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Understanding aging and the brain

November 22, 2017 | UCI Health
dr. claudia kawas examines a patient

One of the most unique and fruitful studies on aging began in 2003 under the direction of Dr. Claudia H. Kawas, a geriatric neurologist, and her UCI Health colleagues.

The 90+ Study is the longest continuing research effort focused exclusively on the health and lifestyles of Americans in their 90s or older. The study of 1,600 residents of Laguna Woods has shed light on possible clues to healthy cognition and memory during aging.

Successful strategies to help seniors live full, productive lives can’t come soon enough. The number of Americans 65 and older will double in the next 45 years.

Live Well talked to Kawas, co-director of the study, about memory disorders and her research.

Are we any closer to understanding what is normal, age-related memory loss and what constitutes dementia?

We would like to be able to say what is normal and what is dementia. But I think normal to dementia is a spectrum. We treat it binary — you’re either normal or you have dementia. I think, in a way, that approach clouds our thinking.

Instead, what happens is that as people age they have a range of change in their cognitive abilities.

So if someone is concerned about what is normal and what isn’t, is it best to contact his or her doctor for an evaluation?

Reach out to your doctor and get a reasonable evaluation. If nothing else, cognitive testing will help us understand a lot more when we see you six or 12 months later because we have that baseline test. In large measure, the definition of dementia is the loss of abilities from a previous level and the rate at which you lose those abilities.

Do you think we’ll see more effective treatments for Alzheimer’s disease in the near future?

I think we’ve got a lot more things going on that are potentially good leads in combating Alzheimer’s disease. There are a lot of studies right now that have to do with affecting amyloid (an abnormal build-up of protein) in the brain. It’s going to take a few years to get results of those studies.

If removing amyloid helps improve cognition, that can really catapult us to a treatment approach. If the studies are negative, though, it will also teach us a lot.

According to your research, what helps preserve memory and cognitive function as we age?

One of the things we’ve learned is that a healthy lifestyle matters. Exercise, social engagement, a good diet that is not too high in fats and has a variety of fruits and vegetables and fish — all of those things matter. It’s just that no single one of those things makes a big difference. Taking a pill with vitamin E isn’t the same as eating a good diet.

Is there any proof that having an overall healthy lifestyle helps?

Over the last 10 to 20 years, the age-specific risk for dementia is going down compared to what it was before. What this means is that the risk of dementia for an 80-year-old today is lower than the risk was for an 80-year-old 20 years ago. Why is that happening? It definitely isn’t because of any pharmaceutical cure. I think it has to do with healthier lifestyles.

In the past 20 years we’ve become more attuned to healthy lifestyles and dietary concerns. Education is strongly related to dementia risk, and the educational levels in many places have improved over the last two or three decades. Also our management of vascular dementia risk factors — such as blood pressure and blood sugar — has improved.

What has your 90+ Study taught you?

This is the hardest study I’ve ever done but the most fun. It’s also the most interesting and surprising in terms of results.

We’ve learned that 40 percent of 90-year-olds who don’t have dementia still have a significant amount of Alzheimer’s pathology (amyloid) in their brains. Yet they continue to have good cognition. This tells us that amyloid can be present and still be tolderated, if we knew the secret, and that something may be causing Alzheimer’s disease other than amyloid.

We also know that 20 percent to 50 percent of individuals who are demented have no pathology — evidence of disease — in their brains. It will be important to figure out what is causing dementia in these individuals.

For people who have memory disorders now, why is the UCI Health Memory Disorders Program an important resource?

This clinic gives people access to an academic medical center where specialty-trained professionals understand the full spectrum of cognitive disorders and patients have access to a workup as well as treatment and management. Most physicians and primary care doctors don’t have the time to work with patients who have memory complaints. Unfortunately, there’s no blood test that makes it quick.

The people at the UCI Health Memory Disorders Program are highly trained and board-certified in their specialties — and all have had additional training in memory disorders. At present there are only about three places in the U.S. that have an accredited geriatric neurology fellowship program. We’re one of them.

In addition, the doctors in the Memory Disorders Program are actively doing research and can help patients and their families get access to participate in research, including experimental treatments and other clinical trials.

Key findings from the 90+ Study

  • People who drank moderate amounts of alcohol or coffee lived longer than those who abstained.
  • People who were overweight in their 70s lived longer than normal or underweight people did.
  • More than 40 percent of people aged 90 and older suffer from dementia, while almost 80 percent are disabled. Both are more common in women than men.
  • About half of people with dementia over age 90 do not have sufficient neuropathology in their brain to explain their cognitive loss.
  • People aged 90 and older with an APOE2 gene are less likely to have clinical Alzheimer’s dementia but are much more likely to have Alzheimer’s neuropathology, such as amyloid, in their brains.

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