Dr. Miia KivipeltoProfessor of Clinical Geriatric Epidemiology at the Department of Neurobiology,

Care Sciences and Society Karolinska Institutet Sweden

Monday, September 16, 13

Is it possible to prevent

Alzheimer’s disease?

Karolinska Institutet Alzheimer Disease Research Center and

Aging Research Center, SwedenMiia Kivipelto, MD, PhD, Professor

Monday, September 16, 13

What is dementia?

Dementia is not a specific disease. It is an “umbrella term” used to describe the symptoms of a group of conditions that impair memory, behaviors and thinking.

DEMENTIA

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

What is dementia?

Dementia is not a specific disease. It is an “umbrella term” used to describe the symptoms of a group of conditions that impair memory, behaviors and thinking.

60-80%

DEMENTIA

ALZHEIMER’S

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

What is dementia?

Dementia is not a specific disease. It is an “umbrella term” used to describe the symptoms of a group of conditions that impair memory, behaviors and thinking.

60-80%

Vascular Dementia

Dementia with Lewy Bodies

Fronto-temporal Dementia

Parkinson’s Disease

DEMENTIA

ALZHEIMER’S

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Alzheimer’s Disease

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Alzheimer’s Disease

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

What are the symptoms of Alzheimer’s ?

Memory loss:Short-term memory

Dementia is progressive: as time advances, symptoms worsen.

Communication difficulties:finding the right words, understanding what is said

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Dementia is progressive: as time advances, symptoms worsen.

Ability to focus & concentrate: E.g. following a conversation

Mood changes:Sadness, anger, fear, irritability…

Miia Kivipelto, MD, PhD, Professor

What are the symptoms of Alzheimer’s ?

Monday, September 16, 13

Memory loss is a normal part of aging

Common incorrect belief

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Now we know that dementia is NOT a normal part of aging

Memory loss is a normal part of aging

Common incorrect belief

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Now we know that dementia is NOT a normal part of aging

Memory loss is a normal part of aging

Common incorrect belief

If we have a family member who is showing signs of dementia, it is important to see a doctor to determine the cause & follow the patient.

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Expected lifetime

(Christensen et al. Lancet 2009)

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

CIA World Factbook 2012, Estimated Life Expectancy at Birth.

+80 +77 +75 +72 +70 +67

Expected lifetime

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

The proportion of older adults (65+) will reach 28% in 2050

The aging population in the UAE

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

0

7.5

15

22.5

30

3.4 3.4 3.51.8 1.5 2.1 1.3 1.4 1.1 1 1 0.8 0.4 0.8 1.7

3.66.3

10.2

15.6

22.1

28

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

The proportion of older adults (65+) will reach 28% in 2050

The aging population in the UAE

Trends of UAE’s Elderly Population, 1950 - 2050

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

0

7.5

15

22.5

30

3.4 3.4 3.51.8 1.5 2.1 1.3 1.4 1.1 1 1 0.8 0.4 0.8 1.7

3.66.3

10.2

15.6

22.1

28

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

The proportion of older adults (65+) will reach 28% in 2050

The aging population in the UAE

Trends of UAE’s Elderly Population, 1950 - 2050

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

0

7.5

15

22.5

30

3.4 3.4 3.51.8 1.5 2.1 1.3 1.4 1.1 1 1 0.8 0.4 0.8 1.7

3.66.3

10.2

15.6

22.1

28

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

The proportion of older adults (65+) will reach 28% in 2050

The aging population in the UAE

Trends of UAE’s Elderly Population, 1950 - 2050

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

(Fratiglioni, Qiu, Oxford Textbook Old Age Psychiatry, 2013)

Advanced age: A major risk factor for dementia

Age-specific prevalence rates of dementia across the world

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Effects of Delay of Onset of Disease on Prevalence of Dementia

5 year delay in the onset of Alzheimer’s would decrease the disease prevalence by 50%

US

pre

vale

nce

of A

D (m

illio

ns)

Delay (years)

0

.5

1

2

5

1997 2007 2017

2027 2037 2047

Year

8

6

4

2

0

Brookmeyer et al., 1998, Jorm et al., 2005

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Dementia: importance of life-long exposure to multiple factors

Mangialasche, Kivipelto et al., 2012

BirthChildhood

2nd DecadeAdult Life - Middle Age Transition Old Age

0 20 60 75

Genetic EnvironmentHealthy Brain Alzheimer’s Brain

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Modifiable risk factors for Alzheimer’s

Risk Factors Protective Factors

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Modifiable risk factors for Alzheimer’s

Risk Factors Protective Factors

• Stroke• High Blood Pressure• High Blood Cholesterol• Obesity• Diabetes mellitus• Smoking• Depression/stress• Head trauma• ?

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Modifiable risk factors for Alzheimer’s

Risk Factors Protective Factors

• Stroke• High Blood Pressure• High Blood Cholesterol• Obesity• Diabetes mellitus• Smoking• Depression/stress• Head trauma• ?

• High education • Physical activity• Active lifestyle• Antioxidants• Fish oils• Coffee• Antihypertensives• Statins

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Combined effect of vascular risk factors at midlife

Risk

BMI

>30 kg/m2.1

Systolic blood

pressure >140mmHg

2.0

Cholesterol >6.5 mmol/l

1.9

Kivipelto et al., Arch Neurol 2005

0

1.75

3.50

5.25

7.00

0 1 2 3

6

3

11

Number of risk factors present

2

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Healthy, balanced diet can reduce the risk for memory problems

Luchinger et al., Curr Neurol Neurosci Rep 2007 - Scarmeas et al., Annals of Neurology 2006, JAMA 2009 - Mangialasche, Kivipelto et al., JAD 2010

• Fish • Vegetables and fruits• Vitamins B, C and E

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Rovio, Kivipelto et al., Lancet Neurology 2005 Rovio, Kivipelto, et al. Neurobiol Aging 2009

Physical activity at midlife

Couch Potatoes Dementia Alzheimer’s

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Rovio, Kivipelto et al., Lancet Neurology 2005 Rovio, Kivipelto, et al. Neurobiol Aging 2009

Physical activity at midlife

0.25

0.5

0.75

1

Couch Potatoes Dementia Alzheimer’s

ReducedRisk

Miia Kivipelto, MD, PhD, Professor

100%

60% 70%

Monday, September 16, 13

Rovio, Kivipelto et al., Lancet Neurology 2005 Rovio, Kivipelto, et al. Neurobiol Aging 2009

Physical activity at midlife

Physical activity – larger brain volume

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

(Karp et al, Dement Geriatr Cogn Disord 2005)

Leisure time activities in late life

0

0.25

0.5

0.75

1

High Mental Score High Physical Score High Social Score Low Score

Miia Kivipelto, MD, PhD, Professor

30% 40% 35% 100%

Reduced Risk

Monday, September 16, 13

Håkansson, Kivipelto et al., BMJ 2009 Håkansson et al., manuscript

Social and psychological factors

Social Factors Psychological factors Social+psychological

Loneliness

0

1.5

3

4.5

6

Risk Risk

Living Alone

Being Widowed

Hopelessness

Alone+Lonely

Widowed+ Hopelessness

Loneliness

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Håkansson, Kivipelto et al., BMJ 2009 Håkansson et al., manuscript

Social and psychological factors

Social Factors Psychological factors Social+psychological

Loneliness

0

1.5

3

4.5

6

Risk Risk

Living Alone

Being Widowed

Hopelessness

Alone+Lonely

Widowed+ Hopelessness

Loneliness

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Håkansson, Kivipelto et al., BMJ 2009 Håkansson et al., manuscript

Social and psychological factors

Social Factors Psychological factors Social+psychological

Loneliness

0

1.5

3

4.5

6

Risk Risk

Living Alone

Being Widowed

Hopelessness

Alone+Lonely

Widowed+ Hopelessness

Loneliness

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Loneliness

Loneliness

FUTURE

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Loneliness

Loneliness

FUTURE

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Clinical Trials

Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Intervention Schedule

NUTRITION

EXERCISE

COGNITIVE TRAINING

MONITORING AND MANAGEMENT OF METABOLIC AND VASCULAR RISK FACTORS

INTENSIVE INTERVENTION

Inte

rven

tion

Kic

k-Off

Scre

enin

g

1st B

asel

ine

visi

t

2nd

Base

line

visi

t

RAN

DO

MIZ

ATIO

N

Months

Months

3 6 9 12 15 18 21 24

MiniIntervention

Miia Kivipelto, MD, PhD, Professor

REGULAR HEALTH ADVICE

Monday, September 16, 13

FINGER intervention

Months

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

European Dementia Prevention Initiative

Months

EDPI%

http://www.edpi.org/

Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability

Prevention of Dementia by Intensive Vascular Care

MAPT Multidomain Alzheimer Preventive Trial

FINGER

preDIVA

MAPT

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Healthy Aging Through Internet Counseling in the Elderly

Months

www.HATICE.eu

Miia Kivipelto, MD, PhD, Professor

New use of technology to improve dementia prevention

Monday, September 16, 13

Months

(Mangialasche, Winblad, Kivipelto, et al., Lancet Neurol 2010)

Drug development in Alzheimer’s Disease

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Months

Is it possible to prevent dementia?

•Control blood pressure and other vascular risk factors

•Be active and maintain an active life

•Healthy, balanced diet

•Avoid negative stress

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Months

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

Months

LIFE MATTERS !

Miia Kivipelto, MD, PhD, ProfessorMonday, September 16, 13

THANK YOU

Karolinska Institutet Alzheimer Disease Research Center and

Aging Research Center, SwedenMiia Kivipelto, MD, PhD, Professor

Monday, September 16, 13