Transcript What is Brain Health? - Brain Injury Association of Louisiana

What is Cognitive Health?
Dr. Korak Sarkar
Department of Neurology
March 3, 2017
Disclaimers and Disclosures
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The following presentation contains copyrighted
materials used under the MultiMedia Guidelines and Fair
Use exemptions of U.S. Copyright law. Any unlawful use
is prohibited.
No relevant disclosures
Objectives
• Defining Cognitive Health
• Understanding Cognition
• Interventions for Cognitive Health
What is Cognitive Health?
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~500,000 people in the US with Parkinson’s Disease
(PD)
~5,000,000 people with Alzheimer Disease (AD)
Adopted from McGovern Institute on Brain Research at MIT
What is Cognitive Health?
• Cognitive Health is an emerging area
within Neurology to
1.Prevent neurodegenerative diseases
2.Maintain cognitive abilities
What is Cognition?
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Memory
Attention
Executive Function
Processing Speed
Calculation
Visio-spatial
Memory
Short-term Memory
Corn
Astronaut
Scissors
Hippocampus
Memory
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Long Term Memory
Motor Memory
Sensory Memory
Sensory Memory: Olfaction
• Up to 1/3 of TBI
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patients with olfactory
dysfunction and
correlates with
severity and
recovery1-3
AD and PD and
olfaction change4
Attention
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Attention video
Processing Speed
Executive Function
Executive Function
McGurk Effect
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https://www.youtube.com/watch?v=G-lN8vWm3m0
Calculation
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Counting backwards by 7’s from 100
Making Change
Visio-Spatial
Worried Well vs Disease?
• Neurological Evaluation by a
Neurologist
• Cognitive Assessment by a
Neuropsychologist
Risk Factors for Dementia and other
Neurological diseases
• obesity, sedentary life style, educational
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level, family history, head trauma,
smoking, drinking
Genetics: APOE4
a third to half of cases of Alzheimer’s
disease worldwide could be attributable to
modifiable risk factors.5
Life Style Modifications
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Exercise
Sleep
Diet
Smoking Cessation, Alcohol moderation
Medications
Exercise 6-9
Exercise
• Australian study in
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individuals with
subjective memory
complaints10
24 week “moderate”
exercise regimen
Modest improvement
in cognitive abilities
Effect lasted for 18
months
Exercise: Active life style
• Parking in the back of the parking
lot
• Taking the stairs
• Standing desks
Sleep
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Brazilian meta-analysis
of 5 studies found an
increased risk of all
cause dementia in
people with insomnia 13
Chronic insomnia
independently
predicted incident
cognitive decline in
older men14
Sleep Hygiene
1. Stick to a sleep schedule
2. Pay attention to what you eat and drink
3. Create a bedtime ritual
4. Get comfortable
5. Limit daytime naps
6. Include physical activity in your daily routine
7. Manage your stress
Adopted from the Mayo Clinic
Sleep, Memory, and Cognitive Health
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Sleep important for consolidation of long-term memory
– first direct evidence for a causal role of a hippocampo-cortical
dialog during sleep in memory consolidation, and indicate that
the underlying mechanism involves a fine-tuned coordination
between sharp wave-ripples, delta waves and spindles.15
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Glymphatic system16
 this system transports waste-laden cerebrospinal fluid (CSF),
including beta-amyloid
 Energy-requiring, increased activity during sleep
Obstructive Sleep Apnea
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breathing to repeated breathing
interruptions at start during sleep
A mild form can impact up to 20%
2-4% can have more severe forms
Increases risk of high blood
pressure, stroke, diabetes, obesity
OSA has negative effects on
cognition, most likely in the
domain of attention/vigilance,
verbal and visual delayed longterm memory, and executive
functions17
Diet: Mediterranean Diet
Fatty Acids
Fatty Acids
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Yield the most ATP on an energy per gram basis
Secondary messenger (intracellularly)
Hormone (extracellularly)
Anabolic process -> cell membranes
Familial types of disorders of fatty acid metabolism
Triglycerides
Fatty Acid
• -carboxylic acid: R–
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C(O)OH, with R
referring to the rest of
the (possibly quite
large) molecule
“R’ is a long aliphatic
chain (non-aromatic,
non cyclic)
MUFA’s and PUFA’s
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saturated: no double or triple bond
monounsaturated fat (MUFA’s), e.g. Olive Oil
– one double bond in carbon backbone
polyunsaturated fats (PUFAs) : e.g. omega fatty acids
->1 carbon double bond in back bone
3 types of omega fatty acids
– eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) both
commonly found in marine oils (marine algae and phytoplankton)
– α-linolenic acid (ALA) (found in plant oils)
Trans Fats
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A byproduct of a process
called hydrogenation that
is used to turn healthy
oils into solids and to
prevent them from
becoming rancid
So where does the
hydrogen sit relative to
each other, same side or
different side
Fats: MUFA’s, PUFAs and Trans
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Saturated and Trans-fats
– a byproduct of a process called hydrogenation that is used to
turn healthy oils into solids and to prevent them from becoming
rancid
– Processed foods; doughnuts, cookies
Mono-unsaturated fats:
– Olive, canola, peanut, safflower and sesame oils
Poly-unsaturated fats
– Omega 3 fatty acids: fatty fish such as salmon, mackerel, and
sardines, flaxseeds, walnuts, canola oil, and unhydrogenated
soybean oil
Mediterranean Diet18
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In a multicenter trial in Spain, >7500
at high cardiovascular risk, but no
cardiovascular disease at enrollment
randomly assigned to one of three
diets: a Mediterranean diet
supplemented with extra-virgin olive
oil, a Mediterranean diet
supplemented with mixed nuts, or a
control diet (advice to reduce dietary
fat).
288 had a primary end point of major
cardiovascular event (MI, CVA, or
death from there of)
multivariable-adjusted hazard ratios
were 0.70 (95% confidence interval
[CI], 0.54 to 0.92) and 0.72 (95% CI,
0.54 to 0.96)
Diabetes19
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Adult Changes in Thought
study and included 839 men
and 1228 women whose
controlled for age, sex,
study cohort, educational
level, level of exercise, BP,
and CV RF
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Patients with Diabetes with
higher risk of Dementia
Patients with Diabetes risk
of dementia higher the
higher their blood sugars
were (adjusted HR 1.4, 95%
CI [1.12, 1.76])
Patients WITHOUT
Diabetes had increased risk
of Dementia the higher their
blood sugars were
(adjusted HR was 1.18,
95% CI, 1.04 to 1.33 )
Diabetes18
Alcohol3
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Moderate alcohol
consumption tended to
be protective against
cognitive decline and
dementia, but
nondrinkers and frequent
drinkers exhibited a
higher risk for dementia
and cognitive impairment2
Smoking2
Nicotine
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smoking elevated the risk
of Alzheimer's disease7
Epidemiological studies
associated (not
necessarily causation)
tobacco smoking to be
associated with
decreased risk of
developing PD10-12
Nutraceuticals
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No meaning under US Law or Regulation
Anything from a drug, food, supplement, ingredient
E.g. Co-enzyme Q10, choline, cinnamon, turmeric
Not regulated, limited but growing data
Discuss with your patient to develop a personalized
understanding and plan
Caffeine and Cognitive decline
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Caffeine prevention of cognitive decline23
– Females without dementia 24
Obesity7
• Midlife obesity had an adverse effect on
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cognitive function in later life.
Analysis showed vegetable and fish
consumption to be of benefit,
Where as persons consuming a diet high
in saturated fat had an increased dementia
risk.
Medications
• Sleep aids (hypnotics) , ie prescription
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sleeping pills, was associated with excess
mortality 25
Anti-psychotics in elderly demented
patients associated with increased risk of
death26
Blood Pressure Medications: meta-analysis
demonstrated a preference for CCB, and
renin-angiotensin blockers 27
Proton Pump Inhibitors28
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73 679 participants 75 years of age or older and free of
dementia at baseline were analyzed
Prospective cohort study using observational data from
2004-11
patients receiving regular PPI medication had a
significantly increased risk of incident dementia
compared with the patients not receiving PPI medication
Hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001
Neuroenhancement
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Neuroenhancement is defined as prescribing
interventions to normal adult patients for the purpose of
augmenting their normal cognitive or affective function.29
Ethics of Neuro-enhancement29
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Not ethically or legally obligatory,
Not ethically or legally prohibited,
Therefore, it is ethically and legally permissible.
– It is also ethically and legally permissible to deny such
a request
Limited evidence, liability, informed consent
Medications
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Neurostimulants: methylphenidate
Cholinesterase inhibitors: donepezil, rivastigmine
Arousal: Modafanil, armodafinil
Dopaminergic: amantadine
NMDA: Memantine
Hormones
Electroceuticals
• TMS32
• DBS for AD33, 34
• TDCS35
Digital Health
Quantified Self
• Steps
• Sleep
• Food Diary
• Migraine Journal
Holistic Approach
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FINGER STUDY30
60-77yo “at-risk” by variety of cognitive and
cardiovascular RF scales followed for 2 years
2654 intervention: diet(omega fatty acid), exercise,
cognitive training, vascular risk monitoring; control:
general health advice
Primary outcome: full battery neuropsychological testing
FINGER Results
Do you remember the 3 words?
Corn
Astronaut
Scissors
Summary
• Cognitive Health is an emerging specialty
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within Neurosciences to prevent
neurological diseases and maintain
cognitive abilities
Cognition includes things like memory,
attention, and executive function
Diet, Exercise, Sleep, Stop Smoking, Drink
less
Thank you
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