powerpoint presentation cognition an… · ayesha sherzai, md, mas co-directors, alzheimer’s...
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Nutrition, Cognitionand Alzheimer’s
Dean Sherzai MD, MAS, MPH, PhD(c)
Ayesha Sherzai, MD, MAS
Co-directors, Alzheimer’s Prevention Program
Loma Linda University Health
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1x1050 power 87 billion cells
Consumes 25%
body’s energy 1 quadrillion
connections
The Incredible Brain
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DementiaThe most devastating disease
of the 21st century
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your
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The Tsunami
5.8
million3rd
64
seconds
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Alzheimer’sHIVStrokeHeart
disease
Prostate
cancer
Breast
cancer
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people age 65 and older has
Alzheimer’s disease1 in 10
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Alzheimer’sgender differences
1 in
11
1 in
6
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Alzheimer’s racial disparities
Hispanics2.7 times
African Americans 4 times
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total annual cost for caring for
individuals living with Alzheimer’s
or dementia in 2019
$290
billion
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cost of Alzheimer’s
by 2050$1.1 trillion
Americans with Alzheimer’s
by 205016 million
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The Big Myth
page
015
• Alzheimer’s cannot be prevented
• Alzheimer’s is a purely genetic disease
• Alzheimer’s starts with symptoms of
forgetfulness
• There will be one medication treatment for
Alzheimer’s
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Alzheimer’s Pathology
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Alzheimer’s drugs failedin more than 400 clinical
trials
100%
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Genes do not
determine destiny
They give us a range of
when disease manifests
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Paradigm Shift
Prevention is the new treatment
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Paradigm Shift
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Paradigm Shift
Can dementia risk due to genes be counteracted
by adherence to a healthy lifestyle?
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Genetic risk, lifestyle and dementia
• 668 dementia cases
• Risk of incident dementia ~ 50% higher among
participants with a high genetic risk in comparison
with those with a low genetic risk
• Participants with a high genetic risk and an
unfavorable lifestyle were more than three times
more likely to develop dementia compared with
those with a low genetic risk and favorable lifestyle
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Genetic risk, lifestyle and dementia
• The risk of all-cause dementia was more than halved
among participants with a high genetic risk following
a healthy lifestyle compared to those with an unhealthy
lifestyle
Adherence to a healthy lifestyle
can offset genetic risk
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To what extent does the combination of lifestyle factors
reduces the risk of Alzheimer’s disease?
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Impact of Healthy Lifestyle Factors on the Risk of Alzheimer's Dementia
• Chicago Health and Aging Project (n=1431)
• Rush Memory and Aging Project (n=920)
• Followed for 9.1 years (median)
• Healthy lifestyle score:
• No smoking
• > 150 minutes of moderate/vigorous physical activity
• Minimal alcohol consumption
• High quality MIND diet
• Engagement in cognitive activity
• 0 to 5 score
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Impact of Healthy Lifestyle Factors on the Risk of Alzheimer's Dementia
39% lower risk
60% lower risk
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451
vol. 13 • no. 5 American Journal of Lifestyle Medicine
Dean Sherzai, MD, MPH, PhD(c), and Ayesha Sherzai, MD
Abstract: Dementia is the fastest
growing epidemic in the developed
nations, and if not curtailed, it
will single handedly collapse our
health care system. The prevalence
of dementia is 1 in 10 individuals
older than 65 years and increases to
50% of all individuals older than 85
years. The prevalence of Alzheimer’s
dementia (AD), the most common
form of dementia, has been increasing
rapidly and is projected to reach 16
million individuals by the year 2050.
Several prevailing myths about the
science of dementia are discussed, such
as that AD is inevitable and that it is
exclusively a genetic disease. The fact is
that AD is dependent on a multitude of
genetic, epigenetic, and environmental
factors that interact with one another.
In fact, 4 core drivers represent 90% of
what determines disease progression
in AD. These are (1) glucose or energy
dysregulation, (2) lipid dysregulation,
(3) inflammation, and (4) oxidation.
Lifestyle change can significantly alter
the course of AD. The authors have
created an acronym—NEURO—to
help lifestyle practitioners and the
public remember the most important
lifestyle elements in the treatment
and prevention of AD based on the
evidence. “N” is for Nutrition, “E”
for Exercise, “U” for Unwind (stress
management), “R” for Restorative
Sleep, and “O” for Optimizing mental
and social activity. The evidence base
for each of the components is reviewed.
Keywords: Alzheimer’s, brain health,
prevention, longevity, cognitive
impairment
Background
We have learned more about the brain,
this 3-pound organ that is the source of
human consciousness, in the first quarter
of the 21st century than ever before in
history. For the last few centuries, we
knew about the importance of this
incredible organ, but we did not know
much about its physiology or pathology,
and we knew even less about how to
improve its function and avoid disease.
It was only at the turn of the 20th
century that we acquired novel tools in
our armamentarium to better understand
the brain. Initially, it was tissue stains
that gave us a better delineation of
structure, and later, amazing imaging
techniques allowed us not only to
understand the structure, but also the
function of the brain.
In fact, it was not until 2009, through
the work of Herculano-Houzel,1 that we
discovered that our brains may consist of
around 86 billion neurons, potentially as
many as 1 trillion supporting cells such
as glial cells, and more than 1 quadrillion
connections. Therein lies the potential
protection against the trauma and wear
and tear that accumulate with aging.
These connections can confer
tremendous cognitive resilience that
could enable the brain to withstand
much of a lifetime’s trauma. In the 20th
century, we have seen a sharp rise in life
expectancy that came about with
life-saving discoveries such as antibiotics
and heroic public health measures. But
with the success came a prolonged,
sustained challenge to this overworked
organ. As society ages, we will face the
challenges that come with cognitive
aging. Given that the fastest growing
population in the United States and most
of the developed world is individuals 65
years and older, there is an urgent need
to address the problem of cognitive
aging.
The challenge ahead of us is expected
to overwhelm the Western world—the
epidemiological “tsunami” of dementia.
Briefly, dementia is a neurological
843465AJLXXX10.1177/1559827619843465 American Jour nal of Lif estyle Medicine American J ournal of Lif estyle Medicineresear ch-ar ticle 2019
Preventing Alzheimer’s: Our Most Urgent Health Care Priority
There has been cumulative evidence
that aging does not have to lead to
cognitive decline.
DOI:https://doi.org/10.1177/1559827619843465. From the Department of Neurology, Alzheimer’s Prevention Program, Loma Linda University Health, California. Address correspondence to:
Dean Sherzai, MD, MPH, PhD(c), Alzheimer’s Prevention Program, Loma Linda University Health, 11370 Anderson Ave B100, Loma Lind a, CA 92354; e-mail: [email protected].
For reprints and permissions queries, please visit SAGE’s Web site at https://us.sagepub.com/en-us/nam/journals-permissions.
Copyright © 2019 The Author(s)
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Risk Factors
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Protective Factors
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The NEURO Plan
N O
Exercise
U
Restorative
Sleep
R
Unwind Optimize
cognitive
activity
Nutrition
E
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Nutrition
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Neurovascular unit
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Neurovascular dysfunction in Alzheimer's disease: two-hit vascular hypothesis
Kisler, et al. (2017). Nat Rev Neurosci.
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Dietary fat composition and dementia risk
Martha Clare Morrisa and Christine C. Tangneyb
Martha Clare Morris: [email protected]; Christine C. Tangney: [email protected]
aSection on Nutrition and Nutritional Epidemiology, Department of Internal Medicine, Rush
University Medical Center, 1725 W. Harrison, Chicago, IL 60612 USA
bDepartment of Clinical Nutrition, Rush University Medical Center, 1725 W. Harrison, Chicago, IL
60612 USA
Abstract
This is a qualitative review of the evidence linking dietary fat composition to the risk of
developing dementia. The review considers laboratory and animal studies that identify underlying
mechanisms as well as prospective epidemiological studies linking biochemical or dietary fatty
acids to cognitive decline or incident dementia. Several lines of evidence provide support for the
hypothesis that high saturated or trans fatty acids increase the risk of dementia and high
polyunsaturated or monounsaturated fatty acids decrease risk. Dietary fat composition is an
important factor in blood brain barrier (BBB) function and the blood cholesterol profile.
Cholesterol and BBB function are involved in the neuropathology of Alzheimer’s disease (AD),
and the primary genetic risk factor for AD, APOE-ε4, is involved in cholesterol transport. The
epidemiological literature is seemingly inconsistent on this topic but many studies are difficult to
interpret because of analytic techniques that ignored negative confounding by other fatty acids
which likely resulted in null findings. The studies that appropriately adjust for confounding by
other fats support the dietary fat composition hypothesis.
Keywords
Fatty acids; Alzheimer’s disease; Dementia; Cognitive decline; Diet; Saturated fats; Trans fats;
Polyunsaturated fats; Monounsaturated fats
© 2014 Elsevier Inc. All rights reserved.
Corresponding Author: Martha Clare Morris, Sc.D., 1725 W. Harrison, Ste 206 POB, Chicago, IL 60612, [email protected],001-708-660-2129 (phone), 001-312-942-563-3883 (fax).
Disclosure Statement
Dr. Morris is a consultant for Abbott Nutrition and Nutrispective, and has received honoraria from the Physicians’ Committee for
Responsible Medicine and the National Institute on Aging.
Dr. Tangney has no potential conflicts of interest.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of
the resulting proof before it is published in its final citable form. Please note that during the production process errors may be
discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
NIH Public AccessAuthor ManuscriptNeurobiol Aging. Author manuscript; available in PMC 2015 September 01.
Published in final edited form as:
Neurobiol Aging. 2014 September ; 35 Suppl 2: S59–S64. doi:10.1016/j.neurobiolaging.2014.03.038.
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Dietary Fat and Alzheimer’s
• Cholesterol plays a central role in AD pathology
• Mid-life high blood cholesterol increases risk of late-
life Alzheimer’s
• Increased risk of Alzheimer’s with higher consumption
of saturated and trans fatty acids
• Decreased risk with higher consumption of
monounsaturated and polyunsaturated fatty acids
Morris, et al. (2014). Neurobiol Aging.
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• 1449 participants, ages 65-79 years
• Apo E4 allele increased odds by 2 folds
• Elevated midlife total cholesterol level
increased the odds up to 3 times and systolic
blood pressure increased odds up to 2.5 times
even after adjustment for Apo E genotype and
other confounding factors
Kivipelto, et al. Ann Intern Med. 2002;137:149-155
“Alzheimer’s Genes, Cholesterol and
Blood Pressure”
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“Dietary Fats and the Risk of Incident
Alzheimer’s Disease”
The Chicago Health and Aging Project
Longitudinal study, 2500 older adults, those who
consumed higher amounts of saturated and trans
fatty acids over a six-year period had a higher risk of
developing Alzheimer’s, while those eating fats
derived from plants had a lower risk.
Morris, et al. (2003). Archives of Neurology, 60(2), 194–200.
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“The Incidence of Dementia and Intake of
Animal Products: Preliminary Findings
from the Adventist Health Study”
Adventist Health Study
A 1993 study titled “The Incidence of Dementia and
Intake of Animal Products,” found that in a group of
over 3,000 individuals, those who ate meat—
including those who ate only poultry and fish—
had twice the risk of developing dementia
compared to vegetarians.
Giem, et al. (1993). Neuroepidemiology, 12(1), 28–36.
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Kaiser Permanente Northern California Group
9,900 patients, individuals with high cholesterol
during midlife had a 57% higher risk of developing
Alzheimer’s disease later on. Even borderline high
cholesterol increased the risk of Alzheimer’s by 23%.
“Midlife Serum Cholesterol and Increased
Risk of Alzheimer’s and Vascular
Dementia Three Decades Later”
Solomon, et al. (2009). Dementia and Geriatric Cognitive Disorders, 28(1), 75–80.
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Women’s Health Study
• Nearly 6,000 women followed over a 4-years
• Higher saturated fat intake was associated with a
poor trajectory of cognition—specifically a faster
decline in memory by 70%
• Women with the lowest saturated fat intake had
the brain function of women six years younger
“Dietary Fat Types and 4-year Cognitive
Change in Community-Dwelling Older
Women”
Okereke, et al. (2012). Annals of Neurology, 72(1), 124–134.
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Researchers at Columbia University found that
participants who ate a plant-based diet had a
lower risk of cognitive decline over a span of six
years compared to those who ate a standard
American diet.
“Diet Cluster in Relation to Cognitive
Performance and Decline in the Northern
Manhattan Study”
Gardener, et al. (2017) Neurology, 88(16), S15–003.
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Rush University Memory and Aging Project:
• 1000 patients, ages 58-98
• Strict adherence to the MIND diet (promotes plant-based diet, limits meat and dairy) resulted in a 53% reduction in risk for Alzheimer’s.
• Even moderate adherence to the diet was associated with a 35% risk reduction.
• Participants who showed high adherence to the diet had cognitive functioning equivalent to a person who was seven and a half years younger.
“MIND Diet Associated With Reduced
Incidence of Alzheimer’s Disease”
Morris, et al. (2015). Alzheimer’s & Dementia, 11(9), 1007–1014.
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Adventist Health Study 2
• Scores on the California Verbal Learning Test
(CVLT), revealed that individuals who ate a plant-
based diet had on average a 28% lower risk of
cognitive impairment
“Role of Nutrition in Vascular Dementia ”
Sherzai, et al. pending publication
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California Teachers Study
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• Meat, poultry, and
dairy• Vegetables
• Fruits
• Whole grains
• Nuts and seeds
• Legumes
• High ratio of polyunsaturated fats
to saturated fats
High Score Low Score
Mediterranean Diet Construct
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Adjusted* Hazard Ratio Mediterranean Diet Score groups (p trend 0.009)
*Age, race, SES, moderate plus strenuous physical activity, kilocalories, BMI, smoking, hypertension, diabetes, atrial fibrillation, hypercholesterolemia, history of cardiac disease and menopausal status and hormone therapy.
Mediterranean Diet and Stroke Incidence
(ischemic and hemorrhagic)
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Supplements
page
050
• No known dietary supplement can prevent cognitive decline or dementia
• In people with suboptimal levels of vitamins, dietary supplements can prevent cognitive decline
Smith, et al. (2016). Annual Review of Nutrition
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VITACOG Study
page
051
Homocysteine-Lowering by BVitaminsSlowstheRateofAccelerated Brain Atrophy in Mild Cognitive Impairment:A Randomized Controlled Trial
A. David Smith1,2*. , Stephen M. Smith3, Celeste A. de Jager1, Philippa Whitbread1, Carole Johnston1,2,
Grzegorz Agacinski1, Abderrahim Oulhaj1, Kevin M. Bradley4, Robin Jacoby5, Helga Refsum1,2,6.
1Oxford Project to InvestigateMemory and Ageing (OPTIMA), University of Oxford, Oxford, United Kingdom, 2UniversityDepartment of Pharmacologyand Department
of Physiology, Anatomy&Genetics,Universityof Oxford,Oxford, United Kingdom, 3Department of Clinical Neurology,Oxford Centrefor Functional MagneticResonance
Imaging of the Brain, University of Oxford, Oxford, United Kingdom, 4Department of Radiology and Nuclear Medicine, Oxford Radcliffe Hospitals NHSTrust, Oxford,
United Kingdom, 5University Department of Psychiatry, University of Oxford, Oxford, United Kingdom, 6Department of Nutrition, Institute of Basic Medical Sciences,
University of Oslo, Oslo, Norway
Abstract
Background: An increased rate of brain atrophy is often observed in older subjects, in particular those who suffer fromcognitive decline. Homocysteine is a risk factor for brain atrophy, cognitive impairment and dementia. Plasmaconcentrations of homocysteine can be lowered by dietary administration of Bvitamins.
Objective: Todeterminewhether supplementation withBvitaminsthat lower levelsof plasmatotal homocysteinecanslowthe rate of brain atrophy in subjects with mild cognitive impairment in a randomised controlled trial (VITACOG, ISRCTN94410159).
Methodsand Findings: Single-center, randomized, double-blind controlled trial of high-dose folicacid, vitaminsB6 and B12
in 271 individuals (of 646 screened) over 70 y old with mild cognitive impairment. A subset (187) volunteered to havecranial MRI scansat thestart and finish of thestudy. Participantswere randomly assigned to two groupsof equal size, onetreated with folic acid (0.8 mg/d), vitamin B12 (0.5 mg/d) and vitamin B6 (20 mg/d), theother with placebo; treatment wasfor 24 months. The main outcome measure was the change in the rate of atrophy of the whole brain assessed by serialvolumetric MRI scans.
Results: Atotal of 168 participants (85 in active treatment group; 83 receiving placebo) completed theMRI section of thetrial.Themean rateof brain atrophyper year was0.76%[95%CI,0.63–0.90] in theactivetreatment group and 1.08%[0.94–1.22] in the placebo group (P=0.001). The treatment response was related to baseline homocysteine levels: the rate ofatrophy in participantswith homocysteine . 13 mmol/Lwas53%lower in theactive treatment group (P=0.001). Agreaterrate of atrophy wasassociated with a lower final cognitive test scores. There wasno difference in serious adverse eventsaccording to treatment category.
Conclusions and Significance: The accelerated rate of brain atrophy in elderly with mild cognitive impairment can beslowed by treatment with homocysteine-lowering Bvitamins. Sixteen percent of those over 70 y old have mild cognitiveimpairment andhalf of thesedevelop Alzheimer’sdisease.Sinceaccelerated brainatrophy isacharacteristicof subjectswithmild cognitive impairment who convert to Alzheimer’sdisease, trialsareneeded to seeif thesametreatment will delay thedevelopment of Alzheimer’s disease.
Trial Registration: Controlled-Trials.com ISRCTN94410159
Citation: Smith AD, Smith SM, de Jager CA, Whitbread P, Johnston C, et al. (2010) Homocysteine-Lowering by BVitaminsSlows the Rate of Accelerated BrainAtrophy in Mild Cognitive Impairment: ARandomized Controlled Trial. PLoSONE5(9): e12244. doi:10.1371/journal.pone.0012244
Editor: Ashley I. Bush, Mental Health Research Institute of Victoria, Australia
Received May 27, 2010; Accepted July 22, 2010; Published September 8, 2010
Copyright: ß 2010 Smith et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permitsunrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported by grants from the Charles Wolfson Charitable Trust, Medical Research Council, Alzheimer’s Research Trust, Henry SmithCharity, John CoatesCharitableTrust,ThamesValleyDementiasand NeurodegenerativeDiseasesResearch Networkof theNational Institute for Health Research,UK,and theSidneyandElizabethCorobCharitableTrust,andMedaAB/Recip AB,Solna,Sweden.Noneof thefundersor thesponsor (Universityof Oxford)playedany role in thedesign and conduct of thestudy, collection, management, analysis, and interpretation of thedata; nor in thepreparation, review, or approval ofthe manuscript.
Competing Interests: Dr. A. D. Smith isnamed asan inventor on two patentsheld by the University of Oxford on the use of folic acid to treat Alzheimer’sdisease(US6008221; US6127370); under theUniversity’s ruleshecould benefit financially if thepatent isexploited. Drs. Refsumand A.D. Smith report having inthepast receivedspeaking honorariafromRecip AB,thecompany that donated thevitamin tablets,and fromAxis-Shield,whomaketheequipment used toassayhomocysteine. These competing interests do not alter the authors’ adherence to all the PLoSONEpolicies on sharing data and materials. None of the otherauthorshave any financial disclosures.
* E-mail: [email protected]
. These authorscontributed equally to thiswork.
PLoSONE | www.plosone.org 1 September 2010 | Volume 5 | Issue 9 | e12244
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VITACOG Study
page
052
Elevated homocysteine is a risk factor for brain atrophy, cognitive impairment and dementia.
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VITACOG Trial
• High-dose B vitamins (folic acid, B6 and B12)
supplements to MCI patients for 2 years
• 30% reduction in brain atrophy in the B vitamin
group compared with the placebo group in participants
with plasma total homocysteine (tHcy) above the
median level
• In patients with tHcy in the upper quartile, the atrophy
rate was reduced by 53%
• Memory decline (both episodic and semantic) was
almost halted in treatment group with tHcy above the
median level
Smith, et al. (2010). PLOS one
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VITACOG Trial
• High-dose B vitamins (folic acid, B6 and B12)
supplements to MCI patients for 2 years
• 30% reduction in brain atrophy in the B vitamin group
compared with the placebo group in participants with
plasma total homocysteine (tHcy) above the median
level
• In patients with tHcy in the upper quartile, the atrophy
rate was reduced by 53%
• Memory decline (both episodic and semantic) was
almost halted in treatment group with tHcy above the
median level
Smith, et al. (2010). PLOS one
In patients with elevated Hcy and MCI, treatment
with B vitamins significantly reduced risk of dementia
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Omega-3 Fatty Acid
• Plays a crucial role in membrane structure and
synaptic function
• Concentrations of DHA is lower in brain of patients with
Alzheimer’s than age-matched controls
• The protective effect of B vitamin treatment on both
brain atrophy and cognitive decline in MCI occurred
only in those with a good status of DHA
Smith, et al. (2010). PLOS one
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Omega-3 Fatty Acid
• Plays a crucial role in membrane structure and
synaptic function
• Concentrations of DHA is lower in brain of patients with
AD than age-matched controls
• The protective effect of B vitamin treatment on both
brain atrophy and cognitive decline in MCI occurred
only in those with a good status of DHA
Smith, et al. (2010). PLOS one
It is the synergy between micronutrients that
determines optimal brain function
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Latest Controversies
• Ketogenic diet
• Choline deficiency
• Vegetarian diet and
stroke EPIC-Oxford
Study
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Journal of Geriatric Psychiatry and Neurology, 2016, Vol. 29(3) 120-125
Article
The Association Between DiabetesandDementia Among Elderly Individuals:A Nationwide Inpatient Sample Analysis
Dean Sherzai, MD, MAS, PhD(c)1, Ayesha Sherzai, MD2, Keith Lui, MD2,Deyu Pan, MS3, Daniel Chiou, MD2, Mohsen Bazargan, PhD3,and Magda Shaheen, PhD, MPH4
Abstract
Background/Aim: To date, few studieshavecross-examined therelationship between diabetesmellitus(DM) and dementia
nationally.Thereisalsoalackofevidenceregardingdementiasubtypesandhowthisrelationshipchangesamongolder individuals.
The objective was to better delineate this relationship and influence of multiple comorbidities using a nationwide sample.
Methods: DatawereobtainedfromtheNationwideInpatient Sample1998to2011usingappropriateInternational Classificationof
Diseases, NinthVersioncodes. Descriptiveandbivariateanalysiswasperformed. Multivariatenominal logistic regression models
adjusted for age, sex, race, and comorbiditiesexplored the independent relationship between Alzheimer dementia(AD), non-
Alzheimer dementia(VaD), and diabetes. Results: 21%of theparticipantswerediabetic patients, 3.7%had AD, and 2.2%had
VaD. Diabetesprevalence in AD, VaD, andno dementiagroupswere20.6%, 24.3%, and 26.2%, respectively. In theunadjusted
model, thosewithDMhadlower oddsof AD(oddsratio [OR] 0.73;95%confidenceinterval [CI] 0.72-0.74) andVaD(OR0.91,
95%CI 0.89-0.92). Adjusting for age, sex, race, and comorbidities, diabetic patients had significantly higher odds of VaD
(OR¼1.10, 95%CI 1.08-1.11) andlower oddsof AD (OR0.87, 95%CI 0.86-0.88). Inclusion of interaction terms (age, race/
ethnicity, depression, stroke, and hypertension) madetherelationship between diabetesand VaD not significant (OR1.002,
95% CI 0.97-1.03), but the relationship of DM with AD remained significant (OR 0.57, 95% CI 0.56-0.58; P < .05).
Conclusion: Patients with a diagnosis of diabetes mellitus had lower odds of having AD. Age, race/ethnicity, depression,
stroke, andhypertensionmodifiedtherelationshipbetweenDMandbothVaD andAD. Further explorationof therelationship
between DMandAD iswarranted.
Keywords
dementia, vascular dementia, Alzheimer disease
Introduction
Currently,therearemorethan24millionpeopleworldwidewith
dementia, andthenumber isexpectedtodoubleevery20years,
reaching 81 million by 2040.1 Our aging society will facean
epidemicof dementia;morethan13%of thoseovertheageof 70
haveaformof dementia,2 andthispercentagedoublesevery 5
years after 70 yearsof age.3 Studies have indicated that the
proclivity for all dementias, including Alzheimer dementia
(AD), is influenced by other comorbiditiesoften seen in the
elderly patients such as hypercholesterolemia, hypertension,
and diabetes. Diabetes mellitus (DM) in particular has been
associatedwithdeclineincognitiveabilities, suchasmemory
andexecutivefunction.4Arecentmeta-analysisrevealedDMto
beastrongriskfactor forall typesof dementia.5Yet onlyafew
epidemiological studieshavebeenperformedtobetterelucidate
therelationship between DM and specific typesof dementia,
with inconsistent findings. Luchsinger et al and Hassing et al
whousedparticipantsaged65yearsandolder and80yearsand
older, respectively, both foundno increased risk of AD and a
greater than2-foldincreaseinrisk of non-Alzheimer dementia
(VaD) in patientswith DM.6,7 In contrast, DM was found to
1Department ofNeurologyandNeurosurgery,Cedar Sinai HealthSystem,Los
Angeles, CA, USA2LomaLindaSchool ofMedicine,LomaLindaUniversity,LomaLinda,CA,USA3Department of Family Medicine, Charles R. Drew University, Los Angeles,
CA, USA4Department of Epidemiology, CharlesR. Drew University, LosAngeles, CA,
USA
Received 9/6/2014. Received revised 5/14/2015. Accepted 9/16/2015.
Corresponding Author:
Dean Sherzai, Department of Neurology and Neurosurgery, Cedar Sinai
HealthSystem, LosAngeles, CA 90048, USA.
Email: [email protected]
Journal of Geriatric Psychiatry
and Neurology
2016, Vol. 29(3) 120-125
ª The Author(s) 2016
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0891988715627016
jgpn.sagepub.com
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Ideal Diet for
the Brain
• Whole food, plant-based
diet
• Eliminate meat, poultry
and dairy
• Specifies consumption of
berries, green leafy
vegetables, beans, nuts
and seeds
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Exercise
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your
logo
Exercise
Regular moderate to strenuous
activity grows the brain
Sedentary behavior nullifies the
benefit of strenuous exercise
Leg strength is associated with a
bigger brain
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Stress
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Good Stress
Boosts new cell
connection
Sharpens memory
Creates brain resilienceSpeeds learning
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Bad Stress
Damages hippocampal
cells
Impairs motivation
and energy
Damages brain blood
vessels
Impairs learning
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Sleep
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your
logo
Restorative Sleep
Sleep apnea can increase the risk
of Alzheimer’s by 70%
Sleep cleanses the brain of bad
proteins and other waste
Memories are consolidated during
different sleep stages
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Optimize
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The London Taxi and Bus
Driver Study• Taxi drivers consistently
had a larger
hippocampus due to the
complexity of daily activity
• More complex navigation
led to more complex
spatial knowledge, which
in turn led to a bigger,
more resilient brain
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The Nun Study
• Autobiographies 60 years
after they were written
• Brain autopsy results
• Nuns with high linguistic
abilities earlier in life did
not show evidence of
Alzheimer’s despite having
abundant the lesion of
Alzheimer’s in their brain
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you
r
log
o
Achieve OptimalBrain Capacity
page
071
Complex
Purpose Challenge
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Healthy Minds Initiative
• Community based study of lifestyle and cognitive health in 1700 participants in collaboration with Beach Cities Health District
• 3 years
• Cognitive test, brain MRI, blood biomarkers, lifestyle questionnaires
• NEURO Plan
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Healthy Minds Initiative
• Community based study of lifestyle and cognitive health in 1700 participants in collaboration with Beach Cities Health District
• 3 years
• Cognitive test, brain MRI, blood biomarkers, lifestyle questionnaires
• NEURO Plan
Connect with our community endeavor
@teamsherzai
@healthymindsinitiative