Is it possible to prevent Alzheimer’s disease? | Dr. Miia Kivipelto
Post on 29-Nov-2014
1053 Views
Preview:
DESCRIPTION
Transcript
Dr. Miia KivipeltoProfessor of Clinical Geriatric Epidemiology at the Department of Neurobiology,
Care Sciences and Society Karolinska Institutet Sweden
Monday, September 16, 13
Is it possible to prevent
Alzheimer’s disease?
Karolinska Institutet Alzheimer Disease Research Center and
Aging Research Center, SwedenMiia Kivipelto, MD, PhD, Professor
Monday, September 16, 13
What is dementia?
Dementia is not a specific disease. It is an “umbrella term” used to describe the symptoms of a group of conditions that impair memory, behaviors and thinking.
DEMENTIA
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
What is dementia?
Dementia is not a specific disease. It is an “umbrella term” used to describe the symptoms of a group of conditions that impair memory, behaviors and thinking.
60-80%
DEMENTIA
ALZHEIMER’S
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
What is dementia?
Dementia is not a specific disease. It is an “umbrella term” used to describe the symptoms of a group of conditions that impair memory, behaviors and thinking.
60-80%
Vascular Dementia
Dementia with Lewy Bodies
Fronto-temporal Dementia
Parkinson’s Disease
DEMENTIA
ALZHEIMER’S
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Alzheimer’s Disease
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Alzheimer’s Disease
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
What are the symptoms of Alzheimer’s ?
Memory loss:Short-term memory
Dementia is progressive: as time advances, symptoms worsen.
Communication difficulties:finding the right words, understanding what is said
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Dementia is progressive: as time advances, symptoms worsen.
Ability to focus & concentrate: E.g. following a conversation
Mood changes:Sadness, anger, fear, irritability…
Miia Kivipelto, MD, PhD, Professor
What are the symptoms of Alzheimer’s ?
Monday, September 16, 13
Memory loss is a normal part of aging
Common incorrect belief
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Now we know that dementia is NOT a normal part of aging
Memory loss is a normal part of aging
Common incorrect belief
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Now we know that dementia is NOT a normal part of aging
Memory loss is a normal part of aging
Common incorrect belief
If we have a family member who is showing signs of dementia, it is important to see a doctor to determine the cause & follow the patient.
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Expected lifetime
(Christensen et al. Lancet 2009)
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
CIA World Factbook 2012, Estimated Life Expectancy at Birth.
+80 +77 +75 +72 +70 +67
Expected lifetime
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
The proportion of older adults (65+) will reach 28% in 2050
The aging population in the UAE
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
0
7.5
15
22.5
30
3.4 3.4 3.51.8 1.5 2.1 1.3 1.4 1.1 1 1 0.8 0.4 0.8 1.7
3.66.3
10.2
15.6
22.1
28
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
The proportion of older adults (65+) will reach 28% in 2050
The aging population in the UAE
Trends of UAE’s Elderly Population, 1950 - 2050
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
0
7.5
15
22.5
30
3.4 3.4 3.51.8 1.5 2.1 1.3 1.4 1.1 1 1 0.8 0.4 0.8 1.7
3.66.3
10.2
15.6
22.1
28
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
The proportion of older adults (65+) will reach 28% in 2050
The aging population in the UAE
Trends of UAE’s Elderly Population, 1950 - 2050
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
0
7.5
15
22.5
30
3.4 3.4 3.51.8 1.5 2.1 1.3 1.4 1.1 1 1 0.8 0.4 0.8 1.7
3.66.3
10.2
15.6
22.1
28
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
The proportion of older adults (65+) will reach 28% in 2050
The aging population in the UAE
Trends of UAE’s Elderly Population, 1950 - 2050
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
(Fratiglioni, Qiu, Oxford Textbook Old Age Psychiatry, 2013)
Advanced age: A major risk factor for dementia
Age-specific prevalence rates of dementia across the world
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Effects of Delay of Onset of Disease on Prevalence of Dementia
5 year delay in the onset of Alzheimer’s would decrease the disease prevalence by 50%
US
pre
vale
nce
of A
D (m
illio
ns)
Delay (years)
0
.5
1
2
5
1997 2007 2017
2027 2037 2047
Year
8
6
4
2
0
Brookmeyer et al., 1998, Jorm et al., 2005
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Dementia: importance of life-long exposure to multiple factors
Mangialasche, Kivipelto et al., 2012
BirthChildhood
2nd DecadeAdult Life - Middle Age Transition Old Age
0 20 60 75
Genetic EnvironmentHealthy Brain Alzheimer’s Brain
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Modifiable risk factors for Alzheimer’s
Risk Factors Protective Factors
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Modifiable risk factors for Alzheimer’s
Risk Factors Protective Factors
• Stroke• High Blood Pressure• High Blood Cholesterol• Obesity• Diabetes mellitus• Smoking• Depression/stress• Head trauma• ?
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Modifiable risk factors for Alzheimer’s
Risk Factors Protective Factors
• Stroke• High Blood Pressure• High Blood Cholesterol• Obesity• Diabetes mellitus• Smoking• Depression/stress• Head trauma• ?
• High education • Physical activity• Active lifestyle• Antioxidants• Fish oils• Coffee• Antihypertensives• Statins
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Combined effect of vascular risk factors at midlife
Risk
BMI
>30 kg/m2.1
Systolic blood
pressure >140mmHg
2.0
Cholesterol >6.5 mmol/l
1.9
Kivipelto et al., Arch Neurol 2005
0
1.75
3.50
5.25
7.00
0 1 2 3
6
3
11
Number of risk factors present
2
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Healthy, balanced diet can reduce the risk for memory problems
Luchinger et al., Curr Neurol Neurosci Rep 2007 - Scarmeas et al., Annals of Neurology 2006, JAMA 2009 - Mangialasche, Kivipelto et al., JAD 2010
• Fish • Vegetables and fruits• Vitamins B, C and E
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Rovio, Kivipelto et al., Lancet Neurology 2005 Rovio, Kivipelto, et al. Neurobiol Aging 2009
Physical activity at midlife
Couch Potatoes Dementia Alzheimer’s
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Rovio, Kivipelto et al., Lancet Neurology 2005 Rovio, Kivipelto, et al. Neurobiol Aging 2009
Physical activity at midlife
0.25
0.5
0.75
1
Couch Potatoes Dementia Alzheimer’s
ReducedRisk
Miia Kivipelto, MD, PhD, Professor
100%
60% 70%
Monday, September 16, 13
Rovio, Kivipelto et al., Lancet Neurology 2005 Rovio, Kivipelto, et al. Neurobiol Aging 2009
Physical activity at midlife
Physical activity – larger brain volume
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
(Karp et al, Dement Geriatr Cogn Disord 2005)
Leisure time activities in late life
0
0.25
0.5
0.75
1
High Mental Score High Physical Score High Social Score Low Score
Miia Kivipelto, MD, PhD, Professor
30% 40% 35% 100%
Reduced Risk
Monday, September 16, 13
Håkansson, Kivipelto et al., BMJ 2009 Håkansson et al., manuscript
Social and psychological factors
Social Factors Psychological factors Social+psychological
Loneliness
0
1.5
3
4.5
6
Risk Risk
Living Alone
Being Widowed
Hopelessness
Alone+Lonely
Widowed+ Hopelessness
Loneliness
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Håkansson, Kivipelto et al., BMJ 2009 Håkansson et al., manuscript
Social and psychological factors
Social Factors Psychological factors Social+psychological
Loneliness
0
1.5
3
4.5
6
Risk Risk
Living Alone
Being Widowed
Hopelessness
Alone+Lonely
Widowed+ Hopelessness
Loneliness
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Håkansson, Kivipelto et al., BMJ 2009 Håkansson et al., manuscript
Social and psychological factors
Social Factors Psychological factors Social+psychological
Loneliness
0
1.5
3
4.5
6
Risk Risk
Living Alone
Being Widowed
Hopelessness
Alone+Lonely
Widowed+ Hopelessness
Loneliness
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Loneliness
Loneliness
FUTURE
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Loneliness
Loneliness
FUTURE
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Clinical Trials
Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Intervention Schedule
NUTRITION
EXERCISE
COGNITIVE TRAINING
MONITORING AND MANAGEMENT OF METABOLIC AND VASCULAR RISK FACTORS
INTENSIVE INTERVENTION
Inte
rven
tion
Kic
k-Off
Scre
enin
g
1st B
asel
ine
visi
t
2nd
Base
line
visi
t
RAN
DO
MIZ
ATIO
N
Months
Months
3 6 9 12 15 18 21 24
MiniIntervention
Miia Kivipelto, MD, PhD, Professor
REGULAR HEALTH ADVICE
Monday, September 16, 13
FINGER intervention
Months
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
European Dementia Prevention Initiative
Months
EDPI%
http://www.edpi.org/
Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability
Prevention of Dementia by Intensive Vascular Care
MAPT Multidomain Alzheimer Preventive Trial
FINGER
preDIVA
MAPT
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Healthy Aging Through Internet Counseling in the Elderly
Months
www.HATICE.eu
Miia Kivipelto, MD, PhD, Professor
New use of technology to improve dementia prevention
Monday, September 16, 13
Months
(Mangialasche, Winblad, Kivipelto, et al., Lancet Neurol 2010)
Drug development in Alzheimer’s Disease
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Months
Is it possible to prevent dementia?
•Control blood pressure and other vascular risk factors
•Be active and maintain an active life
•Healthy, balanced diet
•Avoid negative stress
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Months
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
Months
LIFE MATTERS !
Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13
THANK YOU
Karolinska Institutet Alzheimer Disease Research Center and
Aging Research Center, SwedenMiia Kivipelto, MD, PhD, Professor
Monday, September 16, 13
top related