom and gloom and it's the end. Instead, I think they're feeling like I, I turned 50 and I can do whatever I want and feeling more empowered at that stage in life. And I want all women to feel that way.

Kerry 33:44

Oh, absolutely. You mentioned someone feeling doom and gloom at 50. Is it ever too late to start thinking about your brain health?

Ashanthi 33:52

No, so as I trained in the'90s and at the time when we learned that neurons don't regenerate, neurons don't, you don't get, you get what you get and that's it. And now to know that you can grow neurons is amazing. So I don't think it's ever too late. My oldest patient, I love him, he's 86 and he is a retired professional, retired very recently and just wants to stay as sharp as long as he can. I don't think it's ever too late. And I think knowing that and being motivated and having that outlook in life is really important. I think that sometimes I, I'm gonna be, say for myself as well as a neurologist, I s- I've seen so much disease and so much neurodegenerative illness, it's sometimes easy to feel like that's just inevitable. It's just a matter of time for all of us. I think we're all gonna fall off a cliff one day. That's just life. It's it's the cliff of life, but, genetics sets how high that cliff is, but you can build a parachute and you can build a parachute even when you're in your 70s and 80s. And if you got to your 70s and 80s, it means your cliff isn't that high, isn't that low. I really don't think it's ever too late.

The top habits to support lifelong brain health

Kerry 35:10

Yeah. So what should someone either in their 40s or 50s or at any time really start doing like right now?

Ashanthi 35:17

Mindset I know that's, that, that shapes everything you're going to do, right? If you have a mindset of growth, and brain growth, then every decision you make, whether it's to eat that bag of chips or it's to go exercise, or it's to learn something new, or it's to be on a podcast when you're a really introverted, introvert. It's a matter of brain growth, right? So you are, or you are giving either negative or positive stimulus to your brain, and that might shapes the decisions you make. And we all make, I ate some chips yesterday, I'm gonna be honest, I just love them, but it's the mindset that sh- helps you shape making those regular decisions on a daily basis that incrementally shape brain health.

Kerry 36:09

Are there, would you say there's any two to three specific actions other than mindset that someone listening today can start doing to protect their brain?

Ashanthi 36:17

Yeah, exercise and more of it. I'm sure that many of you, many of your listeners know this, but the good news about exercise is more is almost always a little bit better, but even if you don't do a lot going from zero to 30, actually I'm figuratively speaking, but going from none to a little is incredibly helpful. And but if you can, you get a little bit out of breath at least, four to five times a week for 30 minutes. If you can get a little bit out of breath, enough that you're talking to your friend, but they know that you're huffing and puffing just a bit, and you need to take turns during that conversation that's the start. That's where I would say, for everybody, exercise is the list of good, healthy things that it does for your brain in terms of physiologic benefits, it's just countless. It's the thing that just keeps on giving. So yes, I would say exercises is one. And then I think supporting good sleep is really incredibly important. If you're gonna do one thing in terms of your sleep, it's to anchor the time you go to sleep and the time you wake up. And that, the reason that's beneficial is it anchors your circadian rhythm. It's not just that nighttime sleep that's important, it's what you're gonna do during the day, because each of your cells has a body clock, and by setting that circadian rhythm you're setting your clock for the 24 hours of that, that it's, that it needs to function. So sleep is the second. And I'm gonna say the third is, I, it might sound like a cop out, but I think it's huge. It's pick your stimulus, right? So pick your stimulus. Is it gonna be scrolling on your phone, guilty, but no, it's not good for my brain, or is it gonna be learning a new craft or or writing, or handwriting? If it's as simple as just just handwriting and penmanship, or picking up a paintbrush, or learning to dance, my 80-year-old mom is gonna be in a singing contest next month. I'm so excited for her. So she's, she's picked up a new skill. So pick your stimulus and make it positive, make it something, think of your brain as this generative buzzing organ, and then you wanna feed it with the most positive stimulus you can. So those are the three things, exercise good sleep for restoration and body clock setting, and then the third is just pick your stimulus, make it a good one, make it fun.

Kerry 38:48

That is excellent advice. I think you have covered so much. Is there anything else that you wanted to say that you didn't have time for yet?

Ashanthi 38:57

I think we covered a lot. I think I, I really want people to feel positive and motivated and educated and empowered, most of all empowered. You can take agency over your brain health. I really like the analogy of the cliff and the parachute. Build your parachute. It's so much fun. It really can be I think that healthy brain aging is everything.

Kerry 39:22

Where can people find you if they wanna follow you or work with you?

Ashanthi 39:25

So you can see my website. It's healthspanneurology.com. And you can follow me on Instagram, LinkedIn, YouTube, and I'm Dr. Gajaweera, so d r gajaweera. And yeah, so I'm happy to connect with folks, and I see patients throughout New York, maybe one day in Florida. I have a lot of snowbirds who come out there maybe one day soon.

Kerry 39:51

It's probably a good state to add on, I think, for sure. Yeah all we'll put all that information in this show notes. Thank you so much for coming on. I think there was a lot of good information for the listeners to gather today, so I'm excited for them to hear this episode. But everybody, stay tuned next weeks for next week's episode and get Healthy Tampa Bay. Thanks, Dr. G.

Ashanthi 40:12

Thank you so much.