Can We Avoid Cognitive Decline with Age?
Summary
TLDRThe Sam and Rose Stein Institute for Research on Aging at UCSD School of Medicine explores ways to promote lifelong health and cognitive well-being. This talk delves into cognitive aging, distinguishing normal age-related cognitive changes from dementia, particularly Alzheimer's disease. It highlights modifiable risk factors and the importance of early intervention to prevent or delay cognitive decline. The discussion also covers the impact of lifestyle choices such as exercise, sleep, diet, and hearing loss on brain health, emphasizing actionable steps individuals can take to enhance their cognitive resilience.
Takeaways
- 🧠 The Sam and Rose Stein Institute for Research on Aging aims to promote lifelong health and well-being through various approaches, emphasizing the importance of both research and community service.
- 🧐 The talk discusses the possibility of avoiding cognitive decline with age, highlighting the difference between normal age-related cognitive changes and dementia, specifically Alzheimer's disease.
- 📊 Dementia is identified as a progressive loss of cognitive function caused by various brain diseases, with Alzheimer's being the most common. The presentation points out the high prevalence and the significant impact on individuals and society.
- 🔬 The script delves into the cellular changes associated with dementia, such as amyloid Beta plaques and neurofibrillary tangles, and emphasizes the importance of early intervention during the preclinical phase.
- 👩🦳 The presentation acknowledges sex differences in Alzheimer's disease, noting that women have a higher risk and a different trajectory of the disease, which is a focus of ongoing research.
- 🏃♀️ Modifiable risk factors are a significant part of the discussion, with lifestyle factors such as exercise, sleep, and diet being highlighted as crucial for maintaining brain health.
- 💊 The talk mentions that certain medications can have cognitive side effects and encourages reviewing medication with healthcare providers to consider alternatives.
- 🧘♀️ The importance of managing conditions like hypertension, diabetes, and sleep apnea is underscored to reduce the risk of cognitive decline.
- 🥗 The script points to diet as a modifiable risk factor, with adherence to a healthy diet, such as the Mediterranean-DASH diet, being associated with slower cognitive decline.
- 🌐 The development of an educational platform called Halt-AD is discussed as a means to disseminate information about modifiable risk factors and provide psychosocial support to individuals seeking to improve their brain health.
- 🌟 The talk concludes with a call to action for individuals to make science-based lifestyle changes, engage in research, and consider philanthropic support to advance Alzheimer's disease research.
Q & A
What is the primary commitment of the Sam and Rose Stein Institute for Research on Aging?
-The Sam and Rose Stein Institute for Research on Aging is committed to advancing lifelong health and well-being through research, professional training, patient care, and community service, with a focus on making successful aging an achievable goal for everyone.
What does the term 'dementia' encompass?
-Dementia is an umbrella term that covers various diseases of the brain which result in the progressive loss of cognitive function, including memory, language, problem-solving, and other thinking abilities.
What is the significance of the research on modifiable risk factors for cognitive decline?
-The research on modifiable risk factors is significant because it has identified areas of lifestyle and health that can be changed to potentially improve cognitive aging, delay the onset of cognitive decline, or reduce its severity.
What is the role of amyloid beta plaques and neurofibrillary tangles in Alzheimer's disease?
-Amyloid beta plaques form outside of brain cells, and neurofibrillary tangles form within them. These cellular changes cause brain cell dysfunction and death, leading to cognitive disruption, memory loss, and brain atrophy associated with Alzheimer's disease.
How does vascular health relate to brain health and cognitive decline?
-Vascular health is closely linked to brain health. Conditions like high cholesterol or hypertension can lead to clogged blood vessels in the brain, depriving brain tissue of essential oxygen and nutrients, which contributes to cognitive decline.
What is the Women Inflammation and Tau Study (WITS), and what is its purpose?
-The Women Inflammation and Tau Study (WITS) is an ongoing study that focuses on women aged 65 and older, aiming to understand whether modifiable risk factors like sleep apnea, exercise, and insulin resistance might predict Alzheimer's disease outcomes, specifically cognition and tau, and whether inflammation is a mediator of that relationship.
Why is sleep apnea a significant concern in relation to cognitive health?
-Sleep apnea is a concern for cognitive health because it can lead to intermittent oxygen deprivation in the brain during sleep. This affects the brain's memory center and can disrupt the brain's clearance mechanism for amyloid, potentially contributing to cognitive decline.
What is the relationship between diet and cognitive decline?
-Diet plays a significant role in cognitive decline. Adherence to a healthy diet, such as the Mediterranean-DASH diet, is associated with slower cognitive decline over time.
How does the Halt-AD program aim to educate and support individuals in maintaining their brain health?
-The Halt-AD program is an educational platform that provides quality information about modifiable risk factors for brain health. It offers personalized learning programs, psychosocial support groups, and access to modules on various areas of brain health, aiming to empower individuals to make science-based changes to improve their cognitive well-being.
What are some non-modifiable risk factors for Alzheimer's disease mentioned in the script?
-Non-modifiable risk factors for Alzheimer's disease mentioned in the script include age, gender (being female), race, and genetics, specifically the presence of the APOE E4 allele.
What are some of the modifiable risk factors for cognitive decline discussed in the script?
-The modifiable risk factors for cognitive decline discussed in the script include education, hearing loss, hypertension, excessive alcohol consumption, obesity, depression, social isolation, physical inactivity, diabetes, and vascular risk factors like cholesterol and high blood pressure.
How does the script address the issue of diversity in research studies?
-The script acknowledges the importance of diversity in research studies and mentions efforts to include more diverse groups, such as the launch of the B-Witz study focused on black women and the Selinker study looking at Latinas and Latinos, to better understand the risks and factors related to Alzheimer's disease in these populations.
What is the role of inflammation in Alzheimer's disease and cognitive decline?
-Inflammation plays a significant role in Alzheimer's disease and cognitive decline. It is associated with an increased risk of other inflammatory disorders and seems to be particularly important in driving tau pathology, the spread of tau through the brain, which contributes to cognitive decline.
What are some of the interventions and clinical trials mentioned in the script that aim to improve cognitive health?
-The script mentions the FINGER Study, which is a multi-domain intervention focusing on diet, exercise, cognitive training, and vascular risk monitoring, and has shown improvements in cognition. Another trial mentioned is one that adds metformin to the intervention to explore its potential protective effects.
How does the script discuss the potential of lifestyle changes to impact cognitive health, even in older age?
-The script suggests that lifestyle changes can have a positive impact on cognitive health even in older age. It references research showing that maintaining a healthy lifestyle can protect cognition, and even individuals with a high load of tau pathology in the brain can benefit from a healthy lifestyle.
What is the significance of the research on sleep and its relationship to cognitive decline?
-The research on sleep is significant because it has found that sleep apnea, especially in older adults, is associated with a higher risk of dementia. Treating sleep apnea with CPAP use has been shown to delay cognitive decline, and poor sleep has been linked to increased tau pathology and memory issues.
How does the script address the role of diet in brain health?
-The script emphasizes the importance of diet in brain health by discussing the Mediterranean-DASH diet and its association with slower cognitive decline. It suggests that a diet rich in green leafy vegetables, berries, nuts, olive oil, whole grains, and fish, while limiting fast food, pastries, and excessive wine, can contribute to better cognitive outcomes.
What are the script's recommendations regarding supplements for brain health?
-The script recommends a cautious approach to supplements for brain health. It suggests that while a multivitamin may be beneficial for those with deficiencies, there is not strong evidence to support the use of most brain health supplements. It emphasizes the importance of making science-based changes rather than relying on supplements without evidence.
How does the script discuss the potential impact of exercise on cognitive health?
-The script highlights the importance of exercise in maintaining cognitive health. It cites research showing that physical activity at different life stages, including in older age, is predictive of better cognition and can have a positive impact on cognitive outcomes.
Outlines
🔬 Introduction to the Sam and Rose Stein Institute for Research on Aging
The Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego School of Medicine is dedicated to promoting lifelong health and well-being through research, professional training, patient care, and community service. As a nonprofit organization, it relies on private donors for its research and educational outreach. The institute's vision is to make successful aging an achievable goal for everyone. The speaker introduces the topic of cognitive decline with age and outlines the talk, which will cover healthy cognitive aging, dementia and Alzheimer's disease, modifiable risk factors, clinical trials, and strategies for maintaining brain health.
🧠 Understanding Cognitive Aging and Dementia
The speaker discusses the normal cognitive changes associated with aging, such as a slight decrease in cognitive speed and efficiency, while also noting improvements in knowledge and vocabulary. Dementia is defined as an umbrella term for various brain diseases causing progressive loss of cognitive function, severe enough to interfere with daily life. Alzheimer's disease is highlighted as the most common cause of dementia, with other causes including Lewy bodies, vascular changes, and frontotemporal dementia. The prevalence of dementia is emphasized, with statistics showing that one in three people over 65 dies with Alzheimer's or another form of dementia, although it's not inevitable.
🧬 Cellular Changes and Pathology in Dementia
The talk delves into the cellular changes that occur in dementia, focusing on amyloid Beta plaques and neurofibrillary tangles. The speaker explains that these pathologies can cause brain cell dysfunction and death, leading to cognitive disruption and memory loss. The progression of amyloid and tau in the brain is detailed, with amyloid plaques appearing early in the process and tau tangles spreading later, causing clinical decline. The concept of a preclinical phase is introduced as a potential window for intervention. The speaker also discusses the commonality of mixed pathology in dementia and the importance of understanding these changes for prevention and treatment.
📊 Prevalence and Risk Factors for Alzheimer's Disease
The speaker presents data on the prevalence of Alzheimer's disease, noting that racial and ethnic differences exist, with African Americans having the highest risk. The non-modifiable risk factors of gender and age are discussed, with women being at a higher risk for Alzheimer's. The speaker also emphasizes the importance of modifiable risk factors, which can potentially change the trajectory of Alzheimer's disease by adding resistance to pathology or reserve against cognitive effects.
🏃♀️ Modifiable Risk Factors and Their Impact on Cognitive Health
The speaker highlights modifiable risk factors that can influence cognitive health, such as education, hearing loss, hypertension, alcohol consumption, obesity, depression, socialization, physical inactivity, diabetes, and vascular risk factors. The Lancet Commission report is cited, which indicates that 40% of the risk for Alzheimer's disease and dementia is modifiable. The speaker encourages the audience to consider their personal risk factors and suggests actionable steps to improve cognitive health.
👩🔬 Sex Differences and Alzheimer's Disease Research
The speaker discusses sex differences in Alzheimer's disease, noting that women have a higher risk and a different trajectory of the disease. The Women Inflammation and Tau Study (WITS) is introduced, which investigates the relationship between modifiable risk factors like sleep apnea, exercise, and insulin resistance, and Alzheimer's disease outcomes in women. The study's comprehensive approach, including lumbar punctures, blood draws, activity devices, cognitive testing, and MRI scans, is outlined.
💤 The Importance of Sleep and Sleep Apnea in Brain Health
The speaker emphasizes the importance of sleep, particularly the role of sleep apnea in cognitive decline and its higher prevalence in older adults. The negative effects of sleep apnea on memory consolidation and brain clearance mechanisms are discussed. The speaker shares clinical observations of the positive impact of CPAP use on cognitive function and highlights research showing a link between sleep apnea and tau pathology in women.
🍽️ Diet, Insulin Resistance, and Cognitive Decline
The speaker discusses the impact of diet and insulin resistance on cognitive decline, noting the increased risk associated with untreated or poorly controlled diabetes. The Mediterranean-DASH diet is highlighted as a predictor of slower cognitive decline. The speaker also touches on the importance of managing pre-diabetes or insulin resistance to support brain health.
🚫 Risky Medications and Supplements for Brain Health
The speaker addresses the effectiveness of supplements for brain health, noting the lack of strong evidence for most supplements and the potential risks of certain medications. The speaker advises caution with over-the-counter and prescription medications that may have cognitive side effects and emphasizes the importance of discussing alternatives with healthcare providers.
🌟 Lifestyle Interventions and the FINGER Study
The speaker discusses the FINGER Study, a multi-domain intervention that improved cognition in older adults by addressing diet, exercise, cognitive training, and vascular risk monitoring. The study's findings, which showed improvements in executive functioning and processing speed, are highlighted, along with the ongoing follow-up studies that include metformin as a potential intervention.
🌱 Empowering Individuals to Improve Brain Health
The speaker emphasizes the importance of making small, sustainable lifestyle changes to improve brain health. The Halt-AD program is introduced as an educational platform designed to provide personalized brain health information and support. The speaker encourages the audience to take action, seek medical advice for potential risk factors, and consider participating in research studies to contribute to the understanding of Alzheimer's disease.
🤔 Addressing Questions on Brain Health and Supplements
The speaker addresses questions about the effectiveness of brain health supplements, the role of multivitamins, and the potential benefits of specific medications like metformin. The importance of discussing medication choices with healthcare providers and considering individual needs and risks is highlighted.
🌐 Diversity in Alzheimer's Research and the B-Witz Study
The speaker discusses the importance of diversity in Alzheimer's research, noting the challenges in achieving a diverse sample in studies due to historical and psychosocial factors. The launch of the B-Witz study, which focuses on black women, is announced, emphasizing the need to understand and address the elevated risk faced by minoritized groups.
🏋️♀️ The Impact of Lifestyle Changes at Any Age
The speaker addresses the question of whether there is a maximum age after which lifestyle changes are ineffective in reducing risk, citing research on individuals over 90 who still benefit from protective lifestyle factors. The importance of maintaining healthy habits throughout life is emphasized.
Mindmap
Keywords
💡Cognitive Decline
💡Dementia
💡Alzheimer's Disease
💡Modifiable Risk Factors
💡Amyloid Beta Plaques
💡Neurofibrillary Tangles
💡Vascular Changes
💡Inflammation
💡Sex Differences
💡Clinical Trials
💡Halt-AD
Highlights
The Sam and Rose Stein Institute for Research on Aging aims to promote lifelong health and well-being through research, professional training, patient care, and community service.
The talk titled 'Can we avoid cognitive decline with age?' discusses expectations of healthy cognitive aging and the risk factors associated with dementia and Alzheimer's disease.
Cognitive changes with age are normal, but dementia, characterized by progressive loss of cognitive function, is not a normal part of aging.
Dementia is caused by various brain diseases, with Alzheimer's being the most common, and mixed pathology is common among those affected.
In 2023, it was estimated that 6.7 million Americans aged 65 or over were living with Alzheimer's disease, highlighting the prevalence and impact of the condition.
The cellular changes in dementia include amyloid Beta plaques and neurofibrillary tangles, which lead to cognitive disruption and memory loss.
Vascular changes and inflammation are significant modifiable risk factors for cognitive decline and dementia.
40% of the risk for Alzheimer's disease and dementia is modifiable, with factors such as education, hearing loss, hypertension, alcohol consumption, obesity, depression, socialization, physical inactivity, diabetes, and others being addressable.
Women have a higher risk of dementia and Alzheimer's disease, and research is exploring the role of inflammation in the progression of these conditions.
The Women Inflammation and Tau Study (WITS) investigates how modifiable risk factors like sleep apnea, exercise, and insulin resistance might predict Alzheimer's disease outcomes in women.
Exercise has a robust correlation with better cognitive aging, with studies showing that physical activity during midlife and later years predicts better cognition.
Sleep apnea is associated with a higher risk of dementia, and treatment with CPAP can delay cognitive decline.
Insulin resistance and diet are significant factors in cognitive decline, with adherence to a healthy diet like the Mediterranean-DASH diet showing slower cognitive decline.
Lifestyle interventions, such as the FINGER Study, demonstrate that a multi-domain approach to diet, exercise, cognitive training, and vascular risk monitoring can improve cognition.
The Halt-AD program, an educational platform, aims to provide quality information about modifiable risk factors for dementia and offers personalized learning programs.
Small, sustained lifestyle changes can have a significant impact on brain health, and individuals are encouraged to identify and address their personal risk factors.
Transcripts
The Sam and Rose Stein Institute for Research on Aging
is committed to advancing
lifelong health and well being through research,
professional training, patient care,
and community service.
As a nonprofit organization at
the University of California
San Diego School of Medicine,
our research and educational outreach activities
are made possible by the generosity of private donors.
It is our vision that successful aging
will be an achievable goal for everyone.
To learn more, please visit
our website at aging.ucsd.edu.
The title of the talk today is,
can we avoid cognitive decline with age,
which I think is something we would all like to do.
So to start with,
I'm going to start with a little bit of background.
Just to frame the talk,
I'm going to talk about what I see as
healthy cognitive aging in terms of expectations,
and then talk about the other end of the spectrum.
What is dementia or what is Alzheimer's disease?
Then we'll get into the meat of the talk,
which is modifiable risk and
what we know about risk factors.
This has been a really exciting area
of science in the last few years.
So I'm really happy that I get a chance
to share just some of this information with you today.
Once we've gone over the observational studies,
studies into correlations between risk
and decline or risk and preventing decline,
we're going to talk a little bit about
clinical trials in this area and
whether or not they show that changing
risk factors might improve our cognitive aging.
I'm going to talk a little bit about
how we might get the message out.
So I'm delighted today that
so many people have signed up to listen to this talk.
But there's so much great information that
we as neuroscientists and geriatricians
and Gytologists know now that we need
to be able to share with the population more widely.
Then I'm going to talk
about you a little bit and what can
you do today to improve or maintain your brain health.
We have a lot to cover, so we'll jump for right it.
As we age, some cognitive change is perfectly normal.
It's to be expected.
It's just the way our skin changes with age.
None of us is going to get into
our 80s or 90s without some wrinkles,
things change, and that's fine.
Things change for the worse
and things change for the better.
So we get a little bit slower cognitively with age.
That's pretty much a done deal.
It happens to all of us,
and our brain gets a bit less efficient.
It gets less quick at pulling up
memories and retaining and juggling information.
So there is some normal decline with age.
There are some things that get
better with age, and we all know that.
We know that we have more knowledge,
more general knowledge as we get older,
and we know more words
and more vocabulary and more Lexicon.
Even if we can't pull that word
up exactly when we need it, it's in there somewhere.
There are some things that improve
and some things a decline,
and that's perfectly normal.
What isn't normal is dementia.
I'm going to talk a little bit
about what I mean by dementia,
and what I mean by Alzheimer's,
just so we're all on the
same page going into the talk today.
Dementia is an umbrella term,
and it covers various diseases of
the brain which result in
the progressive loss of cognitive function.
By that, I mean things like memory,
language, problem solving, and other thinking abilities.
The problems have to be severe
enough to really interfere with
our day to day life and our
independence to be called dementia.
Dementia is caused by different brain diseases,
and those include things like Alzheimer's disease,
which is by far the most common,
and other things like Lewy bodies,
vascular changes and things like frontotemporal dementia,
which has been in the news a lot recently with
Bruce Willis and other celebrities.
Mixed pathology.
So having more than one of these is really common.
It's actually the norm for people with dementia.
That's going to be a little bit of
a recurring theme of our talk today as well.
Although dementia is in the norm,
it is really common, and all of us,
unfortunately, probably know someone
who would be close with someone
who's been affected by this.
In 2023, the Alzheimer's Association estimated that about
6.7 million Americans aged
65 or over were living with Alzheimer's disease.
Way too common. Not inevitable.
One in three of our older adults,
people over 65 dies
ultimately with Alzheimer's or another form of dementia.
That's very common, but that means that
two thirds of the population never get it.
However, the number one risk factor for dementia is age.
As our population ages,
as we're getting in theory,
better healthcare and things like that,
dementia is more prevalent.
That affects the individual.
That affects the person who is living with the diagnosis,
but it also affects their family.
We all know the emotional and
also the practical toll that takes on families.
But it's also under
societal and health care systems level,
a bit of a disaster because of the cost
involved and the burden people need to be taken care of.
It's really something that we're all motivated both
on an individual and a more
social level to do something about.
We know with the loved ones
that we've had it been affected by dementia,
that reducing or delaying
those cognitive declines is going to be huge,
both for us and for
other people who might have to take care of us.
It's a necessity beyond that for
our communities and our healthcare systems.
What happens in the brain with dementia?
What are the actual cellular changes
to start with that happen?
There's two key pathologies.
One is amyloid Beta plaques,
and the other one is
these these neurofibrillary tangles and
the plaques form outside of the brain cells and
the neurofibrillary tangles form within the brain cells.
There are other pathologies such as Lewy body and TDP 43,
which we don't have time to go into today,
but just to say there are other cellular changes
that often contribute as well.
Vascular changes are super common,
and that's going to be another theme of today's talk.
I'm going to go into that in more
detail in a couple of slides.
Inflammation changes.
Here on this slide, we have microgliosis and astroplioss.
That's our inflammatory system,
which gets involved in the pathology of
Alzheimer's disease and ultimately helps to promote it.
Vascular changes and inflammation are both
really important factors in modifiable risk.
These cellular changes cause
brain cell dysfunction and
ultimately death down the line.
This dysfunction and death
causes a breakdown of the connections of our brain,
which ultimately result in
cognitive disruption and memory loss
and other cognitive decline and
brain atrophy or shrinking that you see there with
this brain that's with
Alzheimer's disease and half healthy.
These changes happen in a certain order.
So amyloid beta plaques
get distributed diffuse in
the brain quite early in the process,
10-15 years before we
start to see clinical or cognitive decline.
The cognitive decline comes when
the pathological tau tangles
start to spread within the brain.
So we have this gap between when an amyloid starts
and when tau starts to spread about 15 years later,
which we are calling the pre clinical phase,
which we're seeing is a potential window to intervene.
Once the tau tangles start forming,
we get the atrophy and the clinical decline.
Stopping or slowing that
tau distribution is
another target of modifiable respectors.
The amyloid distributes diffusely early,
you're seeing at the top there, these three brains,
where there's just this progression from
lighter red through darker red of amyloid,
but it's really not in a
very specific location in the brain.
It's everywhere.
Then once we get into
more specific stages, there's just more and more.
So it's not very localized.
Whereas what we see with the tau tangles is they
start very early when people are in their 40s or 50s,
we might have a few tau tangles
sitting in our transgener renal cortex,
and it's not really a big deal.
It doesn't cause a problem.
When it does start to cause a problem,
it is a few years after we've had
that amyloid build up diffusely.
For some reason, there's
this interaction between amyloid and tau,
and we start seeing this spread
through the lymbic region,
which affects memory and then beyond into
the other parts of the brain which
affect other cognative syndromes.
We get this ultimate cognitive decline in dementia,
but it happens in these staggered stages.
As I mentioned earlier, mixed pathology,
having more than one pathology in the brain is normal.
I really like this graph,
which was produced by the Rush Alzheimer's
Disease Research Center in Chicago,
and they have a really nice,
diverse data set there with
about 50% black people and 50% white people,
that's why there's the two different pie charts here.
What you can see here is these are people who
had Alzheimer's disease dementia
clinically diagnosed during life.
Then at death, they very kindly gave
their bodies for autopsy on their brains,
so we could see what pathologies they had in their brain.
The blue sections there are the Alzheimer's pathology,
just pure avoid and tow and nothing else.
You'll see that's the smallest section or
a small section of each pie chart,
so about a third of white people and
less than a quarter of black people
with Alzheimer's during life
have pure Alzheimer's when we get to the autopsy stage.
Most people have Alzheimer's
plus something else, so in light pink,
they are Alzheimer's plus in fox or
little brain bleeds or Alzheimer's plus Lewy body.
The people in red there,
which is quite a sizable chunk of the chart on the left,
have all three of those pathologies,
so it's really common.
I want to focus on those people who have Alzheimer's plus
vascular because the vascular system
is something that we've known about for a long time,
and we know that what's good for
the heart is good for the brain.
I want to go into a bit of a deep dive on that topic.
This is the vascularization of the brain,
all the blood vessels in the brain.
I love seeing this image,
and it always surprises me and astounds me that there is
just so much blood
pumping through our brains at any one time,
and that's really important.
This is another image showing an MRI of the brain and
showing how branched those blood vessels are.
I like to think of it like trees.
You have a trunk,
and then you have branches,
and those branches going to
smaller branches, and ultimately,
we get down into little tiny twigs.
Those are the little capillaries
or microcapillaries of the brain.
When we have either just with normal aging or
more so if you have high cholesterol or hypertension,
those little twigs get clogged and
ultimately the blood isn't getting to them,
and then the little bit of brain
that they are serving or supplying
blood and oxygen and nutrients to dies
off and we get
these little white matter changes in the brain.
The bottom image there is
the white matter structure of the brain,
and the white matter provides
the road system of
how information moves around our brain.
That's one of the reasons why we think
the brain becomes less
efficient and speedy with age
because it's getting clogged up and the road system,
the information getting from point A to point
B has to go different circuitous routes,
which takes longer and slows
down our processing speed
and our attention and all of these things.
Small vessel disease of the kind
we just described is very common with aging,
it contributes to clinical decline,
and it's associated with
vascular risk factors like the ones I just mentioned,
cholesterol and high blood pressure.
Another major factor in
clinical and cognitive decline with
aging is inflammation,
and this is again, non-specific.
It's associated with all sorts of things,
stress, or diet, vascular risk, etc.
Importantly it seems to be really
important in driving that tau pathology,
the tau spread through the brain.
Inflammation is present in brains,
it's part of the healthy function of the brain,
even when we're young,
but it becomes more of a prevalent process as
we get older and even more so in Alzheimer's disease.
As you can see from these pet scans from
colleagues in Pennsylvania at the bottom,
where the redness of
the picture is the higher level
of inflammation in the brain.
But let's talk a little bit about who
is at risk for Alzheimer's disease.
There are certain non modifiable risk factors,
and as Daniel mentioned,
a lot of mine researchers in sex differences,
and I particularly hone in on women,
and that is in part because being female
is a major risk factor for Alzheimer's disease.
There's not much we can do to change that,
but another non modifiable risk factor,
unfortunately is rape.
You'll see in this image from the CDC that if you're
over 65 in this country and you're a non Hispanic white,
you have about a 10% chance
of having Alzheimer's disease.
If you're Hispanic, it's 12%,
and if you're African American, it's 14%.
There's a definite difference in risk
based on race and ethnicity for various reasons.
The other factor is genetic.
Again, that goes on the non modifiable category,
but today's talk is really focused
on modifiable risk factors.
What can we change,
and how can we improve our cognitive agent?
This is increasingly recognized
as being really important.
It might not change the initial pathology,
the amyloid, although we
think that maybe some things can.
But it can perhaps change
the vascular and inflammatory factors
that promote the spread of tau,
delaying onset or reducing severity.
Two things that we're looking to do with
modifiable risk factors are to
add the resistance to pathology,
so not getting the pathology in the first place or
getting it later than you would otherwise,
or a reserve against cognitive effects,
so having the pathology in the brain,
but it not mattering so much,
not being such a problem for us cognitively.
It's important to note that a lot of
people will die with a head full
of amyloid and never have
any cognitive concerns or problems.
It's really that tow pathology that becomes problematic
and something that we want
to avoid or diminish in effect.
What am I talking about when I
say modifiable risk factors?
There was a really important paper that
came out in the Lancet called
the Lancet Commission in 2020 by Gill Livingstone,
and she and her colleagues did a large review of
the evidence and derived this beautiful plot which
shows that 40% of the risk for
Alzheimer's disease and dementia
more broadly is modifiable.
Some of that is related to
early life experiences, specifically education,
7% of the risk is
maintained by the amount of
quality of education you have when you're young.
That's really important for policy setting,
and it's important for making sure our kids and
our grandkids go to school and get a good education,
but it doesn't help us much on the adults.
But other things do,
so the mid life blue circle
there shows things like hearing loss,
hypertension, drinking too much alcohol, obesity.
Then we get into this later life section in the purple,
where we have depression,
socialization, physical inactivity, diabetes,
and the cumulative risk
associated with all of those things can
compromise a large chunk of
our individual risk for getting dementia.
That's encouraging,
because there are things that we can do about those.
A lot of those targets are really
actionable and things that we can do something about.
Of course, the actual risk factors are really personal,
and the combination of risk factors
that any one person
has is going to be a little bit different.
As we're talking today,
as we're going through this talk,
think about what your personal risk might be,
things that you might be able to improve.
Maybe you don't have anything which is
fantastic, but if you do,
then maybe you can start making a little list of
things that you might want to target in the future.
Sex differences, again, this
is the lifeblood of my research.
As I mentioned, women have
a much higher risk of dementia,
and it's not just because we live longer,
but unfortunately, two thirds of
Americans living with Alzheimer's disease are women.
Women also have a different kind of trajectory
of Alzheimer's disease than do men where they
have a third burgeoning of tau pathology during
the mild cognitive impairment or MCI phase,
which happens between when we have normal cognition,
but before when we have dementia and
we're dependent on others for help,
so when we have some cognitive difficulties,
but we're still independent.
Women also have a robust and responsive immune system,
which puts us at higher risk for
other inflammatory disorders which
affect the body in the brain,
things like multiple sclerosis,
rheumatoid arthritis, and lupus.
Along with my colleagues,
especially Erin Sunderman,
I'm interested in whether inflammation
could be the key to the surgeon tau.
If we can understand that,
maybe it can help us learn how to
restrict or slow the spread of tau.
For example, this is some work done
by our former postdoc Rachel Bernier,
who looked at neuroinflammatory factor, specifically,
something called sTNFR2 in the cerebrospinal fluid.
That's the fluid that fills the spaces in the brain,
cushions the brain, and also coats spinal cord.
When we look at that fluid,
we can see a lot about what's going on in the brain.
What we found is that
women show a much stronger link between cognition,
in this case, something called the MMSE or
the mini-mental status exam and inflammation.
In this case, a marker called sTNFR2.
Whereas men who are in the light gray
in that graph really don't show a relationship.
There's something going on with
women where there's a stronger relationship,
and we see it in other things
too with things like tower pathology,
which was included actually in Rachel's paper,
where women showed a relationship
between information and tau, whereas men did not.
There's something going on there,
which was very motivating to myself and my colleague,
Dr. Erin Sunderman, here she is.
It led us to produce a study,
which is ongoing, called
the Women Inflammation and Tau Study or WITS.
In this study, we're looking just at women,
and we're looking at whether
modifiable risk factors
specifically sleep apnea, exercise,
and insulin resistance might
predict Alzheimer's disease outcomes,
specifically cognition and tau,
and whether inflammation is a mediator of that,
something that pushes that relationship.
In WITS, we have women who are screened.
They're 65 or older.
They have some cognitive change,
and they have more than
average genetic risk for Alzheimer's disease.
These women are amazing.
They come into our clinic in La Jolla,
and they have a lumber puncture,
a blood draw, they receive
activity devices to take home
to measure their sleep activity.
They come back for another visit for
cognitive testing and an MRI scan,
and then another one for a Tau PET scan.
Then two years later,
we repeat some of that,
and we're in the process of analyzing those data,
and I'm going to give you some little snickets
of it as we go through the rest of the talk.
Exercise is one of the things that we focus on in WITS.
The reason for that is because
that's really robust evidence.
I'd say more than any other modifiable risk factor that
this is associated with how we age cognitively.
This is a study that I love to share.
It's by another of my colleagues and
friends here at UCSD, Dr.
Doctor Emily Reas,
who was analyzing data from the Rancho Bernardo study,
so just here in our backyard almost.
She looked here at self reported levels
of activity at different decades
and people who were being studied when they were older.
Then she looked at the physical activity during
these different decades in
relation to their late life cognitive function.
What she found, and again,
we have the MMSC the mini mental status in
the top left there.
She found that activity during mid life
in your 50s and activity when you're older,
is predictive of better cognition.
The same pattern is true of something called Trails B,
which is an executive task,
where a lower score
is a quicker score and a better score,
where people's physical activity in their 30s
and when they're older predicts
better scores and the same for memory,
specifically, in the bottom right
there for the levels of activity when you're older.
This to me is really encouraging.
It's correlational, so not necessarily causational but
we are seeing this relationship between activity levels,
even when we're older on our cognitive outcomes.
This is one of many studies that have looked into
the relationship between exercise and
brain health and it's the one thing,
I think that is
the leader of the pack with modifiable risk factors.
Other thing that we really focus on here is sleep,
and sleep apnea specifically,
is really common, especially in older adults.
After the age of menopause,
so 50s, 60s,
it's equally common in men and women.
It's associated with a higher risk of dementia,
and excitingly, I guess, CPAP use.
No one wants to wear a CPAP machine, particularly,
but when people do wear them and they adhere to
that, it delays decline.
I've seen this actually in
clinic where someone's come in,
with untreated sleep apnea,
and their testing almost looks like Alzheimer's disease,
and then they go away and they really try very
hard to adhere to that CPAP use every night,
and then they come back and they
look like a healthy older adult.
I'm a little bit of evangelist
when it comes to sleep apnea and CPAP.
The reason why we think that that happens is
because when someone has sleep apnea,
there's a diagram here.
The airway collapses
intermittently when they're sleeping,
and that prevents the right amount
of oxygen getting into the brain.
The hippocampus, which is the brain's memory center,
is really an oxygen hungry organ
and if we don't give it enough oxygen,
it just doesn't behave.
It doesn't do the consolidation of
memories which is meant to be doing overnight,
so people get more forgetful.
Then another reason that sleep
is a problem for the brain is
because the brain's clearance mechanism,
the lymphatic or glymphatic system
clears amyloid when we have effective sleep.
If you don't have good sleep,
you're not getting that quality overnight clearance,
and that also causes problems.
We look at sleep apnea and sleep problems in WITS.
We've been really surprised by the prevalence,
which has been about 80 percent of the women and
with so far have some level of sleep apnea,
and about 40 percent of those are moderate to severe.
It's really common. Most of
those women had no idea that they had it.
In women, it tends to present with less of
the loud snoring and
the gasping that you might see in men,
so it's a quieter syndrome,
and it goes under the radar.
This is some work by our graduate student, Kitty Lui,
who has looked at these strong relationships
that we're seeing between sleep apnea and tau.
Where worse sleep apnea seems to
predict more tau in the women in WITS.
But we get even stronger relationships,
when we just look at their sleep complaints.
If we just have to fill out a 10 minute questionnaire,
we see relationships with tau in the top right there,
Section A, where the more complaints you have,
the more tau you have, and with memory.
The green lines that you see there are
a test called a brief visual spatial memory test,
and we see really strong relationships between
that and sleep complaints in our women.
Another thing that we're looking
at is insulin resistance.
We've known for a long time that untreated or out of
controlled diabetes is
a risk factor for Alzheimer's disease.
Some people refer to Alzheimer's disease
as Type 3 diabetes.
But we also know that pre diabetes or
insulin resistance is a respect
for cognitive decline with aging,
and this is just an example
of research on that where they've
looked at the wordless learning and
recall task and the age of testing,
and you see that the people with the
highest or the lowest, sorry,
insulin sensitivity are doing worse on
those memory tests in the light blue dotted line.
This again, there's a lot of evidence for this.
It seems to be even stronger in women,
which is why we're including it in WITS,
by making sure that any pre-diabetes or diabetes
is in control is really important.
Along those same lines,
diet in general seems to be
a good predictor of cognitive decline.
This is more data from Rush in
Chicago where they've looked
at a special way of categorizing the diet,
by looking at how closely you adhere to something called
the Mediterranean-DASH or dietary approach
to systolic hypertension diet.
What they find is that people
who adhere to this very healthy diet,
who have a high score are
declining much more slowly over time in their study.
These are people who came into
the study in their 60s and 70s,
and now they have 10 years of data,
and the heavy dotted line at the top there is showing
much slower cognitive decline over
time than the solid line at the bottom,
where the score is low.
It's a little tricky to see,
but some of the things that people
get high points on the mine diet,
a questionnaire, how many green leafy vegetables you eat,
berries, nuts, olive oil,
things like whole grains, fish,
and then you lose points for things like fast food,
pastries, and too much wine, unfortunately.
Diet goes a lot with vascular risk,
and we know that vascular health
is really important for brain health.
What's good for the heart is good for the brain.
This is a former research assistant in the lab.
Her name is Amaryllis Tsiknia.
She's now doing her PhD
at University of Southern California.
She did this study looking at the intersection
between lifestyle and vascular risk specifically,
with something called a Framingham risk score,
which combines cholesterol, smoking, diabetes,
and blood pressure, with
genetic risk with APOE E4 status.
This is the strongest risk factor for
Alzheimer's disease in all of the genetics,
at least in white people.
We use the new data here,
which is the Alzheimer's
disease neuro imaging initiative.
What she found is that women who are depicted in red,
who even have a little bit of
vascular risk and have that E4 allele have
much higher tau pathology on
these three different areas of
their brain than do men who were measured in blue.
Men have quite a flat line.
Even though they have their genetic risk,
they don't seem to have this intersection
with these vascular risk factors.
Although we recently did
a follow up study and showed that perhaps
BMI being obese might be
a bigger risk factor for men than it is for women.
The other important modifiable risk factors
that I don't have time
to cover today include sensory loss and specifically,
there's really strong evidence for hearing.
If you or other people
around you notice that you have some hearing difficulty,
get it checked, and then wear those hearing aid.
Avoiding loneliness.
This is something that's really interesting,
having good quality friendships
or relationships even just with one or two people
and that subjective feeling
of loneliness that you could have even when
you're surrounded by people is
a strong predictor of cognitive outcomes.
Blood pressure control, hypertension.
This is something that we've known about for a while,
but we've really seen that
aggressive blood pressure control can be helpful.
Risky medication.
There's a lot of medications that
older adults are exposed to sometimes,
which actually have cognitive detriment
and then chronic stress as well.
All important risk factors that
we don't have time to go into in depth today.
A couple of things that don't seem to work are
supplements unless you have
a specific deficiency for vitamin B12.
People will sell you supplements
for sure, but unfortunately,
we haven't found anything that
is that quick and easy just yet.
The other thing that a lot of patients
will ask about in clinic
are whether or not doing crosswords or Sudoku
or other brain activities like that might be helpful.
They're helpful and they're enjoyable.
This guy seems to be enjoying
his crossword which is great,
but it's a sedentary activity.
I'm hoping that after he's done with his crossword,
he goes for a half hour walk or something.
Unfortunately, we haven't seen
that crosswords and stoke of puzzles and
other brain games have
really strong effects on brain health.
This is a study that I wanted to highlight
just quickly because I think it's really exciting.
This is showing that even if you have a high load
of on the left part towel
or both on the right in your brain,
if you have a healthy lifestyle,
your cognition remains protected.
You might still decline,
but perhaps over a slower period and this is exciting,
because it means that even someone
who's at really high risk or even someone who's in
the early stages of
the disease might be
able to protect themselves in the future.
But, of course, all of the data that I showed you
so far has been correlational.
I do want to get into
interventions and clinical trials just briefly.
There've been a couple of
really interesting studies coming out,
looking at multi-domain interventions.
Recognizing that there's probably not
one thing that we do that's going to fix this.
It's probably multiple things.
This is a study that came out of Finland.
It's very famous at this point.
It's called the FINGER Study,
and it's launched a bunch of
other similar studies across the world.
We now have the worldwide fingers.
This was a two-year multi-domain intervention where
they helped all the adults with their diet,
exercise, cognitive training, and
vascular risk monitoring and
they saw an improvement in cognition.
If you tackle all of these things at once,
you see an improvement in things like
executive functioning in the top
right there and processing speed.
Things that are really reliant on
that vascular system being healthy and the rain,
roads, the white matter being healthy.
They didn't see an improvement interestingly in memory,
which is the area that's
affected earliest in Alzheimer's disease.
But you know what? I would take it.
If my brain can be quicker and more efficient,
I think it's probably worth it.
All of these activities,
as well, just to mention on the side,
are going to improve your overall well-being,
your physical well-being, as well as your brain health.
Because FINGER went so well,
they're continuing it and
now they're looking at intuin resistance as well.
They're adding metformin, which is the diabetes drug,
which is pretty safe.
It's pretty cheap, and they're adding,
so some people are getting just the Lysol intervention
in this latest study
that they're conducting at the moment.
Some people are getting low dose,
and some people are getting high dose of metformin.
That'll be a really exciting study
to keep an eye on and see what they find.
Another study more locally by
Christine Yaffe who's at UCSF staff
and Eric Vittinghoff,
who's in University of Washington in
Seattle did a similar thing where they helped
people get through various respecters at
one with a personalized intervention with coaches.
Unfortunately, for Dr. Yaffe and her colleagues,
the pandemic happened halfway through this study.
A lot of us were a lot more sedentary during that.
I suspect their findings would have been even more
exciting had they not had that to contend with,
but the result was that they saw a subtle improvement in
cognition in a 24 months.
It's encouraging, for sure.
I wanted to spend a few moments to talk a
little bit about this problem.
When I'm in clinic,
I often have people ask what they
can do to help their brain health,
and we have just scratched the surface in
the last 40 minutes
of modifiable respecters and this new science.
Along with my colleague, Dr. Howard Feldman,
we were chatting about how frustrating it
is that there's all this exciting new science.
We know so much more now than we did
10 or 20 years ago about brain health.
But how do we get that across to
the people who need it to the public more widely?
Howard and I decided that we were going to
create this educational platform.
We created something called Halt-AD.
Which is an app slash website,
can be done on the phone or the computer,
developed here at UCSD,
and we're currently studying
whether or not it's optimized.
There are versions in English and Spanish,
which have been adapted for
our regional Latino and Latino population,
so a cultural as well as a linguistic adaptation.
We're running a couple of small studies right now
to figure out how best to tweak
it and also looking for
more funding so we can launch it more widely.
Halt-AD stands for healthy activities and
lifestyles to avoid dementia or an excuse my accent,
Hispanos y el ALTo a la Demencia.
It's, as I mentioned, an educational program delivered
online to provide quality information
about modifiable risk factors.
We thought it was important to accompany
the online program with psychosocial support groups,
so we could create some sense of community and have
some Zoom face-to-face, but face-to-face.
Nonetheless, time with a moderator,
who was a social worker,
and your colleagues who
were going through the program with you.
Some people relate that, and some people so
far take a leave,
but that's getting at
this personalization and what people might
like and how people might want
their brain health education.
This is the landing page for Halt-AD.
Once you sign up,
you fill out some questionnaires and you get
a report on your brain health
based on the information that he's given.
Then you can set yourself
goals for what you would like to improve.
Some of us might be a little bit
sedentary and have not the greatest diet and
not really want to change our diet, and that's okay.
It's a very personalized choice,
and we also want to encourage
people to set reasonable goals which
they're really likely to attain and
set themselves up for success.
Based on their risks and their goals,
they get a personalized learning program,
and they get access
to modules on all of these different areas,
and we plan on adding more in the future, too.
Several of the modifiable
risk factors we've already discussed.
The platform looks a little bit like this,
where you can play
these different factors there
the voiceover if you want it,
or you can just read the material yourself.
There are quizzes and
other game of field components, all that,
and we really try to present it in a way
that's interesting and motivating.
That's Halt-AD. I wanted to just spend
the last couple of minutes talking
about what can you do today.
Hopefully, this has been
interesting and as we've talked,
maybe or as you think about this later on today,
you could identify your own risk factors.
Think about what you can reasonably change.
What might you want to address?
What's worth it for you?
The best thing to do with changing habits
is to make small changes
that you're really likely to sustain.
Because those small changes,
if you do sustain them,
can make a big impact on
your health and specifically your brain health.
You might want to make an appointment with your doctor,
if you have something
like poorly controlled hypertension.
If you have prediabetes or diabetes
which hasn't been addressed or isn't stable.
If you have sleep apnea or insomnia,
and even if you feel like
your sleep is just not very good and you're waking up,
feeling groggy or you're napping during the day,
or otherwise your sleep isn't efficient,
you might have sleep apnea,
and just not be recognized.
We can do home sleep tests now.
It's not such a big deal as it used to.
Hearing loss, as I mentioned earlier,
big low-hanging fruit with
hearing loss and very common again with aging.
I encourage everyone to get moving.
I've been sitting here talking to you.
I'm going to go for a walk with the dogs later,
and definitely get out and enjoy the sunshine.
I want everyone to feel empowered.
I think that this is encouraging,
we can do something about this.
We can maintain our brain health.
We might even be able to improve things.
I think that that's good.
Then I would encourage
people to make science-based changes
using psychology to help with bad habit busting,
and there's some great
reading material out there on that.
Then if you're interested and
you're motivated to join the study,
we would love to have people join studies.
This is my little pitch for
getting involved in some of our research,
the QR code there and the website
underneath is for
our Alzheimer's disease research center,
we need healthy people too.
This is the website for with,
the study that is
really a passion project for myself and Dr.
Sundermann we would love to have the women in
the audience look into that,
so much of what we do both at
the Sine Institute and with research in general,
it's through philanthropy and generosity.
If that's something that you're
able to do and want to do,
please do consider it.
Finally, I would like to thank some of
my colleagues, my funding sources,
and of course, anyone who has contributed to our studies,
we couldn't do it without the participants.
Thank you and thanks for listening.
Thank you so much, Dr. Banks.
It's such a fantastic talk.
As you can imagine, we have a lot of questions for you.
[LAUGHTER] They're great questions.
Let's go ahead and get started.
I'm just going to go in the order that they came in.
Opinion of brain boost or
brain health supplements such
as prevagen and multivitamin,
centrum silver, turmeric, etc.
That covers a lot of ground?
Yes.
Multivitamin there's been some
encouraging research recently,
and there's probably people walking around
who have deficiencies where they don't know.
Taking a multivitamin, maybe that covers your basis.
Definitely, if someone is concerned,
they should go and seek out medical advice and get
blood tests and figure out if they have deficiencies,
and it's definitely something
we do at the memory center all the time.
Vitamins they have their place.
If you don't have the deficiencies,
then your body washes it out and it becomes expensive.
But a multivitamin is not too much of an investment.
Some of the supplements
cause frustration for a lot of us in brain health I
think because there's not a ton of
evidence to suggest that they're helpful and
people will come in and they'll be spending
a ton of money on stuff
that there isn't evidence for and that
was really one of the motivating factors for Halt-AD.
There are things that we can do
which there's a huge body of evidence for now which
I hope I got across with the talk a little bit
and supplements in general are not in that category.
Thank you so much for clarifying that Dr. Bank.
What are some risky medications
that can be modified to help risk factors?
Yeah, so one of the most common ones is given
sometimes for overactive bladder, oxybutynin,
so there's a lot of medications that can
affect the processes of
the brain and some of them something like gabapentin,
something that might be given for
really good reason if you have
neuropathy or something like that.
It's often way up and perhaps having a discussion with
your doctors about whether or
not there's alternatives to some of those medications.
Some of the SSRIs can be detrimental,
definitely some allergy medications, benadryl.
There are medications which
are really not ideal and some of them
are over the counter as well,
so being really mindful about what you're taking
including over the counter medications
because they can have a detrimental effect.
Great. Thank you. Next question.
Dr. Breston has a
multi-vitamin he developed specifically
for brain health, does it help?
I've heard this question a number of times.
I think I'll default to my first answer.
I think in that maybe he knows
something that the rest of us don't.
It's a good answer. Finger study,
what cognitive training was used?
That's a good question.
I would have to brush up on the exact details.
I don't think it was one of the over
the counter things that we can buy,
and it was in finish.
I think it was different, but yeah.
We could definitely look that up.
Great. You had a slide listing Metformin as
a helpful possibility for
current diabetics taking Metformin, can this help?
Well, there's some interesting data
to suggest that it might be protective,
so I don't think that I can
answer that definitively one way or the other,
but it is potentially helpful, so yeah.
Great news. What are the age and
other qualifications to participate
in the Halt-AD program?
That's a great question too.
We're currently running a couple of
studies locally and with partners up here in
Siasho which are going out through
our medical colleagues and
we are looking to launch another study locally,
so let's watch the space with Halt-AD
because we're waiting for
our next step which will be coming soon,
but in the meantime we have
these other two studies that we're
waiting on the data for so.
Yeah, we'll be back in touch.
Fantastic. This next one seems like a statement,
but maybe it's a question.
A fermented soy product
Nate Kane supposedly clears plaque,
do you know about this Dr. Bank?
I've heard mention in
Shidshadow with the soy products in the past.
I don't think too much has come of it,
but I would be happy to be proven wrong.
Great. Which medications are
considered risky for dementia?
Yeah, so that one came up before Benadryl,
Oxybutanin some of these medications
for pain and things like that.
Really thinking about the medications
that you're on and having that discussion,
really is a provided question
with your physician or whoever's providing and
prescribing your healthcare and asking if they have
a cognitive side effect and if so
if there's something else that you can have.
There's the BS criteria
which is you can look it up online.
It gives you points
for the cognitive risk factors based on each medication,
so it's something that we need to be looking at.
Geriatricians are the best and pharmacists at that,
so you can also talk to your pharmacist
about that actually if you're concerned.
Great. We have a few questions that have
come in which I'm curious about.
Have you looked at women taking HRT versus not HRT,
and do we know if there's a risk factor?
Yeah, this is an excellent question.
We are asking lots of questions about from our women
and wits about what they did or did not
take and for how long and when.
What we know from prior studies is
the women's health initiative was stopped
early because of cancer side effects,
but in terms of cognition,
it does seem like when you take your HRT is important,
so there's a critical period
closer to the time of menopause.
Some women I believe were being
prescribed it much later which
was not helpful from a cognition standpoint,
but if you prescribed it earlier it might be helpful.
Menopause is such an interesting topic
and sleep is impacted massively.
Mood is impacted.
Cognition itself is impacted and it's all this tangle.
We need to know more about it.
We would love to run a version of Witz called
Witz Junior where we look at the perimenopausal phase,
so far we have not been able to get the funding for that,
but we will continue to
try because it's such an important question.
Thank you for that. We have
just a few more questions left.
Tell me about diversity in
your studies. Did you consider that?
Yes, we are considering that and I didn't touch
on that very much in this talk,
but we have width which requires lumber punctures.
It requires pet scans.
It requires a lot of
invasive data collection which unfortunately has
been a barrier to diversity in
studies due to a history
of structural racism in this country,
and mistrust in the medical system,
and all complex psychosocial fetal issues.
We have struggled to diversify that sample.
Because of that and because
black women are probably at the highest risk in
this country of any demographic group
for getting Alzheimer's and related dementias,
we've launched a separate study called
B-Witz which is specifically focused on black women.
I didn't go into it today in the talk,
but I could talk about it for hours.
We're just launching it now.
We don't have any data yet.
We've taken a year with
our community advisory board to really try and make sure
that we're doing it in
a helpful way and
we're doing this in collaboration with colleagues,
Mark Norman here at UCSD and April times up in LA
who have experience in
diversity research and experience
specifically in these communities,
and B-Witz will actually go into the community and
rather than asking for lumber punctures than all of that.
We will just be using blood samples
and cognitive testing and sleep and all that thing.
Of course, any woman and B-Witz is welcome to join
wits as well as she wants to do all those components,
but we're really excited about B-Witz.
Then we're also involved in a study
called Selinker which is looking
specifically at Latinas and Latinos
and that's throughout the country,
so getting involved with
more diverse groups is really important.
As I mentioned in the talk,
people who are not white or elevated risk generally in
this country from Alzheimer's and we know the least
about some of these minoritized groups. Really important.
Great. Thank you, and I think we have
time for just one last question.
Is there a maximum age after which
no lifestyle changes seem to be
effective in reducing risk?
That's a great question too,
and there's some amazing research
coming out of Claudia Coosis group up
in Irvine looking at
the oldest old people who are over 90 or a 100 even,
and it still seems to be somewhat protective.
I don't know that we know enough to
say is there an age or
it's okay just to be a couch potato,
but I think what we tend to see
in those really successful aging groups who get up to
those age groups and are still cognitively sharp is
that they tend to have a lot
of protective lifestyle factors already.
That's great. Well, thank you so
much Dr. Banks for such an amazing talk.
I think I speak for everybody that attended today.
It was just fantastic.
I want to thank all of you who
spent your afternoon with us today.
Thank you so very much.
A reminder that if you benefit from these talks,
please do consider donating to us @agingwcsdu.edu.
Thank you so much Dr. Banks.
Thank you for the invitation. See you soon.
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