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♪ From Maryland Public Television, this is "Direct Connection" with Jeff Salkin.

♪ JEFF: Good evening, and welcome to your "Direct Connection."

Coming up tonight, why so many young people struggle with our complex world.

And we will find out how a former police officer is changing lives one laundry load at a time.

But we begin tonight talking about your health, joining us as Dr.

Lisa Shulman, neurologist at the University of Maryland Medical Center and professor of Neurology at the University of Maryland School of Medicine.

Doctor, thank you so much for joining us.

We're learning more about a link between hearing loss and dementia.

What does the research say about that?

Dr.

SHULMAN: It's a pleasure to be with you, Jeff.

There really is an abundance of scientific evidence that people who have age-related hearing loss are at higher risk for memory problems and dementia.

We know that it not only increases the risk of these problems, but that when things are done to treat that, such as using hearing restorative devices, like hearing aids or cochlear implants, you can reduce the risk.

So it's a very convincing story.

JEFF: What are the possible mechanisms behind that link, that connection?

Dr.

SHULMAN: It's really fascinating because we don't have a total understanding of it, but we do have a lot of new clues to that.

I mean, for one thing, if you can't hear well, a lot of your brain is busy putting in listening effort -- so much effort is put into listening that you can't use all of your brain for the thinking process of what you would normally want to be cognitively engaging with.

But there's also a lot of important information about how the lack of stimulation to the auditory pathways of the brain causes atrophy and damage over time.

The interesting part is that age related hearing loss is an aging process of the inner ear.

And so the less you can hear, the less that auditory nerve, and then on into the neural pathways in the brain are being stimulated, and those path pathways begin to weaken just the way other parts of the brain might weaken when you are unable to use them.

JEFF: Are people sometimes slow to recognize or admit that their hearing is starting to go?

Dr.

SHULMAN: Very much so.

And that is a real problem, and that's why I think it's valuable for people to know that it has more serious consequences than they might think.

Another problem is that because they're reluctant to go in for an assessment and then care that they delay utilizing hearing devices, like hearing aids.

In fact, the adherences to people, even when they get hearing aids is relatively poor.

So there are a lot of reasons why we need to get the word out to get assessments and to get treatment.

JEFF: Good argument for Medicare coverage of hearing aids, which I don't believe is the case.

Dr.

SHULMAN: You're very informed.

You're exactly right that Medicare does not cover hearing aids.

It covers cochlear implants.

Cochlear implants are also important for us to all know about because when people have more advanced age-related hearing loss, moderate to profound hearing loss, having increasing difficulties, understanding speech around them, the Cochlear implant also should be considered in terms of the best possible management.

JEFF: I mean, so much is being learned about the pathology of various types of dementia, including Alzheimer's.

I'm just worried that somebody's going to be watching us and we'll feel guilty they didn't get themselves a hearing aid in time when there are so many other potential chemical factors at work.

There could be family history, genetics, could be vascular.

How do you think about that?

Dr.

SHULMAN: In terms of hearing loss, age-related hearing loss, it's fairly incredible that when studies are done, looking at all of the potentially modifiable factors for hearing loss over time, and hearing loss that results in cognitive impairment and dementia, the top one that would have the greatest impact is age-related hearing loss.

It has a greater impact that has been shown than many other factors, such as hypertension, obesity, diabetes, many other factors can have an impact and cause dementia, but hearing loss has the greatest impact in terms of something that is reversible.

JEFF: And I know you're not an expert on which hearing aid does what, but generally, there's a range of options now.

There's over the counter stuff, there's super expensive cutting edge, artificial intelligence, driven hearing aids.

Would you suspect that anything that's going to help you is going to potentially help with the processes we're talking about?

Dr.

SHULMAN: No, I am aware that, and I'm in neurologist, not an audiologist, or ENT doctor, but I am aware that none of these options are perfect.

They don't duplicate exactly the kinds of sound that we are used to hearing.

But people who use them regularly do become adapted and accommodated to them.

And the main thing is to continue to be able to communicate and connect with our environment, because it's sort of like a cascade or a domino effect when people cannot participate and therefore they become increasingly socially isolated, which, as you know, is now understood as yet another detrimental effect.

JEFF: Other ways to prevent or stay away from social isolation.

I mean, we want to be and if the hearing is at issue, you want to be in a situation that's maybe a smaller group of people, maybe it's a quiet room, not the ballpark.

I mean, what else might make sense?

Dr.

SHULMAN: I talk a lot to my patients about the importance of being an effective self manager.

And so, you know, to be an effective self manager, you need to be a good observer about what conditions work best for you and to avoid those conditions that are going to make it frustrating and difficult to participate and to engage with other people.

So, you know, I think that that's part of having virtually any health condition is understanding the kinds of conditions that work best for you and to do your best to embrace those.

JEFF: All right, so the big takeaways on hearing and dementia, number one, there's a link and there's no doubt about it, would you say?

Dr.

SHULMAN: Oh, no, there's absolutely no doubt about it.

I mean, there there's so many studies, big studies, studies that we're talking about involving more than 100,000 people.

So they're very high quality studies.

I myself are involved in an NIH-funded study where we are comparing hearing aids to cochlear implants in people with age-related hearing loss and seeing if we can delay and prevent cognitive impairment.

So there's increasing interest in what we can do to reduce the risk of dementia.

JEFF: And the other big takeaways are that it's important to stay socially connected, and it's important to act as early as you reasonably can to deal with hearing loss.

Dr.

SHULMAN: Very good point, because there was a recent, very recent paper that showed that even very mild hearing loss has an impact on the risk of dementia.

In fact, when you do imaging studies of the brain, you can actually show that certain areas of the brain in people who have even mild hearing loss, are not as the volume is reduced.

So the effects begin quite early.

JEFF: We were talking before the program about your medical practice, the people you see with different degrees of cognitive impairment and the benefits of now having something that you can describe.

What is the cutting edge there?

Dr.

SHULMAN: Well, I think more and more people are now hearing that over the last two years or so, the FDA has approved new therapies for Alzheimer's disease, which is a huge deal because for years, we had very little to offer.

These therapies, which aren't necessarily easy to use because they're right now intravenous infusions, and they're required every couple weeks.

However, the big thing about them is that they fundamentally alter the mechanism involved in Alzheimer's disease dementia, as you may have heard, Alzheimer's disease is involved with having both plaques and tangles.

Those plaques are made of amyloid, and these new intravenous infusion therapies actually break down the amyloid and virtually get rid of the amyloid in the brain.

The result is a slowing down of the progression of a cognitive decline.

Now, it's not as robust as we'd like it to be.

It's about a slowing down of about 30% over a period of 18 months, for example, in the trials, but it's still a huge step forward in the treatment of Alzheimer's disease.

JEFF: How optimistic does that make you for the medium term in the long term?

Dr.

SHULMAN: You know, what happens in every field, and I've been working in neurology for a long time now, but when you have a breakthrough like this in a field, we saw this in multiple sclerosis decades ago.

You have a breakthrough, it is a huge motivator for research, and the engine of research to turn their attention to this.

And little by little, I would expect to see more and more progress in improvement.

JEFF: Dr.

Lisa Shulman joining us from the University of Maryland Medical Center, Doctor, we appreciate your time.

Thank you very much.

Dr.

SHULMAN: It's my pleasure.

JEFF: And we'll be right back.

I love it!

We're on the precipice of a great discovery.

I love it.

Welcome!

Well, Nelly.

[excited exclamation].

Let's set this palace on fire!

Welcome to the News Hour.

What does it mean politically?

Fasten your seat belt.

I love it.

[ music ].

[ music ].

You'll make a good team.

[typewriter keys clacking].

JEFF: Now on the BookBeat, we're joined by Lisa Lawson.

She is the CEO of the Annie E. Casey Foundation, and she has written: " Thrive: How the Science of Adolescent Brains Help Us Imagine a Better Future for All Children."

Thank you so much for joining us.

LISA LAWSON: Thank you for having me.

JEFF: You are not the first person to wonder, what is wrong with adolescent brains?

The question is as old as mankind, isn't it?

LISA: It is, but we should teach young people more about their brains, and parents should get more information about adolescent brains.

There's actually so much interesting happening in that part of young person's life.

JEFF: Tell us about the book.

What age range are you focused on?

LISA: Well, "Thrive" is about adolescence, which is roughly the years between 14 and 24 People often think that it's the same as puberty: It is not.

Puberty is a biological change in the young person's life, but at unless it's actually lasts longer, and it's a period of profound cognitive, emotional, and social development that lasts into your mid-20s.

JEFF: Hope at the end of that you're a well functioning adult.

What are we at the beginning of that - - we're kids, I guess?

LISA: We are.

Adolescence is really the bridge between childhood and adulthood.

We want to make sure all young people make it across that bridge safely and successfully so that they can enter adulthood with independence.

JEFF: The process of adolescence when it comes to the brain, different for boys and girls, men, and women?

LISA: They're all going through the same process.

It might happen at a different pace, not necessarily just because of gender, but because of other environmental circumstances a young person might be going through.

If they are growing up in adversity, maybe surrounded by poverty, that's going to restrict the kinds of resources and opportunities they have, but not necessarily because of gender.

JEFF: Does it have a physical impact on the brain and its structures, if somebody grows up with great challenges?

LISA: You know, the brain grows from the back to the front, the last part of our brains to develop is the front.

It's called a prefrontal cortex, and it controls cognitive thinking, emotional regulation, and how we build deeper relationships.

If a young person grows up in adversity, it doesn't mean that that development isn't going to happen, it just may be delayed in happening.

And what we know is that connection to adults who can help guide them through life actually helps the healing process for young people.

JEFF: A lot of young people don't want anything to do with adults.

We so we think.

LISA: So we think.

I don't think that's necessarily true.

It's a time when young people are definitely building deeper relationships with their peers, but they are also keenly aware of the challenges and the navigation they need to make it through life.

Maybe more so now because of how complex life is.

So while we might think young people aren't listening to us, they absolutely are and are desperate for guides, whether it's coaches or mentors, it might not always be their parents that they are excited to listen to, but they definitely want the advice of adults to help them navigate life.

JEFF: You're a big time foundation CEO, not a scientist, but what has changed on the science?

Has anything changed on the science side of this?

And I'm thinking about all the developments, put people's brains into MRI scanners and almost tell what they're thinking these days.

LISA: Well know, I'm not a neurologist, so I can't answer all of that, but I do know we've done a lot more study to understand how these changes happen, the context that helps them happen more positively.

Similar to what we learned about early childhood in 40 or 50 years ago, in the neurons to neighborhoods research.

So adolescence is having a moment, if you will.

JEFF: I told you before the show, one of the most no doubt the most interesting course I took in college.

I stumbled into because I needed some type of elective, and it was developmental psych.

And it was dealing with young kids, the idea that there's a period of time where language acquisition can take place.

The brain is designed to learn a language, up until about age seven.

You can do it after that, you just can't do it as efficiently, you wind up with an accent.

The whole field fascinates me.

LISA: It really is amazing to really understand how we develop as humans that early childhood, science is really important, helps us know how to get kids off on the right foot, but you can't stop at five, you've got to keep going.

And that's where the adolescent science comes in, and it's exciting to think about what's happening in the brain and to actually educate young people about what's happening.

It gives them a lot more empathy for themselves.

And I think it would give parents a lot more empathy, too, if they understood.

JEFF: There's any adolescent know that?

I mean, does anybody tell them, Hey, your brain is not fully developed yet?

LISA: Sometimes my daughter had a forward thinking biology teacher who told her in the ninth grade and when she got in trouble, she would say, but my prefrontal cortex isn't developed yet."

So that knowledge can be power if it's given to them.

But it does help them understand why they might have more trouble regulating their emotions or why they have trouble following multi-step tasks.

It's all because their brain didn't fully developed yet.

JEFF: Is that why they're bad drivers?

You know, boys in particular?

I mean, you think about them being less risk averse than older people, whether that's just lack of experience, hormones, or something else.

LISA: Well, their brains are wired for new experiences, we often call that risky, but it's really creating new context for them to have experiences that help them learn.

And if you understand that about young people, you can create positive opportunities for them to have new experiences, not negative ones.

JEFF: Long tension in Maryland and other places when it comes to juvenile justice, which is one of the issues that the Casey Foundation deals with, and we'll talk more about your work there, but there's always tension between progressives and conservatives about how lenient or harsh the juvenile justice system ought to be.

Does this inform your views about that?

LISA: It does.

We want young people to be held accountable when they make mistakes, but it's a good question of how that should happen.

And we've learned a lot over the last 25 years about what helps get young people back on track and what we know about the brain science is they're motivated by reward, not by punishment, and so creating incentives as a part of the justice system is an important way to help them get back on track.

But when we talk to young people who made mistakes, it is never a facility or a program that helps them turn their lives around.

It's always a person.

And so we think it's most important to make sure those young people have connections because that is what's going to give them real accountability in relationship with others.

JEFF: That person is probably an adult, so it could be a family member, it could be a teacher.

How important is it as a society, we facilitate that?

Even if the 18, 19, 22 year old maybe doesn't seem to be all ears.

LISA: It's extremely important.

As I said, you might think they're not listening, but they absolutely are.

And young people want mentorship; I always hear that.

They want someone to help them figure out, what should I major in?

What career should I pursue?

How do I bounce back from this setback that I've had?

They know adults have navigated pivots in their lives before, and really want someone to help them figure things out.

JEFF: Interesting choice of the person who wrote the forward to the book is Governor of Maryland Wes Moore.

>> He is a person who his mother worked at the foundation that I lead.

So I got to know him first as the son of Joy Moore who worked at the Foundation.

>> How old was the governor?

LISA: The governor was in his teenage years when she came to work for the foundation, but he also wrote a quintessential book about adolescence, The other Wes Moore, and really, I think, exemplifies what the book is trying to tell us, that young people can go in different directions, but it's important to make sure that they've got the support they need, the opportunities to open doors for them and relationships that help them guide them forward.

JEFF: Tell us about the foundation for people who haven't heard of it before.

It was tied to the UPS fortune.

And I believe you used to work for UPS before you came to this position, which was how long ago?

LISA: I've been at the Casey Foundation for 14 years.

It was started by Jim Casey, who was the founder of UPS.

He started UPS as a 19 year old who had dropped out of school in the third grade to support his mom and siblings when his father passed away.

I think the work we do around adolescents couldn't be more of a testament to the brilliance of a 19 year old who created the world's largest logistics company and cared deeply about teenagers.

JEFF: And that's what the mission of the foundation is.

>> So the foundation focuses on helping all young people have a bright future, but particularly those who face challenges, who might be system involved, child welfare, juvenile justice systems, as you mentioned, who are growing up in low income families, we want to make sure their families have financial stability.

Then the neighborhoods, safer, healthier places to grow up.

So we work all over the country, on those issues.

JEFF: But you're sited in Baltimore, and that hasn't always been the case.

LISA: We have been based in Baltimore for the last 25 years.

We were founded in Seattle, moved to New York.

The company moved to Atlanta, and we moved to Baltimore.

JEFF: In what way do you feel you've made the greatest impact?

So you have billions of dollars, and you have a clear mission, and we know a lot about brain science now.

What's been the most effective program that you've funded?

LISA: Oh, boy, that's a hard question over 60 years.

>> What works?

Maybe what don't you fund anymore?

>> I think the work we've done to one provide data through our kids' count data report to help all of us make better decisions about young people have been really important.

We have had a focus on basic needs for families, for the entirety of our existence, and we know how important it is for kids to have safe housing, to have food, to have health care, that continues to be important and to make sure that young people have a pathway to independence with jobs and education.

JEFF: And just a couple seconds, would you want to be an adolescent today?

LISA: It's hard.

Life has changed a lot, but I certainly think that we have all the tools we need to build a stronger bridge for young people.

JEFF: Lisa Lawson is the author of "Thrive."

Thank you so much for joining us.

LISA: Thank you for having me.

JEFF: Now, Nancy Yamada with our salute to veterans.

>> NANCY YAMADA: I've been volunteering every Thursday.

It's my new commitment.

I recently retired and serving is what I'm called to do.

Deborah ever imagined her calling would be to do laundry, complete strangers laundry, but each week, that's what she does as a dedicated volunteer for fresh step laundry, a nonprofit mobile laundry service for those who are experiencing homelessness.

We started doing laundry September 4 of this year, and as of a couple days ago, we've done just over 2,000 pounds of laundry.

NANCY: Wade Milyard came up with the idea while serving as a Frederick police officer and seeing the challenges that the unhoused faced firsthand.

WADE MILLIARD: As they were actually doing laundry in the creek, that was about 50 yards away from where they were camped, and they would hang it up in the trees or on a fence post to dry.

NANCY: When he retired, the Frederick Police Department donated an old bus that he and his family renovated, installing three sets of washers and dryers and a hookup for water, three times a week, the fresh step bus is the go-to destination for anyone who needs to get their clothes washed, dried, and folded, free of charge.

I live in the shelter nearby.

I don't have the money to go to the laundromat and pay to get my clothes cleaned, so this is a very good way to rely on getting your clothes cleaned.

You know, you feel cleaner when you have clean clothes to walk around it.

MAN: Clean laundry is, I mean, I don't want to say everything, but when you don't have it, it's everything.

You know, it helps with your hygiene and it just makes you feel better.

NANCY: That's the idea behind every load that gets dropped off and picked up an hour and a half later.

WADE: It's just one more thing they don't have to worry about.

I want them to feel that dignity that they deserve.

In society, I think it's easy for us to dismiss somebody who's unhoused.

and just say, well, they've put themselves in this situation, so it's their problem.

That's not always the case.

NANCY: Milyard says he hopes the clean clothes may even inspire some to clean up their lives and address any issues that may be preventing them from securing stable housing.

His next goal is to raise funds to get a second bus focusing on school children who need clean clothes.

He says his drive and determination comes from a higher power.

WADE: Even if I can do a fraction of what Christ did when he was on Earth, if I can do something like that to help these people and maybe bring them to God as well, that's what I'm getting out of it.

NANCY: I'm Nancy Yamada.

JEFF: Now, for all of us MPT, thank you for watching, and have a good night.

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