is it alzheimer’s? the latest update on optimal evaluation and treatment of patients with memory...
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Is It Alzheimer’s? The Latest Update on Optimal Evaluation
and
Treatment of Patients with Memory Loss
Majid Fotuhi, MD PhD
March 5, 2014
New Discoveries
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65 year old woman with history of depression and OSA presents with memory loss and
concern for Alzheimer’s disease
Was working full time until two years ago at SS, as a manager and program analyst
Husband had severe respiratory disease and she was taking care of him until three months ago, when he died
Family had noticed a progressive memory loss for approximately 1-2 years (since retirement)
Spends much of her time at home, with no social activities or interest in taking on new hobbies
Sister is convinced she has Alzheimer’s disease Was referred to NeurExpand Brain Center for further evaluation and
treatment Is it Alzheimer’s? What can be done for her?
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Immediate Memory
Letter Fluency Sustained Attention Processing Speed
Delayed Memory
Baseline NeuroCognitive AssessmentsApril 18, 2013
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Mood Anxiety Insomnia
Cognitive Inhibition Cognitive flexibility Inhibition & flexibility
Baseline NeuroCognitive AssessmentApril 18, 2013
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Objectives What is the difference between memory loss,
MCI, and Alzheimer’s?
Why does the brain shrink with aging?
Can we reverse the effects of aging on the brain?
Can we grow the size of our brain?
Can we expand our cognitive performance and brain size? The Brain Fitness Program
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Objectives What is the difference between memory loss,
MCI, and Alzheimer’s?
Why does the brain shrink with aging?
Can we reverse the effects of aging on the brain?
Can we grow the size of our brain?
Can we expand our cognitive performance and brain size? The Brain Fitness Program
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Estimate MMSE as a function of time
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Estimated years into illness
MM
SE s
core
MCI DEMENTIA
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Memory Lapses
Memory Lapses or Alzheimer’s?
Age-Associated Memory
Impairment MCI
Alzheimer’s
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Short-term: HippocampusLong-term: Cortex
Cortex Hippocampus
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Beautiful Neurons in Hippocampus
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Hippocampal Atrophy is the Most Robust Marker for Dementia
Duara et al., Neurology 71:1986–92, 2008
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Objectives What is the difference between memory loss,
MCI, and Alzheimer’s?
Why does the brain shrink with aging?
Can we reverse the effects of aging on the brain?
Can we grow the size of our brain?
Can we expand our cognitive performance and brain size? The Brain Fitness Program
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Overlapping Causes of Atrophy in Hippocampus
Obesity-Diabetes
Stroke
Sleep Apnea
Concussion AD
Inflammation
Stress
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Brain is a Highly Vascular Organ
Zlokovic et al. Neurosurgery 43(4), 877–78, 1998
Zlokovic et al. Neurosurgery 43(4), 877–78, 1998
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Vascular Brain Atrophy in OSA
Am J Respir Crit Care Med 2002; 166:1382–7
Am J Respir Crit Care Med 2002; 166:1382–7
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Obesity Shrinks the Brain
Associated with reduced brain volume
Ward, et al., 2005
Slows cognitive function
Debette, et al., 2011
Brains of overweight and obese individuals appeared 8 and 16 years older, respectively
Raji, et al., 2010
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Brain Research Volume 1280, 14 July 2009, Pages 186–194
Figure 1 Comparison of studies of hippocampal volume in patients with cardiovascular disease
Fotuhi, M. et al. (2012) Modifiable factors that alter the size of the hippocampus with ageingNat. Rev. Neurol. doi:10.1038/nrneurol.2012.27
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Multiple Vascular Risk Factors: Worse Atrophy in the Brain
Multiple Vascular
Risk Factors
No Vascular
Risk Factors
HippocampusHippocampus
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Objectives What is the difference between memory loss,
MCI, and Alzheimer’s?
Why does the brain shrink with aging?
Can we reverse the effects of aging on the brain?
Can we grow the size of our brain?
Can we expand our cognitive performance and brain size? The Brain Fitness Program
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Treating Vascular Risk Factors Slows Decline in Dementia
Deschaintre et al., Neurology 73:674–80, 2009Deschaintre, 20093:674–80, 200921
Physical Activity and Mediterranean Diet, More Effective
Together
al., JAMA 302 (6):627–37, 2009Scarmeas et al, 2009
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Objectives What is the difference between memory loss,
MCI, and Alzheimer’s?
Why does the brain shrink with aging?
Can we reverse the effects of aging on the brain?
Can we grow the size of our brain?
Can we expand our cognitive performance and brain size? The Brain Fitness Program
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6 Steps to Grow Your Brain
1. Get Fit
2. Tease Your Memory
3. Eat Well &Take DHA
4. Sleep
5. Relax Your Mind
6. Start Early
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1. Hippocampus Grows Biggerwith Getting Fit
Erikson, PNAS 2011
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Arch Gen Psychiatry, 2010
Hippocampus Grows Biggerwith Exercise, Even After 3 Months
After
Before
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More Exercise: More Brain Cells
Van Praag, Trends in Neurosciences, 2009
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Draganski et al. J Neurosci 2006; 26:6314–7
2. Hippocampus Grows Bigger with Memorization Training
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3. Hippocampus Grows Bigger with Eating Well & Taking DHA
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More DHA-EPA: Bigger Hippocampus
Pottala J V et al. Neurology 2014;82:435-442
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Fotuhi et al., Nature Clinical Practice Neurology 5(3):140–52, 2009
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4. Hippocampus Grows Bigger with Treatment of Sleep Apnea
Canesa, American Journal of Respiratory Medicine, 2011
5. Hippocampus Grows Bigger with Relaxing Your Mind
Holzel , Psychiatric Research, 2011
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6. Hippocampus Grows BiggerWhen You Start Early
Figure 3 Pathways leading to hippocampal growth or atrophy
Fotuhi, M. et al. (2012) Modifiable factors that alter the size of the hippocampus with ageingNat. Rev. Neurol. doi:10.1038/nrneurol.2012.27
Objectives What is the difference between memory loss,
MCI, and Alzheimer’s?
Why does the brain shrink with aging?
Can we reverse the effects of aging on the brain?
Can we grow the size of our Brain?
Can we expand our cognitive performance and brain size? The Brain Fitness Program
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Brain Fitness Program
A multidisciplinary program devoted to: - Improving memory and brain performance- Enhancing long-term brain health- Reducing risk for dementia, Alzheimer’s disease
and stroke in the future
Each patient receives a comprehensive baseline assessment followed by a personalized treatment plan
This program is based on latest research and has shown remarkable results
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Comprehensive Diagnostics to Evaluate Brain
Health
Customized Treatment Program to Maximize Brain
Performance
NeurExpand’s Unique Integrative Approach
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Neuro-feedback for Treatment of Depression
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Immediate Memory
Post Brain Fitness Program Follow-UpJuly 29, 2013
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Letter Fluency
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Sustained Attention
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Processing Speed
Delayed Memory
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Anxiety
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Insomnia
Cognitive Inhibition Cognitive flexibility Inhibition & flexibility
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Post Brain Fitness Program Follow-Up
July 29, 2013
HC
2.86 cm3
HC
3.14 cm3
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MRI Results
Before
After
Objectives What is the difference between memory loss,
MCI, and Alzheimer’s?
Why does the brain shrink with aging?
Can we reverse the effects of aging on the brain?
Can we grow the size of our brain?
Can we expand our cognitive performance and brain size? The Brain Fitness Program
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Baseline MRI…
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