Welcome To Brain Health and Risk Factors for Dementia Presented by Kamal Masaki, MD Professor and Chair Department of Geriatric Medicine John A. Burns School of Medicine, UH Manoa April 4, 2018 10:00 11:00 a.m.
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Brain Health and Risk Factors for Dementia Kamal Masaki, MD Department of Geriatric Medicine John A. Burns School of Medicine University of Hawaii
Today s Training Objectives To learn about the changes in structure and function of the brain with normal aging To discuss cognitive reserve To discuss ways to keep your brain healthy, and know about the CDC Healthy Brain Initiative To recognize dementia, and know the risk factors for the two most common causes Alzheimer s disease and vascular dementia To learn about how the Alzheimer s Association Aloha Chapter can assist patients and families once a diagnosis is made
Alzheimer s Disease is a Public Health Crisis! Estimated 5.7 million Americans living with AD AD is 6th leading cause of death across all ages 1 in 3 seniors dies with some type of dementia www.alz.org/facts
Healthy Brain Aging To continue to have the ability to: o Think, reason and remember o Plan and carry out tasks o Live a purposeful life o Function normally and remain independent o Maintain social connectedness o Maintain a sense of identity Healthy Brain Initiative: CDC and Alzheimer s Association Brain Health As You Age: NIH, CDC, Admin. for Community Living
Structure of the Aging Brain Certain parts of the brain shrink, especially the center responsible for memory Decrease in neurons and neurotransmitters Brain volume and weight decreases, starting in the 30s Changes in blood flow to the brain Decrease in the blood-brain barrier
Function of the Aging Brain Modest decline in ability to learn new things and retrieve information (remembering names, finding words) Difficulty in multi-tasking Improve in other cognitive areas, such as vocabulary and problem-solving wisdom Improve in impulse control, better judgement
Cognitive Reserve Ability to function normally and compensate for difficulties that certain regions may be having due to disease or injury Associated with higher educational and occupational achievement May help brain plasticity (ability to adapt to change)
Maintaining Brain Health Physical Activity Social Activity Reducing risk factors for heart disease Mental Activity Good Nutrition
Physical Activity and the Brain May reduce risk of diabetes, heart disease, stroke and depression May reduce falls May help improve connections between brain cells Learn safe ways to exercise regularly Check with your doctor
Mental Activity and the Brain Continue to perform mentally stimulating activities Read books, play games Learn new things, take classes Volunteer Not proven to prevent dementia (be mindful of unrealistic claims made)
Social Activity and the Brain Continue to remain socially engaged Associated with reduced risk for some health problems, including dementia and depression Join senior centers or other community organizations
Good Nutrition and the Brain Lots of fruits and vegetables, whole grains, lean protein Less sugar, salt, saturated fats Adequate liquids Some studies suggest that the Mediterranean diet may help reduce risk for dementia
Reduce Heart Disease Risk Factors Control high blood pressure Control diabetes Control high cholesterol Avoid obesity Stop smoking! Stay physically active Start in mid-life, don t wait until old age!
Healthy Brain Initiative Road Map http://www.cdc.gov/aging/pdf/2013-healthy-brain-initiative.pdf 17
WHAT IS DEMENTIA?
Dementia Definition (DSM IV) Acquired deficits (not mental retardation) Deficit in memory Deficit in at least one other cognitive domain Affects social and occupational function Absence of delirium and major psychiatric disorders
Mild Cognitive Impairment (MCI) Petersen Criteria Subjective cognitive complaint (pt or proxy) Cognitive deficit on testing in at least 1 domain (memory, language, attention, executive function, visuospatial) Normal social & occupational function (ie. NO DEMENTIA) High risk of converting to AD
Stages of Cognitive Function Abnormal Cognitive performance Function (Activities of Daily Living) Normal Presymptomatic Prodromal MCI Dementia Time
SUB-TYPES OF DEMENTIA
Not All Dementias Are Alzheimer s Disease (AD) DEMENTIA Lewy Body Dementia Other Dementias 60-80% Alzheimer s Disease Vascular Dementia Fronto- Temporal Lobe Dementias Metabolic Drugs/toxic Tumors Depression Infections Parkinson s Some forms are reversible (treatable)
Dementia Sub-Types Alzheimer s Disease Vascular Dementia White Populations PD Mixed/ Other Lewy Body Dementia Parkinson s Disease Vasc AD Fronto-Temporal Dementias Other causes (possibly reversible)
Alzheimer s Disease First described by Dr. Alzheimer in 1906 pre-senile dementia Most common cause of dementia (2/3 rds in Western countries) Short-term memory, orientation and problem-solving are affected early Behavior problems common Insidious onset, progressive course, usually slow Duration 2-20+ years, mean 8-10 years
Alzheimer Pathology Neurochemical abnormalities: Deficiency of acetyl choline and other neurotransmitters Pathology: - amyloid plaques and neurofibrillary tangles NEURON LOSS!
Vascular Dementia Sub-Types Multiple large cortical infarcts Single strategic infarct Multiple lacunar infarcts Extensive white matter disease (Binswanger s disease) Mixed vascular types Mixed vascular and Alzheimer s
RISK FACTORS FOR DEMENTIA
Risk Factors for Vascular Dementia Age Heart Disease risk factors o High blood pressure o Diabetes o Smoking o Obesity o Lack of physical activity o High cholesterol Dietary factors
Risk Factors for AD Non-modifiable Age Low education Traumatic brain injury Genetic susceptibility (ApoE4) Family history of AD Family history of Down syndrome Modifiable Cardiovascular risk factors o High blood pressure o Diabetes Dietary factors Heavy alcohol intake Depression Chronic Inflammation
Education and Cognitive Reserve Low education is a strong risk factor Education (and occupation) may contribute to cognitive reserve Nun Study Essays written in young adulthood Low idea density associated with low cognitive function and AD almost 60 years later
AD Potential Protective Factors Physical activity? Social activity? Mental activity?
33 Kuakini Honolulu Heart Program & Honolulu-Asia Aging Study HHP started in 1965 at Kuakini Medical Center 8,006 middle-aged Japanese-American men study of heart disease and stroke HAAS began in 1991 in the HHP cohort in 3,734 men ages 71-93 years Purpose: to study cognitive function, dementia, disability and diseases of aging Serial exams over 50 years
Mid-Life Physical Activity & Dementia Relative Risk with Low Activity 2.0 1.59 1.44 1.8 1.5 1.0 0.5 0.0 All-Cause Dem AD VaD
Walking and 8-Year Incident Dementia Relative Risk 2.5 2.0 1.5 1.93 1.75 1.33 1 1.0 0.5 0.0 <1/4 1/4 to 1 1 to 2 >2 Distance Walked (miles/day)
Social Engagement and Incident Dementia Relative Risk 2.34 Test for trend p < 0.001 2.5 1.98 2.0 1.5 1.38 1 1.0 0.5 0.0 Low Medium- Low Medium High High
Genetic Factors in Late-Onset AD Family History of AD or Down s Apolipoprotein E4 (chromosome 19) Increases the likelihood of developing AD), but does not guarantee it ApoE4 increases risk (RR=2.4 in HAAS) - more so in those with HTN or DM ApoE2 allele protective Testing NOT recommended routinely
CARIOVASCULAR RISK FACTORS FOR DEMENTIA
Adjusted RR Cross-Sectional Association BP & Poor Cognition: HAAS Late-life high BP protects against poor cognition 2.5 1.5 0.5 Late-life Low Normal Borderline High Blood Pressure Categories
Adjusted RR Longitudinal Association BP & Poor Cognition: HAAS Mid-life high BP increases risk of poor cognition 2.5 *4.7 (never treated) 1.5 Mid-life 0.5 Late-life Low Normal Borderline High Blood Pressure Categories
Relative Risk 41 Mid-Life Systolic BP & Neuritic Plaques: HAAS 2.5 * 2.0 1.5 1.0 0.5 Low Normal Borderline High Blood Pressure Categories
Relative Risk 42 Treatment Modifies Association of Mid-Life BP & AD: HAAS 4.5 Untreated * * Treated 4.5 3.5 3.5 2.5 2.5 1.5 1.5 0.5 Low Normal Borderline High 0.5 Low Normal Borderline High
Late-Life Diabetes and Dementia Relative Risk 2.5 2.0 1.50 1.5 1.0 0.5 1.80 2.3 0.0 All-Cause Dem AD VaD
Diabetes and Dementia Diabetes + ApoE4 positive relative risk for Alzheimer s disease was 5.5 Diabetes also associated with changes in the brain on MRI scan: Lacunes 60% increased risk Hippocampal atrophy 70% increased risk
Mid-Life BMI and Late-Life Dementia Relative Risk 2.5 2.0 1.82 1.87 1.5 1.00 1.0 0.5 0.0 15.5-22.5 22.6-25.0 >25.0 Mid-Life BMI Note: Stronger association with VaD rather than AD
Weight Loss and Dementia Incident dementia was associated with significant previous weight loss A high proportion of men with dementia had lost at least 5 kg (about 10% of average body weight) This weight loss occurred in many cases over the 2 to 4 years prior to diagnosis of dementia The association was similar in AD and vascular dementia
Smoking and Dementia Some studies have found increased risk of dementia in smokers Alzheimer s disease and Vascular dementia Higher risk with more pack years of smoking
Stages of Cognitive Function Abnormal Cognitive performance Function (Activities of Daily Living) Normal Presymptomatic Prodromal MCI Dementia Time
Preventive Strategies Preventive measures for the whole population Early recognition of people at risk Early diagnosis of dementia and treatment of reversible causes
Alzheimer s Association- Aloha Chapter Leading source of information on dementia Caregiver classes, support groups, community presentations, professional trainings Care consultation assistance with planning, provide counseling services MedicAlert + Safe Return program 24-hr. nationwide emergency response service TrialMatch Clinical trials matching service Alzheimer s Association, Aloha Chapter Tel: (808) 591-2771 Fax: (808) 591-9071 www.alz.org/hawaii 1-800-272-3900
51 Mahalo! Questions?
On behalf of the Healthcare Association of Hawaii and Hawaii Alzheimer s Disease Initiative, thank you for attending today s webinar: Brain Health and Risk Factors for Dementia Email the Primary Care Survey to Lori Henning at lhenning@hah.org Complete the Evaluation for this webinar session at https://www.surveymonkey.com/r/hz69bzg www.hah.org