Medicine in Our Backyard - 90+ Study and Memory Disorders

[Music] [Applause] [Music] you well welcome this is the Newport Beach Public Library Foundation series medicine in our backyard and I am Susan GRU the director of programs for the foundation tonight is our concluding lecture of this series but not to worry we start up again in September for a whole new programming year and we look forward to seeing you all then we would like to thank you see Irvine health for bringing their extraordinary group of doctors here to the library and also for the sponsorship of this series a quick bit about the Newport Beach Public Library foundation the foundation is a membership driven organization if you are not already a foundation member I invite you to please join us tonight it is through your membership that we are able to support this wonderful library and to bring stimulating programs such as this one to you the community membership applications are available in the back at the entrance to this room they're located in our bookmark newsletter I invite all of you to take a copy on your way out one other thing about this series is we are so lucky we have at video recorded and it will be made available to you in the next week or so through our the foundation website which is enbe pl foundation org and you can download this lecture to look over again or to refer other people too that may have missed it the program is going to conclude with a lengthy Q&A session because I know so many of you have many questions that you would like to ask dr. kay wass so I ask you to all to hold your questions until the end for the Q&A portion and we will make sure we allow plenty of time for that this series was made possible through the vision of Mike and Polly Smith Mike is a native of Newport Beach having grown up on Balboa Island and Polly came to the area soon after graduating from college they have both lived in Corona del Mar for over 25 years after a long career in the electronics agency electronics industry thank you final lecture we are lucky to call them both supporters and neighbors I welcome Polly Smith Thank You Susan assuming that you are of good health how many of you would like to live into your nighties okay yeah me too how about 95 and 100 same thing why not well you've come to the right place this evening oh sorry yes you've come to the right place this evening dr. chaos is professor of neurology at the UCI school of medicine and professor of no can you hear me now okay and professor of Neurobiology and behavior at the school of behavioral sciences she received her medical degree at University of Louisville Kentucky and her neurobiology residents training and in a fellowship in dementia and aging at the Albert Einstein College of Medicine in New York after five years of on the faculty of Johns Hopkins School of Medicine she came to UCI and that was in the year 2000 her research interests are dementia and memory disorders geriatric neurology and epidemiology and all of these have helped to lead to her 90-plus study please welcome dr. Claudia chaos [Applause] well hello everybody and I want to thank you for inviting me again but I think this is gonna be my retirement talk because I'm afraid to ask this question how many of you in this room have heard me talk recently oh this is not good okay I'm gonna do my best to pull in some new stuff and in fact although today I am talking yes I always feel a need to about becoming 90 or 100 or even a hundred and eight and I want to mention that one of our most amazing participants used to volunteer at the lie library because she was raesha Streeter and she lived to be a hundred and eight and her brain had no I mean zero signs of any of the abnormalities we find in Alzheimer's disease at 108 so yeah she deserves a but partly what I'm going to talk to you about tonight is mostly about the 90-plus autopsy study because we've learned a lot about the brains of people like her and we're trying to translate that into things that'll be useful for you and me and all the rest of us who may or may not make it to 90 and so I'm also gonna talk about research happening in your own backyard that in fact you can volunteer for and as we try to figure out how to prevent dementia so since this whole talk is on dementia there we go okay so I'm gonna start with what is dementia really often when I give these talks I realize that something this basic is often need we all need a reminder of so here's a very straightforward definition of dementia first of all it needs to be a decline from a previous level so that separates it from mental retardation or a lot of other problems it has to be in mental abilities that include at least a couple of the things that the brain does for us so memory is often affected but doesn't have to be but but frequently is our ability to talk or do calculations or find our way around the parking lot or any of those other things or could also be affected and whatever it is it has to be bad enough that it keeps us from doing things that we couldn't do before whether they be things at work or things at home or any other activities that we were able to do before now many people tend to equate dementia with Alzheimer's disease and one of the main points I want to make is that a dementia and Alzheimer's disease are not synonymous so here are the cause a partial list of the causes of dementia it is the only slide I'm going to show you today that I don't want you to read you're not expected to be able to read that small print but what I want you to understand is that these are there are more than a hundred causes of dementia and all of them can cause a loss of mental abilities and all of them need our attention in our research not just Alzheimer's disease now when the dust settles and you look at dementia what you'll see is this actually came from time magnet figure with the face and everything came from a picture I took in Time magazine more than 25 years ago and this is exactly what they said were the causes of dementia at that time and in some ways not a whole lot has changed and I think that the reason why Alzheimer's disease is often interpreted as being the same as dementia is because it is probably the most common cause of dementia at least as we get older but today I'm gonna show you some things about it which I hope we're gonna make you realize it might not be the most dreaded thing that can happen to you in fact most more research is devoted towards this and in fact Alzheimer's disease is probably not nearly as malignant as most of us in this room assume so going back to dementia in general whether it's caused by Alzheimer's disease or not on this slide you see the risk of developing dementia in a variety of countries throughout the world and the most notable thing to see is that as you get older the risk goes up almost exponentially and it goes up whether it's this one down here which are Rochester and Seattle Washington it goes up if it's this one up here which is Munich Germany it goes up everywhere but you see that around the world when we do these studies we pretty much get the same answer about what your risk is so for example at age 80 your risk is somewhere between 3 & 5 percent per year of developing dementia but at age 90 you can see some people say it's 5% some people say it's 20% and once you get to 95 or a hundred you can see there's a tenfold difference now I remind the students always that all these studies were very well done in a lot of ways I stand by them they were published in reputable journals but they can't all be right at the same time right it's not possible for the risk of dementia at age 95 to be 3 or 4 or 5 percent and also be 30 or 35 percent unless you really believe that there's something different going on in these countries and if you do I would point out that the risk estimates between Framingham Massachusetts and Boston are almost 5 fold difference suggesting that if I were living in Boston I would move to Framingham and if it was that simple I wouldn't have a job but unfortunately I do for the last third of a century I've been trying to figure out how to change our risk of developing dementia and it's not as simple as moving 20 miles the main difference between those two studies for example was dementia is not an easy thing to diagnose there's no blood test or anything that we can just send to the laboratory and say okay these people have it in these don't and depending on the methods that everybody uses and they used very different methods in East Boston than they did in Framingham you will get a very different estimate so much of the difference here has to do with the methods that we use and unfortunately at the end of the day that means that we don't really understand what the risk is at this age and that's getting pretty important because I like this quote that I found a few years back but I think it takes people aback to realize that your grandchildren who are being born today can expect in the United States more than half of them will reach their 100 and third birthday and that is true pretty much throughout the world in almost all the developed countries if they can be expected to reach more than one hundred so we've added more than 27 years to life expectancy in the last century and we are creating an entirely different life expand they are the fastest growing segment of the population throughout the entire world so right now in the United States we only have about two million people over the age of 90 and this is what's going to happen by 2050 there's going to be one in every 50 people in the u.s. are going to be over the age of ninety six percent of the entire Japanese population will be over the age of 90 and we don't know very much about these pioneers of aging and it turns out that as many of you probably know wisdom is a big thing and they have wisdom and they have wisdom to share with us and the 1,800 people who have joined the 90 plus study over the last 15 years have really contributed their time their blood their family members and definitely their wisdom so the 90 plus study many of you might have seen you know Lesley Stahl a couple of years ago did a very very nice segment about the study in your backyard if you're interested in seeing that or some of the other things that have that was a very nice public television show the first year of the study and you can see some of those things if you wanted to on our ninety study org website and here I want to point out is the hundred and eight year old lady who was featured in the Orange County Register peeking through the library stacks staying busy and curious and she attributed her excellent cognition to the fact that she read constantly and volunteered at the library every week so I'm gonna spare you this this videotape but just to remind you if you haven't had an opportunity to hear me talk before the 90-plus study had its birth as part of the leisure world cohort study when in nineteen eighty one investigators from the university of southern california sent out a 14 page questionnaire to every single residence in what we now call Laguna Woods leisure world community about eight miles south of us and in those questionnaires they asked him about what they did with regards to exercise whether or not they took vitamin E whether or not they took vitamin C how many vegetables they ate how many activities they did and those were followed up with four more surveys over the next twenty years and tonight I'm not gonna talk about the results of that but most of you know that I love the findings because basically people who gained weight people who drank alcohol people who had moderate coffee and people who did all sorts of other activities lived longer than people who did it so those those were good results I'm often asked if I've changed my behavior and everything because of these studies the only one that I really needed to change and I haven't been real successful with his exercise but the others I'm good with so all that work though was was done with 14,000 people returning this questionnaire and ultimately looking to see if you had vitamin E or if you exercised did you live longer than someone your age who also answered the questionnaire but said they weren't doing those things but we didn't want to just find out about living long we wanted to find out about living well I mean I think the question was asked in a very important way how many of you want to live long assuming you are living well meaning healthy so this had all been done just through the mail and we needed more than that and so what we did was in January 1st 2003 we said if you were one of these 14 thousand people and we we wanted you to be in the stand we're 90 years old and still alive we wanted you to be in the study so it turns out these 14,000 people now if they're not deceased now live in 37 states so we have flown all around the country to see these individuals and we bring them in also to the UCI and we do an incredible amount of stuff with them so we ask them all kinds of information we ask them to do neuropsychological tests we ask them to do physical performance with repeated share stands and time them we ask them to give us some of their DNA so we can do genetic studies we ask them to stick their heads and MRI machines and PET scans and at the end of the day we also ask them if they'd consider giving us their brains where we have learned some of the most important things that we found to date so after we do that here's a snapshot of what they look like so this is of the first 1600 people we are now actually up to over 800 people 1,800 people at making it far and away one of the largest and longest studies of extreme aging in the entire world you can see that by age 90 because even though it's a somewhat well-kept secret women age better than men and live longer than men on every species on the planet where there is a difference by longevity it is always the female that lives longer than the male and so by age 96 there are three women alive for every man alive and although some of them were in sheltered living 40% were in some kind of group home or nursing home or or with family help a third of them continued to live alone at home with minimal or no assistance and when you look at their cognitive abilities at baseline about a third of them are normal about a third of them had dementia and about a third of them were in an in-between zone where they sort of had problems with memory or their thinking in some other way but did not have full-fledged dementia or weren't felt to be completely normal so the first question we wanted to know was if we caught you and you were still normal or without dementia when you first came into the study what was the risk of developing dementia after age 95 so here is the scale the slide I showed you before and usually the correct answer when you've got a lot of these answers ends up being somewhere in the middle and in fact that is what we found from age 90 to 94 our estimate was right in the middle but from age 95 to 99 and over a hundred it continued to rise exponentially so that by age 100 the risk of dementia was 40 percent per year which is pretty devastating but it still doesn't mean that everybody gets it I mean it's easy to think okay if I don't get it this year I'm not in that forty percent then the next year I'll be in the next forty percent but in fact I told you about the hundred and eight year old lady who had very good cognition and in fact we find many people who resilient to the development of dementia later in life and I'm gonna talk about them a little later so what are the causes when you have dementia this often we wanted to know what were the causes of dementia it's easy to assume that it's going to be Alzheimer's disease again and maybe it will be but we looked in the 90-plus autopsy study so more than 500 people have agreed to give us their brain in order to do research and of these about 300 of them have now come to autopsy and I'm going to show you the results from all the things we've learned from them so here are four pictures this is a picture of Alzheimer's disease you can see these dark spots which are what we call plaques senile plaques these plaques are made of amyloid and I'm going to come back to this a lot in the talk because up until now we could not see amyloid in the brain of an individual and it is one of the characteristic features of Alzheimer's disease but we couldn't see it in the brain of an individual until we got a chance to look under the microscope but things are changing these black spots are what we call neurofibrillary tangles and once again up until now we were not able to tell if they were in somebody's brain until they come to autopsy those are the two hallmark findings when a pathologist looks under the microscope and sees plaques and tangles in sufficient quantities he or she will call it Alzheimer's disease so this is a characteristic of what Alzheimer's looks like under the microscope but here are some other things how many of you have heard of hippocampal sclerosis one person you're good is that because you heard me talk before so I'm hoping that I'm gonna surprise the rest of the room when I tell you that one out of three dementia cases in the 90s is due to hippocampal sclerosis it's exceptionally common and it is very malignant as I'm going to show you later and yet we hardly ever hear anything about it so hippocampal sclerosis refers to the part of the brain the hippocampus where we think is most crucial for memory and it's not surprising that it's an epicentre for a lot of dementing disorders including Alzheimer's disease here's another one these are called micro infarct s' so that very thin line white line there that you can probably not see is a microscopic infarction or what we think of as a supermini stroke I was taught and truthfully we still teach the residents that I trained that you don't know when it happens you don't know if somebody has any of them we don't know what the risk factors are but you don't need to worry about it too much because it's so small we don't think it causes any damage and we're definitely wrong on that one and here is another kind of vascular disease in the white matter hypertension does increase your risk of having this but we're still not sure why some people develop it and most people with hypertension don't but it is also highly associated with dementia so the first thing we wanted to see was okay if you died with dementia what was the likelihood that it was due to Alzheimer's disease so of the individuals who came to autopsy with dementia it turns out about 60% of them have Alzheimer's disease which is what you saw in that face I showed you in the beginning from Time magazine that was looking at all ages so this is an answer that most of us would have expected I think that what nobody expected though was that if we looked at your brain and you had no dementia you had a 40% likelihood of having Alzheimer's disease so well 60% of people with dementia had severe AD pathology in their brain 40% of people who were wandering through their life doing just fine thinking memory and other abilities without problems they also had Alzheimer's disease in their brain and I think here's a picture of one of those so this person has Alzheimer's disease there's plaques there's tangles and they had bad cognition this is a normal person no plaques almost no tangles and their cognition was good but here is one of our subjects this person happens to have the very rare Jena people we - - but despite that even though it's supposed to protect you from Alzheimer's disease she had all the pathology of Alzheimer's disease all the plaques she had all the tangles but her thinking was still fine before she died so the real question is is this somebody who if they'd lived longer would have developed the disease and that's entirely possible it could be like a heart attack where you have atherosclerosis for years and years but you don't have the heart attack until you've had this for a long time or is it the case that the genotype she has or some other factor has made her resilient that is she can develop Alzheimer's pathology and still continue to be able to think and do the things she wants and that's one of the big research questions of the of the decade here is a slide that is probably the single most common slide in all of Alzheimer's research for the last few years and I know you can't read it but this red line is for the plaques and it suggests that people might develop plaques a long time before they start developing memory problems right here or before they have full-fledged dementia right here and here is the tangles this green one saying it comes after the plaques and as it's rising you start developing cognitive problems and then once it gets really bad you have dementia too now this is a hypothesis we do not know if this is true because keep in mind up until now we've only known if somebody has a plaque or tangle when they die we don't know if you have plaques and tangles in your head for a year or 20 years or whatever we only know what is in your brain when you die but the hypothesis is that maybe these things kind of like hardening of the arteries or clogging of blood vessels from hypertension and cholesterol can go on for many years before it causes enough trouble for you to actually have dementia and I'm gonna come back to this because this is the the key to seeing if we can prevent Alzheimer's disease right now but beyond Alzheimer's disease as I pointed out there are a lot of other things going on and I think this was pretty striking so over here you see Alzheimer's disease and what these graphs mean is half of the people had Alzheimer's disease of all the brains we looked at and if you look in those half of the people they're a likelihood of having dementia when they died was twice as high as if we found no Alzheimer's disease in their brain which actually we find in about 25 percent of people so having Alzheimer's disease wasn't great it doubled your likelihood of having dementia this is another amyloid pathology related to Alzheimer's disease and it did the same thing it doubles your likelihood of having dementia but nothing like what the others did if you had that white matter disease that I showed you in the right lower corner before compared to not having it you had a 13 fold increased risk and having dementia really bad thing to have if you had hippocampal sclerosis which I told you is quite common in this age group a tenfold difference of having dementia virtually everybody who has those pathologies unlike Alzheimer's disease has dementia in fact if you even had just 3 micro infox on the half a dozen slides we looked at your risk of having dementia was four times greater all of these and everything Lewy bodies big strokes all of these are much more malignant pathologies to have in your head and more likely to lead to dementia then Alzheimer's disease even though that's the one that everybody always talks about being worried about so there's lots of pathologies and not only that the majority of people they have two or more that is actually true even in your 70s if you look and the brains of individuals with dementia who come to autopsy the likelihood is you'll find two or more pathologies the majority of the time even though we tend to say to the family oh this was Alzheimer's disease we often find that they also had micro infarct sore other kinds of abnormalities that sort of get a second fiddle so what is the effect of having these multiple pathologies was one of the things we're interested in so here is if the pathologist said to us I think this person should be fine because the brain looks pretty much normal and I don't see anything interesting you still had a 40 percent likelihood of having dementia in our in our study and this is a group that actually I'm really going to be paying a lot of attention to over the next few years because I want to understand them better if you had one pathology most commonly it was Alzheimer's disease but it could be hippocampal sclerosis or whatever then your risk of having dementia went up to 60% so it definitely increased but if you had two or three or in some cases four or five then all bets are off you essentially always will have dementia so the more pathologies we find in your head far and away the more likely you are to have dementia but it doesn't just influence the likelihood of your having dementia it also influences the severity of you having dementia so this is a that we give called the mini-mental a perfect score is 30 most of you in this room I'm sure because you came to hear this talk or easily you know 26 to 30 and it's it's a fairly basic tested ask things like what the date is and who the president is and things like that and what we found was that if the pathologist didn't see any reason for your thinking problem you still had had dementia your score was 17 which is not ideal on average but it's much better and a much milder dementia than if he found something and and as you can see with successive pathologies the severity of the dementia greatly changed so the more pathology you've got in your head of all sorts the more likely you are to have dementia and also the more severe your dementia is likely to be and one of the things that this raises to me is the idea that well what if I could take somebody for example and change them from four dimensions to two for pathologies then I could double the number of questions they could answer on the test or if I could take somebody who has two like Alzheimer's disease and micro infox and get rid of of them then I could maybe get somebody who would who's thinking would be improved just by improving one of the pathologies even so everybody's interested in Alzheimer's disease and there's been a lot of research in this area and what we want to know is in people who have amyloid deposition in their head but no dementia can we stop or delay that the problems that they might have so here's the kind of glitzy sort of picture of two different participants these participants are both from the 90-plus study they both are normal and have good thinking and this individual I told you we could not see the plaques in people's head made of amyloid until they died till these PET scans were developed there are now about four or five companies that have developed these PET scans they are approved by the FDA they are available commercially but in general they are not paid by Medicare or any insurance providers at this time but if we've done about 180 of these in our 90 year olds and we found a lot of people like this who with good thinking also appear to have no plaques in their head plaques are shown by red and to a lesser extent yellow so the more orange that you see the more plaques you've got this person essentially has a negative study you can't see really virtually anything in there this person however you can see has a lot of orange patches and a lot of yellow and in fact has a very positive scan for amyloid this person has had two scans separated by five years both scans were floridly positive and all through that time the cognition of this individual has remained fine despite even having a stroke in between the two scans that's pretty amazing so I think this is this is a definition of what we're now calling resilience somebody who can have all these things I already know that in addition to amyloid plaques that this individual has had a stroke in their brain I already know that they've got two pathologies and yet the cognition remains excellent so we can now because of this technology do things that we couldn't do before so this show was actually shown on 60 minutes I think last Thanksgiving Sunday of Thanksgiving weekend and I've never shown it to anybody before but I'm hoping it's going to going to work and I thought I'd let lesley stahl charm you for a few minutes and not having to listen to me and she's gonna tell you a little bit about a study that is being done in Columbia South America with oh you already saw it yeah okay it's just a five I mean this is actually a 30 minute show but I'm only going to show you a five minute clip from it to sort of introduce it oh this tab study is referred to as the API the Alzheimer's prevention initiative it is specifically in genetic carriers of this disorder which is less than 1% of all the cases in the world as you saw they get this disorder unfortunately when they're very very young and 50% of everybody in the family will be stricken so it's it's an important study that's being done but I wanted to point out that actually we pretty much have the same studies going on right here in your backyard so let's start with the Dyan study which stands for dominantly inherited Alzheimer's Network that is a study that began originally in the United States has now expanded to Europe and Australia it is study of similar families with autosomal dominant disease and we have sites here right in Southern California run by dr. John ringman because in fact even in my clinic I do come across families in Southern California and Mexico who have these genetic disorders they are also involved in a national and international trial getting different drugs to see if they'll be useful in them and right in our backyard is the a4 trial so the a4 trial is stands for the A's are anti-amyloid treatment in asymptomatic Alzheimer's disease so essentially all those A's are targeting individuals who have normal cognition good thinking but in fact when we put their head in the machine they have a positive amyloid scan and if they meet those requirements and a few others then they can join in a proven chin trial which right now you can see is throughout the United States and Australia again and one of those bubbles that you see down in Southern California is us another one is UCLA UCSD so the a for trial is happening nationally and is exactly the same trial to see if we can take people who have amyloid in their head but still prevent them from declining or delay their decline if they're going to decline we have other studies that have started at UCI one was called the genetic gene generation study these are for people with a genetic risk factor that I was talking about earlier a belief for and we're also starting a study very soon that'll be of pill treatment for individuals who are normal to see if it'll prevent or delay Alzheimer's disease and all of these studies you can participate in and I'm hoping that some of you will think about being part of this research for yourself and for the generations to come so before I finish I want to remind you in addition to medication studies we are doing studies in lifestyle starting this month in fact is the exert trial this you can join at UCI also it is specifically to see if exercise aerobic or stretching or both will affect and improve people with memory problems people with memory problems that we often refer to as mild cognitive impairment are at high risk for developing Alzheimer's and other dimensions and the idea is to show whether or not exercise can be used to improve the situation for people a big diet study called the mind diet is being started in Boston and Chicago and to look and see if nutrition and different kinds of diets can be useful in delaying or preventing Alzheimer's disease now people talk a lot about cognitive stimulation and brain games and all sorts of things social engagement I have to tell you I really think is important I think you're being in this room is probably cognitive stimulation and maybe more important than listening to me is the social engagement you get from being out of your house interacting with other people and I honestly believe that these things really matter in fact although I'm not going to show you the data it has come to everybody's attention in the Alzheimer's world and dementia that the risk of developing dementia at any specific age right now is lower than it was 25 years ago so an 80 year old now has a lower risk of developing dementia than an 80 year old did a quarter of a century ago and since we haven't approved any new drugs and since no pharmaceutical companies have come up with the solution you know that that difference almost certainly had to come from one or a combination of these things because over that 25 years we have improved lifestyle we have improved diet we've gotten more exercise at least some of us have and maybe most importantly and I think this is going to turn out to be you know really also a big part of it is we manage vascular risk factors much better both in terms of diet and exercise but also managing blood pressure and managing high cholesterol so the the the impact that's happened over the last quarter of a century even though I can't tell you exactly where it came from I'm sure it came from this and not from a foreign pharmaceutical company so the last thing I'm going to talk about for a couple of minutes is what if any of these things were successful whether it be the drugs that remove amyloid or other drugs that are in development or one of these lifestyle factors what would be the effect if we were able to reduce or even better eliminate Alzheimer's disease pathology using or more of these strategies and the data I'm going to show you is specifically for 90 year olds and here's what we what we did in the darker pink colors that I'm about to show you that's what would happen if we completely eliminated every plaque and every tangle that was in somebody's head so no matter what was going on it wasn't due to the plaques and tangles of Alzheimer's disease and then these are successively more modest reductions so if we took everybody who had a lot and gave him very low levels or people who had had some and gave them at least less than they had before or you know the most modest reduction in the lighter pink and here's what would happen today which is that among 90 year olds you can see that we would go from having about a million and a half cases of dementia due to Alzheimer's disease to less than half of that so that's pretty good I mean there's still a lot left but that's a very nice reduction I think the thing I need to point out though is the chances of us reducing it to zero is pretty much close to zero so more likely even in the drugs and the pharmaceutical industry we're talking about this kind of reduction much more modest reductions but it still would be very good especially from a public health standpoint but what would happen by the middle of the century is staggering so by the middle of the century there are going to be more people with dementia over the age of 90 then we currently have in the entire United States at all eight and those of us who don't have it are going to be taking care of people who do have it this is a tsunami of a public health problem and you can see that once again if we were able to eradicate Alzheimer's disease we would essentially reduce the dementia burden by half which would be really good although still an awful lot of cases because all of the rest of these cases are due to the other pathology that I showed you and probably several pathologies that we don't even understand or know about yet so to summarize people are living longer and the oldest old are the fastest-growing segment of the population and that is true worldwide the risk of dementia is really high with aging and especially in this age group but it's not just due to Alzheimer's disease it's due to a lot of things and we need to start figuring out risk and treatment factors for all those other dementing illnesses because they can cause trouble just as much studies are underway is the good news a lot of them are happening in your backyard and we need your help so if anyone is interested in participating or getting more information I really would encourage you to give us a call we takes a village to do this I want to thank mostly the 90 year olds and their families for all the things they do for us it really has been amazing but also the amazing staff and colleagues that I have at UCI as well as other places around the country where we share our brain tissues DNA and and our data but if you want to volunteer or learn more about aging research at UCI if you're under the age of 90 called the top number and if you're over the age of 90 you can call the bottom number and no matter what we're always happy to hear from you so thank you very much for inviting me here again and I promise I won't come again too soon doctor we have time for some questions so please raise your hands I just mr. Smith oh that's a great question do I see Alzheimer's disease plaques and tangles and other species apes for example so it turns out that there are some animals that develop plaques and tangles but not very many of them the majority of primates do not although chimpanzees do polar bears develop plaques but not tangles certain kind of whale has been found to have plaques but in general it's much more of a human thing in order to do the studies that we do all the time in mice what we do is we put three human genes from families like this and it takes three of them basically to get what we call a mouse model of Alzheimer's disease and when we do that I have to tell you we're really good at curing it unfortunately we haven't gotten so well at doing it with people but one of my favorite quotes and I probably you've heard me say this before we have cured or prevented Alzheimer's disease in mice with more than a hundred different compounds but not a single one of them has yet translated to humans and I think the fact that we don't have a good animal model is a problem I think that if more animals develop this it would be easier for us to understand the biology but when we make these sort of fake models we actually are very good at treating these fake models but it doesn't translate to the kind that people get so yes ma'am okay so this is a question about genetics and specifically if it comes through your mother's side and maybe because it comes through the mitochondrial I I there's not a simple answer to that question but I will say this I mean having a family history of dementia does increase your risk it is possible that having a family history through your mother is a little worse than having a family history through your father but I want to point out once again that because women live longer than men and because age is the biggest risk factor and because one's mother generally lives 1020 years longer than one's father one's mother gets a better chance of getting dementia right so it's not completely clear that it's really going straight through mitochondrial DNA which a lot of maternal inheritance does I think it goes through both parents to the extent that it goes but it's also the case that you know identical twins don't necessarily both get it and when you know that you can kind of keep in mind that it isn't all DNA period it's got to be other stuff too it does look like there might be a little more inheritance to the mother but that's complicated by the fact that the mothers are usually you know if your father dies when he's 50 or 60 he doesn't look like he's got a family history or has a dementia I tell people you show me a family that doesn't have a history of Alzheimer's disease and I'll show you a family that doesn't live very long yes yeah I there's a whole lot of stuff I don't know and that ranks right up there so we've actually done a fair amount of research on this and I am trying to sort it out because it's even more complicated it actually looks like in ninety year olds that people who have a high cholesterol are protected not at increased risk but protected and that could be because the cholesterol or some of the fats or whatever that we don't quite understand you know have different effects it also have could be because the medications that one takes for high cholesterol might in and of themselves provide some protective benefits I think that and we actually have drawn a lot of blood looking at the different subtypes of lipids and we're analyzing it right now so if I do come back maybe I will have have an answer for you I mean right now what I would say is if you have high cholesterol I wouldn't worry about it if you treat it because you actually a 90 year old with high cholesterol has lower risk of dementia than a 90 year old who never developed high cholesterol or or required any treatment so in your 90s having a history of high cholesterol is actually actually protective and lipids are a big part of the brain so I don't think it's I don't think it's going to be as simple as your cholesterol is what matters I think it's almost certainly going to be some combination of the other sub cholesterol lipid molecules and we were checking out which ones yeah oh yes sorry yes yeah Falls are a big problem I mean in fact we just published a paper recently by way for everyone in this room if you in 1981 when people reported their exercise at a mean age of 70 the more people exercised in their 70s the less likely they are to fall in their 90's so it's not just exercise is good for your brain but also your balance and other things too I think we get a lot of stories about you know mother was fine until and the until almost invariably has to do with a hospitalization and because of that there's been a lot of interest in the idea that maybe anesthesia makes amyloid plaques deposit or maybe it does other things to the brain and I think the best evidence right now is not that it's one thing that happened during the hospitalization it's the hospitalization that hospitalization is really a stressful thing that surgery is really a stressful thing I'm not it's due to the anesthesia but due to the whole process of being cut cut open having all sorts of things done to you and so we a really common story is that after a hospitalization people never spring back to the level of cognitive abilities they had before that is absolutely true the only thing we don't understand because if we did we would avoid it is what part of the hospitalization if any is really causing it and I think once again it's because we're often asking for a simple answer you know we want to prevent Alzheimer's disease by taking vitamin E you know forget eating five five million vegetables than getting all kinds of you know just give me a vitamin E pill or and and I think it's the same with the hospitalization we do so many things to people in the hospital I don't think it's just the anesthesia or just the surgery it's just the whole thing that we do to them and they're reserved in in being able to withstand these kinds of assaults are not good as they get older especially in their 90's I think that's the the the question is you know when you have an elderly person who needs a big procedure like brain surgery you know should it be done or not and I I don't have any any general thoughts I have more specific thoughts I think that for each person you need to ask the physicians involved what they are all the alternatives are I mean if your father had not gotten the surgery I suppose there's a chance he could have died but there's also a chance that he could have lived and been a lot worse off than he would have been without the surgery and and that's the balance you know that you want to kind of think about and without knowing anything about a particular patient or how big the bleed was or how deep it was I don't understand the balance between those two possibilities I mean I think our goal should be the best quality of life and that's true at any age and that includes in your 90s for sure how about somebody over in that back area okay so the question was does Alzheimer's disease occur more or less a lot in certain pockets of the world maybe because they're at higher altitudes or they have other other things that distinguish them and there's been a lot in this that's why people worldwide did all those studies I showed you in the beginning and when everybody sort of jumps to the idea that oh my goodness you know it might be terrible to be a German and it's great to be a Californian or whatever I mean I used to show a slide where I showed that to two places in Cal in Southern California had a tenfold difference and as I pointed out Framingham and East Boston and you know a tenfold difference overall there it appears to be an egalitarian disease it appears to happen worldwide it appears to happen to rich and poor people one of the strongest things that influences how likely it is in a population though is education so high education groups have lower risk of developing all kinds of dementia including Alzheimer's disease and low education has much higher risk we're not completely sure but I think it comes back to my mind to the lifestyle because lifestyle varies a lot by education there have been some people that have suggested that in Africa there are individuals that appear to have lower risk and then people from Africa who were in Indiana and a similar genetic strain I've never quite known how to how to look at that data because the fact of the matter is when Alzheimer described his first case in the United States life expectancy was 49 for women and 47 for men so it's easy not to think you have any Alzheimer's disease when that's the age expectancy and the truth is that is the life expectancy for the average person in the average African state so it's very very hard to compare you know what's going on against that backdrop my take on it though is if you get people in a place to live long enough their risk is pretty much the same worldwide yes okay so there were a couple of parts to this the first observation that this very smart lady made was that a lot of the drugs that I showed and drugs that you hear about Alzheimer's and also a recent cholesterol drug ended with the letters a B a B and these drugs stands for antibody so all of the drugs that I showed you that ended in a B today like the ones in the a4 study the one in Columbia South America the one with other drugs that were using for that I am study those are all what we call antibodies to amyloid which is a kind of immunotherapy it's like a vaccination when we give you a vaccination to keep you from getting polaroid or polo hello polio or smallpox or one of those we are either stimulating you to make antibodies or we are giving them to you and that's what these drugs do they make amyloid they make antibodies to amyloid there is a new drug that has to do with cholesterol that is also ending in a B because it is a form of immunotherapy these forms of immunotherapy though I don't think are related at all to the cholesterol effect in 90 year olds which was the second part of the question in 90 year olds I think that what we're going to find is that either various lipids are actually protective and good for the brain or else the drugs that we're giving you are protective and good for the brain I think that's going to be the case and I didn't and though that data all comes from non antibody cholesterol therapy mostly from statins so I think that's one of the areas where we're more interested yeah yes sir yeah polar bears whales a couple of other species but it's yeah mostly it's a human thing I think that's a great idea the comment was we should start feeding our food to other species and then maybe they will develop all these problems and I think there's a lot of truth to that I think we underestimate you know what our diet does to us and the worst of it is I don't think we really know what our diet is at this point you know when I I grew up in Kentucky we had a garden in the backyard I mean I most of the things I ain't actually I grew and now I don't I don't know what's in my food anymore and I think that you know you've got an important point and what we eat is important and probably important for this excellent let's see that's it that's a very good question have we seen any connection between drugs in our medicine cabinet and at least increased risk of dementia or Alzheimer's disease and truthfully I mean that's been an under studied area but nothing definitively has popped out so especially when you look worldwide you know where there's all different kinds of drugs and you go to places that don't have drugs like we have and you still find it it doesn't appear to be straightforwardly related to any of our common treatments anyway and it's a disease that people so many people get and although there's some things we treat a lot of people for like hypertension or cholesterol you know it other than those kinds of drugs I don't think there are any drugs in common enough usage having said that I wouldn't be surprised there's somewhere along the line if we find that some of these drugs actually do increase your risk that's different from giving it to you or making you have Alzheimer's disease but I can see how they could lower your threshold so one of the things for example that we're about to study is I'm very interested in these resilient people these people who appear to have all summers disease in their head and yet think just fine and one of the questions that I'm about to ask and try to do some research on is is that ability to be resilient to the disease related to taking or not taking any drugs or having or not having any other medical conditions because it's possible that something like that might be influencing it yeah yes ma'am yeah okay so this lady asked why can we remember the parts but have trouble coming up with the word or the name first of all is there a single person in this room who's never had that experience good and is there a certain person than anyone in this room who doesn't think that that's increased with age right so I mean this is a really common problem that we call word finding difficulty I don't know the answer to why some people have more of it than others but it's it's very notable and definitely some people do have more problem with it than others sometimes you know we when people come to me and tell me about it I you know want to make sure that I think that they're okay and in some cases they aren't but in many cases they give a story just like you which is this has been going on for years maybe even getting worse but but it doesn't necessarily portend you know a more serious problem I also want to make another comment that has to do with cancer because one of my students right now just got a manuscript accepted for publication and essentially what it what it discusses is the observation that many people have made and is starting to become of interest to me that individuals who have cancer especially individuals who've had multiple cancers and actually actually seem in some ways protected from the development of dementia and if that is in the story you wouldn't expect there's a lot of possible explanations there and the one that we're trying to get a little bit of a handle now on is that you know some people are more likely to get cancers and we think that that has to do at least in part with their physical and genetic makeup such that they tend to grow new cells really well and then growing too many new cells is how you get cancer and not a good thing but the brain grows new cells and it's also possible the people who get dementia are people who aren't growing new cells or pi having plasticity in their brain as much as others and there is a feeling in the field right now that it might be a balance that if you've got too many of these regenerative cells you are at high risk for cancer but if you have too few of them then you're at and don't get cancer then you're at higher risk for dementia so maybe it's all a trade alpha we're gonna end it there so you all have time to come up and greet the doctor and make her feel welcome and convince her to come back for one more year also and also I do want to encourage her and support what dr. K wass is saying to take down the phone number and also visit Kamla who is back there at the UCI health table she can give you more information on how to participate in the studies thank you and we'll see you in September you [Music] [Applause] [Music] you

Channel: City of Newport Beach

Views: 1,336

Rating: 5 out of 5

Keywords: Newport Beach Library, Medicine in our Backyard, Dr Claudia Helen Kawas, City of Newport Beach

Id: nnVF7py2G-o

Length: 66min 2sec (3962 seconds)

Published: Sat Feb 08 2020