Dr. Briana Auman – The Need for Cognitive Disease Testing
Dr. Briana Auman is a neuropsychologist who specializes in Alzheimer’s disease, Parkinson’s disease, and dementia. She’s currently based at the Banner Sun Health Research Institute, where she works primarily with adults and geriatric patients. She completed her fellowship in neuropsychology at the University of Virginia, cultivating her specific passion for neurological diseases. Dr. Auman enjoys teaching and training the upcoming generation of neuropsychologists.
Here’s a glimpse of what you’ll learn:
- Dr. Briana Auman’s pathway to becoming a neuropsychologist
- The utility of different tests for cognitive health
- Dr. Auman talks about Identifying cognitive issues in loved ones
- Which test questions are most predictive of future diseases?
- How the training program at Banner Health works
- The key signs to look for in people who might have dementia
In this episode…
With no known cure for Alzheimer’s or dementia, the best-case scenario for those with neurological disorders is to be diagnosed early on. Earlier testing has been growing for cognitive diseases, but there’s still a long way left to go. With barriers like access, awareness, testing usually takes place after the symptoms have already set in.
Dr. Briana Auman’s philosophy is to test early and broadly — a sentiment shared with her coworkers at the Banner Sun Health Research Institute. She is a trusted neuropsychologist with an expertise in dementia, Alzheimer’s disease, and other cognitive disorders. She works with people on a daily basis to test and take care of their health.
Dr. Mark Syms invites Dr. Briana Auman, a neuropsychologist at the Banner Sun Health Research Institute, onto the ListenUp! Podcast to talk in-depth about testing for cognitive diseases. The two discuss the warning signs of dementia, how loved ones can help identify the condition, and how early someone should be tested. They also talk about Dr. Auman’s process for testing her patients and which methods she uses. Stay tuned to hear all this and more.
Resources mentioned in this episode
- Arizona Hearing Center
- The Listen Up! website
- Listen Up!: A Physician’s Guide to Effectively Treating Your Hearing Loss by Dr. Mark Syms
- Dr. Mark Syms on LinkedIn
- Dr. Briana Auman
- Banner Sun Health Research Institute
- ”Dementia prevention, intervention, and care: 2020 report of the Lancet Commission”
Sponsor for this episode…
This episode is brought to you by the Arizona Hearing Center.
The Arizona Hearing Center is a cutting-edge hearing care facility providing comprehensive, family-focused care. Approximately 36 million Americans suffer from some sort of hearing loss, more than half of whom are younger than the age of 65. That’s why the team at the Arizona Hearing Center is focused on providing the highest-quality care using innovative technologies and inclusive treatment plans.
As the Founder of the Arizona Hearing Center, Dr. Mark Syms is passionate about helping patients effectively treat their hearing loss so that they can stay connected with their family and friends and remain independent. He knows first-hand how hearing loss can impact social connection and effective communication. By relying on three core values—empathy, education, and excellence—Dr. Syms and his team of hearing loss experts are transforming the lives of patients.
So what are you waiting for? Stop missing out on the conversation and start improving your quality of life today!
Welcome to the ListenUp! podcast where we explore hearing loss, communication, connections and health.
Dr. Mark Syms 0:15
Hi everybody, Dr. Mark Syms here, I’m hosting the ListenUp! podcast where we feature leaders in healthcare. This episode is brought to you by Arizona Hearing Center, I help patients to effectively treat their hearing loss so they can better connect with fans and friends and family and remain independent. The reason I’m so passionate about hearing loss is I lost my brother Robby twice, first to hearing loss from radiation from his brain tumor and then complications from his brain to I am the founder of Arizona Hearing Center I treat the E of ENT i only treat years at performed over 10,000 year surgeries in my 20 year career. And I also treat 1000s of have since an oral hearing loss or nerve hearing loss. If you want to learn more about my book, which I’m an author of it’s called Listen Up: A Physician’s Guide to Effectively Treating Your Hearing Loss you can go to www.listenuphearing.com or you can go to my practice website, which is www.azhear.com. I am really excited today I have Dr. Briana Auman, she is a clinical neuropsychologist specializing in aging and larger brain disorders. She earned her doctorate degree in psychology at Yeshiva University in New York, excuse me. And then she completed a two year postdoctoral fellowship in the Department of Neurology at the department, a University of Virginia health services, you now join the Banner Sun Health Research Institute, and she provides outpatient or psychological testing. She also supervises graduate students, and helps run their brain here at health check program. It’s a free community program to see if you have cognitive problems outside of work, and she spends her time gardening and working on her new house and exploring restaurants at Phoenix. I’m really excited to have her here. Welcome on the show.
Dr. Briana Auman 2:02
Oh, thank you for having me.
Dr. Mark Syms 2:03
Oh, my perfect. My pleasure. Can you tell me so I always want to tell people what, okay, so now you’re a neuro psychologist who specializes in aging, who as background for the listeners, who also did a podcast on hearing loss and dementia. And we’ve worked together before, but we don’t want to get that far. How did you go from being whoever you were to being a neuropsychologist, tell me your your pathway to that.
Dr. Briana Auman 2:30
As an undergraduate student, I was well first of all entered pre med, I wanted to help people wanted to do something in the healthcare field. But it turns out, it wasn’t very good chemistry. But it was the best failure ever, because it might be on the path that I am now. So I switched to psychology and was so excited about helping patients through therapy, counseling, things like that. And then once I finally got into grad school, years later, I realized that that was really hard without having a decent assessment of what the problem is begin with. progress there. So that’s what led me more towards the assessment side. And as you get deeper each layer of asking, Well, why is that? Why do they do that? Why does their brain do that led me into neuro psychology.
Dr. Mark Syms 3:16
When you say the assessment side, can you expand a little bit more, I mean, I know what you guys do, but we can you for the listeners to explain what that means.
Dr. Briana Auman 3:24
So in psychology, there’s all different kinds of tests, great tests of personality that you can even take online. Now. Back in the day, there was like the more shop inkblot test to death, your personality, your mental functioning. And those capture traits really well. But I felt like I was still kind of missing the underlying neuroscience piece, like where’s all this coming from? So that made me want to specialize adding in the brain part.
Dr. Mark Syms 3:53
Okay, and so you do end up testing a particular key other brain is functioning.
Dr. Briana Auman 3:58
Yes, that’s what we do. Now, we do end up testing the end result of all those electrochemical signals in the brain. That’s memory, that’s attention. And so that’s what we end up measuring, try to infer what’s going on.
Dr. Mark Syms 4:12
So what type of reasons for patients be sent to you for evaluation.
Dr. Briana Auman 4:17
In my clinic, at least, it’s mostly people who have concerns about their memory, or some other aspects of their thinking that they feel like is changing as they’re getting older. So that’s always a big question for me as long as I change for you.
Dr. Mark Syms 4:33
And so, we assess that, you know, if you don’t have a baseline, right, like so they probably didn’t come in and get testing to say, Well, now I’m thinking normal, and my memory is good. So let me go get a test. So then if it changes, so how do you do that?
Dr. Briana Auman 4:47
I wish that everybody did have a baseline. So I always feel like it’s okay, I’ll schedule mind. It’s a great idea. So we kind of call it like a checkup from the neck up. You know, you go in every year and get your Heart tested the blood pressure there a one C for diabetes, but nobody thinks to worry about their cognitive functioning until they have concerns. But since we’re not at that point yet, we try to get an estimate of cognitive functioning based on some general factors like education. What someone did for a living, what their skills would be, someone who worked on jet engines is probably going to have a lot stronger visual problem solving than their verbal skills. But we also have some tests that are affected even by the changes associated with aging and tobacco. Use those estimated baseline and compare everything against that.
Dr. Mark Syms 5:43
So what’s the most unusual occupation you’ve had a patient? Because I can’t imagine that somebody’s like, wow, I never thought anybody did that further.
Dr. Briana Auman 5:53
That is a great. I have met many people who work their whole careers as self published authors, and I never knew that was possibility. Wow.
Dr. Mark Syms 6:07
Yeah, that’s right all day and are able to sell enough books to make a living.
Dr. Briana Auman 6:12
And they got to keep doing it, like, I would say, into retirement, but they’re still working but well into their 70s and 80s.
Dr. Mark Syms 6:20
They must have had, like dozens and dozens of books and a written one. That’s a lot of work. Just for some people. It’s a love, obviously. And so do they get referred by family, friends, their physicians? How does? How does one get to you in terms of not just physical calling of the phone number, I mean, what is the typical pathway to?
Dr. Briana Auman 6:41
People will follow up with their primary care doctors office, and during your visit mentioned, I do have some concerns about my memory, as their primary care doctor might do a short cognitive screening, hopefully, either Ray or refer them on to us because those short cognitive tests don’t always pick up on things. They’ll see one of the neurologists at our clinic, and 95% of our patients with our ologists also get cognitive testing an important piece of the puzzle.
Dr. Mark Syms 7:15
So one of the things I mentioned in your introduction was, you know, the brain health check. And so what does that program composed of lower? You know, somebody is going to get a bring up checklist, what does that mean?
Dr. Briana Auman 7:27
We just started this program about two years ago. And it’s a totally free community service. People don’t, don’t have to be a patient of any particular clinic. And you don’t have to sign up for any research. It’s just that we felt that a lot of people were being Miss getting that cognitive screening, maybe out their primary care, doctor’s office. So what it is, is people do short cognitive assessment about 15 minutes. And we put that into an algorithm that compares that to what are the expected results? And actually, more pieces, give them a printout that shows where you stand related to what we would expect. And
Dr. Mark Syms 8:09
So it’s like your vitals or your brain.
Dr. Briana Auman 8:11
Dr. Mark Syms 8:12
So what what does that test consist of? Is that the milk, what is?
Dr. Briana Auman 8:18
Actually it’s like a mocha plot. So we do a mocha, also some additional tests of language visualization skills, we weren’t really captured there. And then some questionnaires, and one of them is about genetic changes in thinking daily functioning, because that’s actually been shown to be a really important predictor of later cognitive change, even if every cognitive testing will find.
Dr. Mark Syms 8:44
So for the listeners, the mocha is atrial cognitive assessment. It’s a test that people can be taught how to do to, initially so many people, and so if correct, if I’m wrong, Did I just hear you say that people their own awareness of their cognitive issues, one of the most predictive things of cognitive problems?
Dr. Briana Auman 9:07
Right. So for example, in our screening program, if someone endorses concerns about changes in their functioning over the past number of years, even if they perform well, they’ll still be in our high risk category. And we’ll recommend that they get an additional evaluation.
Dr. Mark Syms 9:22
Yeah, I see. Interesting because you know, if you think of athletics, right, I mean, you know, if somebody was performing at the level of an NFL player right, and then drops down to playing at the level of peewee from for many of us, playing at the level of peewee might be great. But for those people, it’s a huge performance decline. So it is hard because it has been normalized to the way you were used to functioning. If I’m not mistaken. That’s exactly what it’s designed to capture. And so habits of Winston’s passes, are they highly predictive of cognitive issues? The wife or a husband or a loved one, are they highly productive do you have cognitive issues?
Dr. Mark Syms 10:02
That’s and that’s actually a part of it to begin to get a brain health check and chooses to bring someone with them and is okay with their person with them also filling out some of the questionnaires nearly have the exact same questions, we get their perspective too, because that’s also been shown that it can predict your cognitive decline.
Dr. Mark Syms 10:22
So I guess the takeaway could be if your loved ones telling you your memory is not as good as a blessing, it probably is not as good as much, right? Because it’s really like, why would a loved one tell you that? Unless true, right? I mean, unless they’re the meanest person around?
Dr. Briana Auman 10:37
Exactly. They don’t want to hurt you. And if anything, it might come up during that meeting. And our brain health took it and never was mentioned before. because nobody’s asked.
Dr. Mark Syms 10:48
You know, I’ve always, you know, one of the things that fascinates me about medicine is like utilization like so of the people who should I mean, what percentage of people are actually coming to you? In other words, you have a predicted size of a patient population that has this problem. And then of that predicted size, what percentage are actually getting this type of evaluation today? I bet it’s small, unfortunately, just-
Dr. Briana Auman 11:14
That’s there’s huge proportions of untreated dementia, unfortunately, especially in populations that are most at risk. Or underserved populations, whether that’s based on their demographic background, or where they live like it rural area. epidemiological studies show those people are most at risk of developing dementia, or they’re the least likely to seek out.
Dr. Mark Syms 11:39
So is it a small fraction should be evaluated are getting evaluated?
Dr. Briana Auman 11:46
I think it’s growing, though, because I think older, Alzheimer’s disease and other dimensions kind of go along with it, but we’ll take it.
Dr. Mark Syms 11:55
No, that’s great. I mean, you know, and, and so are, is their outreach to the primary care doctors about this issue? Or how does what does that?
Dr. Briana Auman 12:06
Yeah, that’s funny, you actually mentioned another new program that we have here. It’s called dementia care partners. And they train health coaches to work with people with cognitive problems. And it’s all done through primary care. So it’s made to try to reach out to those people who don’t get into one neurology specialty clinic, but still need the psychosocial support. So I’m just reviewing medical records, we’re affiliated with a few different primary care doctors here in the Sun City area, and just look for signs that that could be some sort of cognitive problem, and then reach out to the doctor. And if they say, It’s okay, they go right to the patient without all of the testing in between.
Dr. Mark Syms 12:49
So you guys are prospectively looking at charts for this assumption, like getting that correctly.
Dr. Briana Auman 12:56
You know, both ways. So they’re reviewing charts looking for like certain keywords. And then also the doctors can make a referral directly to them if-
Dr. Mark Syms 13:04
Are you using artificial intelligence or something?
Dr. Briana Auman 13:08
Dr. Mark Syms 13:09
Just reading or reading, right. And so are there particular questions that primary care doctors ask on a regular basis that are more predictive than other ships saying, like, you know, I mean, people always ask, like, how many flights of steps can you go up without getting out of breath, for instance, is a very typical question, a primary care doctor will ask to see if they have heart disease. Right. So is there are there some that are in the standard corpus of questions that primary care that are maybe more predictive of dementia? I’m just now I’m really kind of just wondering out loud.
Dr. Briana Auman 13:40
I think in general, the last about concerns about your memory. I think the depression questions are also really relevant to the questions about mood, could be a sign that there’s action, because there’s things to worry about in the world, but they could be a sign that there’s some brain changes happening to that or emotional processing. But I really like the functional ones, like character medications. And if it turns out over the past couple of years, a lot more responsibility has shifted to this house.
Dr. Mark Syms 14:13
Yeah, no, that makes sense, right? Because, you know, you got to put in the hours of the day box and all of that stuff. So that that is some calculation and memory of? Well, you know, I know, one of the things that you and I have talked about is is hearing loss and dementia. And I know, one of the reasons I circle back to you is you’ve done a prior presentation about So, you know, tell me your take on that poll connection. It’s become, you know, the literature the research is becoming stronger and stronger. So, you know, if you could speak to, you know, what the thinking is mechanism extension.
Dr. Briana Auman 14:51
I think the mechanism question is what they’re investigating Now, before we can get there, so I thought It was really interesting how I was reviewing the literature and finding more and more evidence. And then within this past year, I finally got recognized by those big epidemiological studies. And then that gets picked up by something like the New York Times. Just even research into it. Hopefully now also makes it a lot more accepted among the general population, that hearing loss, maybe consider something you can do to prevent dementia.
Dr. Mark Syms 15:32
Yeah, so you know, what’s very much us and our us as the Lancet position paper on dementia, and modifiable factors. And so, you know, what’s coming through our literature is that hearing loss is the most modifiable factor at a large like, five fold over, you know, lowering your cholesterol blood pressure, which are, you know, exercising blood pressure have always been the two things that people have been told to be preventative for dementia. And it’s kind of interesting that they’re finding the impact of that magnitude impact is greater for hearing what’s
Dr. Briana Auman 16:10
really interesting, the fact that it’s much more than things you can’t change, like genetics, which everyone’s always worried about.
Dr. Mark Syms 16:17
I always tell people, there’s a lot of things, you can’t escape your genetics.
Dr. Briana Auman 16:23
So usually, more sorry, hopefully, some of these modifiable things count even more.
Dr. Mark Syms 16:30
No, that no, it’s it’s true that I overall diseases, right, not necessarily dimension. And so you also train students, what how, What’s that like?
Dr. Briana Auman 16:41
So our students, primary role is in our brain and body donation program, where participants come back yearly for a range of assessments, and one of them is our cognitive assessment. And that’s staffed by our students, their graduate students usually advanced towards closer to graduation and starting school. And they’re here to learn more about neuro psychology, get experience working with older adults, and really learn how to give the test and the nice, nice format. So every year, I’ve learned that working with students makes me realize how much you don’t know. Because they always ask questions that we all have to just look up together. So it’s so good to have that like fresh perspective, every time.
Dr. Mark Syms 17:25
So one of the things that I you know, research projects you guys have going on your institute in terms of dimension.
Dr. Briana Auman 17:34
And growing is something I’m learning. But I was thinking about this. And it really lines up with our talk about hearing loss as a preventable risk factor, because one of the big focuses is prevention study. just observing people over time to see what are some of those other risk factors. And then some are a lot more active with testing out a drug that could potentially treat or reverse those early ranges.
Dr. Mark Syms 18:03
So you guys are basically touching memory problems with dementia, across all the spectrum, detection, prevention, treatment, cause, pharmacology, all that stuff.
Dr. Briana Auman 18:17
That’s what’s really cool. That’s actually what drew me to the tree was that there’s all these different intersections of ways that they’re trying to address the same problems. So I never worry about being out of a job. What is a cure Alzheimer’s disease? Are you going to do?
Dr. Mark Syms 18:39
Well, the other question is not to be but if all timers get skewered, it will likely be cognitive degeneration of other mechanisms that need to be addressed.
Dr. Briana Auman 18:50
Yes, absolutely. And in the meantime, we can still help everyone great strengths and weaknesses, which could exist with or without Alzheimer’s, please focus on how to improve cognitive functioning. So I don’t think that’s going away anytime soon.
Dr. Mark Syms 19:07
So how often do you see patients with hearing loss?
Dr. Briana Auman 19:13
Patients with any hearing loss at the time, I now know that actually having hearing loss at low levels that they don’t even notice it’s probably 100%.
Dr. Mark Syms 19:25
Or a little bit less, but yeah, it’s pretty prevalent. That’s for sure. 80% of 80 year old Savitri. As they get older, and I assume the age of your average patient is relatively high, based on your location, its density.
Dr. Briana Auman 19:39
We actually don’t see patients under 6065 typically really specialized hurdles.
Dr. Mark Syms 19:45
I didn’t know that. And so just as a you know, I was just thinking about it as an overall in your institute. How many people are involved in the institute like in terms of staff, I mean, it’s pretty big if I call but you know, how many clinicians and people are involved?
Dr. Briana Auman 20:01
Start small with our department even has grown over this past year. So we have two full time nurse psychologists, but also postdoctoral fellows. So myself a couple years ago, they really get to function like neuropsychologist and or psychometrics, and then also senior psychologist, coordinators and assistant and that’s just our team
Dr. Mark Syms 20:26
So psychologists, people who administer the test.
Dr. Briana Auman 20:29
Yes, they have the hard job, talk to patients learn about their backgrounds, interpret their data, but they actually collect it.
Dr. Mark Syms 20:40
So that’s just here to fire, multiple other departments.
Dr. Briana Auman 20:44
We also have neurologists, and neurology, nurse practitioners, of course, all of our awesome like medical assistants in front office staff, and our science researchers in the autopsy lab.
Dr. Mark Syms 20:59
And like statisticians, you must have all that work to research support.
Dr. Briana Auman 21:04
It kind of depends how far out it goes, because we also have our sister campus, the Banner Alzheimer’s Institute downtown, and we basically mirror each other and do the same things.
Dr. Mark Syms 21:13
That’s amazing. That’s amazing. So, you know, if somebody wanted to get an evaluation, you know, what things would you tell them they should be looking for? Or what what are the things that you would say, hey, this or this is happening, you should consider getting?
Dr. Briana Auman 21:30
Just as Jim, I think one of the big things is thinking about, is this different than myself just a couple years ago. Of course, everyone’s going to be different than they were when they were a young adult. But it’s there’s been a big change in how sharp you feel, are the things that you do notice that the world has gotten smaller. But really specific things that people often tell me is forgetting conversation. People start saying, Yeah, you talked about this, remember? That’s a sign that definitely worth checking out.
Dr. Mark Syms 22:09
That’s a short term memory issue.
Dr. Briana Auman 22:13
Long term memories that if I had a nickel for every time I heard, I can remember things from so long ago really well. Those are really resilient. They typically aren’t affected by any of these, or energetic diseases.
Dr. Mark Syms 22:24
They’re also landmark memory, right? I mean, they don’t, they don’t remember what they have for breakfast on there, you know, nine and a half years of life, they remember like big events. That’s the silver lining is those important memories usually don’t go anywhere. That’s great. That’s, that’s encouraging. So, other questions, I always like to ask people, you know, I was asked people, who would you thank? If so if people said to you, you know, you’re getting award lifetime award, I want to thank those people on the stage.
Dr. Briana Auman 22:57
Oh, I have to start with my husband who’s followed me around the country for this different training. And I only do this up here in Arizona, which I think was our biggest adventure. And then also my parents who I was thinking back about the journey. And they supported me even when I was a little kid. And I was one of those kids who always asked why, why why. never told me not to worry about it. And so they said, Let’s figure it out. So I really appreciate that.
Dr. Mark Syms 23:26
That’s awesome. That’s a great, sir. And then the last question, being that it is a hearing podcast. What’s your favorite sound?
Dr. Briana Auman 23:38
I’ll be brewing in the morning.
Dr. Mark Syms 23:39
That going through that that gurgling sound are you talking about? Or just? Uh, no, I mean, the reason I was asked people that is, you know, as somebody who’s in hearing loss is just thinking about what are those pleasurable sounds and, and you no longer have, right? And so that that to me becomes a real big deal. Right? So it’s a way to contextualize. You know, what for people to understand, like, think about that, what is the most amazing sound you have? Imagine if that went away. And unfortunately, as you know, and I do that.
Dr. Briana Auman 24:15
And that’s, that’s a signal to me every morning. Alright, time to pick up other days. So that goes to show you how without that hearing, without the sound of you don’t have those triggers.
Dr. Mark Syms 24:27
Or an alarm as a practical matter, that’s what alarms so if people want to get a hold of you, how could people get a hold of me?
Dr. Briana Auman 24:37
On the web, our website is bannershri.com. And that lists all of those different things we were talking about all the different ways we’re working on dementia. And of course, talk to your doctor about memory concerns and you want to come see us and eventually you’ll come to me.
Dr. Mark Syms 24:58
You’re going to get to her sooner or later. Basically this has been great ever. We’ve had Dr. Briana Auman. She is a neuro psychologist at the sun, the Banner Sun Health Research Institute. This has been great to have you visit and share about dementia and neuro psychology. And I really appreciate you coming on today. How this has been excellent. Thank you so much.
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