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Brain Span =s Life Span James Siberski MS,CMC Assistant Professor Misericordia University jsibe@msn.com Slide 2 Defining the problem! Can we handle the BOOMERS Slide 3 Boomers + today's cohort of older people =s $$$$$$$$$ A hypothetical intervention that delayed the onset of AD dementia by 5 years would result in a 57% reduction in the number of patients with AD dementia, and reduce the projected Medicare costs of AD from $627 to $344 billion dollars Everyone - religious organizations, big business, Government, to have a prayer of meeting the needs Slide 4 Slide 5 Roger Bacon (c. 1220-1292) Franciscan friar English philosopher Oxford professor Old age could be thwarted off by: eating a controlled diet proper rest exercise moderation in lifestyle good hygiene inhaling the breath of a young virgin (Kind Davidsleeping between 2 virgins) Aging healthy it has not changed that much? Slide 6 Memory Processes Slide 7 Memory Memory is the basis for knowing your friends, your neighbors, the English language, the national anthem, and yourself. If memory was nonexistent, everyone would be a stranger to you; every language foreign; every task new; and even you yourself would be a stranger. 7 Slide 8 The Phenomenon of Memory Memory is any indication that learning has persisted over time. It is our ability to store and retrieve information. BRAIN HEALTH IS IMPROTANT BRAIN SPAN NEEDS TO = LIFE SPAN NOT MATTER 8 Slide 9 Reserve Function Age 40 Basal Capacity Reserve Function Age 80 Basal Capacity Reserve Function Excess Capacity (Developed) Slide 10 Memory Health How healthy your memory is depends quite a bit on how healthy you are. We all notice fluctuations in our ability to remember from time to time. Your memory might seem less efficient when you are very sick, emotionally stressed or excessively busy. Take the time to run through this memory health check: Are you taking any medication, and if so, do you know if it can affect your memory? Is your vision or hearing impaired in any way? Do you have chronic pain? Is your sleep disturbed? Are you experiencing a high level of stress or anxiety? Could your hormone levels be altered at the moment? Do you think you might be depressed? Is your workload to heavy? Do you drink too much alcohol, or use drugs to excess? If you are worried about your memory and you answered yes to any of these questions, it might be time to take action. Slide 11 Brain Myth #1: You can't change your brain. Your brain is constantly changing in response to your experiences, and it retains this basic "plasticity" well into old age. Everything we do and think about is reflected in patterns of activity in our brains. Scientists can see these patterns in brain-imaging scans that show which parts of the brain are functioning during specific tasks. Changing our thinking or changing the way we behave causes corresponding changes in the brain systems involved. This is why therapy that teaches people to alter negative patterns of thought and behavior (like cognitive therapy, for example) can be effective in treating some mental disorders. Slide 12 Brain Myth #2: People lose brain cells every day and eventually just run out. Actually, most regions of the brain do not lose brain cells as you age. While you may lose some nerve connections, this is not necessarily a bad thing. It can be part of the reshaping of the brain that occurs with experience. It's also possible that you can even grow new brain cells and create new connections, or prevent the ones you have from withering, if you exercise your brain Slide 13 Brain Myth #3: The brain doesn't make new brain cells. This myth was widely believed for generations, but has recently been proven false. We now know that certain areas in the brain including the hippocampus (where new memories are created) and the olfactory bulb (the scent- processing center)regularly generate new brain cells. Many of these cells go on to become working parts in brain-cell connections. Slide 14 Brain Myth #4: Memory decline is inevitable as we age Many people reach very old age and are still sharp as ever. Genetics clearly plays a role in "successful aging," but how we live our lives on a day-to-day basis is also critical. To help your brain age well, you can: Perform physical exercise (especially aerobic exercise) Engage in intellectually stimulating mental activity Eat a healthy diet Maintain social connections (spending time with friends and family members, for example) Learn to manage stress Develop a positive attitude toward yourself and your world Slide 15 Ginkgo biloba Ginkgo biloba is the oldest species of tree known, dating back 300 million years. In Europe physicians write over 1.2 million prescriptions per month for ginkgo to help improve cerebral circulation, mental alertness, and overall brain functioning. Numerous human studies on ginkgo have been published, which show that ginkgo leaf works by increasing blood flow throughout the body and brain. It has been shown to be helpful with many of the complaints of the elderly such as short-term memory loss, slow thinking and reasoning, and dizziness. Slide 16 Fish oil/DHA/EPA The omega-3 fatty acids EPA and DHA are the preferred brain fats. Essentially the only place you can obtain these fatty acids is by eating fish and other seafood. The saying, Fish is brain food is correct: if you dont eat fish and consume other less desirable fats such as the trans-fats found in margarine or heated rancid fats such as are typically found when food is deep fried, your brain incorporates these fatty acids into its infrastructure(!) Slide 17 L-glutamine L-glutamine is an amino acid that serves as an important source of energy for the brain. Supplementation with l-glutamine has been found to help improve mood, mental performance and both long- and short-term memory. Slide 18 What can be done to improve, maintain our memory ? Slide 19 1 st do not: Slide 20 Slide 21 Slide 22 Compared with the brain of an individual with no history of inhalant abuse (A), that of a chronic toluene abuser (B) is smaller and fills less of the space inside the skull (the white outer circle in each image). Slide 23 2 nd Do stimulate your whole brain Slide 24 Why am I optimistic? The defective, right side of three-year-old brain which was removed during surgery for Rasmussen's encephalitis, a condition that causes seizures every few minutes. The right side of brain typically controls the muscles on the left side of the body and is more dominant for processing music and visual imagery Slide 25 The 3 key principles for good brain exercise We need to know and teach: Novelty: you need to try new things, including things you arent good at. Variety: given that the brain is composed of a variety of functionally distinct areas, you need to ensure a complete mental workout circuit to maintain sharpness in all areas. Excessive specialization is not the best strategy for our long- term Brain Health. Challenge: you need to be exposed to increasing levels of challenge, so the task is never too easy. If you can only do one thing, learn something new every day, no matter how small. Slide 26 Neuroplasticity The hope of many scientists researching neuroplasticity is that humans will be able to combat things such as ID, addiction, dyslexia, and more by harnessing the brain's inborn ability to change. One way to harness the power of neuroplasticity is through the use of Brain-computer interfaces Slide 27 Brain Plasticity Brain reacts and adapts in response to challenge. Recent brain imaging technologies show as we receive input through our senses with frequency, intensity and duration, the brain physically changes its structure. New connections and neurons sprout. Once structure changes, function can change. Slide 28 Slide 29 Alzheimers Dementia Slide 30 Today Slide 31 Tomorrow Slide 32 Alzheimers TESTS WILD CARD MEDICATION AND TREATMENT Slide 33 BETTER - TESTS EARLIER TREATMENT BETTER MEDICATIONS WILD CARD Slide 34 WILD CARD (all of you!) YOU Slide 35 TECHNOLOGY YOU HAVE TO GO TO DOCTOR YOU HAVE TO HAVE ASSESSMENT YOU HAVE TO ALTER LIFE STYLE YOU HAVE TO PLAN YOU HAVE TO POSTPONE YOU HAVE .. Slide 36 AD DISEASE & AD - DEMENTIA Converging evidence from both genetic at-risk cohorts and clinically normal older individuals suggests that the pathophysiological process of Alzheimers disease (AD) begins years, if not decades, before the diagnosis of clinical dementia The long preclinical phase of AD provides a critical opportunity for potential intervention with disease-modifying therapy A recent report on the economic implications of the impending epidemic of AD, as the baby boomer generation ages, suggests that more than 13.5 million individuals just in the United States will manifest AD dementia by the year 2050 A hypothetical intervention that delayed the onset of AD dementia by 5 years would result in a 57% reduction in the number of patients with AD dementia, and reduce the projected Medicare costs of AD from $627 to $344 billion dollars AD would be optimally treated before significant cognitive impairment, in the presymptomatic or preclinical stages of AD Slide 37 This model postulates that amyloid beta (A) accumulation is an upstream event in the cascade that is associated with downstream synaptic dysfunction, neurodegeneration, and eventual neuronal loss Slide 38 Slide 39 Slide 40 Slide 41 Gammagard "If we have a patient who goes out to 18 or 24 months without changing, then we usually begin to doubt that they have Alzheimer's...but to have 4 patients, all of whom received the same dose and who are effectively unchanged after 3 years, is a remarkable Slide 42 It is given once every two weeks, with an estimated to cost a patient $2,000 to $5,000. Immunotherapy with intravenous immunoglobulin (IVIG/Gammagard, Baxter) appears to stabilize symptoms of Alzheimer's disease (AD) over the long term At 36 months, IVIG slowed the rate of expected cognitive decline in all participants. But the most striking finding was that it stopped decline in a subset of patients who received what proved to be the optimal dose of the immunotherapy for the entire study period. For this subset of 4 patients, measures of cognition, memory, daily functioning, and mood were unchanged from baseline after 3 years of treatment. To put this in perspective, when we see patients in our clinic with AD who are untreated, there's usually measurable decline below baseline in 3 to 6 months. If we treat them with the currently available agents, they typically drop below baseline between 6 and 12 months. Slide 43 Souvenaid, Nutricia/Danone) Medical nutrition product (Souvenaid, Nutricia/Danone) showed that memory performance continued to improve in drug-nave patients with mild AD for up to 48 weeks. These latest OLE results immediately follow those of the double-blind, randomized controlled Souvenir II study, published in the July issue of the Journal of Alzheimer's Disease, which showed significant improvement in memory performance compared with placebo over 24 weeksstudy The bottom line is that we have now conducted 2 large studies with this medical food that aims to restore the function of synapses in mild to very mild Alzheimer's disease and have proven that it improves memory Slide 44 Axona The bottom line is that we have now conducted 2 large studies with this medical food that aims to restore the function of synapses in mild to very mild Alzheimer's disease and have proven that it improves memory Both coconut oil and Axona are high in calories and saturated fat, but some research suggests that coconut oil neither increases weight nor adversely affects lipid levels. [2,16,17] Gastrointestinal adverse effects, particularly diarrhea, were frequent causes of discontinuation in the phase 2 study. [3] Coconut oil costs about $12 for 16 oz. Axona costs about $85 per month. Slide 45 Memory/Brain Health Spas Slide 46 Slide 47 #5 Inhibition Planning Eye-hand Divided attention Visual perception Time estimate Shifting Visual scan Awareness Wk Memory Response ST Memory Spatial Naming http://www.cognifit.com Slide 48 Waitlist Inhibition Planning Eye-hand Divided att Visual perc Time est Shifting Visual scan Awareness Wk Memory Response ST Memory Spatial Naming Placebo Inhibition Planning Eye-hand Divided att Visual perc Time est Shifting Visual scan Awareness Wk Memory Response ST Memory Spatial Naming Experimental Inhibition Planning Eye-hand Divided att Visual perc Time est Shifting Visual scan Awareness Wk Memory Response ST Memory Spatial Naming #5 SO ID INDIVIDUALS CAN LEARN! Slide 49 Slide 50 A pumped-up blood flow Variety and Challenge Good Nutrition What the aging brain needs: aging brainaging brain Slide 51 If you are 45 years old and do all of these (rather than none) you will live longer. (men- 7 years, women-11 years) 1.Sleeping 7-8 hours per night 2.Weight Control 3.Exercise 4.Limited Alcohol 5.Non-smoking 6.Eating Breakfast 7.Seldom Snacking Lifestyle Choices for Lifestyle Recommendations Health Belloc et al Slide 52 Nutrition or - A Waist is a Terrible Thing to Mind Slide 53 Foods for Health 1. Tea, green1-6 cups 2.Coffee? 3. Fish2-3 times/week 4.Cooked Tomatoes10 servings/week 5. Fiber> 25 gm/day 6. Nuts> 5 oz/week 7. Chocolatedark 8.Saturated fat< 10% total calories/day < 1/3 of all fat intake 9.Fruit > 4 Servings/day 10.Alcohol1.5 oz/day- women 3 oz/day-men Dietary Reference Intakes The National Academies Press, 2005 Minaker et al Lifestyle Recommendations Slide 54 Wine? Slide 55 IF YOU DO STOP! Slide 56 Slide 57 Cognitive Remediation of the Alzheimer Patient: Client Disease Modification or Symptomatic Relief Slide 58 Shore, R. 1997 Slide 59 Medication Slide 60 Drug Side Effects Include Memory Loss Drugs That May Interfere in Thinking and Memory: Antiarrhythmics: Digoxin (Lanoxin), disepyramide (Norpace) Antibiotics and antivirals: Acyclovir (Zovirax), ciprofloxacin (Cipro), ganciclovir (Cytovene), metronidazole (Flagyl) Antihistamines: Chlorpheniramine (ChlorTrimeton), dimenhydrinate (Dramamine), diphenhydramine (Benadryl Allergy) Antihypertensives: Clonidine (Catapres) and beta blockers, such as atenolol (Tenormin), metoprolol (Lopressor), and propranolol (Inderal) Corticosteroids: Methylprednisolone (Medrol, Meprolone), prednisone (Deltasone, Orasone) Cough and congestion medications: Dextromethorphan (Robitussin Cough Gels), pseudoephedrine (Sudafed) Incontinence medications: Oxybutynin (Ditropan), solifenacin (VESlcare), tolterodine (Detrol) Slide 61 Drug Side Effects Include Memory Loss Drugs That May Interfere in Thinking and Memory: Gastrointestinal medications: Cimetidine (Tagamet), diphenoxylate (combined with atropine in Lofene, Lomotil), dicyclomine (Bentyl), glycopyrrolate (Robinul), hyoscyamine (Anaspaz, Cystospaz), scopolamine (Scopace) Migraine medications: Naratriptan (Amerge), rizatriptan (Maxalt) Muscle relaxants: Cyclobenzaprine (Flexeril), orphenadrine (Antiflex) Painkillers: Codeine (generic); meperidine (Demerol), pentazocine (Talwin), propoxyphene (Darvon) Parkinsons medications: Amantadine (Symmetrel), levodopa (Sinemet), selegiline (Eldepryl) Sleep medications: Eszopiclone (Lunesta), zaleplon (Sonata), zolpidem (Ambien CR) Tricyclic antidepressants: Amitriptyline (Elavil), imipramine (Tofranil), notriptyline (Pamelor) Slide 62 Any intellectually challenging activity stimulates dendritic growth, which adds to the neural connections in the brain. The more mentally challenged sisters had more neural connections, which allows them to reroute messages to the brain. Counteracting the debilitating effects on the brain of dementia and Alzheimers. Slide 63 Slide 64 View Enlarged Image View Enlarged Image Slide 65 The phone has one pre-dialed number Slide 66 If you want your brain span to equal your life span? Conclusions! At any age: Enrich your environment - travel, games, dancing Eat right - Med diet, H2O, supplements Exercise - mind, memory and body Education - learning new things everyday Entertain - socializing Evaluate - health, practice wellness, drugs you take Estimate - quality of sleep Examination - by MD and Dx. Memory issues Expend the effort to have memory span = life span Slide 67 The End IT WORKS FOR ME!