Alzheimer's Prevention Program: Keep Your Brain Healthy for the Rest of Your Life

this ucsd-tv program is presented by university of california television like what you learn visit our website or follow us on Facebook and Twitter to keep up with the latest programs also make sure to check out and subscribe to our YouTube original channel you see TV prime available only on YouTube the Sam Andros 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 tonight we have a wonderful lecture for you dr. Gary small is always a lecturer that brings a lot of people some thrilled to have you all here tonight dr. Gary small is a professor of psychiatry and bio behavioral sciences and the parlo salomon professor on Aging at the David Geffen School of Medicine at UCLA director of the UCLA longevity Center and director of the geriatric psychiatry division at the Semel Institute for Neuroscience and human behavior dr. smalls team has developed brain imaging technologies that detect the first signs of brain aging and Alzheimer's disease years before patients show symptoms his discoveries have made headlines in the New York Times Wall Street Journal USA Today and he frequently appears on the Today Show he has newest book called the Alzheimer prevention program where he shares the latest scientific evidence on Alzheimer's prevention and a daily lifestyle strategy designed to delay the onset of Alzheimer's symptoms so people can keep their brains healthy through the rest of their lives and that's what he plans to speak on tonight so please welcome dr. Gary small thank you for that wonderful introduction and I want to thank my mother for writing it she's very kind to me and I want to thank all of you for coming out this evening to hear what I have to say I'm just curious by a show of hands how many of you heard about this lecture through the University on email and so forth okay how many of you heard about it on the radio yesterday okay how many of you can't remember where you heard of it so we either have one person with a sense of humor or who's very honest very good now you think you've got problems I'm supposed to be a memory expert I mean it's it's daunting and we're going to talk about some of these mild age-related memory complaints so we that are annoying and we'll talk about it when they become worse cinema knowing when they really interfere with our lives and how do we know the difference and so forth and what we can do about it so I'm going to move on to the first slide and acknowledge some of the wonderful support we've had for the research I'm going to be showing you and also thank some of my many colleagues who have helped me out also acknowledge some potential conflicts of interest and move right on to the first point I wanted to make about healthy aging I direct the UCLA longevity Center and we think about this a lot how we can live better longer and when we talk about Alzheimer's prevention and brain health the topic of successful aging often comes up and it's quite interesting and you might have heard about clusters of centenarians people who live to a hundred or more and how there are areas of the world where they seem to be clustering and I have on this slide just a few examples of them Sardinia Italy Loma Linda California not far from here and another one Okinawa Japan and if you look at these different areas it's quite interesting that people share some traits some lifestyle traits they tend to be physically active they're working in the fields they also have very strong social networks they tend to sit around sip their cappuccino drink a glass of wine and talk about things and they also have diets that are rich in antioxidant fruits and vegetables whole grains healthy proteins the kind of diet we know is a heart-healthy diet but it turns out it's also a brain healthy diet now this doesn't prove that if you get up and decide to move to Sardinia Italy that you're going to live to be a hundred but it is a clue that maybe there's a connection here now it's possible also these people have very good genes there have been some scientists particularly at the Albert Einstein College of Medicine that have been looking at families that live a very long time and they found some longevity genes and there's in in most of these studies usually there's a genetic and environmental interaction but there are other examples of extreme longevity healthy brain longevity if you can still subtract you can figure out that madam common lived to be a hundred and twenty-two and she did not have Alzheimer's disease when she died she had a healthy brain and she too was physically active she drove her bicycle around town she lived in the South of France anybody here from has visited the South of France and so you know the Mediterranean diet lots of fish and with its omega-3 fats and fruits and vegetables and a little bit of wine it's hard it's good for your heart it's also good for your brain and she was mentally active too in fact she was an astute businesswoman at the age so she lived to be 122 at the age of 94 she sold her apartment to a French businessman who agreed to pay her rent for the rest of her life the real punchline is that the businessman died 10 years later so you've all heard of the Ponzi scheme I call this the common scheme of successful aging now we're going to be talking about Alzheimer's and what we can do to hopefully stave off the symptoms but the flip side of Alzheimer's is brain health and many people equate brain health with having a strong memory but as this slide shows brain health is not just about memory now clearly memory is important it defines who we are without our memory we have no past we cannot plan for the future and we can't enjoy the present but if you think about it brain health also involves paying attention you can't focus your attention you can't remember anything and it involves thinking and reasoning putting things together and that depends on attention and memory and mook if you're anxious or depressed you can't focus your attention you can't think clearly and you can't remember things and of course you have to learn to relax and physical activity depends on our brain health if I didn't have my brain health I wouldn't be here lecturing to you today I wouldn't be able to talk it would be able to move my arms and what's interesting is we need our brain health to make the right decisions about lifestyle about diet about exercise the kinds of things we need to do to maintain our brain health so it's sort of a cycle if you can if you've got your brain health then you're going to do the right things to maintain it now if you get a chance to take a look at my book the Alzheimer's prevention program and we were hoping to have books here but I think somebody forgot so they obviously didn't read the books but we'll figure out a way I mean there are ways to get books even if they're not if you're not here and I'll direct you to places maybe they'll get some books here that would be nice but in the book I talk about inflammation and brain health and it's kind of a theme we all know about inflammation being a normal physiological process if you sprain your ankle or your wrist or if you have an infection your inflammatory system deals with it those inflammatory cells will repair the damaged tissue they will fight off the foreign body and that's a good thing you may feel some pain you may have some redness on the joint but that means your body is healing one of the problems we see with brain aging and actually a lot of age-related illnesses is that the inflammatory system kind of gets into high gear we have too much inflammation for our own good and in fact if you look at an Alzheimer brain you can see evidence of inflammation the amyloid plaques I'm going to be talking about there's up your physician you'll know about activated microglia or complement you see that in the amyloid plaque and I'll show you some of the studies we've done where we've actually used anti-inflammatory drugs to help with memory and a lot of the strategies in the Alzheimer's prevention lifestyle our anti-inflammatory strategies getting a good night's sleep eating omega-3 fats from fish or nuts or flaxseed or physical exercise these are anti-inflammatory strategies I know when I've had a brisk swim or a jog or ridden the bicycle I've got my heart pumping I've had a good cardiovascular workout I have less joint pain I feel better my mood is elevated for other reasons but this is all your inflammatory system coming into play now it's it's great to see such a large crowd tonight and I appreciate your attendance and I know that part of the reason is that Alzheimer's is on our mind we hear about it every day I get Google Alerts and all kinds of news articles there's all kinds of things going on there's new research that's happening all the time and frankly it's confusing and as a scientist and a physician it's confusing to me and I know for the public it's confusing one day we're saying take vitamin E the next day we say don't take vitamin E and this was in part would motivated us to write this book to try to take this science and put it in perspective so people could understand it and take it one step further to create a practical program where people can get themselves started in fact in the book we have a one-week jumpstart program where we suggest with people out to eat you give them exercises mental and physical exercises that build up over the week and there are assessment tools so they can see their progress and we think this is important because it's important to get started if this is a topic that celebrities have taken on Maria Shriver is crusaded against it because it's affected her family we had lots of people telling us about their diagnosis musicians actors and of course Ronald Reagan put his face on the disease one reason many people are declaring their diagnosis and they don't seem to be confused is that we're better at diagnosing it earlier that's good but the problem is we need more effective treatments another reason we're hearing so much about it is that we're living longer thanks to medical technology in part if you were born at the turn of the 19-hundred the turn of the last century you'd be lucky if you live to be 50 if you're born today you're going to live to be 80 age is the single greatest risk factor for developing Alzheimer's disease by age 65 or older the risk is 10% by age 85 or older it can be as high as 40 or 50 depending on the study so this is a big problem we know we have 80 million baby boomers who just a year ago started turning age 65 when they're concerned about what they can do every 70 seconds another American is diagnosed with Alzheimer's dementia so this is a big public health concern well let's begin by defining what it is in 1906 all of these Alzheimer present presented the first case to the medical community it was a 51 year old woman who had psychosis and confusion so she was out of touch with reality she had a very aggressive illness and for years she died and what he did that was novel was to do an autopsy and apply special stains to the brain tissue and he found in her brain these amyloid plaques his little round proteinaceous waxy filamentous deposits and these elongated tangles abnormal protein deposits and they collected in areas of her brain that control brain health all those functions that I was talking about a moment ago so this was a big breakthrough but the medical community assumed this was a rare pre senile dementia because a woman was only 51 years of age now years later pathologists did autopsy Studies on older people who had what we then called senility we used to assume that as people got older they just became seen oh and it was a normal part of Aging when they did those autopsy studies they found the same plaques and tangles in these older individuals and so now we had early onset Alzheimer's and late onset alzheimer's now what that also resulted in was an epidemic of Alzheimer's disease because all of a sudden all these older people weren't just normally seen out they had a disease that was frightening in part but it also pushed scientists to begin to look for better diagnostic tools and also for better now if you look at a normal brain see it's nice and plump and if you look at Alzheimer brain its atrophy or shrunken and here you see these inset show you in the frontal lobe and the temporal lobe these concentrations of plaques and tangles in fact they're sort of regional in the medial temporal lobe there's more tangles and in the frontal lobe and the parietal lobe there's more plaque but look at the the healthy brain you see an occasional plaque and you see an occasional tangle and it turns out that these proteinaceous materials that define the disease start building up in our brains years even decades before we have symptoms and I'll get into some of the evidence for that in just a moment but let's define a couple other other terms that I'm going to be using first memory now memory is a very complex function but to keep it basic we can think of two components to memory learning and recall so we have to learn the information get it into our heads and we have to be able to retrieve it later I also use a term cognition which encompasses memory but other mental functions attention thinking reasoning visual spatial skills of the ability to read a map and then there's a term dementia which also many people equate with senility it's basically memory loss another cognitive impairment and the impairment is to the degree that it interferes with everyday life so people with dementia need help from others and the most common cause of dementia is Alzheimer's disease that's where you have the plaques and tangles in the brain it has a gradual onset and progression but many different things can cause dimension you can become demented from having small strokes in your brain and they're the onset might be sudden or it could be a sudden onset from a depression and that can be a treatable reversible dementia or you can be demented from a thyroid imbalance medications can cause dementia one of the first patients I saw with the diagnosis of dementia when I was in my training was taking ten milligrams of Valium the day I stopped his valium and I cured his dementia so it's important if somebody has a cognitive impairment in it's interfering with their daily life that they see the doctor because not only can there occasionally be a reversible cause but even if it's Alzheimer's dementia there are treatments that can help so the most common memory complaints anybody want to take a guess if you can remember it somebody's got to blurt it out I can names that's right 85 percent of older people complain about names and then somebody said words I'll get to that where you put things in memory places prospective memory so you leave the house and you forget your cell phone and then the tip of the tongue phenomenon where you you should know that word it just doesn't roll off the tip of the tongue out those first two common problems you can get there's a lot of places you can get techniques on improving that the last two there's not I couldn't find anything out there on it so I was adamant about getting it into this new book so we have for the first time practical techniques that really work for these last two annoying memory complaints so these are common everybody has these problems and and we'll talk about how you can alleviate them but first I wanted a segue with another example of successful brain aging my wife's 104 year old grandmother grandma Ollie and I would like to disclose that at the time that we took this photograph I was not injecting myself with anabolic steroids grammo is very short to begin with and relevant to that issue was that she did not take estrogen after menopause and she probably got shorter because she developed osteoporosis and compression fractures and there have been some studies looking at estrogen as possibly protecting an older woman's brain and there's mixed results the latest data suggests that if a woman takes estrogen around perimenopause in midlife it may be brain protective but if she takes it later in life after age 65 at least the Women's Health Initiative found that for certain forms of estrogen it can actually accelerate cognitive decline so this is true about many different treatments a similar phenomenon with anti-inflammatory drugs that earlier in life that may be helpful later it may accelerate the problem there's a tipping point that we don't quite understand and in fact in the book I have a section where I talk about first I begin with the three most important words in real estate everybody knows right location location location in this area its timing timing timing because the timing of the intervention is critically important I think one reason we have not been as successful as perhaps we could be with some of the new drug development with Alzheimer's diseases we've been testing those drugs too late after people have dementia we should be using them in prevention trials which is what's starting to happen now but getting back to Grandma Holly she did very well she lived in an apartment without an elevator so she was physically active she was mentally active she was kind of a feisty woman if you forgot her birthday she would let you know about it and she was very proud I mean she was a hundred and four and I knew her risk for dementia was high even though she was always pretty good every time I saw her I'd always worried about her and I'd want to do a Mental Status exam and she would not let me do it so I'd have to sneak it in so I remember this visit I started off the conversation by saying so grandma how old you now and she said shut up so she passed her mental status exam she did very well I kind of mentioned a lot of these things that can cause dementia but there are many different conditions vascular dementia Lewy body disease frontal temporal dementia head injuries important we just did a study looking at NFL retirees and theirs we used our PET scanning the chemical I'll talk about just a moment and I can't really talk about it because of pressing bargain on it but it'll come out on Tuesday and it's actually being reported in the American Journal geriatric psychiatry so my colleague Dilip jester who's the editor unfortunately just got back from India he couldn't be here tonight but he's at the he is a director of the Stein Institute isn't he but it's in his journal that it's going to be published and is a lot of interest in this but head trauma is not good for the brain as are many other things what we find in fact if you look at an autopsy series of patients with Alzheimer's disease you'll see those plaques and tangles but especially if they're older you see a lot of other things gone wrong you see a lot of vascular disease you see evidence of head trauma so the brain gets knocked around with age and a lot of the strategies I'm talking about are helpful regardless of what's happened to our brains as we've aged now genetics are important but they're not the whole story there are rare mutations and I've listed them here press Anil ins a P P mutation that caused the disease and these occur in families where 50% of the relatives get the disease usually at a younger age age 50 or 60 and if you're in a family like this we call it autosomal dominant inheritance pattern then genetic counseling may be helpful but for most people that's not the case and we're learning more about the genetics the biggest breakthrough for the common genetic risk was April we for a number of years ago and we were fortunate our group collaborated with Duke University on this and we were involved in those discoveries and the bottom line is that 20% of the population has a form of this gene April e4 and it increases their risk of Alzheimer's disease but it's not necessarily meaning that you're going to get it so we don't recommend it as a predictive test we use it in our research because it can be helpful and determining who's going to respond or not respond to a certain treatment but we generally don't recommend people get April retesting and there's some newer genes that have been discovered there's a trim gene that just was discovered and I mention that because it's a gene that's linked to immunity and inflammation so again it goes along with that inflammatory story where actually it's not inflammatory the story but it's a story about inflammation so we've at UCLA done a fair amount of work with PET scanning positron emission tomography and it's basically a simple explanation of a PET scanner it works like a Geiger counter so measure measures radioactivity and in these experiments we inject the patient or volunteer with the radioactively-labeled chemical goes in the vein it's taken up by the brain and in these experiments we used a chemical marker that we invented at UCLA George Barrio myself several several other scientists were involved in this this chemical marker attaches itself temporarily to the plaques and tangles so this is the first time that this has ever done we could see the physical evidence of Alzheimer's disease in living people and so here's some examples of the scans here's an older normal person and here's that person two years later and you see there's not much yellow or red in the brain that means there's not much plaque and tangle and the person has normal aging here's somebody who had a condition called mild cognitive impairment so their memory was worse but they were not demented and you can already begin to see the buildup of the plaques and tangles and two years later that person had Alzheimer's disease and look at the difference the brain is riddled with it and here's an individual who had Alzheimer's disease when we started the study an individual died a year later and Harry Venters did an autopsy study and stained the brain with immunohistochemistry so we could see here in the lateral part of the brain the lateral temporal region you can see there's a lot of plaques and a few tangles and in the medial temporal region there are relatively fewer plaques and more tangles so we can even pinpoint different regions of the brain even though this particular marker is not specific for plaques or tangles or other chemical markers out there right now one's just been approved by the FDA that's being commercialized that is thought to label amyloid but there's even controversy about that I mean that there's a perception that these compounds are specific just for these proteinaceous deposits but they can label white matter they can be relatively nonspecific so we need to be careful on how we interpret the results but it's interesting with this compound it's called ddnp - the chemical structure if you look at autopsy studies that have been done on people ranging in age from 20 to 90 people dying of car accidents and so forth pathologists have tracked the build-up of the plaques and tangles in the brain and you can see this is the pattern and when we look at our ddnp marker and if we plot memory score versus the the stain you can see it's very similar to what you'd expect from autopsy studies and what's also interesting is as the animation loops around - right about now this individual these individuals have normal aging they're not going to get Alzheimer's dementia maybe for 10 or 20 years so one way to understand what's going on we have brain health and there's this decline depending on our genetic profile will decline at a certain rate and there are three critical stages that we can track by neuropsychological testing by different other sorts of PET imaging looking at glucose metabolism or accumulation of plaques and tangles so here's normal aging if it gets worse and people develop this mild cognitive impairment where they're compensating more takes them longer to function to do their everyday life but they're still independent now if that progresses then they develop dementia where they need help from others and in fact people who have mild cognitive impairment have a 10% risk of developing dementia each year so here's that cognitive decline curve what we're trying to do in our studies and in our programs and in the Alzheimer prevention program is to help people early on to try to protect a healthy brain rather than try to repair damage once it sets in we think this is going to be a better strategy but even people who already have a diagnosis of dementia we think we can help them just not quite as much and the way we help them is medically using medicines like the ones you see here you've seen them advertised on television they cause temporary improvement but you can see the slope of decline is equivalent if somebody were on a placebo and if you stop the medicine too soon the patient will decline more rapidly what we're looking for in the research is to find a disease modifying drug that alters the slope of decline and if the patient stops a medicine there'll be a sustained effect haven't found that yet there have been there's been a lot of studies looking at the amyloid plaques trying to clear that out of the brain they have not been successful it may be because they're treating people too late they're starting prevention trials with these drugs maybe they'll work they're looking at anti-tangle drugs that may work there's studies looking at drugs developed for medical conditions and even intranasal insulin spray and there's a connection I'll talk about between Alzheimer's and diabetes so there may be something to that they've looked at vaccines infusions so far we don't have a disease modifying treatment but we're hoping we will in the near future now we did a study a few years ago that was supported by the NIH where we looked at an anti-inflammatory drug Sealy Cox abour the brand name is celebrex and we looked at people who had normal aging on average about 59 or 60 and we either gave them the drug or a placebo an inactive compound or sugar pill treated them for about 18 months and we found that it improved their cognition and also improved their brain function we looked at a glucose metabolism with PET scanning we saw there was better metabolism in the front part of the brain but we weren't quite sure how that worked it could be that the drug did something directly to the brain or it could have been indirect in fact when we started the study or remember there was a gentleman who was enrolled and this is before we broke the double blind and he said you know doc I don't know if this medicine is helping my memory but I can sure go up the stairs faster and I thought well maybe that's the explanation people were taking these medicines they were walking more they had less joint pain and we'll talk about physical exercise as having a similar kind of effect in fact so this is what I'd like to be doing when I'm 90 but I probably won't be doing it because I've never pulled volted in my life so so I don't think I have the pole vaulting gene but that doesn't bother me because we know from the MacArthur study of successful aging and other studies that for the average individual when it comes to cognitive and physical success as we age about a third of that is determined by our genetics that means that two-thirds has to do with non-genetic factors and we're learning more and more about these factors and I'm going to focus on these four major areas physical exercise mental exercise nutrition and stress management and I'd like to start with physical exercise because we have the most compelling scientific evidence with physical exercise recent study found that if you walk briskly 20 minutes a day it will lower your risk for Alzheimer's disease if you can't walk swim if you can't swim move your arms around do whatever you can to get your heart from oxygen and nutrients to your brain cells your body will secrete something called BDNF brain-derived neurotrophic factor which stimulates your neurons to grow dendrites or connections between your brain cells so your brain cells will actually communicate more effectively in fact you'll have a bigger brain and a bigger brain is a better brain so if somebody calls you a Fathead it's a compliment so physical exercise is very important Arthur Kramer at the University of Illinois has taken older adults put them on walking programs compared them to similar groups who just do stretching and toning he finds better brain function larger brain areas and better cognitive results what about mental exercise there the evidence is not quite as compelling we have a lot of studies showing an association so epidemiological studies showing that if you get a college education you have a lower risk for getting Alzheimer's disease now we know that's true about UCLA we're still tallying the results for USC but I you know I'm unprotected there because I was an undergrad at UCLA and I went to med school USC but in all seriousness even if you didn't go to college there's some recent data showing that lifelong learning will protect your brain so we often stimulate we often encourage people to remain stimulated to learn to educate themselves to try new things but to train and not strain their brains if you don't like learning languages don't bother with that do something else that you enjoy but it's not a guarantee I mean you can do lots of crossword puzzles you'll get better across your puzzles but it's not going to guarantee you that you won't get Alzheimer's now I will show you some data on how how much we can stimulate our neuro circuits from simple exercises just searching online so it is possible that it does something but it's not a guarantee now on the other hand if you exercise your brain with focused memory techniques and you're not demented you will improve your memory in fact we've studied this other groups have studied it in large multicenter studies you can improve your memory performance right away and you can have sustained effects they've studied it for up to five years but I suspect for even longer and so in the Alzheimer Prevention Program we combine the physical and the nutritional strategies along with these sorts of methods to compensate for the normal memory losses we all experience but one thing that is contributing to our memory loss I mentioned that you have to pay attention is we're distracted by all these devices and people are worried oh you know I don't remember all the phone numbers I used to remember and so my you know my response is try to turn off your computer once in a while it's good for your brain but also don't worry about remembering the phone numbers use your computer as a an electrical device to augment your biological memory in fact if we use these computers effectively we can compensate to a great degree for our memory loss I I remember a few years ago I'd gotten a new smartphone and my wife asked me where we having dinners you know where the restaurant is tonight and I said I'll find it on my phone so she left the room came back 10 minutes later so where is that restaurant said what restaurant look at this cool website so it's not great especially for aging baby boomers when you walk into a room and you can't remember why you're there you know we really need to kind of put these things down a bit but I'm you know bullish on technology if we use it right and I think it's challenging as we get older because older people tend to adopt these technologies slower you know we kind of like these sorts of things and then there's a lot of debate in the media is Google making us stupid and I want to point out anybody who's a digital native in the room that stupid is misspelled and so we at UCLA wanted to find out is Google making us smarter so we decided to do a study and I was curious to see what the brain looked like the first time it searched online I was I want to see this and and in order to do this study I had to recruit people who had never searched online and I very quickly learned I couldn't recruit them online this is so eventually I found people like this congratulations you're the last person on earth to get an email account that's probably the hardest part of the study so we found these people they were on average 65 years of age we matched them up with a group same age that had a lot of internet experience and we put them in the MRI scanner and we use functional MRI so we can alter the sequence of the MRI scanner so we can see brain blood flow from moment to moment and see where the brain is working when we present people or research subjects with a mental task and so in this experiment they were these special goggles and in the goggles we project images like a book page and we say read the book we're going to test you later and then we had these internet search sites and they had a little clicker that operated like a mouse so they could search online and this is what we found on this study here we have the Internet naive people reading the book page and you can see there's activity in the visual part of the brain language areas decision-making areas and so that's what you'd expect from reading and so the first time these people searched online I was all excited I didn't see anything that was different very disappointing and then we looked at the internet savvy people reading the book page in the same pattern but the big difference was here when the internet savvy people searched online there was a two-fold increase in activity it's quite interesting so here's your brain on a book and here's your brain on Google and part two the experiment we took those Internet naive people and we had them search online for an hour a day for a week and we found significant increases in their neural activation after just a week of practice and it was primarily in the frontal lobe areas that control decision-making and what we call working memory very short-term memory the kind of memory you use when you call directory assistance and you get a number and you dial it of what you used to do and then the memory goes away of that number so what we think happens is when we're presented with a an unfamiliar mental task our brain doesn't quite know what to do and there's random activity once we figure out a strategy there's a surge in neural activity and once we get good at it we see less activity so our brains become efficient it's very similar to a physical fitness model and there's a lot of games and puzzles out there too to help keep our brains fit and so forth and a lot of them have not been tested we've tested some of them we have a brain bootcamp at UCLA we have a memory training program that we've licensed is now in 14 states in 50 different sites and people will learn these techniques thousands of people take these courses learn these methods we did one study with Erikson living communities and we found after six weeks that there were significant improvements we did another two-week program and here with the PET scan we saw that brain efficiency in addition to the improvement in memory so so people can improve very quickly with these programs and it's very gratifying and individuals you see results like this so this is a woman who we put in the functional MRI scanner instead of searching online we gave her a memory task and a baseline she was about 46 she's relatively young but she was complaining about her memory and her brain was working really hard to remember the words we put her on a two-week program very similar to the program in the Alzheimer Prevention Program two weeks later not a lot of activity and her memory scores her verbal memory improved dramatically so it's highly significant improvements and we teach simple techniques we make it user friendly things like look snap connect so look as a reminder to focus your attention the biggest reason we don't remember is we're distracted we're not focusing attention Snap is a reminder to create mental snapshots our brains are hard-wired to remember visually and connect is a reminder to link up those mental snapshots so they have meaning if something is meaningful they will be memorable so at UCLA there's a lot three B and when I park in Lot three B I see three large bumblebees hovering over my car if I park just below it in lot to B I see William Shakespeare standing on my car reciting to be or not to be it's very effective you may not want to share all your stories with your friends but trust me it really works now who remembers her name Holly very good now you remembered it because I showed her name I emphasized her name so you rehearsed it that's important for memory but if I had glossed over it you might have said that was grandma because grandma was part of the story it had meaning but you can give her face meaning by perhaps looking at her eyes and think you know she has olive shaped eyes all of Allie ware here's Paul Foreman Paul Foreman has a prominent forehead where Harry has a lot of hair and Lisa as a Mona Lisa smile and you can infuse qualities about the individual into your memories sue bangle is an attorney with bangs and she's an attorney so she could sue you now that is memorable because it's an emotional memory okay if you've ever been sued now while you're stressing out about your last lawsuit let's talk about stress animal studies show that chronically stressed animals have smaller hippocampal memory centers human studies that show that chronic stress can lead to depression which can increase the risk for dementia people prone to stress have a two-fold increased risk for dementia and humans injected with cortisol stress hormone have temporary memory impairment now it's temporary which is good and it means that we can do things to reduce stress we can't eliminate it but we can manage it better we can spend time with friends we can talk about our feelings in fact being social is critically important we cite some of the newer studies in the book about how just a 10-minute stimulating conversation is better for your brain health and watching 10 minutes of the Seinfeld rerun I would have liked to have volunteered for that study because I like sign fed and I like to talk about the triple threat to Alzheimer's disease and that's taking a walk with a friend every day so you're going to take a walk you're going to get that cardiovascular conditioning that protects your brain you're going to talk about your day that conversation will stimulate your neuro circuits having the conversation and finally you talk about your feelings you're going to reduce your stress level put things into perspective and you can try other things like tai chi yoga meditation in our division at UCLA some of our investigators Helen labret ski and others have studied Tai Chi and meditation they find alterations in neural activity as a result of these exercises and also find in addition to improvement in cognition and mood changes in inflammatory markers in the blood so again that theme inflammation and finally it's good to take breaks and to relax nutrition is related to brain health one of the first points is trying to achieve our optimal body weight we have an epidemic of obesity and overweight worldwide and we know that those conditions increase the risk for Alzheimer's you know megha three fats from fish and nuts is anti-inflammatory and good for brain health as well as eating antioxidant fruits and vegetables which help to protect the brain from oxidative stress associated with aging and then finally trying to minimize the refined sugars and processed foods which are not good for brain health so obesity and overweight increase the risk for Alzheimer's the good news is recent studies have found that losing weight actually improves memory performance one study of obese individuals who underwent bariatric surgery found that after 12 weeks not only did they lose significant amounts of weight but they also had significant improvement in cognitive performance now it's easy for me to say lose weight it's hard to do it there's been some recent neuro scientific investigations of that and and they've actually pinpoint in some of the brain regions that are involved in this process so if you're successful if I'm successful in avoiding this beautiful piece of chocolate cake it's my dorsal lateral prefrontal cortex that's telling me Gary's don't eat that cake I know it looks good don't eat it but then there's a part of my brain just above my eyes the orbital frontal cortex that's saying eat the cake okay so so it's kind of a battle of the brain that goes on but but what's even more important when people are successful in dieting it's hard in the beginning it gets easier with time when they check their brains out there's actually alterations in their neural so you actually change your brain as a result of being successful on a diet there's there's some other interesting surprising things about the brain and weight loss if we have time we can talk about it during the Q&A period so while we're on food let's talk about alcohol and wine in moderation it's associated with a lower risk for Alzheimer's disease so people often ask well well how much is a glass of wine this was more like this and we're not sure why it is it may be that people who drink in moderation are just more laid back or it could be something in the alcohol in wine is a chemical called resveratrol and in animal studies it has anti-aging effects so scientists have extracted the resveratrol from the wine but we're not sure it gets into the brain I'm not sure passes the blood-brain barrier so anybody here who's taking resveratrol capsules make sure you wash them down with a nice Bordeaux just to be safe and moderation is the key here and it's true about caffeine and coffee in moderation it's associated with a lower risk for Alzheimer's and Parkinson's disease now there's a lot out there about supplements and there's a lot we know and we don't know in fact the the new book has a whole section on supplements one of the problems is they're not all tested in a double-blind fashion we're testing them at UCLA we have a study on curcumin curcumin is in turmeric and encourage foods in India there's a lower rate of Alzheimer's disease than in the US but more importantly our scientists have found that curcumin is both anti-inflammatory and attacks those amyloid plaques in the laboratory so we're doing an 18-month double-blind study we're also looking at pomegranate extra extract we did a short-term study and we found that people who drank eight ounces of pomegranate we're going to juice a day for a month had better memory but we're not sure is a small study so we're doing now one-year study using the ex now other things to think about I mentioned avoiding head trauma is important if you smoke try to quit try to keep a positive outlook and simple things like treating hypertension or high cholesterol not only protects brain health but it also helps people live longer so can we really prevent Alzheimer's disease if we think about prevention as being equivalent to a cure than the answer is no but the way I think about prevention I think of it in a more modest way of delaying the onset of symptoms and I think in that case there is compelling evidence that we can do something to stave off symptoms so a way to look at it is here if we have a decline curve for one individual where that person may become demented at this point there's non dimension dimension if we can get that person on a program that delays those symptoms for this amount of time they may have a year and a half or so of dementia free life and if that person dies of natural causes before then we've prevented the disease and that's the goal that we're looking for to definitively prove that we can prevent Alzheimer's disease II would taken a Framingham like study it would take 10 to 20 years and frankly I don't want to wait 10 or 20 years for someone to tell me by the way you should have been exercising and eating right because I know if we do those things we start feeling better it will help us with other health issues and another argument that this is effective is two of the key Alzheimer prevention strategies exercise and diet we already know that that will prevent diabetes and the latest large-scale studies tell us that if people develop diabetes that doubles the probability they'll develop Alzheimer's disease so we're really talking about a lifestyle that bolsters brain health protects their brain cells and we add to that cognitive techniques that compensate for the natural decline that everybody experiences and in the book we talk about the science we make it clear thanks to my wife being my co-author she if it were up to me the book would be organized introduction methods results and discussion but she's able to make it accessible to a wide audience and you know you can look at it in terms of an individual here's a hypothetical person who comes to my office a busy 62 year old executive has a terrible diet doesn't exercise I talked him into exercising so he starts walking every day for 30 minutes with his friend if he maintained a sedentary lifestyle according to his genetic risk he might get dementia by age 72 now the studies tell us if he keeps up his physical exercise he may forestall those symptoms by almost 2 years so he's getting excited he's feeling better he's walking with a friend so he's lowering a stress level he's starting to change his diet he's doing brain exercises he's doing crossword puzzles and I think to annoy me he's doing the New York Times Friday puzzle in ink but you know all power to them if you add it all up he may forestall symptoms by four years so for many people this could really make an impact on their lives but other scientists have looked at it in terms of public health Barnes and yoth a UC San Francisco have estimated about five million people with Alzheimer's in the US and 34 million worldwide and they talked about modifiable risk factors so changes that I'm talking about that are very similar stop smoking exercise lose weight and so forth they project the effect of just a 25% risk factor reduction would mean three million fewer cases in the US and 17 million fewer cases worldwide so we're talking about personal health and public health now it's easy for me to say change your habits but I know human nature I know I'll get a traffic ticket I'll be go to traffic school I'll Drive well but after six months I noticed my god I rolled through that stop sign so we all have a tendency to forget and so when Gigi and I wrote this book we wanted to try to help people to change their lifestyle to really create brain healthy habits so the first thing we tried to do was make it clear the connection between brain health and lifestyle if we see that connection we're more inclined to follow through it has meaning it's memorable second we created this seven-day program a jumpstart program make it easy show people how much fun it is and then finally give them assessment tool so they can see the results and in that way we hope to try to encourage people motivate them to really change their lives because one week is not going to make a difference we're really talking about creating these habits so let's see how well you did what's his name Paul Foreman very good can't forget Harry su bangle there you go with the bangs so go your your all memory mavens okay very good so just to summarize you know I think that it's important if somebody has a cognitive problem that's affecting their health to see their doctor because doctors can help in the earlier we intervene the better the outcome I'm excited about the research that's going on right now that I think that within the next decade or so we're going to see some better treatments in the meantime while we're waiting for science to catch up there's a lot we all can do right now to feel better to improve our physical health and our brain health and possibly stave off future symptoms of Alzheimer's for more information about the book dr gary small comm dr. gary small comm for information on our programs at the UCLA longevity center longevity UCLA edu thank you so much for your attention you

Channel: University of California Television (UCTV)

Views: 552,149

Rating: 4.7664895 out of 5

Keywords: Alzheimer's, stress, Alzheimer's prevention, whole body, memory

Id: r5HXPxB837s

Length: 57min 29sec (3449 seconds)

Published: Thu Feb 07 2013