Alzheimer Disease: Knowledge Gained Through Research

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Outline

• What is dementia? • What is Alzheimer’s Disease (AD)?• Risk factors for AD• Current FDA treatments for AD• Current research projects• What can you do to advance AD

research?

What is Dementia?

• Not a normal part of aging• Characterized by problems with:

– Thinking– Language– Memory– Judgment – Reasoning

• Problems get in the way of how life was once lived (impaired activities of daily living)

• Many biological causes of dementia

What is Dementia?

Dementia

Frontotemporal Lobar Degeneration

Parkinson’s Disease-related Dementia

Alzheimer’s disease

Dementia with Lewy Bodies

Creutzfeld Jacob Disease

What is Alzheimer’s disease?

Staggering Statistics

• 5.4 million Americans with AD• 1 in 8 older Americans has AD• 6th leading cause of death in the U.S. • Over 15 million people providing unpaid

care – 80% family caregivers

• Annual cost in 2012 = $200B

Alzheimer’s Association, 2012 Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia.7

AD is an Increasing Crisis

Alzheimer’s Facts and Figures 2011.

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More Staggering Statistics

• By 2050, the number of Americans age 85+ will quadruple to 21 million

• The number of AD patients is expected to reach 16 million– 10 million baby boomers will get Alzheimer’s

disease

• Total cost of AD could exceed $1 trillion

Alzheimer’s Association, 2012 Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia.9

Age Is the Greatest Risk Factor for AD

Evans DA, et al. JAMA. 1989;262:2551-2556

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Genetics

• APOE gene– We all have this gene, it helps make proteins

that carry cholesterol in the bloodstream– 3 common variations

• ApoE ε2• ApoE ε3• ApoE ε4

– ApoE ε4 increases risk for AD.

Protect Yourself from Head Injury

• Aβ (the protein that accumulates in the brain of someone with Alzheimer’s disease) levels go up after head trauma

• Persons who experience head trauma are more likely to develop Alzheimer’s disease later in life

Johnson, VE, et al. Nature Reviews Neuroscience 11, 361-370, 2010. Image credit NickVeasey.com

The Heart-Brain Relationship

• Your brain accounts for 2% of your total body weight

• Your brain uses 20% of your blood oxygen/sugar

• If your brain does not get enough blood, brain cells can die

Cardiovascular Conditions Increase Risk for Alzheimer’s disease

• Cardiovascular disease

• Hypertension

• Stroke

• Diabetes

• High cholesterol

Lowering your risk for/ controlling these conditions can lower your risk for AD

A healthy diet can go a long way!• Several studies link diet to dementia

• Foods high in fat and cholesterol increase risk for conditions on previous slide

• Daily consumption fruits and vegetables reduced risk for all-cause dementia in one study

• Weekly consumption of fish associated with reduced risk for AD

Barberger-Gateau, et al. Neurology 2007.

Some Data Suggests Particular Dietary Ingredients May Be HelpfulAntioxidants• Vitamin E - oils, nuts, fortified cereals• Vitamin C – citrus fruits• Folate - leafy green vegetables (spinach), citrus fruits• Cruciferous vegetables - broccoli, cauliflower• Vitamin B12 – meat, fish, poultry, eggs, milk• Resveratrol - red wine • Docesahexaenoic acid (DHA) - omega-3 fatty acidOthers• Curcumin - curries (anti-oxidant, anti-inflammatory) • Soy Isoflavones - hormone-like compound

www.nia.nih.gov/Alzheimers

Mediterranean Shopping List

• Fish (omega-3 fatty acids; salmon, herring, mackerel, other cold-water fish)

• Fruits and vegetables (antioxidants and anti-inflammatories; leafy greens like kale, spinach, brussel sprouts, and collard greens, deeply hued produce like eggplant, bell peppers, tomatoes, blue berries, strawberries, and blackberries

• Olive oil (monounsaturated fat; extra virgin)

• Nuts (FDA recommends 1.5 oz/d; walnuts, pine nuts, pistachios, almonds)

• Beans (red kidney, pinto)

• Red wine (moderate consumption)

NeurologyNow 2013

Cognitive Activity may lower risk

• In a study controlling for age, education, and other background variables, cognitively inactive persons over the age of 65 were 2.6 times more likely to develop AD

Wilson RS, et al., Neurology. 2007;69:epub.

Keep active (mentally and physically)Longitudinal studies show that persons

with higher level of activity are less likely to

develop dementia• Puzzles

– Crossword– Sudoku

• Traveling• Knitting• Gardening• Reading

30 Minutes of Moderate Exercise 5 Times/Week is Recommended for Adults

74% do not

26% do

Center for Disease Control. www.cdc.gov.

Being active is good for you!• There is much data to

support the importance of physical activity and its ability to lower risk for dementia

• Framingham Study– Moderate to heavy

physical activity is associated with a reduced risk for dementia

Z.S. Tan presentation at 2010 Alzheimer's Association International Conference on Alzheimer's Disease

Alzheimer’s Care

• Diagnosis is important– Rule out other causes of cognitive impairment– Begin appropriate treatments– Make a plan

• Work with appropriate physician– Primary care– Geriatrician– Psychiatrist/Geriatric Psychiatrist– Neurologist

FDA Approved AD Treatments

• Aricept® (donepezil)—all stages• Razadyne® (galantamine)—mild to moderate• Exelon® (rivastigmine)—mild to moderate• Namenda® (memantine)—moderate to severe

• None are approved in people with mild cognitive impairment or normal memories

• None have been shown to slow the course of Alzheimer’s disease

How to Assess Information

• Gingko Biloba• Coconut oil• Aluminum• Flu shots• Many, many more

• Talk to your doctor before you begin any new medication or supplement

Current Research Toward Disease-Modifying

Therapies• Treatments that prevent or reduce the

formation of Aβ and amyloid plaques• Treatments that removed Aβ and

amyloid plaques from the brain• Treatments that reduce tau (the protein

in neurofibrillary tangles)• Neuroprotective strategies

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Moving Earlier More Efficiently

• AD is an insidious neurodegenerative disorder

Sperling R et al. Alzheimer’s & Dementia. 2011

What Can YOU do?

• Everyone can contribute• Consider the three –ates

Advocate Donate Participate

Advocate• AD research and care support are

underfunded • Contact local, state, and federal elected

officials and tell them of the importance of AD research and services

• Consider participating in California State Advocacy Day (contact the Alzheimer’s Association for more information)

Donate

• No gift is too small• Federal funding levels below 10%• Private philanthropy is important and

supports high risk/high reward science• Some employers do “matching gifts”• Easton Center is nonprofit = tax write off

Participate• Research cannot advance without participants

– Minority participants are underrepresented in research

• Who can participate?– People with AD and other dementias– People experiencing mild memory problems– Older adults with normal memory

• If you are interested in being informed of research opportunities, consider enrolling in the Easton Center’s Potential Subject’s Database

Interview Studies

Biomarker Studies

Clinical Trials

• Lifestyle interventions

• Pills• Infused

medications• Surgeries

• Blood tests• MRI• PET scans• Lumbar

punctures

• Telephone interviews

• In-person interviews

• Cognitive testing

Many Types of Research Studies

Easton Center Goal• To find 1500 individuals of diverse backgrounds

age 65 or older who are willing to be contacted about prevention studies when they begin

How Can I Participate?!

There are 4 easy steps:1.Sign a “Consent To Be Contacted” form2.A member of our staff will contact you3.You will be enrolled in the Easton Center’s

Potential Subject Database4.We will contact you when enrollment begins

to see if you are interested an eligible(participation is ALWAYS optional)

Summary• Alzheimer’s Disease is the most common cause of

dementia• There are lifestyle risk factors for Alzheimer’s

disease• There are 4 current FDA-approved treatments for

Alzheimer’s disease, but none slow or prevent it• Research is actively pursuing better treatments

and diagnostic tools• Researchers need your help!

Helpline: (310) 794-6039

www.EastonAD.ucla.edu