Dr. Mark D'Esposito

the thought these days about sort of promoting recovery and then really getting your brain back working i think you know a lot of my patients they're off from work for a couple weeks and they feel fine and they think they're pretty much normal and then the first day of work is a complete disaster because until you actually test it in real life you don't know how what kind of troubles you have so i don't recommend going back full steam but i do recommend going back trying to build up these

these skills again.

And then I think we, you know, I think we need to develop therapies that people will use.

You know, things like goal management training, which involves a therapist and, you know, health insurance doesn't pay for this.

So 99% of my patients don't get any help, you know, by any kind of intervention.

uh unfortunately but now we talked about technology things like um brain hq do you know about brain hq so mike merzenich um which i know you've talked about with eddie um developed a a a company called posit science where developed these brain training games that that can help improve specific cognitive functions and they're very easy to do because they're online and they you know they're

There's science behind them and you can do them.

So in that way, you don't have a therapist in your room, but you can online sort of do these sort of things that are targeting specific mechanisms to try to improve the kind of things that we think are impaired by concussion.

And I'd like to see more patients get started on some of those things.

Unfortunately, if you go on the web and just say, I won't do brain training, you'll be overwhelmed with things and you don't know what works and what doesn't work.

Yeah, I think that's fair.

I think, you know, of all the systems that decline with aging, not every brain system declines, but certainly the frontal executive system we're talking about is one that takes more of a decline than others.

That's just how it is with healthy aging.

Not surprising, it's the most complicated system and it's probably the most biologically costly.

And so the more complicated system is going to take more of a hit than other systems.

And so certainly, I don't know about regressing, but certainly we're maybe accelerating this decline that we know exists.

But a way I would think about it, though, is that not just...

trying to prevent a decline, but what we talked about before, there's no reason not to optimize.

If everything is couched and I don't want to get dementia and don't want to get Alzheimer's disease and I don't want to get this and that,

I think that's not the way we should be looking about it.