Brain Health: What You Should Know and What You Can Do

Good afternoon everybody Welcome to the third lecture in our series healthy aging series prepare prevent and get proactive my name is Shannon Neary I’m the director of silver Club memory programs and the interim director of the Turner senior wellness program and assistant director of geriatrics Community programs the healthy aging

Series is a collaboration between the four Community programs at Michigan medicine’s Turner geriatric Clinic which is silver Club memory programs oer lifelong learning Institute the Turner African-American Services Council and the Turner senior wellness program the Turner geriatrics Clinic the national poll on healthy aging The Institute of healthc care policy and Innovation at

The University of Michigan and new this year AARP our topic today is brain health what you should know and what you can do um we are going to be talking today about a lot of topics including preven I some risk factors and research as well so before we get started a couple things

About Zoom I’m when using the zoom webinar uh the main thing to know is that questions should all go in the Q&A icon so you can put your questions there uh throughout the presentation and we will address as many questions as we can at the end while there is a chat icon

Please don’t use that please um reserve your questions for the Q&A please note that we do have a closed caption option fore to use you to use if you wish on your Zoom computer screen you’ll see an icon labeled CC in the meeting controls you can click on that for closed

Captions or a live transcript of the presentation if you have any issues during this presentation such as your screen freezing up the best way to alleviate that is to exit and then try to get back into the zoom if you continue to have issues please give us a

Call at the Turner office at 734 998 935 53 the session is going to be recorded and once it’s edited we’re going to update our website which is mish med.org healthy aging we’re also going to follow up with an email to all the registrant here when the link is available uh

Please share this with anyone that you think could benefit from the information um also like to call your attention to our next lecture which is going to be our final lecture in the 2020 23 healthy aging series which is Friday October 27th navigating your Medicare choices

And benefits so now we are on to today’s lecture we will have about an hour presentation followed by a 30 minute Q&A and remember to put all your questions into the Q&A so it’s my pleasure to introduce our speakers today uh we have uh Dr Edna Rose since 2008 Dr Edna Rose

Has provided education about the risk factors associated with dementia and the benefits of participating in research search to underrepresented communities she has successfully enhanced minority inclusion in Center supported activities through linkages at local churches sororities fraternities and other social organizations she is also a nurse clinician that assesses many of the

Michigan Alzheimer’s dises center research participants in the um memory and aging project Dr Rose received her MSW and PhD from Clark Atlanta University in Social Work planning and administration and her undergraduate Nur Nursing degree from Kennesaw University in Atlanta next we have Scott Roberts Scott Roberts is a professor of health

And health education at the University of Michigan School of Public Health where he directs the school’s Public Health genetics program and teaches a course on public health ethics a clinical psychologist by training Dr Roberts conducts research on the psychosocial implications of genetic testing for adult onset diseases he has

Served since 2001 as co-principal investigator on the nah funded reveal study which is risk evaluation and education for Alzheimer’s disease a series of randomized clinical trials examining the impact of genetic susceptibility testing for peoples at risk for ad Dr Roberts has published numerous articles that address participants motivations and interest in

Genetic testing the psychological impact of providing risk disclosure and health behavior changes prompted by risk assessment he has also examined ethical and practical issues involved in the return learning of research results to individuals enrolled in cancer genetic studies and lastly but not least we have

Dr Donovan Moss Dr uh Donovan Moss is a geriatric psychiatrist and Health Services researcher he has two primary areas of research interest first he is interested in understanding both the drivers and consequences of potentially inappropriate psychotropic use among old older adults focusing on Beno diazines and antis psychotics in addition his

Research explores the factors that drive the potentially inappropriate Healthcare utilization of patients with dementia Dr Moss earned his medical degree degree from John’s Hopkins University he completed his psych Psychiatry residency and geriatric Psychiatry fellowship at the University of Pennsylvania with further training in Health Service research at the University of Michigan

He’s an associate professor in the department of Psychiatry and a research scientist in the Center for Clinical management research of the VA an arbor care system so with that being said I would love to pass it along to um our first Speaker which is going to be Dr

Roberts all right well thanks um Shannon are you seeing my slides okay yes okay great well it’s wonderful to be here thanks for the opportunity it’s great to have such a a big crowd online here um so I’m going to kick us off by talking about dementia and brain health and um

I’m GNA just start by talking a little bit about the term dementia which I’m sure you’ve all heard of but oftentimes that gets kind of conflated with different specific medical conditions so just a reminder uh to folks that when we talk about dementia it’s really just a broad umbrella term that describes this

Phenomenon of gradual decline over time in people’s memory and thinking skills but there’s a lot of different uh underlying causes of dementia so you probably heard of Alzheimer is the most common type but there’s several other types of dementia as well uh you may have heard of vascular dementia Louis

Body phot temporal Etc so I think it’s really important when we think about dementia ideally folks would be getting a diagnosis that’s more specific than that to help understand what’s going on so that the condition might be treated and to make matters even more complicated sometimes people have uh

Both uh Alzheimer’s symptoms and other types of dementia symptoms happening at the same time so for example it’s very common to have what’s called mixed dementia where maybe you have Alzheimer’s pathology in the brain co-occurring with vascular pathology so I’m going to talk mostly about Alzheimer’s today I’m part of the

Alzheimer’s center and it is the most common type of dementia but sometimes I’ll be talking more broadly about these different types as well but to focus in on on Alzheimer’s in particular I mentioned it’s the most common type of dementia you can see from this graphic

Here just what a uh challenge it’s going to be for our society we are currently estimating that over six million adults in the United States currently uh have Alzheimer’s and you can see the projections are that these numbers are going to continue to rise dramatically over time unless we can find better ways

To prevent or modify uh the disease and a lot of this is driven as you can see from this graph by the 85 and over group what we call the oldest old that’s the fastest growing demographic among older adults in the US and so that helps account for why we expect these numbers

To increase and so I think it’s really important for us to be talking about brain health and Beyond brain health I think it’s very important for us as a society to be thinking about you know how are we going to manage this challenge thinking about our our health

Care Workforce uh Etc um so I’m going to talk about risk factors for uh Al alers and other dementias uh because um I think it’s important for us to know what places people at risk uh unfortunately there are some very important risk factors which we really can’t do much

About and so I think even though we’re going to talk today a lot about strategies for brain health I think it’s important to recognize that people can do all the right things and may still develop Alzheimer’s or another type of dementia uh age is uh as you probably

Know the most important risk factor for the the disease so as people get into their 70s and 80s we see rates of Alzheimer’s disease go up women are at elevated risk compared to men so you can see 2third of Alzheimer’s cases are estimated to be women women are also disproportionately represented among

Alzheimer’s and Dementia caregivers so you don’t think of Alzheimer’s as a women’s health issue but you could make that case given these kinds of numbers and then um family history and genetics is a really important risk factor uh and so I’m going to talk a little bit more

Uh about this because I think people are often interested they may have you know a parent or extended family member who’s been affected by Alzheimer’s and wondering what does that mean in terms of their own risk um there are some rare genetic factors that are highly causitive of Alzheimer’s so we’ve known

Since the 1990s about these very rare mutations that do exist fortunately they are very rare they count maybe for like 1 to 2% of all Alzheimer’s cases but when they are present within a family you might even see the development of Alzheimer’s even in people’s 30s and 40s

You know well earlier than we typically see that and so uh it’s very important that we uh recognize uh in these families these uh patterns of disease you may have read the book Still Alice or seen the Hollywood picture with Julianne Moore uh so that describes a case of early onset Alzheimer’s

Caused by one of these rare uh genetic factors and so in these families the affected parent does have a 5050 chance of passing that genetic mutation on uh to their children and so we do have genetic testing and counseling available in these cases but again these are very

Rare so most people who have Alzheimer’s disease in their family it’s more the later onset uh form of the disease that’s not caused by one of these rare mutations but I did want to mention uh this this kind of case uh the genetic Factor that’s perhaps more relevant to

Those later onset cases is known as the apoe gene so we all have an apoe genotype and we inherit one Al from each parent such that you can see on this figure here we all have one of these apoe genotypes and what if you do have

What’s called this E4 alil it does put you at higher risk for Alzheimer and if you have two copies so if you have an E4 E4 genotype you’re at even higher risk and so the general population risk just to put this in terms of of numbers is

About 10 to 15% chance of developing Alzheimer’s in one’s lifetime but you can see if you have one copy of that E4 apoe alil it about doubles your risk and if you have two copies you may even be at over 50% lifetime risk so this is an

Important um genetic risk factor uh to be aware of as well uh in the Q&A maybe we’ll even get into it’s apoe testing is now being considered uh when we’re thinking about prescribing medications for Alzheimer’s because the E4 alil is not just a risk factor for the disease

Development itself but is also a risk factor for side effects from some of these new medications that are coming on board to treat the disease so I think that’s uh it’s an important factor to be aware of on the other hand and uh having the E4 alil is neither necessary nor

Sufficient to cause Alzheimer so you could have an E4 and never get the disease or you can also get the Disease by having another genotype that doesn’t include that E4 a uh so this kind of testing isn’t typically done in medical practice but interestingly you may have

Heard about companies like 23 and me the FDA did a few years back approv genetic testing Direct D to Consumer this is kind of a controversial decision but this kind of testing is available uh through some direct to Consumer uh genetic testing companies so I wanted to highlight some of these risk factors

That we can’t really do much to change but I think most of our Focus today is going to be on what can we do to change our potential risk for dementia and maybe enhance our brain health so let’s talk about some of those Health behaviors and some of these lifestyle

Interventions that you might consider or recommend to loved ones that you know who might be concerned about their brain health uh a great resource in this realm is I’ll try to put after I speak I’ll try to put it in the chat as well the Alzheimer’s Association has a website

Focused on uh this campaign that they call 10 ways to love your brain and so you can see some of these ideas listed here that I’ll get into I know Dr Moss is going to talk a lot about the uh sleep issues in particular so the good

News is is there are things that one can do to help enhance your brain health and potentially reduce your risk of Alzheimer’s or other types of dementias so let’s talk about some of these specific examples and the wh you know the World Health Organization they put out some guidelines to give us some

Ideas about what might be done to reduce uh risk of dementia you can see they came out with very strong recommend recommendations for these particular behaviors so enhance your physical activity stopping smoking managing hypertension diabetes and cholesterol and interestingly they came out against vitamin and supplement use specifically

For this purpose of dementia risk reduction they weren’t saying you shouldn’t use vitamins or supplements period but they were saying there’s not enough evidence to support it specifically for the purpose of reducing risk of dementia and then they had more moderate recommendations around you know cognitive training you might have heard

That there are some programs out there to help you know you you doing like brain games keeping your your mind sharp that way they also uh counseled reducing alcohol use and managing weight now I think the challenge here is we know from the general population figures that a

Lot of folks uh find it very challenging for very good reasons to to follow these kinds of recommendations so you can see that uh you know about 14% of us adults are smokers uh a much higher proportion are obese or have hypertension so it’s a lot easier

Said than done and we recognize that but I did want to kind of put out these General recommendations uh for you to consider and we’ll try to get into a little bit more detail on just uh you how these might be useful in the realm

Of brain health uh to kind of follow up on that point about vitamins and supplements I think part of the reason for the concern in this realm is you know there are a lot of products out there uh in this nut nutritic industry that are maybe making claims that go

Beyond the evidence so you you’ll often see them at health food stores where they might say you know supports you know memory function or these kind of vague claims that I I think have not been highly evaluated neutraceuticals are different from Pharmaceuticals and that they’re not rigorously evaluated by

The FDA for their efficacy so i’ like to kind of point this out so that people um aren’t kind of purchasing expensive products that my advice is if it sounds too good to be true it probably is and I think this refers not only to neutrals but some of these other programs you

Might hear that kind of make very bold promises about brain health so I think some uh some dash of skepticism is is perhaps important to keep in mind for some programs that that are these kind of for-profit uh bold claims about brain health uh I mentioned physical activity

Earlier I think if we could uh bu mod exercise in a pill form it would be probably the biggest Blockbuster drug in medical history because exercise is so important for so many reasons it is very relevant for brain health because there have been a lot of epidemiological

Studies that have shown that people who are regular uh engagers in physical activity do have lower risk of Alzheimer’s and other types of dementia uh and of course uh exercise can be good in so many ways so it can not only uh enhance our brain functioning so you can

See there have been studies that have looked for example at parts of the brain implicated in memory like the hippocampus and it shows up on people’s ability to complete memory tasks as well but as you probably know it can be helpful for our mood it can be helpful

For our well-being it can be helpful for reducing risk of all kinds of other conditions so there’s a lot of reasons uh to think about the importance of physical activity and just as a reminder you know the general federal guidelines are or to have a goal of about you know

20 minutes a day if possible but I think any anything is better than just being completely sedentary and so I think trying to kind of figure out for yourself what might be an achievable goal in this realm of remaining Physically Active is is important uh there’s also the importance of being

Kind of socially and mentally active so you may have heard of this uh phrase use it or lose it when it comes to brain health and so there’s some evidence that social engagement has cognitive and mental health benefits and I mentioned cognitive training programs earlier so I

Think whether you know a lot of people think about well maybe it’s like doing word games or Sudoku puzzles or I to me it’s not so much what’s the specific activity you engage in but just trying to be uh active both mentally and socially is really important and

Sometimes you know some of these advice uh we’re giving you you can combine these things so maybe social engagement could be combined with physical activity by going to a senior center or the why or things like that so you might be able to kind of meet these goals multiple

Goals at once with with certain activities another slogan that’s kind of emerged from the literature is what’s good for the heart is good for the brain so we know that a lot of the risk factors for heart disease that you can see uh listed here are also risk factors

For dementia and so kind of staying on top of hypertension high cholesterol Etc I think can have brain health benefits as well and so there’s a big study called the Sprint mind trial that showed that kind of management of high blood pressure did have benefits in terms of

Reducing risk of dementia um diet is really important of course too that’s another realm where kind of intervention can have both cardiac benefits and brain health benefits so the type of diet that’s been the most studied uh in this realm is the Mediterranean diet that you may have heard about which really

Focuses on increasing fruit and vegetable intake uh avoiding kind of Highly processed foods a lot of sugar fats Etc kind of cooking uh more healthfully uh in different ways and believe me I know this is a lot easier said than done I’m from the Philadelphia area the home of the cheese steak and

The soft pretzel and from a big Italian family so I know how tempting these these uh kind of unhealthy foods can be but I think if we think again about maybe we could make some start small with some different kinds of substitutions uh that you can see listed

Here and kind of tackling this uh bit by bit and there this uh these dietary changes might be important to consider as well um I think uh I like to show this slide this is from the Lancet commission which a few years ago commissioned a blue ribbon panel of experts in this

Area and so you can see some of the things that they’re recommending on the left here we we’ve already talked about uh but I wanted to make a couple points related to this so they’re highlighting both some of these individual level changes but they’re also highlighting

Some things we can think about from a more macro level so you can see for example reduce air pollution that’s something that we have to think about not just at the individual patient level but thinking about from the broader social area and of course A lot of these individual behaviors could be enhanced

If we think about how can we change our built environment or how can we have policies that allow older adults you know easier access to primary care or or have kind of easier access to kind of healthy uh neighborhoods to be able to exercise and walk in so I think I want

To kind of make that point that we need to be thinking as a society not just at the individual level but thinking at the community level at the at the structural level Etc uh and then also I think a lot of these things you could if you look at

This kind of middle part of this graphic you know the these recommendations can be beneficial in a couple of different ways some of these healthy behaviors may actually have a direct benefit on the brain so maybe reducing the likelihood that your brain will develop some of these Cardinal features of Alzheimer’s

Like you may have heard that Alzheimer’s the classic signs in the brain are these amalo plaques or towel Tangles that build up over time so some of the healthy behaviors that we’re talking about may actually be directly relevant to lowering your chances of having these things happen in your brain uh but some

Of the other uh Health behaviors may not have that direct effect the effect may be Instead at that lower uh box there of increasing what we call cognitive Reserve so even if your brain does start to develop these ameloid plaques or tow Tangles doing some of these other healthy behaviors maybe enhances your

Brain’s ability ility to compensate for having those things going on in your brain so I think just wanted to kind of point out there are different Pathways to brain health we’re still learning about this through our our scientific studies but I think the end result is a

Lot of these different behaviors can act in different ways to have the end result of hopefully reducing your chances of developing Alzheimer’s or related dementia and one of these you can see listed here is is thinking about hearing loss for example uh there have been some studies that have you know showed that

People’s who have hearing impairment maybe have a higher likelihood of developing what we call Mild cognitive impairment and so there’s this thought that really treating hearing loss might be another piece of the puzzle here to keep in mind and I I was always uh amazed to see some of the statistics

Here of just how prevalent this is among older adults so over 30 million older adults uh and and actually adults in general have hearing loss the majority of whom could benefit benefit from hearing aids but I’ve seen this in my own family where a lot of my relatives

For a variety of reasons are maybe they’re stubborn maybe there’s a stigma involved but don’t necessarily Avail themselves of uh what’s out there in terms of uh being able to improve their hearing and we know that uh improving uh hearing can also lead to better social and mental uh engagement like we were

Talking about earlier um so there’s been some interesting research studies that are now kind of moving beyond looking at these kind of individual health behaviors and and changes and trying to think about what about a combined approach so a lot of This research got its start a few years back overseas in

Finland through this major finger study so they had a really provocative trial where they were trying to combine some of these recommendations so giving nutritional guidance exercise training cognitive training monitoring some of those risk factors I talked about for heart disease like hypertension and they found that this combination approach did

Seem to have some benefits for the older adults that they followed over several years time and so we’re now seeing uh efforts in the US to try to replicate and expand on this work the uh National Alzheimer’s Association has a a project called The Pointer stud pointer study

That’s also trying to look at some of these combined approaches so I think the science is really active in this space and so I think uh be on the look out for maybe more precise guidance over time and a clearer sense of what are going to be the most beneficial approaches in the

This realm of of Lifestyle uh interventions so um I want to be uh relatively brief here because we have some other great presenters but hopefully this gives you a flavor of some of the science around brain health some of the Practical tips for what you and your family members might engage in

So I’m going to close for now and uh I’ll put some of these resources in the chat but I want to turn it over uh to Dr MOS at this point hi there everyone let me pull up my slides there we go um so like Dr Robert

Said um there are a number of things that you can do that can potentially influence your risk of dementia um I’m a geriatric psychiatrist and like Shannon mentioned in the introduction I do a lot of work and a lot of thinking um about medication use and uh how can

We think about sort of maximizing the the benefit of the medications that people are taking and so I just wanted to do a little bit of a uh uh go little bit in depth uh on that topic uh building on some of what Dr Robert’s already presented so I want to start talking

About the national poll on healthy aging I suspect maybe you might have heard about this if you’ve attended any of the previous seminars in the session it’s sort of jointly um conducted by uh joint initiative between the University of Michigan and AARP um and this is a poll

That we did that was specifically related to brain health and how do people think about brain health and what are they doing to protect their brain health um and it was specifically focused on those in the ages of 50 to 64 so sort of in midlife where there are

Kind of behaviors that you can be um uh practicing that can reduce your risk over the long run and so it turns out like if you combine the somewhat worried and the very worried not quite half of adults 50 to 64 we’re kind of already thinking about and having some concern

About the possibility of dementia which I think isn’t really that surprising uh because it it’s definitely um an A A syndrome and illness that’s that’s on folks Radars um and it’s something that most people would like to to avoid if they could so then we also ask some

Questions to understand what are people actually doing um to try to prevent dementia um and what we found just to remind you actually before I show you the results this uh slide that I borrowed from Dr Roberts that specifically has recommendations from the World Health Organization and focusing on that um strong

Recommendations top bullet uh let’s see if I can get a pen here so these right here are the kinds of things where there’s the best evidence either to do um to reduce your risk of Dementia or to not do that really doesn’t have any evidence of benefit for reducing your

Risk okay so this is the background so this is what we know um uh about reducing risk of dementia so then when we actually look at what people are doing so just H so this is the percentage of respondents so the we go all the way up to 60% of respondents and

What we get are like 30% of people saying that they use fish oil um the the dark blue bar is people who thought they were very likely or somewhat likely to develop dementia the light blue bar are people who thought that they were not likely so regardless about 30% of people

Report using fish oil um gink goes down here around 5% and then other vitamins and supplements again specifically with the idea that they’re reducing dementia um and then and then also cow crossword puzzles so again what we know from the the evidence we have uh from lots of different places including those World

Health Organization recommendations is those are not things that will reduce your risk of dementia the things that the bullets for reducing your risk like stopping smoking like managing your weight like managing your hypertension um your diabetes um those are the kinds of things that you would potentially talk about with your doctor

And actually very few people have have done that and so it seems like there’s a real gap between sort of what we know you can do to help reduce your risk of dementia and what people actually say that they’re doing to reduce their risk and so um Dr Robert spent a slide sort

Of talking about the neutraceuticals and the vitamin supplements specifically related to your memory and cognition you know you might as well just throw your money away there are much better things that you can do with with those dollars so if if we think back to the

Title of my the the subtitle of my talk is like what what’s in your medicine cabinet that that can influence your risk of dementia so there might be some things that you want to add there specifically when it comes to if you have poorly controlled hypertension if you have poorly controlled diabetes

These medical chronic medical conditions that we know can elevate your risk of dementia over time and if there’s any listeners out there who are in the sort of 50 to 65 age group in particular in midlife where where you have um many you know years or decades ahead of you the

Um if that’s really the time that you really want to start to address it and make sure um those those chronic conditions are under control so then but the other thing about the medicine cabinet so in addition to things you’re you’re putting in your cabinet what are

Some things that you want to take away so one thing would be sort of um supplements vitamins specifically that are related sort of marketed or brand is as protecting your memory okay so yes but what else and so that’s what I’ll spend the last couple slides talking about are just a couple other

Things to have on your rer to think about um whether or not it’s a good idea for you to be using these medications so the place that I’ll start is sleep uh which is probably the the main area of concern so this is another poll uh another report from the national poll on

Healthy aging um I think this might have been either the first or the second ones was in the early days of the poll released in fall of 2017 and it was questions about sleep and so turns out um like about a third of respondents reported that at

Least one to two nights a week they had trouble falling asleep and then um uh 15% said more than three nights a week they had trouble falling asleep so that the the kind of headline of the poll report was trouble sleeping don’t assume it’s a normal part of aging so I added

This caveat that in fact it it’s kind of complicated um that that answer for whether or not trouble sleeping is a normal part of aging so the truth is that your sleep sort of architecture does change with age so people have a harder time falling asleep the total

Amount of sleep time at night decreases some and on average you have three to four Awakenings per night and so what’s the real kicker is that because with age people sleep more lightly they’re more aware of being awake so you might not say if you compare yourself at 75 to

When you were 55 or 35 you might not be sleeping less you might not be waking up more but your sleep is lighter and so you’re more aware of the fact that you’re having these nighttime Awakenings and so basically you your perception is that you’re more sleep

Deprived and so this is all this is normal this is not pathological to have changes with sleep as you age and so that’s why it gets a little bit tricky to figure out sort of what is a sleep problem that should require medical attention intervention versus what’s a normal part of

Aging and the reason that’s a concern is that people report taking a lot of sleep medications so not necessarily prescription sleep medications but one and three older adults report taking something to help them to sleep um they’re typically over-the-counter medications um and they don’t necessarily tell their Physicians that

They’re taking these medications and so um here’s a another table of results from that poll where we on the this y AIS we get up to 30% of respondents and we we broke the groups down by people who the light gray people who reported occasional use and the dark gray is

People who reported regular use so you can see about 25% of respondents reported over-the-counter Aid use a bunch of people reported herbal or natural sleep aid use um and then a little bit under 10% reported prescription sleep medication use um and then some who reported actually using

Their pain medication to help them be able to sleep so that the concern here specifically with with sleep medication use so I I’ll talk about the cognitive part here in a second the main concern with sleep medications is that increases your risk of a fall and so that’s not

That um surprising that’s something that you take to help you sleep basically means it kind of sedates you a little bit and so if you wake up in the middle of the night because your back is bothering you or you need to use the restroom and you get out of bed but

You’re actually a little bit groggy because of that sleep medication then that increases your risk of a fall so if I’m talking to medical students they might be like oh what’s the big deal if you have a fall like it’s not a big deal

The problem is for a 75 85 95 year old a fall can really be like a lifechanging even catastrophic event and so you really want to be very careful about taking anything that’s increasing your risk of fall because of how severe the consequences can be of a fall

And sort of across the board the common thing many of these SL sleep medications have is that they do um increase the level of sedation and so that’s increasing the potential risk of a fall um the the other reason that I’m talking about them today are the cognitive

Effects of sleep aids um and so if there’s nothing else that you remember from this talk I hope you’ll remember this this is particular for over-the-counter sleep medications most over-the-counter sleep medications include dyen hydramine uh which is the generic name for badril so diven hydramine or badril is what we call an anti-cholinergic

Medication which blocks so acetylcholine is a is a um neurotransmitter you have receptors for it all through your body it plays a very important role in your nervous system and benad dril blocks that uh neurotransmitter and so the side effects of that include constipation and urinary retention which you know isn’t

Necessarily catastrophic but can actually cause problems for folks it dries you out so your mouth is really dry in the long run you can develop cavities um it also impairs cognition um uh in the short term and then in the long term with long-term use it is um there’s good evidence that

Increases your risk of dementia so that might seem crazy like how is it possible that Tylenol PM increases the risk of dementia did he really just say that and I really did just say that so there are high quality studies where they’ve looked at long-term exposure to these anti-cholinergic medications and then

Your risk of dementia and so I’m going to remind you again Dien hydramine or badril is anti-cholinergic and so the the reason conceptually this makes sense is that in Alzheimer’s dementia people lose neurons they’re neurons that produce acetylcholine in the brain die and then the medications that have

FDA approval to treat dementia at at least the not the brand new ones you’ve heard about in the news but the ones that have been around longer uh since maybe the early 2000s the most common one is deosil or aerosp so those medications are called acetal colon esterase Inhibitors they break they

Inhibit the breakdown of acetylcholine so they boost so these dementia treating medications boost the level of acetylcholine so conceptually that hopefully makes sense to people that if you’re taking something like Benadryl that’s blocking acetyl choline it makes sense that potentially it increases cognitive problems and in the long run

Increases your risk of dementia and so by long run I mean over years or over Decades of regular use of these medications uh but even um short-term use again because of the risk of fall related injury is just something that I’d be um mindful of so then nonprescription uh excuse me so

Prescription sleep medications there are a number of different classes and there are some newer classes that have come out um but what we know about some that have been around on the Block for a little while is they’re just not great so when you actually look at studies and you

Look so these are Placebo controlled studies where participants either get basically a sugar pill that they think could be medicine or they get a pill that looks the same and is the actual medicine there were really very small participants reported very small Improvement in their Sleep Quality when

You ask them about good how good their sleep was overall their sleep time increas increased 25 minutes so that’s not nothing but if you’re thinking about like six or seven hours of sleep at night it’s less than half an hour and then mean nighttime Awakenings so remember it’s normal to have three to

Four Awakenings at night the the number of Awakenings reduced by not even one so like a a half an Awakening so relatively small benefits and then when they looked at side effects um if you got the medication you were five times more likely to report um cognitive problems

Like memory loss almost four times more likely to report daytime fatigue and then two and a half times more likely to report to have psychomotor events so this is what I’m concerned about the dizziness the loss of balance so again the sort of the risk benefit balance of

Of medications for sleep is like really pretty limited and so I apologize to not have a good message I’m sharing here an email from between my mom and I over the summer where she was kind of like asking you know they’ve gotten the lecture like no Tylenol PM I like look in the

Medicine cabinets when I go home um and then she was asking me about another medication and I was like nope that one’s no good either um it was something that she had taken uh earlier her while she was pregnant the doctor said no it’s totally fine it’s totally safe but um it

Is one of these medications it’s a strong antihist mean strong anticholinergic has all the same risks of vadil and my mom does not want to do anything that’s increasing her risk of dementia and so that’s all she needed to hear but the again the bottom line is is um in particular for over-the-counter

Sleep aids to beware and the truth is there are a lot of things you can do to improve sleep so the most important thing is to talk to your doctor and make sure you don’t actually have a medical reason that is causing you to have poor sleep maybe

It’s untreated pain maybe it’s Prost State enlargement um maybe it’s obstructive sleep apnea so once you rule out possible medical causes I’d say the next step is is behavioral sleep modification sleep is a habit we can get out of habit and we can do things to get

Us back into good habits so like not having a big meal before bed not having stimulants like caffeine or black tea not taking naps during the day you want to build up sleep debt during the day so that then you’re ready for bed at night um

The the bed to train your mind to see the bed as a place for sleep or for marital relations it’s not for bill paying it’s not for watching TV it’s not having for it’s not for having fraught discussions with your spouse about anything um and so there’s lots of sort

Of sleep hygiene you can do um and in the interest I’ll I’ll wrap it up here but sort of the the the bottom line from my talk is um when you think about the prescription medications that you’re taking there’s potential for both good and for bad add in terms of reducing

Your risk of dementia and and cognitive impairment um echoing again what dror Robert said don’t waste your money on any kind of supplements that are branded as being like memory boosting or or preventing dementia because it’s just not true um beware of sleep medications in particular anything that you can get

Over the counter and again else please get rid of Tylenol PM if you have it and that’s all thanks and now we’re going to uh go into research everything that you’ve heard so far has been a result of people participating in research so when we think of research we think of who needs

To be a part of research research and why participate as you can see with the statistics and the information that both uh uh previous presenters Donathan and Scott have talked about these results came as a result of people being involved in research and so who needs to participate in research next uh slide

Please okay one of the reasons you want to participate in research is because you’re contributing to the body of knowledge and what we contribute to the body of knowledge it benefits society and ourselves and then when we uh are part of research we can determine how we’re going to treat these chronic

Conditions now both of your previous presenters have talked about the different uh uh problems that we have that are related to dementia the lack of sleep and things of this nature throat tossing the tile all and all of those things are a result of people finding

Out that this was a problem and being in research and giving this information to doctors it added to the body of knowledge it uh also determines the cause and effect effect and when you become a part of research it helps us to comprehend the biomarkers or comorbidities uh which I’m going to

Discuss consider the next slide with the African-American population often times there we have what we call biomarkers and we have those biomarkers in place because research has shown that these particular situations present this type of disorder so oftentimes African-Americans do not have at the beginning Alzheimer’s disease but they

Have vascular dementia and now vascular dementia is brought about by hypertension diabetes high cholesterol and these are all arterial diseases now the arteries carry oxygen so anything that diminishes the amount of oxygen to the brain is considered to be a biomarker it does not mean that if you

Have these diagnosis that you will develop Alzheimer’s disease these are just considered some uh precursors to the disease if they are controlled if your medication is stabilized then there should be no problems you can go to the next slide so when we talk about a transport system in the body

Specifically to minority we’re talking about transporting oxygen from the arteries to the brain and other parts of the body so when there is a diminished amount of oxygen to the brain and the neurons are not fed with the oxygen the protein that they need then this can

Cause damage to the neurons in the brain so the hypertension high cholesterol and diab diabetes are called biomarkers especially in minority populations and with that act with that oxygen being carried throughout the system through the arteries they become the life support system for the body next slide

Please so what is the best time to begin research research right now at the University of Michigan and Wayne State and Michigan State we’re taking all ages anyone 18 years and over because there are all types of research that are going on and so what happens is that we have

Research based on caregivers taking care of someone with Alzheimer’s disease there’s research regarding uh uh uh movement disorders so there’s all types of research and often times people will come into research and may need a study partner next slide when they’re using a study partner in research then that

Person comes with them they become a part of the research as a partner but they are not actually in the research so oftentimes we’ll get people at the U ofm that are uh a part of our memory and aging system and when they come in they come in with their children if they’re

Over the age of 18 or they come in with their uh husbands or friends now when you participate in research it allows you to rece your interest in the subject matter often times we’ve had family members when uh Scott was talking to you about the genetic predisposition and

Carrying this apoe Gene from one generation to the other this allows you to find out more information about those things that interest you it’ll learn it gives you an opportunity to learn something new because oftentimes we have what we call appreciation lunches or we have um uh Avenues by which we go out

And talk to the community in the churches in the sororities in the fraternities anywhere in the community because we know that people are destroyed because they lack knowledge so what we’re trying to do is give them the knowledge and the opportunity to become a part of research it allows you to

Challenge yourself in new ways also oftentimes people come into research and they’re Blown Away by some of the testing that’s done they they didn’t realize that it was that easy they didn’t know how the lines connected how the dots went from one way to the other

But when you’re a part of research it gives you that opportunity to ask questions and to become a part of something that you’re giving back to society it gives you an opportunity to learn Cutting Edge information it it teaches you about the new studies that are there and it updates you on the

Latest treatments next slide please so when we go out into the community and as of to date uh we have spoken at over 4 500 churches in the Detroit metro area we are able to go out to churches and the community we talk about some of the

Same issues uh that that that Scott and dunan have spoken about it gives you an opportunity to ask questions and when you participate in research you you learn about all the different medication trials that are present the biomarkers the memory training studies the lifestyle interventions some of which

Were uh mentioned today the caregiving studies and more and so we ask people to sign up now we also have inclusion and exclusion criteria when we talk about inclusion criteria it may be that you’re the right age for this particular research project or your biomarkers May uh point you into a direction where

We’re studying those that have hypertension diabetes or high cholesterol then we have the exclusion criteria which means there are some uh research projects where if you’ve had a stroke you may not be able to be a part of or if there’s a research project where we need to perform an MRI and

That’s that magnetic magnetic Renaissance Imaging and let’s say that you’ve had a a plate or you’ve had tattoos well you may not be able to be involved in that research project because that’s an exclusion criteria because you would not be able to have an MRI done so we have the inclusion and

Exclusion criteria we also have the educational component where we’re able to come out and talk with you your organization uh and when we do this then people learn more about what’s available and how to go about uh getting into research with us so we do have the mindset registry here at the um

University of Michigan uh we’re actively recruiting research uh for all different types of studies right now we have over 20 research study projects that are going on and because because we are affiliated with Wayne State and Michigan State there are times that they’re involved also so what we’re trying to do

Is get people to understand that participating in research will allow you to add to the body of knowledge you may not receive um the benefits of the research that you’re participating in but others around you and for future Generations you’ll know that you’ve had

A part and so when we talk about uh the lack of knowledge what we do is when we come we have more time than we do today to take your questions to discuss with you what’s going on and so there is a number that’s uh located at the bottom

Of this Slide the 734 the 936 8803 and I’ll also put that in the chat but if you call that number we have people that will take your information it’s just a brief questionnaire and from that questionnaire they can point you in the direction where your research can be uh

Begin oftentimes people are really excited about being in research because what we do with research often times the person comes back every year now there’s no insurance company that’s going to pay for neuros pychological testing every year but just as you have your eyes checked just as you have a history in

Physical every year sometimes being in research allows you to have a neuropsychological exam each year if in fact you are uh designated in your research project that you participate in to have that done oftentimes too uh graduate students are trying to find answers to questions and most of our

Research is OB observational but there are times that questionnaires are just sent out just to ask you information that can give them the in the the the knowledge that they need to pursue the degree that they’re looking for and also by doing that they’re adding to the body

Of knowledge that next screen please so this is how we get involved we have Kate Hansen and her information is listed there and you can uh and I’ll put that in the chat room for you afterwards but this is a team we have research assistants that perform a lot of the

Neuros pychological testing we have a lot of Educators and Scott and myself we uh Scott actually goes out we come to Detroit we come to the surrounding areas and we have different topics that we discuss every month we have a different topic that’s discussed and oftentimes those topics that we discussed are

Presented to us by the people that we’re giving the information too and so we’d love to have you come on board for research it’s really interesting uh you gain a lot of knowledge but Above All Things the information all of the information that Scott and Donovan have

Given to you today is based on Research it’s based on people coming in giving their time becoming a part of research so that what they too can add to the body of knowledge I’m going to turn it back over to our moderator Shannon and now we’ll have our question and answer

Session thank you so much all right that was extremely informative and we have many questions that people gave us uh prior to when they registered and then also a lot of questions that came up so do have about 35 minutes so I’ll try to get to as many

As possible uh but we likely won’t be able to get to all of them so please if your question um we weren’t able to address your question we do have an email address healthy aging series um.edu also as a gentle reminder we will be sending out uh the recording once we

Have it available in about a week or so along with any slides that that the presenters will share with us and some of the links that have been shared in the Q Anda as well so let’s go ahead and get started lots of wonderful questions here um so

We have a lot of questions about medications um and one of and some of them about sleep Dr Moss that you were talking about so someone had a uh Mary had a specific question about melatonin um are there increased risks of dementia with that medication yeah I saw a bunch of

Questions about melatonin so um I’m I’m not aware of there being any evidence or sort of a conceptual reason why melatonin would increase risk of dementia um I’d say where melatonin maybe makes the most sense for use is particularly so melatonin is sort of helps regulate your

Body cycle so in a case of like travel across multiple time zones or if you have what’s like a circadian rhythm disorder where sleep wake is off is probably where maybe it makes the most sense to use melatonin um I know lots of people use

It I think probably the use is more than there’s really evidence to support the use but I’m less concerned about fall risk with it I’m really not concerned about increasing risk of dementia thank you so Terrence had the question um to get a clarification about can you define the long-term use

Of Ben Benadryl and are other anti-histamines also a potential problem another good question so the the studies that have specifically linked so again it’s use of these anticholinergic medications um with increasing risk of dementia have looked at sort of consistent use over years you know up to

One year one to five years five to 10 years so I’m not talking like a week or two at a time type of use so if you know you have terrible seasonal allergies and you need to use some benad drill for like a shortterm period of time um that

Would be reasonable it’s just the type of thing to not make it a habit month over month year over year that you’re using it consistently if that makes sense thank you um also related to sleep um people are asking a couple questions about snacks so what snacks that anyone May

Recommend would be a healthy choice before bed what about the skinny pop popcorn yeah I like that I like skinny pop as a choice I don’t have a great answer other than maybe like you know some of the the dietary rules that Scott went over probably also apply for good

Snacking choices as well you know in general avoiding processed foods you know maybe a small quantity of almonds something like that um yeah I’d say general rules of your diet would apply to you to a snack at any time of day in particular uh before bedtime mainly just have it be something

Relatively healthy and also relatively small perfect so segueing into the diet conversation so I would I would love to hear from anyone or from multiple of you what your thought is on this so we discussed the Mediterranean diet um and Lenell had the question about how does the Mediterranean diet compare with the

Keto diet in terms of health benefits so the Mediterranean uh diet recommends low fats and keto is a recommendation of higher fats so 70% of diet I don’t know the answer to that question directly because I’m not as familiar with the literature on the on the keto diet I guess I I highlighted

The Mediterranean diet because I feel like that has been the the best studied in the context of benefits for both heart health and brain health and I think um so that’s part of my reasons for prioritizing that but that’s not to say that you know there are other

Approaches to dietary changes that I think can be useful that aren’t kind of specifically the Mediterranean diet so I think it’s not to say it’s the only path forward but it it does happen to be I think the approach where we just have the best uh science behind it at this

Point so um it’ll be interesting to see if some of these other uh dietary approaches also uh Garner evidence as well so sorry I can’t speak directly to the direct keto versus Mediterranean comparison but hopefully that’s uh helps clarify some of why I was highlighting the Mediterranean

Diet thank you and would um would you recommend that if people have specific diet questions to talk to a diet Ian or or someone that studies that specifically or what do you suggest for that yeah I think that that makes a lot of sense and I’m I’m not a practicing

Clinician anymore so I defer to Donovan and Edna as well in terms of if they have specific recommendations in terms of like nutritional counseling or or dietetics here in Michigan there was a time that we had a registered dietitian on board with us and believe it or not she was um her

Concerns were the low fat because of the uh biomarkers in the African-American population and so I’m sure that if you go to a dietitian or you go to your medical doctor he would probably suggest if you have any of those biomarkers that we were speaking of that lowfat diet is

Opposed to a Hy that diet but like I’m saying there are other underlying causes or underlying diagnosis that we just can’t address because we don’t know the history of the individual that might be asking thank you so there are a lot of questions and

I get this question a lot in my work as well about the efficacy of brain games so one one person when they registered they were or they were asking about um do specific mental exercises such as crossword puzzles generate generalize to other cognitive abilities another person asks a similar question um is it

Actually help helping your cognitive functioning or is it just making you really good at doing cross word pudle puzzles or Wordle um and there is sort of a second part of that question if if you do believe that those things are helpful if you’re aware of any uh games

Or resources of where people can find these yeah I can take a First Step at that I’m sure other panelists may want to add on yeah so I think you know there is the reason why cognitive training made it into those like who recommendations is there is literature

To suggest suggest that it that it can cognitive training or these brain games can and of course it can take a a variety of different forms but they they have demonstrated benefits in terms of you know some just key domains of cognition whether it’s memory or executive functioning or or other you

Know domains of memory and thinking I think uh the challenge is that you know a lot of times these effects might go away if you don’t sustain the specific cognitive training program and I think my other kind of caveat here too is that a lot of these things there are these

Kind of commercial programs out there that can be you know pretty expensive uh but you can still get the benefit from your own self-designed kind of program it doesn’t have to be kind of a fancy computerized brain app um you know we can we can all kind of think about mentally stimulating activities

That we can partake in for free um and I think there is some suggestion if that if you’re doing things that maybe are kind of new skills like learning a new language or I saw in the chat somebody you know a ballroom dancing class I like the ballroom dancing example because

That’s kind of you get kind of bang multiple bangs for your buck in terms of it’s not just like a new skill that is mentally challenging but it’s physically uh getting some activity and it’s also social so you’re kind of hitting multiple buckets at once so maybe

Thinking about in terms of activ ities that you might choose that you might combine not just the brain game piece but can you add a social piece to it and then just also thinking about what’s going to be sustainable over time if you’re really doing it just out of this

Sense of oh I really like it’s like homework to do to to reduce my chance of dementia and it’s really not kind of intrinsically motivated that the chances are that you might start uh and then give up pretty quickly but if you’re if you have a passion for these things yeah

I’m a total Wordle and spelling bee and all the New York Times stuff you know addict and so I there’s going to be no problem for me to sustain that over time so kind of thinking uh in terms of what what might you be able to sustain over

Time what might not cost an arm and a leg and what might be able to allow you to combine the mental stimulation with some of the social piece would be some of my suggestions and I think you go back Scott to what you said about if you

Don’t use it you begin to lose it so I think that stimulation of the brain you know sometimes uh people can become potato couches and that’s one way that you can get up and physically exercise with the ballroom dancing to stimulate your mind with the uh with the games

That you play and so um I think anything is better than nothing so doing something to keep yourself together is better perfect thank you so a question that that I have uh because I know we talked about lifestyle interventions how people can prevent dementia in different ways obviously that’s not foolproof but

Something that would certainly help what about for people that are watching now that either themselves are diagnosed with mouth cognitive impairment or a type of Dementia or they know somebody who has dementia how how important are those factors in preventing further cognitive decline yeah I think a lot of the advice

We’re would apply to someone who’s been formally diagnosed with with cognitive impairment I think I think about physical activity for example being one great example and I think you know the goal might be a little bit different the goal might be rather than I want to prevent you know the onset of a

Condition it’s more I want to kind of maintain functioning for as long as possible uh but even so I think a lot of these uh recommendations would still be applicable and can and like we’ve talked about a lot of these behaviors have broader physical health benefits for

Other issues and have a lot of kind of just mental health and well-being benefits so uh the there’s kind of multiple reasons to engage in these kinds of behaviors yes and I think it go I think it goes back to a previous session um that we had talking about the important

Of social connection and I just think about how all these different lifesty interventions how many of these are things that can help prevent other diseases and conditions and help with a healthy life so I think all those together that that’s all great advice okay was someone else going to

Mention something yeah I was I was basically just gonna Echo what Scott said you know a general rule of thumb again echoing him is you know encouraging people for activity in three domains social intellectual and physical and that really Frank for anyone of any age um any most levels of cognition

That’s a A good rule of thumb um for as a way to kind of approach and think about well-being um again something that Scott touched on was really thinking uh and and thinking about in particular cardiovascular disease managing cardiovascular risk factors because we know for sort of multiple types of

Dementia um that seems to be on the pathway uh to developing it and so the extent to which you can manage um your hypertension your cholesterol diabetes which cont contribute to vascular disease um again is important both for preventing dementia but also um thinking about um not having it progress by by

Keeping those chronic medical conditions that we know are part of the the risk picture thank you so I know this was touched upon in the presentation about the connection between hearing loss and developing dementia um can we get some expansion on that of why hearing loss and dementia are so so

Interconnected I mean I think we’re still learning and I think the when I showed the graphic I think it was from the Lancet group I think it was it was linking the hearing loss not so much that it’s directly related to alzheimer’s pathology in particular so

You know the amalo plaque and the tow tangles in the brain uh so it wasn’t so much that that if you have hearing loss that th that kind of neuropathology is going to occur but more it might affect people’s ability to cope in the face of those kinds of neuropathology symptoms

And so uh it might increase what’s called cognitive Reserve this the ability to kind of even if your brain is is starting to develop some of these issues that you’re you’re able to still function well um you know and I think and just practically of course it allows

You to maybe be able to more meaningfully take part in a whole range of activities in social life and so I think that was the The Importance but there have been studies that have I think I cited one from the University of Wisconsin where they followed people with hearing loss longitudinally over

Time and did find that hearing loss did seem to be a risk factor for uh ultimate cognitive impairment not specific to alzheimer’s but just cognitive impairment more generally and um Joshua Erick who’s an Opthomologist here at the university has actually done sort of similar work looking at uncorrected visual impairment

Um also increasing increasing risk of dementia um and it’s it’s interesting to think about you know the way possibly say a a brain is handling sensory input you know if I think about when I uh get out of the car and my glasses fog up how

Difficult it is to navigate the world if if you think about you know this critical information that our brains are getting either from what we’re hearing or what we’re seeing and if that is sort of clouded or obscured in any way how much harder your brain has to work to

Manage and make sense of the world around you I I think it kind of makes sense how these kinds of sensory impairment might make it difficult to maintain that cognitive Reserve to be able to sort of go through the world making sense of everything and putting

It all together um so do you know uh um you w to um talk to your relatives perhaps reluctant relatives about having their hearing checked and corrected and you know making sure fortunately in the US uncorrected vision isn’t that common but it definitely is out there and so you

Know you want to go through the world as best able to navigate and manage everything that’s happening around you as possible and so that means good vision and good hearing yes and Johanna actually had a question quite related to that so her question was specifically about are you

Aware of any studies on a connection between macular degeneration and the relationship to brain health not off the top of my head but it’s for the reasons Donovan was just outlining it wouldn’t surprise me if there was some kind of potential link there but I’m not aware of any specific studies in that

Realm thank you so this next one is for Dr Rose um is there a geographic area for volunteers for studies and do study offer a participation stien yes we do um we’re here at the uh in fact today I’m here at the University of Michigan in Detroit which is on

Woodward Avenue and so we’re downtown Detroit so though we may recruit in all areas we have the an arbor office where people come and we also have the Detroit Center uh there is a stien that’s given and that’s different based on what uh project you’re in there’s some that pay

Very minimum there’s some that really pay over the top and so uh often times too it may require that you come more times or that you have uh an MRI that’s associated with it and so everything that you do uh uh giving blood samples there’s a fee for that doing an MRI

There’s a fee for that uh just coming in for us to do the neuros pychological testing there’s a fee for that and so uh and we are here in Detroit and we are in an arbor so we try and go both places however if there’s an MRI that needs to

Be done we do have to go to the University of Michigan to have that done because they want want all MRIs done on the same machine and so there is a stifen that’s given and U and like I’m saying the benefit um usually outweighs a sment because uh there’s no your

Insurance doesn’t pay for the neuros pychological exam until you go to a doctor and you refer to a neurologist and then that means that something is wrong and so you know there’s some um when we go out to talk to people we talk about the legalities behind uh coming

Into research because of the anonymity that’s there as opposed to going to a doctor’s office because now it’s going to become a part of your medical record uh when you do come into research um we don’t transfer those forms to anyone else you can elect to have that done but

We don’t do it and so therefore um it’s sometimes better to come in and then uh oftentimes people find out there’s a problem and then they go back to their primary care physician and then they refer it to neurologist because we don’t treat people we just do the research and

Uh and that’s why I push research so much uh simply because it it it helps to educate the client and so often times when we’ve gone out and Scott is over our Outreach and recruitment segment at the U ofm and when we go out to talk with individuals once the knowledge is

Gained then people have a desire to become a part because they realize that the benefit not is not only for adding to the to the knowledge base but it’s information about themselves and so yes there is a stipend that’s paid uh when they come in for research and in during

The consenting they give you that information they tell you how that will be paid when that will be paid and things of that nature thank you for those clarifications yeah I can just add on to what Edna is saying I I put in the chat a couple links if people are interested

In research studies so one of the links I put um was uh to to our Alzheimer Center where we have that’s the edner was referring to the over 20 studies specifically focused on on dementia research but then I also put the university has a broader U ofm health

Research portal um so I’m this group may have interest Beyond just uh Alzheimer’s research so I wanted to also put that link and and uh yes I think and also the stien may as Edna was pointing out depend on the study our our Flagship project is called our uh AAP University

Of Michigan memory and aging project so that one we definitely do have a stien it’s an annual visit and we also have a stip in for what we call our study partners because sometimes we uh co- enroll if the person as memory loss we co- enroll you know like a family member

As well and I think sometimes these studies will not just it’s not just about financial benefit but sometimes certain studies might give you back your individual research results like how did you do on the memory test a lot of people are curious and so we try where possible to give that kind of

Information back as well it’s not financial payment but it’s hopefully a way of paying people back for their participation by giving them information that they or their family members find useful about themselves thank you another theme that I’m seeing in the questions is around quote unquote

Healthy aging um so if I would like to hear your different perspectives on kind of what what people can be looking out for if what they may be experiencing is normal aging versus that there may be some kind of an issue that they should get addressed usually often times it’s the

Family member or friends that notice something is out of the um out of the normal for the individual because what I would say would would be normal for one individual may not be normal for another individual uh you have some people that come into research and they’ve always forgotten people’s names that’s been

There since they were in high school but for another person that could be abnormal because they always did remember people’s names and so uh healthy aging is different things to actually different people but it depends on where you start out uh I think Scott or uh Donovan said something about

People exercising over a period of time and then there’s some people that are just getting on that train a little bit later they just started exercising at 55 or 60 and we were presenting at one facility and the age of the group that we were talking to was about 65 75 and

Then they came back and said well now the information you’re giving us we needed that uh you know 15 20 years ago and so we’re finding out that especially with the African-American population the some of those biomarkers that we were talking about the uh the dep uh the hypertension it’s untreated because it

Just wasn’t treated I mean oftentimes uh we had a um maale today that made the statement that one of the reasons he came off the hypertension medication because the sexual dysfunction well he never really thought to go back and talk to the doctor to see if he could get

That straightened out so therefore he never took the hypertensive medication so oftentimes we do need to dip back a couple of you know 10 or 20 years to try and bring people up so that when they get to that aging system when they get to be 70 or 75 then these problems won’t

Exist but if we don’t catch it at at at 30 or 35 changing the Habit uh decreasing the salt watching those condiments things of that nature sometimes people have not been able to put that together that this you know the cause to the effect when we go out to

Talk to them about it and they have the uh opportunity to ask individual questions then that’s when you actually get to the bottom of it but um I never really thought when um churches were asking us to come out and the population was like 65 plus because that’s the age

Group that we were looking look for that we needed to go back to 35 and 40 to see if we can help them through education to prepare themselves so that they won’t have these biomarkers as they age you see what I’m saying so uh we’re not and

Often times we have to tell them we’re not saying because you have the high blood pressure the diabetes that you’re going to have Alzheimer’s that’s not what we’re saying but we do know that there’s an association between that and vascular dementia and so I think I may

Have forgotten to mention too that this is why we need all ethnicities in research because we need to to understand why things are different with one population as opposed to another population uh Caucasians have a a somewhat high cholesterol level but African-Americans have The Strokes so so

You’re trying to see what why why are these differences there and the only way that you’re going to be able to do that is include everybody in research and so that there’s been some disparities and African-Americans have not always come into research because of our own you

Know certain things like the um Tuskegee St and so when we go out to talk we open up and and and discuss that first and then we talk about the IRB and how things have changed over a period of time because the lack of participation by minorities in research doesn’t give

Them enough to go by when you open up a circular for medication and you look at the demographics and you see that you were not included that’s why that story has to be told and the only way that that story can be told is if people come into research from all different

Populations so that we can see and compare and try and figure out why this thing is attacking one uh you know in the 70s when we first started looking at Alzheimer’s disease mostly Jewish people had the disease and now African-Americans are number one for the diagnosis so you’re asking yourself the

Question is it just from a um a biomarket that’s associated with physical capabilities or are there some social factors are there some dietary factors that are there and so those are the things that you get to when people come into research because now you can begin to make some comparative analysis

As to what things are the way that they are and so that’s one of the reasons um working with squat Scott I love to go out and do the recruitment because that’s the educational component because if we educate correctly then research uh we will have the populations that we

Need in research and just sorry I can’t speak Spanish because that’s another population that we need to reach and we don’t have enough spanishs speaking um uh uh uh employees that can go out with us to to speak but we’re but we’re getting there we’re getting

There yeah we do we just got a supplement to have a new outreach program in the Grand Rapids area Irving Vega as one of our colleagues so we will be uh doing expansion with uh Hispanic Latino participants at least in the western part of the state moving forward

But it’s a great question that we get it a lot like what’s normal aging versus what is really a concerning sign of potential dementia so I I I posted again in the chat just now the Alzheimer Association has this great resource called the 10 warning signs that might

Give people a little bit more information but I think a lot of it has to do with you know how frequent are these concerning things happening and and how much does it really affect people’s functioning so you know forgetting somebody’s name at a party is one thing or occasionally losing your

Keys is you know these things happen to all of us but if it’s you know kind of the frequency the severity and is it really impairing people’s ability to to work to socialize to enjoy life that functional piece is often helps give us a clue as to well well maybe this is

Something that uh should be checked out but I think a lot of times people do and and professionals too also maybe write things off and they say oh that’s just that happens to all of us because it’s kind of more comforting to think about

That way so we I think we do need to try to think about recognizing when somebody might warrant kind of a more thorough assessment to really kind of get to the the bottom of what’s happening and when their memory impairment has began to affect their activities of daily living

Uh that’s when you can began FY signs like forgetting to pay their bills on a regular basis you know uh uh driving and becoming disoriented and a little confused having to you know go so that’s why when uh participants come into research that’s why we’re asking those questions has there been a

Disorientation uh when you go out to eat can you pay your bills are you still able to get the percentages right just simple things like that and that’s one of the reasons that um most of these studies that we’re in they require a a study partner because sometimes the

Individual may not think it a problem when the individual that stays with them or sees them on a regular basis can see the changes that are taking place thank you so much so I’m seeing some questions about resources and I know that we’ve been you know sharing

Some links in the chat and some other information um just just briefly to share for those of you who may be local to was County or even if you’re not the the Turner uh geriatrics Community programs we have numerous programs that work on overall health and well-being for older adults we’ve have exercise

Classes we have um lunch groups we have um the oer life blown learning Institute is a volunteer um organization that does a lot of programming um silver Club memory programs has an adult day Center for people with dementia and also some mild memory loss programs as well um but

Also just more generally I think if you’re not local um your local area agency and aging should have a lot of resources um in terms of those uh types of supports as well as the Alzheimer’s Association um the Michigan Alzheimer’s Disease Center also has some different social and support programs does anyone

Want to add any kind of General programs for health well-being that may help people stay cognitively healthy for longer Laura asinger one of our staff has a program I think it’s called mind is it mind fulness Scott uh that Laura does and it’s it’s a really good program

And I think it not only um offers help for the person with cognitive impairment but for also and so there are a lot of uh because if you’re the you know if you’re a caregiver then there are some stressors that you’re under too and you

Need a little relief there and so um she does a lot of things uh like that yeah that’s a great point and so our um our Center has a Laura leads what’s called our Wellness initiative so we have a variety of programs a lot of it is geared around caregivers and

Helping them deal with with stress uh we have some support groups as well we have some support groups specifically for Louis body dementia caregivers because that’s a condition that has distinct issues and a lot of times Alzheimer’s gets most of the attention so we try to um also offer some programming that’s

Maybe more specific to to different uh types of dementia I mentioned the AL Association they sponsor a lot of kind of education and support programming so our Michigan chapter of the Alzheimer’s Association is a great resource uh there’s a lot of clinical programs I think Donovan posted in the chat you

Know some of the like a Sleep Disorders program he’s a you know geriatric psychiatrist there’s a gerat Psychiatry program we have a cognitive disorders clinic so there’s a lot of kind of specialty Medical Care programming at Michigan that might be Rel so yeah there’s there’s a lot of resources I

Know it can get confusing to kind of navigate and so I think that’s great that that I think through programs like this hopefully uh we can get people pointed in the in the right direction I don’t know Don you want to add more from your group what what programs you have

And uh uh Scott don’t forget our quarterly uh presentations here in Detroit and Inn Arbor uh that we put on and they’re different topics and those are actually open to the public they’re kind of like a lunch and learn they last a couple of hours they have them in an

Arbor they have them here at the Detroit Center and invitations are actually contact information that Scott has placed uh you can get on a mailing list and receive the uh an electronic mailing list as to the things that are going on Dr Moss anything to

Add no it’s a pleasure to go after Scott and Edna because they cover all the bases I don’t have to say anything and if anybody we do at the Turner Center we do care consultations as well and we have a lot of resources so if there’s

Anybody that just wants a little bit of direction of of where to go for these types of things that we’re a good resource for that as well um so we’ve only got a couple more minutes here and we’re getting short on time um so I think this question I’ve

Seen a few times about and this topic I think we could probably go on for much longer than we have but any kind of in thoughts about medications that are on the market to prevent cognitive decline once people are diagnosed with dementia I know that’s a controversial complicated topic but anyone that wants

To take a step at that um so there there are FDA approved medications for dementia not the brand new ones but the older ones that have been now around for several decades most commonly AOSP or Denzil is the generic name uh which is for more mild to moderate and then

Memantine or Menda which is for more moderate to severe um I would say the the the benefits are small if present at all and the important thing the difficult thing to keep in mind is that people don’t improve so in this sense benefit means that the rate of decline is

Slower for some people and the really difficult thing is sort of you you don’t know what it would have been otherwise um so I would say it’s largely up to the clinician that you see whether they’re a person that uses these medications and it’s largely up to the preferences of the family and

The patient whether or not they are interested in these medications um I don’t don’t think that there’s a clear right answer the place I saw a question in the chat in particular these the AOSP family of medications um Can suppress app they can cause nausea and can cause

Possible weight loss and so for patients in particular who are thin or maybe really borderline you’re concerned about how small they are how thin they are losing weight um you would be part particularly concerned about the medications possibly even contributing more to weight loss so it’s just a very

Murky I’d say patient specific decision whether or not they’re the right thing um but really really limited benefit Dr Rose Dr Roberts any final thoughts on that yeah I guess I I I agree I get there is a lot of activity though in this space so it will be interesting to

See moving forward you know we do you have this LMI people may have heard of was just approved this year as a new treatment for Alzheimer’s there’s one called danab that will likely be approved relatively soon so I think we’re fortunately in a time where I think the treatment options are starting

To expand after many years of having zero FDA approved medications uh but you know like Donovan is saying I think a lot of it is really kind of up to the patient the family and the clinician weighing the pros and cons none of these are kind of Slam Dunk it’s kind of stop

The disease in its tracks uh so it’s it’s certainly worth I think exploring um and there’s you know a lot of activity in the space so I imagine are these discussions will be evolving uh rapidly over time thank you Dr Rose any final comments no final comments other than

Like I’m saying it’s an individual matter on the medication because you’ll find some people that said that it didn’t change them and and I think the expectations of the caregiver for the medication is somewhat oftentimes there’s a let down for that and I think someone had had in the chat about the

90y old that was 125 pounds and I think that’s what Donovan was saying that’s going to have to be between them and the clinician or which you want to give someone a medication that can cause weight loss also the newer medication one of the ones that that we’re waiting

For the FDA approval on um initially it was only going to be given to those people who were in research the cost they got the cost but the cost is still somewhat High unless you have all the different parts of Medicare and so the cost is um is something that that

Families have to consider also especially if they don’t have all the different parts of Medicare to obtain the medication I think it was very expensive uh when it initially came out and due to um a lot of the doctors and companies saying you know we’re paying this this higher price for something

That we’re not sure if it works and so those are the considerations that the family has to make even if a doctor states that if you don’t have the Monies to pay for then you have to consider how the caregiver is going to deal with the situation and like Scott was saying the

Percentage of people you’re not it’s not going to improve it it’s just going to slow it down and so that’s a consideration that that’s up to the family to make thank you so I want to be respectful of everyone’s time there are dozens of more questions in the Q&A that

We weren’t able to get to um but this was very helpful I know Dr Moss had to sign off but thank you to the two of you for particip ating thank you for everyone who joined us today um there will be an email in about a week or two

That you will receive that will have the link to the recording to share with anyone you’d like we can also include some of the links that we’ve talked about today and as I mentioned um if you do have questions you want us to follow up with the speakers on our email is

Healthy aging Series um.edu so thank you so much to the both of you and I hope everyone has a wonderful afternoon thank you take care take care

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