Healthy Brain Aging


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Healthy Brain Aging

  1. 1. Healthy Brain Aging November 2, 2012 Brian S. Appleby, M.D.Staff, Lou Ruvo Center for Brain Health
  2. 2. No Relevant Financial Disclosures
  3. 3. Objectives• Describe why healthy brain aging is important• Summarize current knowledge about brain aging• Describe ways to approach aging patients regarding brain health
  4. 4. Healthy Brain AgingWHY IS IT IMPORTANT?
  5. 5. 19.3% ofpopulation
  6. 6. 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)
  7. 7. 2011 Alzheimer’s Disease Facts and Figures
  8. 8. 2011 Alzheimer’s Disease Facts and Figures
  9. 9. 2011 Alzheimer’s Disease Facts and Figures
  10. 10. 2011 Alzheimer’s Disease Facts and Figures
  11. 11. 2011 Alzheimer’s Disease Facts and Figures Dementia caregiver spouses had 6 times therisk of incident dementia compared to those who had spouses without dementia Norton MC, J Am Geriatr Soc 2010
  12. 12. 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
  13. 13. Healthy Brain AgingWHAT IS IT?
  14. 14. Emery V, 2011
  15. 15. Non-Modifiable Risk Factors for Alzheimer’s Disease (AD)• Age• Genetic - PS1, PS2, APP mutations (pathogenic) - APOε4 roughly doubles risk (risk factor)
  16. 16. In a Nutshell Chronic DiseasesLifestyle Engagement
  17. 17. Increased risk for cognitive decline All low level of evidence• Low plasma selenium• Depression• Diabetes• Metabolic syndrome• Current tobacco use Williams JW, AHRQ Publication No. 10-E005 2010
  18. 18. Increased risk factors for 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
  19. 19. Rodrigue KM 2012
  20. 20. Vemuri P, 2012
  21. 21. Singh-Manoux 2012
  22. 22. Pimentel-Coelho PM 2012
  23. 23. Dotson VM 2010
  24. 24. Double TroubleDiabetes and Depression Katon W, Arch Gen Psychiatry 2011
  25. 25. Solomon A, 2012
  26. 26. Decreased risk for cognitive 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
  27. 27. Decreased risk factors for 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
  28. 28. 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 reductionImproved objective and subjective aspects of memory Miller KJ, Am J Geriatri Psychiatry 2012
  29. 29. Nutrient p valueVitamin E 0.75Vitamin C 0.13Folate 0.26Vitamin B12 0.45Vitamin D 0.75Beta-carotene 0.78Omega-6-polyunsaturated fatty acids 0.96Saturated fatty acids 0.84Monounsaturated fatty acids 0.92Omega-3-polyunsaturated fatty acids 0.02 Gu Y, Neurology 2012
  30. 30. Ω-3 PUFA SourcesFood Correlation CoefficientSalad Dressing 0.53Fish 0.44Poultry 0.30Margarine 0.19Nuts 0.09 Gu Y, Neurology 2012
  31. 31. Healthy Brain AgingHOW TO APPROACH PATIENTS?
  32. 32. Vemuri P, 2012
  33. 33. 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
  34. 34. Address Medical Risk Factors• Cerebrovascular disease• Cardiovascular disease• Diabetes• Hyperlipidemia• Elevated homocysteine levels• Head injury• Obesity Emery V, 2011
  35. 35. Address Trouble Medications• Sedatives: benzodiazepine & derivatives• Antidepressants: TCAs, paroxetine• Antipsychotics• Antihypertensives: reserpine, clonidine• Anticholinergics: oxybutinin, antihistamines• H2 blockers: cimetidine, ranitidine• Opiates• Corticosteroids• Antibiotics: floroquinolones
  36. 36. Vigen C, Am J Psychiatry 2011
  37. 37. Address Neuropsychiatric Risk Factors• Mood disorders• Anxiety• Stress Emery V, 2011
  38. 38. Address Lifestyle Risk Factors• Education• Caretaker of spouse with dementia• Environmental exposures• Nutrition• Substance abuse/misuse• Smoking• Sleep Emery V, 2011
  39. 39. My ApproachHeart HealthyCognitive EngagementRegularly Scheduled SocialEngagement
  40. 40. Heart Healthy• “Anything associated with keeping your heart healthy.”• Physical exercise• Low fat, low cholesterol diet• No smoking
  41. 41. Physical Exercise“Physical exercise on more days then not for at least 30 min at a pace that you cannot carry a conversation.”
  42. 42. Regular Cognitive Engagement• ANY mentally stimulating activity - Reading - Puzzles - Games - Musical instruments• Pick what you may already be doing• Pick what you like doing
  43. 43. Regular Scheduled Social Engagement• Regular: AT LEAST once weekly• Scheduled: Combats apathy, supplies structure• Does not include errands or chores
  44. 44. • Disease• Life Story• Dimensions (Personality)• Motivated Behaviors
  45. 45. 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.
  46. 46. 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.
  47. 47. 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.