Protecting Brain Health: Chronic Dz Prevention, Risk Management in Alzheimer s Disease Victor A. Hirth, MD, MHA, FACP, AGSF Professor & Chief Division of Geriatrics USC, School of Medicine Medical Director of Geriatric Services Palmetto Health Board of Directors, American Geriatrics Society
What we ll cover u What it is (definition) of dementia u What is happening with Alzheimer s u What are the risk factors? u How do we prevent u What the future holds
First, lets Talk about Dementia u Umbrella term for short-term memory loss plus loss of one other brain function Executive function, judgment Language difficulty (naming) Orientation u Impact significant enough to affect social function u Alzheimer s disease most common, other types PD, Lewy, multi-stroke
Alzheimer s Disease: Practical Points u Slow linear progression (but highly variable) u Dz process starts before symptoms u First thing to go high level functions Hobbies or outside activities Ability to pay bills Social interactions u Later comes overt memory loss
Alzheimer s versus normal brain
What are the risk factors? (Traditional) u Family history of Alzheimer s u Age, older = higher risk u Latino and African Americans u Female>>Male u History of brain injury (concussions)
Associated Risk Factors u Low Vitamin D levels u Physical inactivity u Obesity u Low cognitive activity u High blood pressure u High cholesterol u Air pollution (< 2.5micron)
What can you do about risk? u Follow a reasonable diet Don t worry about aluminum u Try to be active, 150 min per week New 1 minute work out u Participate in life-long learning u Be engaged in your community and/or church
What s protective? u People at the highest quartile of Vit B12 had less atrophy u Statin therapy - + Observational studies inconclusive Large autopsy study @ Group Health (110) u Resveratrol* - Quercitin Increased life span in flies, mice and rats Antioxidant, anti-inflamm, anti-cancer Lowers amyloid peptides (fraud*)
So what works? u Mediterranean Diet lowered risk of Alzheimer s 38% (2,000 over 4 yrs) u People with highest blood levels of Omega 3, Vit. B, C, D & E had less brain atrophy and better memory performance u Walking 6 miles per week maintains brain volume and function (200 over 13 yrs)
What prevents? u Choose good parents u Avoid head injuries Football, soccer bad u No smoking u More years in school (reserve)
What doesn t work? u Brain training (Brain Age, Lumosity, Crossword puzzles, etc) u Motrin, Naprosyn other NSAIDS u Estrogen Replacement u Testosterone replacement
Treatment: Where we are now u Current therapy Aricept, Exelon, Razadyne, Namenda u Symptomatic treatment u Long-term efficacy is unclear u No therapy is disease altering (currently) u At least 3 trials of Secretase inhibitors all negative, 2-3 years ago
Real Fringy u Inflammatory u Non-inflammatory Low Vit. D, high homocysteine, low hormone levels u Cortical Atypical presentations Low serum zinc u Specific Rx regimens based on type
What does the future hold? u More folks with Alzheimer s Disease u In next 5-10 years potentially new types of disease altering therapies u More work needed on prevention u Beta-amyloid theory might be superseded by another hypothesis