Exploring the Latest Research on Caregiver Strategies and Resources for Fighting Back Against Alzheimer’s Disease
Introduction
Welcome to Dementia Matters, a podcast dedicated to educating listeners on the latest research, caregiver strategies, and available resources for fighting back against Alzheimer’s Disease. I’m your host, Nathaniel Chin, and today I’m joined by Dr. Rachel Whitmer, a professor and chief of epidemiology at the University of California Davis and the associate director at the UC Davis Alzheimer’s Disease Center. Dr. Whitmer studies population science to understand brain health and identify ways people can lower their risk for dementia.
What is Epidemiology?
Dr. Whitmer, thank you for being here. Can you explain what epidemiology is and how you use it to study dementia and Alzheimer’s disease risk?
That’s a great question, because often in epidemiology, people sometimes assume that someone is studying skin. They think of the epidermis, so no, I’m not a skin doctor, although certainly someone could do epidemiologic work on skin disease. One of the things that’s a big trigger is people think of the word epidemic and then they think epidemiology. So when you think of an epidemic, that’s an outbreak, so that’s a sudden increase in a disease. The nice thing about epidemiology is it’s not set up to only study infectious disease, it’s also set up to study chronic disease. And so our lab is really interested in cognitive aging, brain aging, brain health, dementia, and Alzheimer’s disease. And so epidemiology is really a toolbox.
Modifiable Risk Factors for Alzheimers Disease
Scientists and doctors are talking about modifiable risk factors for Alzheimers disease. These are characteristics of a person’s health or lifestyle, or even details about their life, that could potentially change. For instance, a person’s weight can change or a person can take blood pressure medication.
Studying Modifiable Risk Factors
Researchers like to focus on modifiable risk factors, which are things that happened retrospectively. This means looking at things that happened early in life, such as young adulthood, midlife, or even childhood. The adage “what’s good for your heart is good for your brain” holds true and sums up the research well.
Population Based Approach
When taking a population based approach to understanding what might drive a certain disease, researchers look at changes in a population of risk factors or protective factors. This includes looking at the number of people who are getting a certain disease or condition, as well as the number of new cases over a certain time period, or the current number of existing cases (prevalence).
To a heart attack or stroke, you might be more likely to be in the group that was followed over time, but when you look at the bulk of the work, it really shows that the things that you think about that you can do to help your heart and be heart healthy, really also help the brain.
Vascular Risk Factors and Brain Health
Having good vascular risk factors in midlife is important for brain health. This includes having good blood pressure, avoiding diabetes or having good glycemic control if you have diabetes, and maintaining a healthy weight.
Smoking and Brain Health
Smoking is bad for the heart and the brain. Studies have shown that smoking can increase the risk of Alzheimers disease. However, there were some studies done where they were following older people just over a short time period and it seemed to suggest that smoking was good for them.
Heart Health and Brain Health
The bulk of the work shows that the things that you can do to help your heart and be heart healthy, really also help the brain. This includes having good vascular risk factors, avoiding diabetes, maintaining a healthy weight, and not smoking.
Heavy Smoking and Dementia
Living to the age of 70 or 80 without suffering a stroke or heart attack is a form of selective survival. As a result, the risk of developing Alzheimer’s disease is lower. However, epidemiological research has found that heavy smoking is a robust risk factor for dementia and Alzheimer’s. This is likely due to the link between smoking and stroke. Several studies have replicated this finding.
Social Epidemiology
More recently, researchers have been looking into social epidemiological questions such as racial and ethnic differences in aging. This includes looking at years of education and state of birth. A study of a cohort from Northern California found that being born in a state with high stroke mortality or high infant mortality rates was associated with a higher risk of dementia, particularly among African Americans.
Researching Racial and Ethnic Differences in Alzheimer’s Disease and Healthy Aging
A lot of research is being done to understand the educational system and access to health care for people from the south. Researchers are trying to understand how early life exposures to adversity or social deprivation can set up the brain for long term risk of dementia. The findings could affect public policy and how we take care of our citizens.
Digging Deeper
Follow up studies are being done to look at segregation and the number of days that schools were open. This is to understand how these factors can set up the brain for either elevated or lower risk of accelerated brain aging. These findings have big implications for policy and show that if we have equal access to high quality education, it can improve the quality of life and protect the brain.
Research Projects
One of the research projects that is being conducted is looking at racial and ethnic differences in the development of Alzheimer’s disease and healthy aging in African Americans. This research is important to understand how these factors can affect the brain and how we can take care of our citizens.
The Pointer Study
The Pointer Study is a lifestyle intervention study funded by the Alzheimer’s Association. It is a clinical trial where people are enrolled in one of two interventions.
Structured Intervention
The structured intervention includes four days a week of physical activity, subscribing to the Mind diet, cognitive brain training, social support, and clinical oversight of risk factors.
Self-Guided Intervention
The self-guided intervention includes health education materials about how to make lifestyle better and clinical oversight of risk factors, but no adhering to a diet, no cognitive brain training, and no physical activity.
Mind Diet
The Mind diet is a combination of the Mediterranean and the DASH diet developed by Professor Martha Claire Morris at Rush.
The Finger and US Pointer Trials
The Finger trial, conducted in Finland by Professor Mia Kivi, Pelto, ended a few years ago and was a lifestyle intervention study. It found a positive association between lifestyle changes and less cognitive decline.
Unique Nature of the US Pointer Trial
What’s fascinating about the Finger and US Pointer trials is that, while the US has had smaller trials that focus on one thing like physical activity, no one has done something that looks at all these different things.
US Pointer Trial Details
The US Pointer trial is being conducted by the University of California Davis (UC Davis) and Wake Forest, with Russia as the coordinating center. It will enroll 2,000 people, 400 at each site, 200 in each arm. The participants must be elderly and somewhat sedentary, and not already following the Mind diet.
Challenges of the US Infrastructure
Unfortunately, it’s not hard to find people with an unhealthy lifestyle in the US due to the way our infrastructure is set up, which can make it difficult for people to make healthy lifestyle changes.
Access to Healthy Food
Getting access to healthy food and finding time to exercise are important components of a healthy lifestyle. The Finger Trial, conducted in Finland, was successful and has inspired a worldwide network of sites to emulate the study.
Finger Study Around the World
The Finger Study has been replicated in Singapore, Canada, China, and other countries. However, the exact prescription of the Finnish study cannot be replicated in every location. The diet that worked in Finland may not make sense in Singapore or China, so the same recipe must be adapted to fit the culture, country, and socio-cultural context.
Follow Up
The Finger Study is a five year study, with enrollment taking approximately a year and a half. Participants are seen every six months over two years, and the primary endpoint is cognitive change. The study will compare the cognitive change of one group versus the other.
Differences in Alzheimers Risk Factors
Research is showing that Alzheimers affects different groups of people differently. We see disparities and differences in rates of dementia among racial and ethnic groups. Race is seen as a psychosocial construct, and there are huge differences in exposures, access to education, and the level of education of the parents. It is important to quantify these differences to understand why they exist.
Understanding the Mind Diet
The Mind Diet is a way to reduce the risk of Alzheimers. It was developed by Dr Martha Claire Morris and has been discussed in an earlier podcast episode. This diet includes eating a variety of vegetables, fruits, nuts, legumes, whole grains, fish, poultry, olive oil, and low-fat dairy. It also includes limiting red meat, butter, and sweets.
Learning More
For those interested in learning more about the research being done on Alzheimers, they can visit the website. Additionally, the podcast episode featuring Dr Martha Claire Morris is available for those who want to learn more about the Mind Diet.
Wisconsin Alzheimer’s Disease Research Center
The Wisconsin Alzheimer’s Disease Research Center (WADRC) is a collaboration between the University of Wisconsin School of Medicine and Public Health and the Geriatric Research, Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It is funded by private, university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer’s Disease Centers.
Dementia Matters Podcast
The WADRC produces the Dementia Matters podcast, which is hosted by Rebecca Wazileski and edited by Bashir Aden. The musical jingle is “Caste to Rest” by Blue Dot Sessions.
Contact Information
For more information about the WADRC, visit their website at adrc.wisc.edu. You can also follow them on Twitter and Facebook. If you have any questions or comments, you can email them at dementia matters at medicine.wisc.edu.
The Wisconsin Alzheimer’s Disease Research Center is an invaluable resource for those looking to learn more about Alzheimer’s disease and dementia. Through their Dementia Matters podcast, they provide valuable information and resources to help those affected by dementia.
