Can We Avoid Cognitive Decline with Age?

Summary

The 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

00:00

🔬 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.

05:03

🧠 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.

10:05

🧬 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.

15:06

📊 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.

20:08

🏃‍♀️ 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.

25:09

👩‍🔬 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.

30:10

💤 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.

35:11

🍽️ 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.

40:11

🚫 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.

45:14

🌟 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.

50:15

🌱 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.

Keywords

💡Cognitive Decline

Cognitive decline refers to the gradual deterioration of cognitive abilities such as memory, attention, language, and problem-solving skills. In the context of the video, it is a natural part of aging to some extent, but the focus is on understanding and potentially mitigating excessive decline that leads to conditions like dementia. The script discusses normal cognitive changes with age, such as becoming slower and less efficient, while also highlighting that certain aspects like vocabulary can improve.

💡Dementia

Dementia is an umbrella term for various brain diseases that result in progressive loss of cognitive function, severe enough to interfere with daily life and independence. The video emphasizes that while dementia is common, particularly with age, it is not an inevitable outcome of aging. It mentions Alzheimer's disease as the most common form of dementia, along with other causes such as Lewy bodies and vascular changes.

💡Alzheimer's Disease

Alzheimer's disease is a specific type of dementia characterized by the progressive degeneration of brain cells, leading to memory loss and cognitive decline. The script points out that Alzheimer's is the most prevalent form of dementia and discusses its impact on individuals and society, as well as the importance of understanding and addressing its risk factors.

💡Modifiable Risk Factors

Modifiable risk factors are elements that can be changed to potentially reduce the risk of developing a condition like dementia. The video highlights the importance of identifying and addressing these factors, such as hearing loss, hypertension, alcohol consumption, obesity, depression, socialization, physical inactivity, diabetes, and others. The script discusses how changes in these areas can help delay onset or reduce the severity of cognitive decline.

💡Amyloid Beta Plaques

Amyloid beta plaques are abnormal clumps of a protein called amyloid beta that accumulate outside brain cells and are a key pathological hallmark of Alzheimer's disease. The script explains that these plaques begin forming in the brain many years before clinical symptoms of cognitive decline appear, indicating their importance in the development of dementia.

💡Neurofibrillary Tangles

Neurofibrillary tangles are another pathological feature of Alzheimer's disease, consisting of twisted fibers of a protein called tau that accumulate inside brain cells. The script describes how the spread of tau tangles within the brain is associated with cognitive decline and is a target for intervention strategies to modify the course of dementia.

💡Vascular Changes

Vascular changes refer to alterations in the blood vessels supplying the brain, which can contribute to cognitive decline and dementia. The video discusses how issues like high cholesterol and hypertension can lead to clogged blood vessels, resulting in reduced blood flow and damage to brain tissue. The script emphasizes the importance of good cardiovascular health for brain health.

💡Inflammation

Inflammation is a natural response of the body to harmful stimuli but can become problematic when it is chronic or excessive. In the context of the video, inflammation in the brain is associated with the progression of diseases like Alzheimer's. The script mentions that inflammation can drive tau pathology and is a potential target for interventions aimed at reducing cognitive decline.

💡Sex Differences

Sex differences refer to the variations between males and females in terms of biological and physiological characteristics. The video discusses how women have a higher risk of Alzheimer's disease and may have a different trajectory of the disease compared to men. The script also mentions research focusing on women, such as the Women Inflammation and Tau Study (WITS), to better understand these differences.

💡Clinical Trials

Clinical trials are research studies that involve human participants and are designed to test new medical interventions or treatments. The video mentions clinical trials in the context of evaluating whether changing modifiable risk factors can improve cognitive aging and potentially prevent or delay dementia. The script discusses the FINGER study as an example of a successful multi-domain intervention.

💡Halt-AD

Halt-AD is an educational platform developed as part of the video's narrative to provide information about modifiable risk factors for dementia. It is designed to help individuals understand their brain health and set personalized goals to improve it. The script explains that Halt-AD includes psychosocial support groups and personalized learning programs to empower people to make science-based changes to their lifestyles.

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.