ALZHEIMER'S - CAN WE PREVENT IT?

ALZHEIMER'S - CAN WE PREVENT IT?

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00:03
it said memory is the mother of all wisdom a fundamental part of being human but Alzheimer's disease slowly robs the mind it's a cruel and undignified descent we know that every five years after the age of 65 your chance of getting dementia doubles and that's very scary currently there is no cure but mounting research suggests that Alzheimer's can be delayed and even
00:37
prevented it's absolutely possible to have a healthy older age with intact memory and cognitive function in this episode we explore how our lifestyle choices today might affect our chances of cognitive decline in the future one year of brisk walking was enough to rollback the aging clock by about one to two years those who were adhering to a met Ryan dodge had better cognition over time from what we eat to how much we move even how we sleep
01:10
scientists are suggesting that the power to push back the disease is largely in our hands I honestly believe that probably as much as 80% of Alzheimer's is preventable that was probably about I'd say my 16th birthday also produced an affair so this cakes that mothers made on the air and there's a bottle of beer which is the old man's I'm getting on the table Grahame plants grew up in country Victoria as a young man he was close to his mum Cathy she lived for the family
01:47
in the kids and that was what really drove her and she was happiest when the family was around her but about ten years ago Cathy plant developed Alzheimer's she was in her late 60's was kind of a slow onset and then as it got slightly worse she started to forget things that she was good at one cooking or she just forget to do things altogether or she just got disoriented like putting electric kettle on hot plate things like that and forgetting what can go in the oven or what can't and those sort of things but people get diagnosed with
02:17
dementia all summers you you lose them long before they go it's kinda way of these old sinus disease is the most common form of dementia accounting for up to 70% of cases the condition is chronic degenerative and ultimately terminal so the hallmarks of the disease clinically speaking is memory loss and changing brain function for some of the dimensions this can be other brain functions than memory but for
02:50
Alzheimer's disease the first changes noticed our memory in a healthy brain billions of neurons send messages to each other via electrical or chemical signals down a long tail an axon these are the synaptic connections through which messages travel but in the Alzheimer's brain toxic deposits accumulate including the protein called beta amyloid the amyloid seems to attract another brain protein called tau
03:22
to form fibrous clumps inside brain cells this disturbs the brains message transport system and neural networks effectively disintegrate until recently this characteristic accumulation of beta amyloid was only detectable after death in a post mortem but thanks largely to Australian research with advanced imaging it can now be seen in the living turns out the process of accumulation
03:53
can begin several decades before Alzheimer's disease appears to get from a normal amount to the amount in people with our summer disease takes about 20 years so we know if we're going to intervene before you've lost near brain cells and before you've got memory loss we need to be intervening much earlier than we are now this is a nail fungus disease brain you can see lots of holes lots of cell loss they're really wide ventricles and we know that this occurs over a great many years if we were to intervene say ten
04:25
years before we would expect still some cell loss but as you can see here there's a lot more of this white matter if we were to intervene 20-30 years before disease we would hope to maintain full cell function and cells without the loss and that's why early intervention is just so important in midlife Graham plant is doing just that after his mother died from Alzheimer's in 2013
04:57
Graham decided to take active steps to try to avoid his mother's faith so that became a clarity point to say well what are the processes what things I can do to reduce the risk and at that point I'd probably recognized that I wasn't overly healthy I was a fair bit overweight and sort of decided well it's time to make a change I was classify runnings not a hobby now it's becoming a way of life it resulted in me being better in a whole host of
05:31
ways as far as health and well-being science is suggesting grams on the right track because the genetic risk for Alzheimer's is actually less than you might think there's a small percentage less than 1 percent of people who have genetic form of Alzheimer's that causes Alzheimer's that's the uncommon familial form of early onset Alzheimer's for the more prevalent later onset form of the disease the risk is gene variant is apoe4 but
06:05
even then environmental factors will largely determine whether the disease develops genetic risk factors don't cause Alzheimer's disease but together with other factors such as lifestyle factors that's when people go over the edge and develop Alzheimer's disease we also know that the genetic component to risk appears to be only about a quarter so that means that three-quarters of the risk is environmental and something that we can change it's an encouraging message and exactly what we should be doing as being the
06:40
focus a professor Serkis latest research she's trying to identify the preventative factors for cognitive decline her team has followed a group of 400 women in Melbourne when the study began the women were aged between 45 and 55 they were then monitored for the next 20 years a wide range of assessments were done from physical measures like their weight and BMI to a battery of
07:11
neuropsychiatric tests the first task I'm going to get you to do is a reaction time task you'll see a deck of cards and fruiting participants in midlife was pivotal a lot of the studies that look at cognitive decline and dementia recruit participants over 60 or over 70 because this is when cognitive decline dementia stands to occur I'm going to ask you to repeat as many of the words as you can remember giraffe cow tract spinach one of the great things that that out work was we were
07:43
able to look at what people were doing at 45 to 55 and then look at cognitive decline across 15 years and see what factors were most important they found that the most important preventive factors against cognitive decline were having normal blood pressure and high levels of good cholesterol but at number one was being physically active so the results that are in the paper of the entire group and their group trends what we're looking at here is individual
08:13
people's test results so this is someone who is exercising every day and they remembered eight words and then they remembered as many words as possible so they hear what we call the ceiling of the test they could not get better than this over time this is another person who was exercising on average daily and again we can see quite good memory recollection and maintained across all of the years of the study we look here at someone who's never exercised and they have a poor memory function and it declines quite considerably over the testing period another person again we
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see a memory decline over this period what we found was that the effect was cumulative so this meant that what you did for that entire 20 years was important for the memory you had in later life it seems a very clear message move often and start today in this study we were not prescriptive about what kind of physical activity you had to do it
09:16
was just being active on a daily basis professor Serkis research was solely in women and only observational the scientific gold standard however a randomized control trials and American neuroscientist Kirk Erickson has conducted several of these trials in older adults with both women and men looking at the effect of moderate exercise on brain size and memory the 2011 trial was particularly provocative
09:49
150 relatively inactive people were allocated to either an aerobic walking group or a stretching control group and it was for a year they come in for the same amount of time three days per week so the main differences between our two groups is the intensity of the activity the walking group is getting moderate intensity and the stretching in Tony more light intensity before the participants began their activities their brains were imaged we put them into an MRI machine a magnetic resonance imaging machine that allows us to take
10:24
very high-resolution detailed images of their brain they were particularly focusing on the hippocampus a region critical to memory formation so if you stick your fingers in your ears and essentially like this pointing at your ears like this you're essentially pointing at the hippocampus so the hippocampus sits behind the ears in the deeper in the center of the brain normal aging sees the decline in the size of the hippocampus of about one to two percent a year after the age of 50
10:55
astoundingly this trial found that brisk walking could reverse that decline in the red line we're seeing a pattern of normal aging this is our control group that is showing a normal decline in the blue line we're seeing those people that are exercising the exercising group showed an increase in the size of the structure over this one-year period the change in the size of the structure amounted to about 2% increase in the hippocampus kind of like rolling back the clock
11:26
about one to two years in terms of aging of the hippocampus whether these very tangible changes to the structure of the brain translating to improved cognitive function is yet to be fully established but Cooke certainly believes they do we know that the hippocampus is involved in memory formation we know that exercise influences the hippocampus and we know that deterioration of the hippocampus happens with age and leads to Alzheimer's disease so there's plenty of reasons that
11:58
enlarging the hippocampus through exercise will have a very clinical meaningful impact on memory function and risk for dementia brian plant is moving much more than his mother did he's also eating very differently to hurt as a lemon slice and jelly slices for the legendary country women's association but baking is kind of what she did there she I've been in the
12:28
kitchen as does Graham but these days he's cooking a very different cuisine to the one he grew up on a variety of tastes that she like that miss myself wouldn't have been on on the country Women's Association it's a diet he believes is better for his brain and
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health in general a lot of cooking you know Stu did a lot of barbecuing a lot of loads and loads of meat waiters probably now I don't really have any still fish the fish side of things is want to keep as part of moderate protein intake twofold as one is the other good for me and there's a whole host of benefits around fish but primarily vegetable no dairy and it's helped on I guess reduced my weight but also to I feel better for it there's been plenty of research over the years showing the cardiovascular benefits of a
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healthy diet now there's mounting evidence diet also impacts on the brain and cognitive function much of the research has looked at the Mediterranean diet and one of those investigations is the Australian imaging biomarkers and lifestyle study known as the able study it investigated the effect of a Western diet this is a Mediterranean diet on cognitive change in a group of 500 people they're able study which is a longitudinal study over
14:05
the last eight years we've been able to look at diet and what we clearly show is that people who are dear very strongly to a Mediterranean diet have a lower risk of Alzheimer's and there's a lot lower levels of beta amyloid in their brain although the able study is not a gold standard clinical trial its findings are consistent with other similar studies adherence to my training diet means you're more likely to have good executive functioning which is what we call planning and that a Western diet is
14:37
more likely to drop your visio speacial and these kind of things are associated with the vascular disease which is expected for a Western diet the first dish I'm going to make is a very traditional village style vegetable stew sooo red is a dietitian and an expert in the Mediterranean diet most dishes in the Mediterranean started off with garlic onion and olive oil what we're currently lacking is good
15:12
quality clinical trials on the Mediterranean diet and cognition and brain function so this I think is going to be the next frontier but we have reason to be optimistic because the Mediterranean died generally speaking is also associated with a longer lifespan and everything goes into one pot this is what I love about this dish the Mediterranean diet refers to the cuisine consumed in the olive growing regions around the Mediterranean Sea it's a
15:43
culturally broad in diverse area so it's not exactly identical say in Lebanon or Morocco or Spain but what is characterizing the Mediterranean diet is that it is a plant-based diet based on unrefined food so lots of whole grains legumes fruits and vegetables nuts and seeds and of course extra-virgin olive oil what olive oil does is it sweetens the vegetables so even bitter tasting vegetables such as those edible wild
16:14
greens can be masked the bitterness can be masked and the olive oil makes the veggies taste really sweet the extent to which each ingredient in the diet is protective against Alzheimer's isn't yet clear do you think two particular ingredients are very very powerful roles to play what is fish everything the mega trees and fish are going to be a big players and fruit and vegetable so a lot of the antioxidants you'd find it for the vegetables what we've done we have thoroughly washed our dark leafy greens
16:47
and died in this case and we're just going to stuff those as many as we can into a pot so with the dark green leafy vegetables what we know at present with scientific research is that they're very rich in something called lutein lutein is an important antioxidant that gets deposited in the back of the eye the macula and it's a bit like sunscreen for the eyes but also it gets taken up into the brain where it's Shadid and we believe it may have an important role there is an antioxidant
17:16
they call this hot tub what the means grass these dark green leafy vegetables are loaded in something called nitrate nitrate when consumed gets converted into the body into nitric oxide and nitric oxide is crucial to helping keep your blood vessels flexible and that's important as we get older because blood vessels tend to stiffen up does anyone dayquil volleyball another thing about the Mediterranean diet is it's low in refined sugar the
17:58
traditional Mediterranean diet was very low in added sugar content that was because they had to buy it and people were poor in those times so if anything was used for sweetness it was either a bit of honey or a bit of grape must or something like that but the diapers generally low sugar striking sugar off the menu is a challenge for many like Susan Lynch a participant in the able study the hardest part of the of trying
18:31
to follow the Mediterranean diet is cutting out all the cakes and biscuits and ice creams and that really is difficult for me the excessive sugar intake in the Western diet increases the risk of developing insulin resistance this is essentially when the action of the body's insulin becomes ineffective some researchers like Professor Susan dellamonte believe this has a detrimental effect on the brain leading
19:07
to a type of brain diabetes and eventually help Simas people have gradually increased the interest in the brain diabetes story and I think it's very exciting time to be doing this type of research insulin is a hormone best known for controlling the amount of blood glucose in the body but it wasn't until professor dellamonte began researching that she realised insulin has a crucial role in the brain - it
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aids the uptake of glucose in the brains nerve cells and helps regulate the chemicals involved in the brain signaling knew that insulin had an effect on keeping neurons alive and at the time I was studying there was actually no information so I was the beginning of studying how insulin worked in the brain to begin with professor diliman steam blocked the action of insulin in the brains of rats to see if it had any effect the results
20:10
were profound so the way we test the animals we put them in in a maze it's called the water maze and they're supposed to be able to learn where the platform is and they swim until they find the platform and the smarter they are they quickly recognize where the platform is even if they can't see it but the rats that lose their hippocampal function because we knocked out the insulin receptor or we knocked out insulin they spend a longer time looking for the platform they don't remember
20:43
where it was and they're very slow and sloppy at learning these rats had developed amyloid like plaques resembling the ones found in people with Alzheimer's many of the features that we look for in Alzheimer's were present in these animals and I think that helped to fortify the hypothesis that Alzheimer's is a metabolic disease very similar to diabetes but pretty much confined to the brain it is attempting thesis but the
21:13
researchers like Professor Sir key Alzheimer's prevention likely involves more than one factor it's about combination I think also when we look at diet and exercise and a lot of these factors social engagement all these things we need to do we forget about the overlaps between them so with physical activity those people who aren't doing more physical activity often it was in group activities or even when they're going for a walk that going for a walk with someone else so there are added benefits more than just the
21:44
exercise on its own that combination of lifestyle interventions on cognitive function is the focus of this randomized control trial it's been conducted by a team of sleep scientists in Melbourne so diet exercise and sleep are considered the three pillars of health and based on research in the sleep field we know that maintaining good quality sleep is key to maintaining cognitive function in later life okay so for this task you're going to be trying to find a hidden pathway
22:23
through a maze so we're looking to see whether enriching someone's lifestyle improves both their sleep and their memory and then we're looking to see whether those improvements are related to each other so whether by improving sleep you can also improve memory the intervention involves what they call an enriched environment it features three different activities and they're done in a group there's a creative class like painting a cognitive activity like chess and an exercise class because you
23:04
use other colors that are in your painting there's mirror vahanam and color harmonies up to now most of the lifestyle intervention studies have isolated each of the interventions they generally never combined the activities together however animal research has shown that by combining these things together you get greater improvements we suspect that the total of those is greater than a sum of its parts so by combining them we hope to alleviate more the cognitive symptom or
23:35
G of these individuals sleep is essential for a host of reasons including for brain function recently we've learnt that one specific stage of sleep is critical for memory formation we know this because if we deprive an individual of slow-wave sleep memory is severely impacted and if we enhance though way of sleep we enhance memory performance but as you age you spend much less time in that memory forming slow-wave sleep phase as you can see in this comparison of an older and younger
24:06
person so this represents an eight-hour sleep period for n1 sleep and two sleep which are lighter stages of sleep and the slow-wave sleep which is represented here by the blue bar we can see for the first sleep cycle there's a lot of slow-wave sleep in this younger participant and also in the second sleep cycle as well if we compare this to the older participant and again looking at the blue bar you can see that there's a much less duration of slow-wave sleep the team is hoping the combination of lifestyle activities will have a positive effect on slow-wave sleep and
24:41
in turn on memory because the study is ongoing we haven't analyzed all of the data at this point but we have had a look at some initial results and they are promising so we've seen that there is an improvement and self-reported memory we've long known the healthy aging is possible though far from inevitable but we now know Alzheimer's isn't just a lottery I don't think anyone in this field is
25:21
saying that participation in physical activity or eating a healthy diet will eliminate your risk there's always going to be a risk right no matter how healthy you are no matter what you do there's always going to be a risk for heart disease or cancer or dementia so we can't be we can't be a hundred percent certain ever but I think that if we can cut your risk in half that's that's pretty substantial it's pretty soon making the right choices throughout life increases the odds of a good old age
25:55
that benefits ourselves our families and society at large else I was a it's terrible for the person it's equally is bad for the family and so I would like to think I'd put my family to it for that as a consequence of poor maintenance I certainly believe we can delay the onset of our farmers disease without a doubt now a lot of little things together actually make a big difference a little bit of diet a little bit exercise you have to do a lot then
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it also succumb together and you feel much better for

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