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![References
• Singh-Manoux A, Czernichow C, Elbaz A, et al. Obesity
phenotypes in midlife and cognition in early old age: The
Whitehall II cohort study. Neurology 2012;79:755-762.
• Solomon A, Kivipelto M, Soininen H. Prevention of Alzheimer’s
disease: Moving backward through the lifespan. J Alzheimer Dis
2012 [In Press].
• Vemuri P, Lesnick TG, Przybelski SA, et al. Effect of lifestyle
activities on AD biomarkers and cognition. Ann Neurol 2012 [In
Press]
• Vigen CLP, Mack WJ, Keefe RSE, et al. Cognitive effects of
atypical antipsychotic medications in patients with Alzheimer’s
disease: Outcomes from CATIE-AD. Am J Psychiatry
2011;168:831-839.](https://image.slidesharecdn.com/healthybrainagingeuclidhosp2012-11-2-121106082836-phpapp01/75/Healthy-Brain-Aging-50-2048.jpg)
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Healthy Brain Aging
- 1. Healthy Brain Aging November 2, 2012 Brian S. Appleby, M.D. Staff, Lou Ruvo Center for Brain Health
- 2. No Relevant Financial Disclosures
- 3. Objectives • Describe whyhealthy brain aging is important • Summarize current knowledge about brain aging • Describe ways to approach aging patients regarding brain health
- 4. Healthy Brain Aging WHYIS IT IMPORTANT?
- 5.
- 8. Rank Cause of death 2010 Age-adjusted % change death rate from 2009 1 Heart disease 178.5 -2.4 2 Cancer 172.5 -0.6 3 Chronic lung disease 42.1 -1.4 4 Cerebrovascular disease 39 -1.5 5 Accidents 37.1 -1.1 6 Alzheimer’s disease 25 +3.3 7 Diabetes 20.8 -1 Adapted from: NVSR, 60(4)
- 9. 2011 Alzheimer’s DiseaseFacts and Figures
- 10. 2011 Alzheimer’s DiseaseFacts and Figures
- 11. 2011 Alzheimer’s DiseaseFacts and Figures
- 12. 2011 Alzheimer’s DiseaseFacts and Figures
- 13. 2011 Alzheimer’s DiseaseFacts and Figures Dementia caregiver spouses had 6 times the risk of incident dementia compared to those who had spouses without dementia Norton MC, J Am Geriatr Soc 2010
- 15. Work Force Concerns •57 new geriatric psychiatrists certified per year • 54/120 (45%) training spots filled per year • Now: 1 geri psych doc per 23,000 patients • 2030: 1 geri psych doc per 27,000 patients ABPN, 2010 Annual Report Jeste DV, Psychtri News 2012
- 16. Healthy Brain Aging WHATIS IT?
- 17.
- 18. Non-Modifiable Risk Factorsfor Alzheimer’s Disease (AD) • Age • Genetic - PS1, PS2, APP mutations (pathogenic) - APOε4 roughly doubles risk (risk factor)
- 19. In a Nutshell Chronic Diseases Lifestyle Engagement
- 20. Increased risk forcognitive decline All low level of evidence • Low plasma selenium • Depression • Diabetes • Metabolic syndrome • Current tobacco use Williams JW, AHRQ Publication No. 10-E005 2010
- 21. Increased risk factorsfor AD Moderate Level of Evidence Low Level of Evidence • Conjugated equine estrogen + • Some NSAID’s methyl progesterone • Depression • Diabetes • Mid-life hyperlipidemia • Traumatic brain injuries in • Pesticide exposure • Never married, less social support • Current tobacco use Williams JW, AHRQ Publication No. 10-E005 2010
- 22.
- 23.
- 24.
- 25.
- 26.
- 27. Double Trouble Diabetes andDepression Katon W, Arch Gen Psychiatry 2011
- 28.
- 29. Decreased risk forcognitive decline High level of evidence Low level of evidence • Cognitive training • Vegetable intake • Mediterranean diet • Omega-3 fatty acids • Physical activity • Non-cognitive, non- physical leisure activities Williams JW, AHRQ Publication No. 10-E005 2010
- 30. Decreased risk factorsfor AD All are low level of evidence • Mediterranean diet • Folic acid • Statins • Higher level of education • Light-moderate alcohol use • Cognitively engaging activities • Physical activity Williams JW, AHRQ Publication No. 10-E005 2010
- 31. Memory Fitness Program Structure Content • Biweekly classes • Brain health education • 60 min in length • Memory strategies • Lasted 6 weeks • Diet • Given materials • Exercise • Given homework • Stress reduction Improved objective and subjective aspects of memory Miller KJ, Am J Geriatri Psychiatry 2012
- 32. Nutrient p value Vitamin E 0.75 Vitamin C 0.13 Folate 0.26 Vitamin B12 0.45 Vitamin D 0.75 Beta-carotene 0.78 Omega-6-polyunsaturated fatty acids 0.96 Saturated fatty acids 0.84 Monounsaturated fatty acids 0.92 Omega-3-polyunsaturated fatty acids 0.02 Gu Y, Neurology 2012
- 33. Ω-3 PUFA Sources Food Correlation Coefficient Salad Dressing 0.53 Fish 0.44 Poultry 0.30 Margarine 0.19 Nuts 0.09 Gu Y, Neurology 2012
- 34. Healthy Brain Aging HOWTO APPROACH PATIENTS?
- 35.
- 36. Interventions (Delay Onset of AD) • Evaluate current medications • Evaluate and treat AD risk factors • Systemic mental exercise • Physical exercise • Treatment non-cognitive causes of disability • Supportive psychotherapy Emery V, 2011
- 37. Address Medical RiskFactors • Cerebrovascular disease • Cardiovascular disease • Diabetes • Hyperlipidemia • Elevated homocysteine levels • Head injury • Obesity Emery V, 2011
- 38. Address Trouble Medications • Sedatives: benzodiazepine & derivatives • Antidepressants: TCAs, paroxetine • Antipsychotics • Antihypertensives: reserpine, clonidine • Anticholinergics: oxybutinin, antihistamines • H2 blockers: cimetidine, ranitidine • Opiates • Corticosteroids • Antibiotics: floroquinolones
- 39. Vigen C, AmJ Psychiatry 2011
- 40. Address Neuropsychiatric Risk Factors • Mood disorders • Anxiety • Stress Emery V, 2011
- 41. Address Lifestyle Risk Factors • Education • Caretaker of spouse with dementia • Environmental exposures • Nutrition • Substance abuse/misuse • Smoking • Sleep Emery V, 2011
- 42. My Approach Heart Healthy CognitiveEngagement Regularly Scheduled Social Engagement
- 43. Heart Healthy • “Anythingassociated with keeping your heart healthy.” • Physical exercise • Low fat, low cholesterol diet • No smoking
- 44. Physical Exercise “Physical exerciseon more days then not for at least 30 min at a pace that you cannot carry a conversation.”
- 45. Regular Cognitive Engagement • ANY mentally stimulating activity - Reading - Puzzles - Games - Musical instruments • Pick what you may already be doing • Pick what you like doing
- 46. Regular Scheduled Social Engagement • Regular: AT LEAST once weekly • Scheduled: Combats apathy, supplies structure • Does not include errands or chores
- 47. • Disease • LifeStory • Dimensions (Personality) • Motivated Behaviors
- 48. References • Dotson VM, Beydoun MA, Zonderman AB. Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology 2010;75:27-34. • Emery VOB. Alzheimer disease: Are we intervening too late? Pro. J Neural Trans 2011;118:1361-1378. • Gu Y, Schupf N, Cosentino SA, et al. Nutrient intake and plasma beta-amyloid. Neurology 2012;78:1832-1840. • Jeste DV. Aging and mental health: Bad news and good news. Psychiatr News 2012; 4:3. • Katon W, Lyles CR, Parker MM, et al. Association of depression with increased risk of dementia in patients with type 2 diabetes: The Diabetes and Aging Study. Arch Gen Psychiatry 2012;69:410- 417.
- 49. References • McHugh PR & Slavney PR. Perspectives of Psychiatry. The Johns Hopkins University Press, 2nd edition, 1998. • Miller KJ, Siddarth P, Gaines JM, et al. The memory fitness program: Cognitive effects of a healthy aging intervention. Am J Geriatri Psychiatry 2012;20:514-523. • Norton MC, Smith KR, Ostbye T, et al. Greater risk of dementia when spouse has dementia? The Cache County study. JAGS 2010; 58:895-900. • Pimentel-Coelho PM & Rivest S. The early contribution of cerebrovascular factors to pathogenesis of Alzheimer’s disease. Eur J Neurosci 2012;35:1917-1937. • Rodrigue KM, Kennedy KM, Devous MD, et al. Beta-amyloid burden in healthy aging: Regional distribution and cognitive consequences. Neurology 2012;78:387-395.
- 50. References • Singh-Manoux A, Czernichow C, Elbaz A, et al. Obesity phenotypes in midlife and cognition in early old age: The Whitehall II cohort study. Neurology 2012;79:755-762. • Solomon A, Kivipelto M, Soininen H. Prevention of Alzheimer’s disease: Moving backward through the lifespan. J Alzheimer Dis 2012 [In Press]. • Vemuri P, Lesnick TG, Przybelski SA, et al. Effect of lifestyle activities on AD biomarkers and cognition. Ann Neurol 2012 [In Press] • Vigen CLP, Mack WJ, Keefe RSE, et al. Cognitive effects of atypical antipsychotic medications in patients with Alzheimer’s disease: Outcomes from CATIE-AD. Am J Psychiatry 2011;168:831-839.