Remembering, Forgetting and Protecting the Aging Brain Presented by Stuart Zola, Ph.D. Emeritus Professor, Psychiatry and Behavioral Sciences Emeritus Co‐Director, Alzheimer’s Disease Research Center Emory University, Atlanta GA Senior Research Career Scientist, Atlanta VA Medical Center Disclosure Neither Dr. Stuart Zola, the presenting speaker, nor the activity planners of this program are aware of any actual, potential or perceived conflict of interest. Sponsored by Institute for Brain Potential PO Box 2238 Los Banos, CA 93635 COURSE OBJECTIVES Participants completing this program should be able to identify: 1. Disorders associated with short-term, working, long-term, and habit based memory. 2. Strategies to protect the aging brain from memory impairments, Alzheimer’s disease and other dementias that have common risk factors. Policies and Procedures 1. Questions are encouraged. However, please try to ask questions related to the topic being discussed. 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Post webcast materials are available for each participant at the following URLs: Live Webcast Evaluation: http://www.ibpceu.com/content/pdf/remembering-s18-eval.pdf On-Demand Webcast Evaluation: http://www.ibpceu.com/content/pdf/remembering-s18-dl- eval.pdf All licensed health professionals are required to complete all pages. Please transmit by Monday, March 12, 2018. 7. IMPORTANT: Your certificate of completion will be available by email, mail or fax following receipt of your fully completed evaluation form. If you request the certificate by mail, it will be mailed within 2 business days upon receipt of your fully completed evaluation form. In the unlikely event that you lose your certificate, please send your request in writing and a check for $20 payable to IBP at PO Box 2238, Los Banos, CA 93635, email [email protected], or call 866 -652-7414. IBP is a nonprofit scientific and educational organization dedicated to promoting advances in behavioral medicine. IBP is entirely supported by the tuition it charges for its seminars and the sale of educational materials. Neither IBP, its planning committee, nor any of its instructors has a material or financial interest with any entity, product, or service mentioned in the seminar unless such relationship is disclosed at the beginning of the program. The information presented is of a general nature. For specific advice, please consult a specialist in your area. Remembering, Forgetting, and Protecting the Aging Brain 3 SECONDS… Stuart Zola, PhD Emeritus Professor, Psychiatry and Behavioral Sciences Emeritus Co‐Director, Alzheimer’s Disease Research Center Emory University, Atlanta GA Senior Research Career Scientist, Atlanta VA Medical Center Co‐Founder, NeuroTrack Technologies, Inc President and CEO, Quiet Developments, LLC Order of Merlin, International Brotherhood of Magicians Feels no pain 75% water 3‐4 lbs. Sulci and gyri folds provide more area Soft; boiled tofu 80 billion neurons Neurons can fire 50 times/sec 100 trillion synapses Hippocampus 60% of brain is white matter fibers Requires 20% of body’s blood and oxygen Neuron cell bodies and glia make up the gray matter 1 Healthy Habits Rule # 1: There is More than One Kind of Memory Healthy Brain 1. Healthy Diet 2. Exercise 3. Sound Sleep 4. Meditation Short‐Term Memory 5. Social Connections Working Memory 6. Intellectual Engagement Quick Quiz ■ People’s earliest recollections do not date back before ??? years of age. What is YOUR earliest conscious memory? 2 Short‐Term Memory and Working Memory Many Different Views Short‐Term Memory Working Memory Working Memory / Short‐Term Memory 1‐4‐9‐2‐9‐0‐2‐1‐0‐7‐1‐4 A collection of temporary memory capacities Work spaces where the brain processes newly acquired information Each work space is specialized in processing specific types of information ‐ visual, auditory, stories ‐ operate in parallel What can be held actively in mind beginning the moment that information is received. 1 4 9 2 ‐ 9 0 2 1 0 ‐ 7 1 4 Working memory is the bridge between the first few seconds of encoding and the process of storing memory for a longer time. Digit span test CHUNKING Short‐lasting, limited capacity, 7+2 items. 3 RULE # 2 Amnesia Can Be Pure Memory impairment can occur in the absence of other cognitive Short‐Term Memory deficits and on the background of Working Memory normal IQ. RULE # 3 Certain Memory Abilities Can Be Spared • On the background of profound amnesia, certain kinds of memory abilities can be quite normal and entirely intact. • Motor skills, habits, can be entirely normal. • Different brain regions 4 Everything You Need to Know Understanding Dementia Declarative Memory: The ability to consciously recollect facts and events from Hippocampus our lives. Our everyday memories Passage of time Consolidation Encoding And Retrieval Storage Depression Alzheimer’s Both 5 Dementia Amnesia: Over 90 Causes Memory impairment; absence of other cognitive deficits (damage limited to the hippocampus) ❑ Alzheimer’s Disease Dementia: ❑ Lewy‐Body Disease Memory impairment together with other cognitive deficits (damage ❑ Vascular Dementia involves hippocampus plus cortical regions) ❑ Frontotemporal Dementia (Picks, PSG) Alzheimer’s Disease ❑ Parkinson’s Disease Parkinson’s Disease ❑ Huntington’s Disease Huntington’s Disease Alzheimer’s Disease Alzheimer’s Disease Cognitive Profile • Age‐related, and thus far an irreversible Early Changes brain disorder. • Memory - Rapid Forgetting • Cognitive impairments are related to the development of • Executive System Function plaques and tangles; abnormal deposits of proteins • Confrontation Naming • Develops gradually and results in memory loss initially (the hippocampus. • Behavior and personality changes, and a decline in thinking Later Changes abilities (cortical regions associated with each of the specific activities). • Course of decline varies from person to person. • Visuospatial • Age is the greatest risk factor; education is a reverse risk factor. • Increased severity in all cognitive domains 6 Neurodegeneration in Alzheimer’s Disease Healthy Aging Alzheimer’s Disease 7 Impact of Alzheimer’s Disease Alzheimer’s Disease Links? • No link between aluminum exposure and AD. • Over 4 million people currently • Age is biggest risk factor and there is a dramatic increase in life • No evidence that the use of aspartame is linked to AD or any other dementias. expectancy • No good evidence of increased risk of AD in individuals who were heavy drinkers earlier in life. • The group over 85 ‐ the group with the highest risk of AD ‐ is the fastest growing group in our population. • Blood transfusion: Sweden and Denmark study: authors conclude that "although our findings do not formally exclude the possibility of neurodegenerative diseases being transmissible via • By the year 2050, 14 million Americans will have AD, if no treatments transfusion, they do offer reassurance" that if transmission exists, it must either involve a available.40% will need intensive care latency period of more than 20 years or be extremely rare. Risk Factors for Alzheimer’s Differences between men and women and race in Alzheimer’s •Age • Almost 2/3 of Americans with Alzheimer’s are women • it is mainly after the age of 60‐65 that proportion of AD patients becomes sizable • Women live longer than men, and older age is a prime risk factor • Genetics and Family History • New evidence suggests higher risk is due to genetic or biological • presence of ApoE4, the gene coding for apolipoprotein • (cholesterol); more likely to develop at younger age variations or even different life experiences • first‐degree relative with AD • Type and amount of education • 40‐65% of AD have 2 copies of APOe4 • Occupational choices • Gender • seem to be more women than men affected • Possible links between APOEe4 and estrogen • could be artifact because life expectancy longer in women • Older African‐Americans and older Hispanics more likely than older •Head Trauma • even brief period of unconsciousness Whites to have Alzheimer’s • Education • Variables such as cardiovascular disease, education, social engagement • dementia is greater among illiterate subjects • education may increase synaptic density 8 At Least 27 Genetic Variations Underlying Alzheimer’s Genes Are Essential But Not The Whole Story • Genome‐wide association studies (GWAS) and whole exome sequencing (WES) and whole genome sequencing (WGS) Genes and environment interact. • Identified 27 susceptibility genes or loci • Genetically complex disease: each variant has a small effect on There is genetic vulnerability, but not inevitability.