View
284
Download
2
Category
Preview:
Citation preview
Healthy Brain AgingHealthy Brain Aging
November 2, 2012
Brian S. Appleby, M.D.
Staff, Lou Ruvo Center for Brain Health
No Relevant Financial Disclosures
No Relevant Financial Disclosures
ObjectivesObjectives
• Describe why healthy brain aging is important
• Summarize current knowledge about brain aging
• Describe ways to approach aging patients regarding brain health
WHY IS IT IMPORTANT?WHY IS IT IMPORTANT?Healthy Brain Aging
19.3% of population
Rank Cause of death 2010 Age-adjusted death rate
% change 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)
2011 Alzheimer’s Disease Facts and Figures
2011 Alzheimer’s Disease Facts and Figures
2011 Alzheimer’s Disease Facts and Figures
2011 Alzheimer’s Disease Facts and Figures
2011 Alzheimer’s Disease Facts and Figures
Dementia caregiver spouses had 6 times the risk of incident dementia compared to those who
had spouses without dementiaNorton MC, J Am Geriatr Soc 2010
Work Force ConcernsWork 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 ReportJeste DV, Psychtri News 2012
WHAT IS IT?WHAT IS IT?Healthy Brain Aging
Emery V, 2011
Non-Modifiable Risk Factors for Alzheimer’s Disease (AD)
Non-Modifiable Risk Factors for Alzheimer’s Disease (AD)
• Age• Genetic
- PS1, PS2, APP mutations (pathogenic)
- APOε4 roughly doubles risk (risk factor)
In a NutshellIn a Nutshell
Chronic Diseases
EngagementLifestyle
Increased risk for cognitive declineIncreased 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
Increased risk factors for ADIncreased risk factors for AD
Moderate Level of Evidence
• Conjugated equine estrogen + methyl progesterone
Low Level of Evidence
• Some NSAID’s• 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
Rodrigue KM 2012
Vemuri P, 2012
Singh-Manoux 2012
Pimentel-Coelho PM 2012
Dotson VM 2010
Double Trouble Diabetes and Depression
Double Trouble Diabetes and Depression
Katon W, Arch Gen Psychiatry 2011
Solomon A, 2012
Decreased risk for cognitive declineDecreased risk for cognitive decline
High level of evidence• Cognitive training
Low level of evidence• Vegetable intake• Mediterranean diet• Omega-3 fatty acids• Physical activity• Non-cognitive, non-
physical leisure activities
Williams JW, AHRQ Publication No. 10-E005 2010
Decreased risk factors for ADDecreased 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
Memory Fitness ProgramMemory Fitness Program
Structure• Biweekly classes• 60 min in length• Lasted 6 weeks• Given materials• Given homework
Content• Brain health education• Memory strategies• Diet• Exercise • Stress reduction
Miller KJ, Am J Geriatri Psychiatry 2012
Improved objective and subjective aspects of memory
NutrientVitamin EVitamin CFolateVitamin B12Vitamin DBeta-caroteneOmega-6-polyunsaturated fatty acidsSaturated fatty acidsMonounsaturated fatty acidsOmega-3-polyunsaturated fatty acids
p value0.750.130.260.450.750.780.960.840.920.02
Gu Y, Neurology 2012
Ω-3 PUFA SourcesΩ-3 PUFA Sources
Food Correlation CoefficientSalad Dressing 0.53Fish 0.44Poultry 0.30Margarine 0.19Nuts 0.09
Gu Y, Neurology 2012
HOW TO APPROACH PATIENTS?
HOW TO APPROACH PATIENTS?
Healthy Brain Aging
Vemuri P, 2012
Interventions(Delay Onset of AD)
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
Address Medical Risk FactorsAddress Medical Risk Factors
• Cerebrovascular disease• Cardiovascular disease• Diabetes• Hyperlipidemia• Elevated homocysteine levels• Head injury• Obesity
Emery V, 2011
Address Trouble MedicationsAddress Trouble Medications• Sedatives: benzodiazepine & derivatives• Antidepressants: TCAs, paroxetine• Antipsychotics• Antihypertensives: reserpine, clonidine• Anticholinergics: oxybutinin, antihistamines• H2 blockers: cimetidine, ranitidine• Opiates• Corticosteroids• Antibiotics: floroquinolones
Vigen C, Am J Psychiatry 2011
Address Neuropsychiatric Risk Factors
Address Neuropsychiatric Risk Factors
• Mood disorders• Anxiety• Stress
Emery V, 2011
Address Lifestyle Risk Factors
Address Lifestyle Risk Factors
• Education• Caretaker of spouse with dementia• Environmental exposures• Nutrition• Substance abuse/misuse• Smoking• Sleep
Emery V, 2011
My ApproachMy Approach
Heart Healthy
Cognitive Engagement
Regularly Scheduled Social Engagement
Heart HealthyHeart Healthy
• “Anything associated with keeping your heart healthy.”
• Physical exercise• Low fat, low cholesterol diet• No smoking
Physical ExercisePhysical Exercise
“Physical exercise on more days then not for at least 30 min at a pace that you
cannot carry a conversation.”
Regular Cognitive Engagement
Regular Cognitive Engagement
• ANY mentally stimulating activity- Reading- Puzzles- Games- Musical instruments
• Pick what you may already be doing• Pick what you like doing
Regular Scheduled Social Engagement
Regular Scheduled Social Engagement
• Regular: AT LEAST once weekly• Scheduled: Combats apathy, supplies
structure• Does not include errands or chores
• Disease• Life Story• Dimensions
(Personality)• Motivated Behaviors
ReferencesReferences
• 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.
ReferencesReferences
• 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.
ReferencesReferences
• 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.
Recommended