Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Welcoming Remarks
Henry Simmons
Chief Executive, Alzheimer Scotland
'Prevention: Keeping it Real'
Delivered by Professor C...
Welcoming Remarks
Henry Simmons
Chief Executive, Alzheimer Scotland
Keeping it Real
Prof Craig Ritchie
Psychiatry of Ageing
Centre for Dementia Prevention
University of Edinburgh
The objective of today’s talk is to
convince you that Dementia is
preventable
Whether we do prevent it will be
discussed i...
PREVENTION NEEDS:
Knowing the risks
Knowing the disease
Modifying the risk
Treating the disease
HONESTY or ‘Getting Real’
Strong Weak Fantasy
Strong Weak Fantasy
VITD
?
FAMILY
Hx
SUGAR
PIANO
BLOOD
PRESSURE
SEX
AL3+
ALCOHOL
Strong Weak Fantasy
VITD
?
FAMILY
Hx
SUGAR
PIANO
BLOOD
PRESSURE
SEX
AL3+
ALCOHOL
Strong Weak Fantasy
VITD
?
FAMILY
Hx
SUGAR
PIANO
BLOOD
PRESSURE
SEX
AL3+
ALCOHOL
Strong Weak Fantasy
VITD
?
SUGAR
PIANO
BLOOD
PRESSURE
SEX
AL3+
ALCOHOL
FAMILY
Hx
Strong Weak Fantasy
VITD
?
SUGAR
PIANO
BLOOD
PRESSURE
SEX
AL3+
ALCOHOL
FAMILY
Hx
Strong Weak Fantasy
VITD
?
SUGAR
PIANO
BLOOD
PRESSURE
SEX
AL3+
FAMILY
Hx
ALCOHOL
Strong Weak Fantasy
VITD
?
SUGAR
PIANO
SEX
AL3+
FAMILY
Hx
ALCOHOL
BLOOD
PRESSURE
Strong Weak Fantasy
VITD
?
SUGAR
SEX
AL3+
FAMILY
Hx
ALCOHOL
BLOOD
PRESSURE
PIANO
Strong Weak Fantasy
VITD
?
SUGAR AL3+
FAMILY
Hx
ALCOHOL
BLOOD
PRESSURE
PIANO
SEX
Strong Weak Fantasy
VITD
AGE
SUGAR AL3+
FAMILY
Hx
ALCOHOL
BLOOD
PRESSURE
PIANO
SEX
Strong Weak Fantasy
VITDSUGAR AL3+
FAMILY
Hx
ALCOHOL
BLOOD
PRESSURE
PIANO
SEX
AGE
Understanding why age is a risk may
provide insights for prevention.
Why age?
Brain & Ageing
• But Nerve Cells don’t age…..
• If nerve cells don’t age then
how does the brain age?
What links together the parts of our
body that age?
Skin
Joints
Heart
Muscles
Clue – which area of skin wrinkles first?
They Move
… are subject to mechanical forces
But the brain doesn’t
move…..
…. or does it?
Billions of cells, trillions of cells but only
two types of cells:
Glia
Cell
Glia
Cell
NeuronNeuron
Blood vessels ‘move’, age and
downstream cause the brain to fail…
Glia
Cell
Glia
Cell
NeuronNeuron
Blood
Vessels
Blood
Ves...
Ageing Brain
• The (normally) ageing brain is a
consequence of the mechanical and
inevitable damage to circulation.
• Why ...
Association and Causality
• Bradford Hill Criteria:
– Strength
– Consistency
– Specificity
– Temporality
– Biological grad...
Association and Causality
• Bradford Hill Criteria:
– Strength
– Consistency
– Specificity
– Temporality
– Biological grad...
Association and Causality
• Bradford Hill Criteria:
– Strength
– Consistency
– Specificity
– Temporality
– Biological grad...
Smoking Ban and AMI in England
Reduction in seasonally adjusted
AMI Admissions
Smoking ban Introduced here
£17m per year s...
Association and Causality
• Bradford Hill Criteria:
– Strength
– Consistency
– Specificity
– Temporality
– Biological grad...
Association and Causality
• Bradford Hill Criteria:
– Strength
– Consistency
– Specificity
– Temporality
– Biological grad...
Believe
We have to
believe that
prevention is
a realistic
prospect….
This belief
isn’t a faith
it’s a
confidence in
science
Science
Epidemiology
Pathology, Cell Biology
and Biochemistry
Clinical Trials
www.centrefordementiaprevention.com
@CenDemP...
Why Prevention?
Ritchie et al. 2015
Lancet Psychiatry
(In Press)
Alzheimer’s Disease
Alzheimer’s disease PLUS
• Amyloid Pathology
• Tau Pathology
• Cerebrovascular Changes
• α-synuclein
• Blood Brain Barrier...
SECONDARY PREVENTIONPRIMARY
PREVENTION
PREVENTION PREMISED ON UNDERSTANDING DISEASE BEFORE DEMENTIA
Alzheimer’s disease before dementia
• Models are now
incorporating multiple
pathological processes.
• Biomarkers need to
a...
Different Profiles (Normal Ageing)
ProcessesProcesses 40-5040-50 50-6050-60 60-7060-70 70-8070-80 80-9080-90
ABetaABeta
In...
Different Profiles (Alzheimer’s dementia)
ProcessesProcesses 40-5040-50 50-6050-60 60-7060-70 70-8070-80 80-9080-90
ABetaA...
3-steps for secondary prevention:
Develop accurate disease models
Stratification of risk / probability of decline
Test pre...
3-steps for secondary prevention:
All of these steps are being addressed in
EPAD and PREVENT
www.preventdementia.co.uk
@AD...
The Vision
• That any given individual
from birth onwards can be
given an accurate
‘probability’ of a
neurodegenerative ‘e...
The Vision
• That any given individual
from birth onwards can be
given an accurate
‘probability’ of a
neurodegenerative ‘e...
What do we need
though?
Partnerships
Data
Lots and lots and lots of data on lots and
lots and lots of people…
IMI EPAD-----
Innovative Medicines Initiative
European Prevention of Alzheimer’s Dementia Project
@imi_epad
The European Prevention of Alzheimer's Dementia
(EPAD) project aims to develop an infrastructure that
efficiently enables ...
SECONDARY PREVENTIONPRIMARY
PREVENTION
PREVENTION PREMISED ON UNDERSTANDING DISEASE BEFORE DEMENTIA
 EPAD brings together a trial ready cohort of
well characterized subjects evaluated at highly
qualified sites running a s...
 At least 10,000 people in study
– (>50 and no dementia)
 Imaging
 Blood tests
 Genetics
 Risk factors
 Spinal fluid...
 Super-computers
 State of the art imaging facilities
 Best statisticians and scientists
 Dedicated laboratories
 Ope...
 USA
– GLOBAL ALZEIMER’S PLATFORM
– A4 TRIAL (AUSTRALIA)
– DIAN-TU
– USPAD SUBMITTED TO NIH
 CANADA
– CPAD (Canadian Pip...
HOW DO WE ACHIEVE
PREVENTION?
WE HAVE THE MEANS TO IDENTIFY PEOPLE
ACCURATELY FOR SECONDARY
PREVENTION
WE HAVE THE INTERVE...
HOW DO WE ACHIEVE
PREVENTION?
THE PUBLIC, RESEARCHERS AND INDUSTRY
MAY DELIVER A ROAD MAP
BUT
ULTIMATELY GOVERNMENTS, THE ...
Will they Listen?
If we can bring the data and the evidence
will they listen?
The Public
The PublicThePoliticians
ThePolit...
That bit we don’t yet have an
answer to…..
Relatively speaking – the
science is easy
Listening?
The objective of today’s talk was to
convince you that Dementia is
preventable
Did I succeed?
THANKYOU
Closing Remarks
Henry Simmons
Chief Executive, Alzheimer Scotland
Welcoming Remarks
Henry Simmons
Chief Executive, Alzheimer Scotland
'Prevention: Keeping it Real'
Delivered by Professor C...
Christmas Lecture 2015
Christmas Lecture 2015
Christmas Lecture 2015
Christmas Lecture 2015
Upcoming SlideShare
Loading in …5
×

Christmas Lecture 2015

806 views

Published on

This lecture discusses the concepts of brain health and what we can do as a society or as an individual to prevent dementia.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Christmas Lecture 2015

  1. 1. Welcoming Remarks Henry Simmons Chief Executive, Alzheimer Scotland 'Prevention: Keeping it Real' Delivered by Professor Craig Ritchie Professor of the Psychiatry of Ageing, Centre for Dementia Prevention, University of Edinburgh
  2. 2. Welcoming Remarks Henry Simmons Chief Executive, Alzheimer Scotland
  3. 3. Keeping it Real Prof Craig Ritchie Psychiatry of Ageing Centre for Dementia Prevention University of Edinburgh
  4. 4. The objective of today’s talk is to convince you that Dementia is preventable Whether we do prevent it will be discussed in the future elsewhere
  5. 5. PREVENTION NEEDS: Knowing the risks Knowing the disease Modifying the risk Treating the disease HONESTY or ‘Getting Real’
  6. 6. Strong Weak Fantasy
  7. 7. Strong Weak Fantasy VITD ? FAMILY Hx SUGAR PIANO BLOOD PRESSURE SEX AL3+ ALCOHOL
  8. 8. Strong Weak Fantasy VITD ? FAMILY Hx SUGAR PIANO BLOOD PRESSURE SEX AL3+ ALCOHOL
  9. 9. Strong Weak Fantasy VITD ? FAMILY Hx SUGAR PIANO BLOOD PRESSURE SEX AL3+ ALCOHOL
  10. 10. Strong Weak Fantasy VITD ? SUGAR PIANO BLOOD PRESSURE SEX AL3+ ALCOHOL FAMILY Hx
  11. 11. Strong Weak Fantasy VITD ? SUGAR PIANO BLOOD PRESSURE SEX AL3+ ALCOHOL FAMILY Hx
  12. 12. Strong Weak Fantasy VITD ? SUGAR PIANO BLOOD PRESSURE SEX AL3+ FAMILY Hx ALCOHOL
  13. 13. Strong Weak Fantasy VITD ? SUGAR PIANO SEX AL3+ FAMILY Hx ALCOHOL BLOOD PRESSURE
  14. 14. Strong Weak Fantasy VITD ? SUGAR SEX AL3+ FAMILY Hx ALCOHOL BLOOD PRESSURE PIANO
  15. 15. Strong Weak Fantasy VITD ? SUGAR AL3+ FAMILY Hx ALCOHOL BLOOD PRESSURE PIANO SEX
  16. 16. Strong Weak Fantasy VITD AGE SUGAR AL3+ FAMILY Hx ALCOHOL BLOOD PRESSURE PIANO SEX
  17. 17. Strong Weak Fantasy VITDSUGAR AL3+ FAMILY Hx ALCOHOL BLOOD PRESSURE PIANO SEX AGE
  18. 18. Understanding why age is a risk may provide insights for prevention.
  19. 19. Why age?
  20. 20. Brain & Ageing
  21. 21. • But Nerve Cells don’t age….. • If nerve cells don’t age then how does the brain age?
  22. 22. What links together the parts of our body that age? Skin Joints Heart Muscles Clue – which area of skin wrinkles first?
  23. 23. They Move … are subject to mechanical forces
  24. 24. But the brain doesn’t move…..
  25. 25. …. or does it?
  26. 26. Billions of cells, trillions of cells but only two types of cells: Glia Cell Glia Cell NeuronNeuron
  27. 27. Blood vessels ‘move’, age and downstream cause the brain to fail… Glia Cell Glia Cell NeuronNeuron Blood Vessels Blood Vessels
  28. 28. Ageing Brain • The (normally) ageing brain is a consequence of the mechanical and inevitable damage to circulation. • Why then do some people get dementia • Associated factors…… • We need science to prove it’s real….
  29. 29. Association and Causality • Bradford Hill Criteria: – Strength – Consistency – Specificity – Temporality – Biological gradient – Plausibility – Coherence – Experimental – Analogy
  30. 30. Association and Causality • Bradford Hill Criteria: – Strength – Consistency – Specificity – Temporality – Biological gradient – Plausibility – Coherence – Experimental – Analogy
  31. 31. Association and Causality • Bradford Hill Criteria: – Strength – Consistency – Specificity – Temporality – Biological gradient – Plausibility – Coherence – Experimental – Analogy
  32. 32. Smoking Ban and AMI in England Reduction in seasonally adjusted AMI Admissions Smoking ban Introduced here £17m per year saving for the NHS with approx 5000 admissions per year in England
  33. 33. Association and Causality • Bradford Hill Criteria: – Strength – Consistency – Specificity – Temporality – Biological gradient – Plausibility – Coherence – Experimental – Analogy
  34. 34. Association and Causality • Bradford Hill Criteria: – Strength – Consistency – Specificity – Temporality – Biological gradient – Plausibility – Coherence – Experimental – Analogy
  35. 35. Believe We have to believe that prevention is a realistic prospect…. This belief isn’t a faith it’s a confidence in science
  36. 36. Science Epidemiology Pathology, Cell Biology and Biochemistry Clinical Trials www.centrefordementiaprevention.com @CenDemPrevent
  37. 37. Why Prevention? Ritchie et al. 2015 Lancet Psychiatry (In Press)
  38. 38. Alzheimer’s Disease
  39. 39. Alzheimer’s disease PLUS • Amyloid Pathology • Tau Pathology • Cerebrovascular Changes • α-synuclein • Blood Brain Barrier Integrity • Glial activation and inflammation • Oxidative stress • Mitochondrial dysfunction • Synaptic dysfunction • Metal dyshomeostasis • Apoptosis • Insulin resistance • mTOR signalling • β-HSD function
  40. 40. SECONDARY PREVENTIONPRIMARY PREVENTION PREVENTION PREMISED ON UNDERSTANDING DISEASE BEFORE DEMENTIA
  41. 41. Alzheimer’s disease before dementia • Models are now incorporating multiple pathological processes. • Biomarkers need to accurately reflect these multiple disease processes. • Precision interventions need to be specific to early disease process. ABetaABeta AgingAging TauTau ABetaABeta TauTau AgingAging Inflm*Inflm* Oxdn*Oxdn* ABetaABeta Inflm*Inflm* VascVasc TauTau MitoMito Oxdn*Oxdn* αsynαsyn AgingAging Cortl*Cortl*
  42. 42. Different Profiles (Normal Ageing) ProcessesProcesses 40-5040-50 50-6050-60 60-7060-70 70-8070-80 80-9080-90 ABetaABeta Inflm*Inflm* VascVasc TauTau MitoMito Oxdn*Oxdn* αsynαsyn AgeingAgeing Cortl*Cortl*
  43. 43. Different Profiles (Alzheimer’s dementia) ProcessesProcesses 40-5040-50 50-6050-60 60-7060-70 70-8070-80 80-9080-90 ABetaABeta Inflm*Inflm* VascVasc TauTau MitoMito Oxdn*Oxdn* αsynαsyn AgeingAgeing Cortl*Cortl* Specific interventions at a critical (early) time point on background of general approach to modification of risk…
  44. 44. 3-steps for secondary prevention: Develop accurate disease models Stratification of risk / probability of decline Test precision interventions & combinations
  45. 45. 3-steps for secondary prevention: All of these steps are being addressed in EPAD and PREVENT www.preventdementia.co.uk @AD_PREVENT
  46. 46. The Vision • That any given individual from birth onwards can be given an accurate ‘probability’ of a neurodegenerative ‘event’ – Dementia – Cognitive decline – Biomarker change • We are making a ‘prognosis’ not a ‘diagnosis’
  47. 47. The Vision • That any given individual from birth onwards can be given an accurate ‘probability’ of a neurodegenerative ‘event’ – Dementia – Cognitive decline – Biomarker change • We will be making a ‘prognosis’ not a ‘diagnosis’
  48. 48. What do we need though? Partnerships Data Lots and lots and lots of data on lots and lots and lots of people…
  49. 49. IMI EPAD----- Innovative Medicines Initiative European Prevention of Alzheimer’s Dementia Project @imi_epad
  50. 50. The European Prevention of Alzheimer's Dementia (EPAD) project aims to develop an infrastructure that efficiently enables the undertaking of adaptive, multi-arm Proof of Concept studies for early and accurate decisions on the ongoing development of drug candidates or drug combinations for the prevention of AD dementia. European Prevention of Alzheimer’s Dementia (EPAD) Goal
  51. 51. SECONDARY PREVENTIONPRIMARY PREVENTION PREVENTION PREMISED ON UNDERSTANDING DISEASE BEFORE DEMENTIA
  52. 52.  EPAD brings together a trial ready cohort of well characterized subjects evaluated at highly qualified sites running a standing adaptive proof of concept trial in AD.  8 Work Packages  35 Partners (Academic, EFPIA and non-EFPIA commercial entities)  30 Trial Delivery Centres • Sponsored and Managed by University of Edinburgh • All countries of Europe West & North of Germany. • €64M funding for 5-year grant • Partner in an emerging GPAD (USPAD, JPAD, CPAD and APAD)
  53. 53.  At least 10,000 people in study – (>50 and no dementia)  Imaging  Blood tests  Genetics  Risk factors  Spinal fluid  Cognitive testing  Following up every year (forever) Lots of data lots of people
  54. 54.  Super-computers  State of the art imaging facilities  Best statisticians and scientists  Dedicated laboratories  Open data access Lots of grunt
  55. 55.  USA – GLOBAL ALZEIMER’S PLATFORM – A4 TRIAL (AUSTRALIA) – DIAN-TU – USPAD SUBMITTED TO NIH  CANADA – CPAD (Canadian Pipeline for Alzheimer's Disease Therapeutics) SUBMITTED TO CIHR  JAPAN – LEAD INVESTIGATORS DISCUSSING WITH POLICY MAKERS FOR JPAD  AUSTRALIA – AN AUSTRALIAN PREVENTION OF ALZHEIMER’S DEMENTIA CONTRIBUTION? EPAD PART OF A GLOBAL DRIVE FOR PREVENTION
  56. 56. HOW DO WE ACHIEVE PREVENTION? WE HAVE THE MEANS TO IDENTIFY PEOPLE ACCURATELY FOR SECONDARY PREVENTION WE HAVE THE INTERVENTIONS OF PROVEN EFFECTIVENESS BUT HOW DO WE FIND THE PEOPLE THAT WILL BENEFIT SO WE CAN REDUCE THE INCIDENCE OF DEMENTIA??
  57. 57. HOW DO WE ACHIEVE PREVENTION? THE PUBLIC, RESEARCHERS AND INDUSTRY MAY DELIVER A ROAD MAP BUT ULTIMATELY GOVERNMENTS, THE FOOD AND LEISURE INDUSTRY, PUBLIC HEALTH AND THE PUBLIC MUST USE THE MAP…
  58. 58. Will they Listen? If we can bring the data and the evidence will they listen? The Public The PublicThePoliticians ThePoliticians The MediaThe Media The Food Industry The Food Industry ?
  59. 59. That bit we don’t yet have an answer to….. Relatively speaking – the science is easy Listening?
  60. 60. The objective of today’s talk was to convince you that Dementia is preventable Did I succeed?
  61. 61. THANKYOU
  62. 62. Closing Remarks Henry Simmons Chief Executive, Alzheimer Scotland
  63. 63. Welcoming Remarks Henry Simmons Chief Executive, Alzheimer Scotland 'Prevention: Keeping it Real' Delivered by Professor Craig Ritchie Professor of the Psychiatry of Ageing, Centre for Dementia Prevention, University of Edinburgh

×