(21 mins) In this episode, Dr. Hackie Reitman speaks with Seth Keller, M.D.. Dr. Keller is Co-Chair of the AADMD’s National Task Group on Intellectual Disabilities and Dementia Practices, the first neurologist elected president of the AADMD (American Academy of Developmental Medicine and Dentistry), as well as a member of the American Association on Intellectual and Developmental Disabilities and the Academy of Neurology. Seth discusses the importance of medical professionals understanding people with different brains, the overlap Alzheimer’s has with other neurodiverse diagnoses, and the role concussions can play in the development of Alzheimer’s.
For more about Dr. Keller, visit: http://aadmd.org/
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HACKIE REITMAN, M.D. (HR): Hi, I’m Dr. Hackie Reitman. Welcome to another episode of Exploring Different Brains. Today we’re talking with the world famous neurologist, my friend Dr. Seth Keller who is the head of the National Group Task Force on Dementia and Alzheimer’s and all the stuff that makes our brains not work so good. Seth, welcome. How are ya?
SETH KELLER, M.D. (SK): Thank you Hackie. It’s a pleasure being here. That’s a great introduction; I appreciate that.
HR: Well, I was gonna start to read all of your stuff, but it would take a half hour.
SK: You know, we don’t have, I don’t have all day, Hackie, so come on!
HR: You’ve been all over the map. You’ve done everything.
SK: Yeah, I can’t sit still, Hackie. I got a lot of energy, so…
HR: All right.
SK: You know how that is.
HR: Now why don’t you introduce yourself to our audience the way you’d like to be introduced?
SK: Umm, yeah. Hi folks, I’m Seth Keller and thank you much Hackie for, for having this wonderful conversation. And to start out, it’s great knowing you and working with you and it’s certainly a pleasure. Umm, well I’m from Philadelphia; uhh, I’m married with two children and umm, basically I’m a, a, I’m a general neurologist in a group practice in umm, suburburan, suburban New Jersey, 20, 30 minutes outside of Philadelphia and the passion of what I do and as much as you’re describing it, Hackie, I appreciate that, is truly in regards to, umm, adult care, geriatric care, neurologic complications, and in particular with those who do have intellectual/developmental disabilities. So, so, umm, yeah, I mean it’s a complex life, like all we have but, uhh, that’s a nutshell, I suppose.
HR: Seth, what inspired you to get into this field?
SK: Well, I like to say, Hackie, it’s because I’ve had years and years of training, uhh, or family members that have had, had disabilities, umm, I-I-I can’t admit to any of that cause that is very far from the truth. Umm, I basically, really, to be honest with you, like a lot of people, really didn’t have a lot of exposure to the needs and cares and lives of people with intellectual/developmental disabilities, and my, umm, involvement really became, uhh, as a neurologist who was really looking to help those that were disadvantaged and were having a fair amount of complication within their illness, uhh, per se, and I became very knowledgeable and expertise in the, in the care of those with epilepsy, seizure disorders, and in my training I ran across a number of people with intellectual/developmental disabilities who kept coming to our emergency room and hospital center, uhh, who I might see in my office who I really didn’t know much about. I really didn’t know them as people and their complex lives but it was clear to me that umm, they had certain needs and umm, wants that really weren’t being answered by neurology, by mainstream medicine, and I, I looked at it as an opportunity and it became a growth effort for me that grew and grew and grew with uhh, bumps along the way and, and uhh, hurdles, roadblocks, and uhh, uhh, that’s a, that’s a huge story into itself.
HR: Connect the dots for us, if you will Seth, from various neurodiversities, progression into dementia and Alzheimer’s, which as we all know is a vast epidemic in this world.
SK: Right. Yeah, uhh, I mean, really what it is is that, uhh people with, say developmental disabilities, have childhood onset uhh, difficulties, uhh, with their brain so from the time that they might be born early up until perhaps 18 years old, their, their brain uhh, had some challenges in terms of its development, leading them to have then umm, uhh, difficulties, perhaps, throughout their lifespan in various aspects. Umm, so they, for them, that is their normal. These are individuals, that, you know, G-d bless them and their abilities, this is their normal life and how they uhh, uhh, live their lives with certain difficulties, perhaps. And that’s different, much different than those that have difficulties later on in life. So, so for instance, for me as a neurologist that specializes in geriatrics, I see it both ways. I see people that have had, perhaps, developmental disabilities throughout their whole lifespan, but I also see it where people are living their lives in a certain so called stable way, and then as they turn into adults and even age at adults, they develop some types of newer challenges that are process related to the brain, such a stroke, such as multiple sclerosis, such as uhh, dementia, and these are problems that happen later on in life due to acquired problems, acquired problems, uhh, illnesses and diseases, trauma, perhaps, later on in life.
HR: Then, speaking about trauma, what’s a very hot topic nowadays, as you know, is concussions. Whether it be football, soccer, boxing, whatever. Speak a little about the relationship, from your point of view, between concussions and dementia.
SK: Now Hackie, I do know that you, you were a boxer. Is that true?
HR: I had 26 pro heavyweight fights, and yes, this was a left handed way of me finding out how many years do I have before I get the dementia.
SK: Right, and I know, I mean, I’m kinda kidding with you as a friend, but I know it is a, you know, it is a serious uhh, discussion, that uhh, I kinda, you know, tongue-in-cheek appreciate you know, where you’re coming from and all that. I’m giving it right back to you, my friend. Basically…
HR: It’s very serious. Why are we both laughing? But, it is, you know what…
SK: Really, I’ll just kinda give you a background. Uhh, uhh, back in the day when I was in my youth, I was an athletic trainer. So I worked, I-I have a lot of different hats I wore. So when I was in high school what I did uhh, mostly in high school besides those typical academics and social fun stuff with my friends, I was actually the head athletic trainer for my high school in Philadelphia. And so my interest in concussion or sports related injuries or trauma dates back many years, so I definitely appreciated, from the early 70s, the issues of head injury or concussions. I didn’t really honestly think much about it in terms of, if long term consequences later in life because there really wasn’t much discussed over it, uhh, but over the course of time, uhh, as my involvement grew and became a neurologist, and I started seeing things and treating older individuals who had various injuries to their head, and the science, the research, the information grew and grew that, that concussions were underrepresented, they’re underappreciated, so even the iss-, the aspect of a so called simple concussion, Hackie, a ding, a person that was buzzed in their head, or some kind of word that would be used that would kinda underplay what is really, truly a-a concussion.
Years ago, it was kinda just like, “Shake it off, you know, fella. Get back in the game. You’re good; you’re fine.” when in fact that really led to a lot of problems early on and later on in life when a lot of individual children, ado-, you know, adolescents, young adult, were probably having concussions. So it wasn’t really recognized until their degree of a concussion, loss of consciousness, obvious difficulty seeing on the field that they had a head injury, went down to the ground, weren’t coming back right away, those were obvious. Those were kinda obvious and those that were even more obvious, that were unconscious for a while and had to go to the hospital, you can’t hide that. So as the time went on, Hackie, it became recognized that these things were accumulative. They were noticed that if you kept having concussions later on in life and you had some throughout your lifespan, there was even proof before the more recent information, Hackie, on the NFL scenarios, that, that later that curt-, concussions throughout your lifespan can absolutely, absolutely can lead to long term complications that can affect the memory and your behavior and increased risk of depression, but even that probably wasn’t appreciated as much as the more recent information involving the NFL players and others in life. So right now there really is quite a turn that I see in my practice neurology when parents or young people come in with a sports injury, with a very much heightened sensitivity and appreciation as, “What will this concussion do to me now when I’m younger and therefore what should I do in the future about, near future time or long future time, about participating in any further in sports?” so definitely there’s a big turn in this.
HR: Well, you know umm, when I was, I would commute from Fort Lauderdale up to Boston University to give the first year lectures in anatomy and uhh, I would uhh, speak to Dr. Robert Stern up there, who is the NFL project with the, uhh, you know, progressions of concussion and CTE and so forth. One thing that rang with me, in fact I reserved the uhh, the domain name for it was “reconcussions” because it struck me as almost a-a relative layperson compared to the people like yourself who have devoted your lives to the brain, is umm, it’s the repetitive nature where the metabolites can’t get out of the brain and the system can’t percolate them through such as they did away with the two-a-days uhh, you know, in the NFL and so forth. Umm, could you comment on the repetitive nature as opposed to the big hits when we’re talking about concussions and head trauma?
SK: Well, I’ll give you my u-, I’ll give you my umm, uhh, simplistic way of looking at it is some of the repetitive is that if it’s thought that someone returns to sports play too soon, not only will they have a delay in, in regaining function back or improving their difficulties, but it’s actually, it’s thought that there’s this rare situation with a repetitive injury soon after the, the initial head injury, they can actually have severe trauma with bleeding and swelling in the brain and that is a very rare situation. That may not be quite you’re referring to, but there is, there is that type of rare phenomena which people think about after, after someone had the concussion is something that could happen again shortly after that. That’s a rare situation in the immediate way, but what is here-, I don’t know if that answered your question, but that…
HR: No, I’m, I’m referring more to the, the buildup of the uhh, stuff, if you will, that you end up seeing in these uhh, autopsies, umm, and all of the, you know, the, I’ll call it metabolic debris, rela-, relative to Alzheimer’s with the uhh, anatomical changes and the…
SK: Well, it’s scars. I mean, basically what they are is that with, with concussions, the brain cells themselves and their connuction-, connections can die back and so that leads to analogous which is really like scar tissue and that’s really, basically what they’re alluding to or talking about in some of the autopsies, uhh, of traumatic, you know, traumatic encephalopathies in athletes is some of the debris which is basically from neuronal, or nerve injury, over time, and that can accumulate. And when that accumulates, it, it actually affects the, the person’s ability to reason, and think, and cause risk of high depression, and memory dysfunction, umm, and naturally what the debris is, it’s the neuronal damage from repetitive injuries. There’s a whole cascade of uhh, Hackie, you’re kinda mentioning metabolic changes, so there’s a really a lot of research that talks about what happens when someone has a stun to their head, a head injury, what’s the process from immediately that happening leading eventually to the umm, uhh, nerve injury. And that does have to do with uhh, electrical impulses in the brain, that has to do with slow metabolism within the nervous system, so, so there is a lot of research that’s involving and studies, there’s actually research that’s looking at more sensitive imaging in the brain that can see these things, cause right now, typically when people get a CATscan of their head, or an MRI of their brain, they’re normal. You rarely see much there at all wrong and yet the individual is showing all signs of a concussion and that doesn’t, that isn’t, uhh, umm, objective enough to really know how much problem they’re having.
So all this research now is looking deeper by having more sensitive studies imaging the brain that is in research involving that will show when someone can really, how much damage there really was, and it then can be more sensitive, perhaps to show that the brain is healing, and will be then more important to say when can that person return to back to umm, a contact sport or not. So there is going to be a future evolution, cause right now, my sense, I’m not an NFL coach, I’m not a trainer anymore, but as you know, people who are-, who have an injury, you see them all the time on NFL sports, they take them into this hud of some sort on the, on the sidelines, they do this, you know, this type of testing on the individual and they do an analysis of them in the NFL. They have a report on the NFL, where they, th-th-they have a, a neurologist, like a team neurologist who basically is not dir-directly connected to the team because of a conflict of interest. Before years ago, there was actually a conflict cause the coach wants a player in, wants a coach, wants a player in, the player wants to play, so you have this physician or trainer on the side who basically doesn’t have a lot of authority and sometimes they’re afraid to pull their star player off the field because the implication of the team. So there’s been a lot of social issues that have gone into denial, delay, recognizing dementia, sadly enough, because the bottom line at that point: win win win win win! So there had to be some disconnection between the people who’re the coaches and the player, and that’s where they got a semi-independent person like a neurologist who basically cared only about the individual. They, they didn’t have pressure on them to kind of make the decision, “Well, if I get this player out, well, there goes my team.” So they really needed that somewhat independent way, but it’s the testing and the assessment that they use to try to, like, validate how much problem they have in this testing that they do which honestly, at this point, I can’t really say how accurate really is, and I’m kinda, that’s not my deep specialty at this point, but they have this criteria that they must use by these teams after they assess the person. Do they have a concussion? Do they not? And then what is showing on their abilities to then say, “You’re free and clear of your concussion and now you can safely go back and play at your prior level of contact sports.”
HR: Well, it’s a sticky wicket, it’s, that’s for sure.
SK: Yes, absolutely.
HR: Let’s leave that-
SK: You can go on and talk about, if you want, you know, we can open up about other sports, too. I mean, uhh, you know, not to open up a can of worms, but certainly there are other sports that are also going on day-to-day that basically, I hate to say this, you know, in this interview but basically boxing, I mean, where does boxing come in in terms of where they are at the state of the stage of, of, uhh, concussion awareness and understanding of that? You know, I don’t know if you want to talk about that, Hackie, but you might have stories yourself about people you know.
HR: Well, I will, listen, I think, uhh, society in general has to come to grips with the reality of it, that, uhh, this stuff is gladiatorial and it’s not good to get hit in the head. Whether it’s soccer, hockey, or anything else. Now when you talk about football and boxing, boxing especially is a little bit different because the object is to knock the other guy out. Now, I would get called during my, you know, I-I fought pro, my 26 fights between when I was 38 up till I was 52, and at the time I was the team physician for the, the state champion, uhh, football team here, and I would appropriately get called a hypocrite because on a Friday night, I would take the quarterback out for at least two weeks after he got his bell rung, and Saturday night I’d be on TV in a ten round fight getting knocked down three times in one round myself and getting back up and fighting.
HR: And I think we’re kidding ourselves when we send our kids out to play pop one a football, and, umm, and we’re at every level. It’s not just the NFL. But it is such a big, big, big industry and all of these of the feeder system, that’s a very difficult problem that you and I aren’t going to solve today. But I can tell you one thing that based on my limited knowledge would help without hurting the game, and I honestly believe this, that, you know, based on my limited knowledge, some of these tau proteins and other debris and stuff that forms in the brain, the, the body and the brain have to have time to kind of flush them out.
HR: And how-, whenever that process is taking place, one thing we know is not good that would not affect the quality of the game at all is to outlaw the congratulations by butting heads and smacking each other on the head. Because here-
SK: Yeah, yeah.
HR: -you have a running back who just went through from three yards out, took a bunch of knocks to the brain, and now everybody’s tapping him on the head. Now he’s butting heads with the other guy. That should be outlawed because that can’t be doing you any good, it can’t be doing you any good.
SK: Yeah, I suspect not.
HR: So I think that right here at Different Brains, Dr. Seth Keller and Dr. Hackie Reitman, we’ll have to figure out how to get ahold of the NFL commissioner and the owners and say, “Let’s get rid of that, at least.” I think we should. It’ll be a step in the right direction.
SK: I’m sure. It’s a good cause. Okay.
HR: I’m going to use your name and say, “I got him into this.” Now-
SK: That’s for sure.
HR: -I would like you to tell our audience, if they want to learn more or get in touch with you, how do they do so?
SK: Absolutely. Yeah, umm, it’s easy to find me; I’m all over my own, uhh, organizational website: aadmd.org. So to find me is easy cause, cause I’m splashed all over our organizational website, AADMD, and within that is information about the national task group, all the work that I do and my colleagues, so that would probably be the easiest way to do. Uhh, and I’m not alone in this, Hackie. I mean, honestly, I appreciate, you know, all these things we’re talking about. I’m just one person amongst a good number of people who enable me and I enable them in a group fashion to do, you know, things that we really couldn’t do individually in the group. And even what you do, Hackie, is a tremendous benefit cause we all work together. So the networking, the camaraderie, I appreciate all that you do.
HR: Well, thank you very much, but my job is simply to try to highlight what you people in the front line, in the trenches are really doing day in, day out; you’re in there; you’re doing it and, uhh, I salute you and admire you and anything that differentbrains.org, that we can do here to spread the word, we’re glad to do it. We’re very glad to do it, and thank you so much for spending time with us, Dr. Seth Keller.
SK: My pleasure.
HR: Thank you.
SK: Thank you very much.