9UNP1146SD_Bendlin

- Thank you, everyone, for coming out on this, I don't think I'd be exaggerating if I said frigid February day, for our Better With Age series.

My name is Marge Murray and I am director of Geriatric Services, which I would really like to rename director of Aging Services just because I don't like the name, but at UW Health.

And I'm really proud to be putting on this series on healthy aging.

If, after the program, anybody has any thoughts on future shows, future presentations, please come up and give me some ideas because we're looking to program out into 2016, and we are looking at topics of interest as we all age.

And I think there's probably nothing more pertinent than memory loss.

I'm hoping to learn if I'm okay today, also.

We have a substitution.

We don't have an understudy, but Dr. Carey Gleason was supposed to be our presenter today and had an illness in the family, and we are so lucky to have Dr. Barbara Bendlin agree to step in at the last minute to talk about what is normal aging and what is memory loss.

Dr. Bendlin is actually a Canadian, and I picked her up to bring her out here today and she said it's not cold out, what are you talking about?
[LAUGHTER]

And she says that even though she did her doctoral work in University of Arizona, so she did go farther south.

But we are really lucky to have her here.

She researches the brain and Alzheimer's and different that affect it, and hopefully she'll be part of the team at the Wisconsin Alzheimer's Disease Research Center that someday helps us find cures or treatments for Alzheimer's.

So, here's Dr. Bendlin.
[APPLAUSE]

- Thank you, Marge, and thank you to all of you for coming here this afternoon.

Just in terms of housekeeping, I'm going to go over the presentation today, and we're going to save questions to the end.

But I'll stay as long as you want to ask questions.

So, today, I'm going to talk about normal aging and memory loss.

My subtitle is Lessons on Aging, Alzheimer's, and Maintaining a Healthy Brain.

And just to tell you a little bit about my background, my training is as a cognitive neuroscientist, which essentially means I'm interested in the mind and the brain, and I'm particularly interested in aging and what happens to the brain in aging and then how that translates to changes in thinking abilities.

So, first of all, I don't have any conflicts of interest.

My research is funded by the National Institute on Aging, and also by the Alzheimer's Association.

So what I'm going to do today is just give you a short tour of the brain.

Then I'm going to talk about how the brain and our thinking abilities change with aging.

We'll discuss Alzheimer's disease, and then in my conclusions, I just want to maybe discuss some ideas we have for aging more healthily.

So, here is the organ that I study.

And this is truly the organ that makes us who we are as people.

It's how we recognize ourselves, how we form our memories, how we were able to get here today, anything you remember from this talk, it's all based in this organ right here.

The brain weighs about three pounds.

It's only about 2% of your body weight, yet it uses a lot of your body's energy.

About 15% of your cardiac output goes to the brain, 20% of your body's oxygen, and 25% of your body's glucose, or sugar, is used by the brain.

So it's a very hungry organ.

Now, the way that that energy is delivered to the brain is through this very complex vascular system.

And shown in this picture are the large vessels that deliver the blood to your brain.

But there are also very small vessels that travel to all the different parts of your brain.

And those are shown here.

Has anybody seen this picture before?

This is called a corrosion cast.

This is actually a plastic cast of the blood vessels in the brain.

And the way that this is made is by taking a brain out after someone has died and infusing it with liquid plastic, and the liquid plastic goes through all the vessels in the brain.

Once they harden, the brain is dropped in acid, and that corrodes away the brain tissue, and what you're left with is this very beautiful model of all the vessels in the brain.

And some of these are so small that you can actually only see them under a microscope because some of the vessels in our brain are so small that only one blood cell can pass through.

This is a cross-section of the brain.

So this would be, if we took a brain and we cut it this way, you should be able to see that there's sort of a surface of the brain, that's called the gray matter, and then underlying that is what we call the white matter.

And you can sort of see it looks white in this picture.

And the reason why I'm showing you these pictures is because I want to talk about how the brain changes with aging.

This cartoon here is of a brain cell.

And the brain cells are what form the neural networks.

So anything you remember from this talk today is actually encoded in the brain through connections between the cells.

So, what happens to the brain as we get older?

If you could imagine after death, if you had the brain of a young person and the brain of an older person, what would be the first difference you would notice?

The size and the weight.

So, the older brain shrinks.

It weighs less.

And there's about a 15% to 30% drop as we get older.

Now, what causes that loss of cells?

Or the loss of the weight, I should say.

The loss of the brain volume.

Well, to answer that question, I should just give you a little bit of history.

For a long time we believed that that loss of volume was due to loss of brain cells.

So these are a couple of studies from the 1980s that actually suggested that as we age, we lose about 50% of our brain cells.

How many people here think that might be true?
[LAUGHTER]

I see a couple hands.

I'll tell you right now, it's not true.

So, why did we believe that the brain lost so many cells?

So in these studies, what they did was they compared younger adults and older adults.

They compared the brains after death, and what they did was they dropped the brains in fixative.

Now, it turns out that the younger brains, when they were dropped in this fixative, shrunk more.

So when the scientists looked at small cubes of brain tissue under the microscope, they found that the younger adults had more density of neurons.

So there was more cells in the small piece of tissue.

And it was really because their brains were responding differently to the fixative.

So they concluded that older adults have less brain cells.

They also found that there was less large cells.

So when they looked at sizes, small, medium, and large cells, they found that there was 60% less large brain cells.

Based on that, they concluded that those cells had disappeared.

The truth was the cells had shrank.

We now know that in aging we don't lose a lot of brain cells.

We lose some, but not as many as previously thought.

Another thing you might not be aware of is that we actually grow brain cells.

And this happens throughout your whole life span.

So, every day, thousands of new brain cells are added to the brain.

And this is something that goes on for your whole life.

So, what's causing this loss of volume?

Probably it's due to the shrinkage, and it's also due to some specific parts of the brain that are shrinking.

So here I have an example of a young person and an older person, and there are three brains at the top and three brains at the bottom.

It's basically different sections through the head.

If you had to guess who the older person was, is it on the top three or the bottom three?

- Bottom.

- Bottom three.

That's right.

Okay, so let's talk about what some of the differences are.

You'll notice that in this part of the brain right here, you see more dark fluid.

That's a fluid filled space in the brain.

And you can also see it looks a little bit more dark around the edges of the brain.

Again, as the brain shrinks, there's more fluid around the edges.

Another thing you'll notice, if you compare the top brain and the bottom brain here, and I'm not sure if you can see my little arrow, but the shape of the fluid filled spaces is different.

Even though the young person and the old person had their brain picture taken at the same location, the shape of those fluid filled spaces is different.

And the reason for that is that as we age a certain part of the brain starts to shrink, and it's the frontal lobes.

We also see changes in the temporal lobes, and this is a normal part of aging.

Now, the reason why this is important is because the brain shrinkage is really maps on to the types of changes in thinking that older adults notice with aging.

So, what's the number one complaint with aging in terms of thinking abilities?

- Memory.

- Memory loss.

And this is very normal in aging, and it's because we have changes in the temporal lobes and in the front of the brain.

Now, some of the changes that we experience in the front of the brain actually map on to some of the examples that I'm going to give you.

So, one thing that we notice with aging is that we might have trouble with decision making or problem solving

Now, this is under very specific circumstances because, in general, older adults actually are fairly good problem solvers

They get along quite well.

They live independently.

Let's take a problem such as arriving home from a trip, you're at the airport, you go to pick up your car and you notice a flat tire.

Most older adults can solve this problem.

Teenagers?

Not so much.

Teenagers will immediately call for help.

Now, where would an older adult have more problems?

The example I use here is scams.

And this is something that maybe you or your friends have experienced.

Someone calls you on the telephone, tells you that you've won a lottery, and if you would only give your bank number, then you will get your money.

And I use this example because it happened to my own mother-in-law.

And she is a very sharp woman, but she was convinced that this was a true scenario.

So, what's going on here?

In this case, when my mother-in-law was on the phone, she's getting a lot of information.

She's also having appeals to her emotion.

She's put under pressure.

She needs to make a decision very quickly.

These are situations where, as we age, we have more difficulty.

So, as an older adult, you sort of have to have rules in place.

If somebody calls you on the phone, first thing you need to do, if you think it's a scam, is hang up the phone.

That goes for sort of any appeals for money.

And it's a very common problem.

In fact, the costs of financial exploitation, I've read, have been very high.

$2.9 billion in financial exploitation in 2010.

So that is a lot.

So that could be an example where because brains are changing as we're getting older, we have more difficulty making quick decisions.

Attention, especially divided attention, can become more difficult as we age.

So, for example, if you're driving in the car, it may be harder to pay attention to a GPS that's talking to you, a phone that's ringing, radio that's on, and cars coming from many directions.

This is something that becomes more difficult as we age.

Something called prospective memory.

This has to due with remember appointments, remembering to take medications.

In these cases, memory aids can be very useful.

And especially if we have busy lives, we need to keep track of this information, usually using some type of memory aid.

Writing these things down on a calendar.

Source memory.

Does anybody know what that is?

It's kind of a scientific term for remembering where you heard something.

So, you might know something but you can't quite remember where you heard it.

Did you hear it from a trusted source?

Did you hear it from a doctor?

Did you read it at the checkout stand?

This is something that becomes more difficult as we age.

And then working memory.

And this involves holding things in mind for a short period of time.

So, tell me, how many of you have sat down to read a book, realized you needed your glasses, walked into another room to look for them, and then could not remember why you walked into that room?
[LAUGHTER]

This is something that happens quite often.

I see a lot of hands out there.

This is something that is just, it starts in middle age, and it seems to get worse, but once you go back into your original location where you were, you remember what you had gone to look for.

And so this is, some people call it a senior moment.

It's just the inability to hold things I mind for a short period of time without a cue.

And this is what happens when you walk into a new room.

Whatever cued you in the first place is gone.

Now, I actually am going to ask Marge to come up here and give an example for us.

This is a test that we use in the laboratory to measure what we call frontal lobe function.

So Marge's task here is quite easy.

I just want her to look up at the screen and name the color.

Are you ready, Marge?

- I'm ready.

- Okay.

Name the color, Marge.

- Which one?

- Starting at the top and go down.

- Red, yellow, green, blue, red, blue, yellow, green, blue, red.

- Very good.

Now I'm going to ask you to do it again for me.

Name the color.

- Read it or name it?

- Name the color.

- Yellow, green, blue, red, green, yellow, blue, red, green, yellow.
[APPLAUSE]

- Very good.

Thank you.

- She told me I would ace this, and, trust me, that's hard.

- Thank you, Marge.

So, for those of you that tried that, it's quite a bit more difficult to name the color if it's different than the word.

And that is because most of us here are very good readers, and reading is very automatic.

And in order to suppress the urge to read the word, you need to inhibit.

And that is something that changes as we get older.

So, young people do very well on this task.

I had a student in my class, in fact he was even colorblind, and he did quite well.

So, when you're younger, this goes faster.

But as you get older, and especially because of those frontal lobe changes, this becomes more difficult.

Okay, so why do I have a picture of a cat and a dog up there?

It actually has nothing to do with the next demonstration, but it will sort of make us all more relaxed because we're going to try a memory demonstration.

So, you can participate if you want, but you don't have to.

What I'm going to do is I'm going to read a list of words.

And then what I want you to do is just try to remember the words.

And after I'm done reading the list, you can say them to yourself, if you like, or you can just listen and watch.

So I'm going to read a list of words.

Listen carefully.

When I'm finished, you will repeat to yourself as many of the words as you can remember.

It doesn't matter in what order you repeat them.

Just try to remember as many as you can.

Are you ready?

Trumpet.

Window.

Shell.

Tea.

College.

Child.

Sun.

Field.

Bib.

Teacher.

Mouth.

Chicken.

Sound.

Garage.

Lake.

Now, say to yourself as many words as you can remember.

It's a lot of words, I know.
[LAUGHTER]

So, for those of you that think you can remember some of them, there's a lot of things that will affect your ability to remember those words.

Some of the things that affect how many words you remembered are whether you are male or female.

Women tend to remember slightly more words.

Your education actually influences how many words you're going to remember.

Another interesting thing that will affect how many words you remembered is what you ate for lunch.
[LAUGHTER]

So, I don't know how many people had pad Thai, but those people probably did really well.

The truth is that how much sugar you have in your blood at any one time will affect how well your memory is functioning.

After you eat a meal, your blood sugar raises.

You also release a hormone called insulin, and both of those things are critical to memory function.

This is a picture here, again, of the brain.

This particular structure here, it's called the hippocampus.

And this is the brain structure that lets us form new memories.

And the reason it's called the hippocampus is if you look at this picture here, this structure has been cut out of a brain postmortem, and it looks an awful lot like a seahorse.

So hippocampus is Latin for seahorse.

And that brain structure needs glucose or sugar.

It also needs insulin to new memories

What else do you think affects your memory performance.

I think I heard someone say sleep.

And up here we have a picture of someone sleeping like a baby.

You probably thought I was going to say if you have a new baby at home then you're going to lose sleep, but the truth is that if you don't get adequate sleep, that will also affect your memory function.

It'll affect your memory function after just one night of poor sleep, and chronically over time, if you have many nights of poor sleep, that will affect your memory in the long-term.

And there's actually new research suggesting that disrupted or interrupted sleep could be a risk factor for developing dementia.

What else?

On the opposite side of sleep, being awake certainly is useful.

Having a cup of coffee or taking caffeine is actually really good for memory function.

I'm not suggesting anyone who normally doesn't drink coffee should take it up, but if you do drink coffee, it can actually help your memory performance.

And, in fact, there was a recent study showing that if you learn new information and you drink a cup of coffee afterward, you will actually remember the information better the next day.

So this doesn't even have to do with feeling awake or having good attention while you're learning the information.

There seems to be something special about caffeine that will help you form longer lasting memories.

These are just a handful of the factors that could affect how your memory functions.

Of course, we know hormones are important.

Menopause could affect memory function.

It's thought, in general, that actually natural transition during menopause doesn't have that much of effect on memory function.

It's subtle.

In fact, some of the other changes, for example disruptive sleep, may be having more of an effect.

But other factors, like anxiety and stress, definitely affect memory performance.

So, normal aging.

It clearly involves brain changes that are part of normal aging.

The types of thinking changes I described are also perfectly normal.

When we get older, we still retain a lot of cognitive abilities, but it becomes the case that we're perhaps not as well able to deal with less than ideal circumstances.

So when we have a lot of information coming at us, for example, or if we have stress or anxiety, those things can become more disruptive to our memory function.

So, what is abnormal, and when should we become concerned?

And so the area that I study is Alzheimer's disease.

As many of you know, this is a degenerative condition.

It is not a part of normal aging.

Alzheimer's disease affects over five million people in the United States.

It's rising in numbers.

As our population gets older, more people are affected by this disease.

And it's currently the sixth leading cause of death in the United States.

The types of risk factors that we know are closely associated with Alzheimer's disease include age, number one risk factor, genes.

So genetics plays a role.

Most of the genes that we know about don't determine whether someone will get Alzheimer's disease.

There are a couple of genetic mutations that mean someone will get the disease, but that's only less than 2% of cases.

The majority of genes that are involved are called risk genes.

So the one that we study is ApoE4.

And in the general population, about 15% to 30% of people have an ApoE4 gene.

When we look at patients with Alzheimer's disease, about 50% of them have ApoE4.

So, would it be useful to go to your doctor and ask for this test?

Not likely, and that is because even if you had the ApoE4 gene, it doesn't mean you're going to get Alzheimer's disease.

Family history plays a role.

So if you have a parent with Alzheimer's disease, that increases your own risk.

It's particularly true if you have a mother with Alzheimer's disease.

Being a woman affects your risk.

So, women have a much higher risk than men.

Prior brain injury.

So you may have heard in the news about, for example, professional athletes or other people that have had repeated head trauma, they are at increased risk for developing dementia.

And then cardiovascular risk factors.

So things like blood pressure, high blood pressure, high cholesterol, having diabetes, obesity, these things are all associated with increased risk for developing Alzheimer's disease.

That's particularly true if people develop these conditions in middle age.

It's actually not as true if you develop these conditions later in life.

So if you're over the age of 65 and you're diagnosed with diabetes, that does not increase your risk.

I have a slide here just to show you what is the pathology in Alzheimer's disease.

And what we have here, on this side, is a brain with Alzheimer's disease.

You can see that it's undergone a lot of shrinkage, and it's a lot more than what we see in normal aging.

The other main changes that we see are changes that you would only be able to see under a microscope.

And the two pathological features are plaques and tangles.

Some of you may have heard of those before.

The plaques happen between the brain cells, and the tangles occur inside the brain cells.

But, really, the main feature that distinguishes Alzheimer's disease is the extensive cell loss.

A lot of cells die in the brain in Alzheimer's disease, and we don't see that in healthy aging.

All right, so what are the things that we should watch for in terms of aging, in terms of changes that are not normal in our thinking abilities?

One thing we see in Alzheimer's disease is forgetting recently learned information.

And if you've met someone with Alzheimer's disease, you know that they ask a lot of questions.

And that's because that brain region that's important for memory function, which I mentioned earlier, the one that looks like the seahorse, the hippocampus, if that brain region is affected, a person cannot keep information in mind and they can't lay it down for the long-term.

There's actually some cases in the medical literature of people having injury to the hippocampus or having it removed surgically as a treatment for epilepsy, and those people developed amnesia.

And so that's what we see in Alzheimer's disease.

A form of amnesia where you cannot lay down new information.

An early sign could be forgetting important dates or events.

Something that was important to the person and they forget it.

Now, that, of course, happens to all of us.

We forget appointments.

But what usually happens in just sort of in normal aging is that information comes back.

We might forget an event, but we will remember it later.

Another thing we see in Alzheimer's is challenges in planning or solving problems.

We know that also happens in normal aging.

But in Alzheimer's disease, it really affects your ability to manage your life.

And you might notice trouble following a familiar recipe or keeping track of monthly bills.

Things that normally would have come easily are now affected.

A typical age related change would be making occasional errors.

Things that wouldn't necessarily happen often.

Another warning sign: difficulty completing daily tasks at home or at work or in your spare time.

This could include having trouble managing a budget at work, remembering the rules to a familiar game, or having trouble driving to a familiar location.

This is something that we can see in Alzheimer's disease.

And patients with Alzheimer's disease can also show trouble putting together spatial relations, and this can also affect driving.

So you might have a patient who's trying to, for example, drive home or drive to a local grocery store and become lost on a familiar route.

So this is what we would consider not a normal memory problem.

On the other hand, what would be considered kind of a normal sign would just be needing help to navigate because we all sometimes have trouble navigating.

In Alzheimer's disease, we also see confusion with time or place, losing track of dates, seasons or passage of time, forgetting where and how you got somewhere.

And this can be very frightening for an Alzheimer's patient to suddenly find themselves somewhere and not know how they got there.

In normal aging, we sometimes forget the day of the week, but the information comes back to us.

And, finally, another sign that we might notice is problems with word finding.

Now, I think all of us have trouble occasionally with names.

For example, we'll forget the name of someone, especially if you see them outside of context.

And Alzheimer's patients, on the other hand, will show new problems with word finding.

Words that should normally come easily.

Patients might also have trouble holding a conversation.

So they might stop in the middle of a conversation.

We do have one more.

This does occasionally happen to us as well, which is putting things in the wrong location.

So you come home from the grocery store and you put the milk in the cupboard.

We all experience that.

Or maybe not all of us.

Maybe just me.

But we have these experiences where we put things in the wrong location, but we usually notice and we correct it.

In the case of Alzheimer's disease, it's the case that the person might not notice that they misplaced the item.

Another thing that can happen is, if they misplace an item, they might become suspicious and think that someone stole the item.

So this would be a greater sign of concern.

So, if you are having trouble with your memory, sometimes it can be scary to go to your doctor and be evaluated.

Why should you go to your doctor and be evaluated?

In general, earlier evaluation is better.

There are actually several reversible causes of memory loss.

So I have a few of them listed here.

All of these things can affect memory function, and they are things that you should be checked for.

So, for example, the medications that you take.

Certain medications affect memory function.

For example, pain killers.

If you've experienced a recent head trauma.

If you have depression, this is well known to affect memory function in aging.

Alcoholism, and, in this case, alcoholism affects the same memory systems that are affected in Alzheimer's disease.

Vitamin B12 deficiency.

Hypothyroidism.

Brain tumors.

All of these things can affect memory function and may be reversible.

Can you protect your brain as you age?

We know that once a patient is diagnosed with Alzheimer's disease that a lot of changes have already taken place.

So, prevention, as far as we're able to engage in prevention, can be very useful.

And, as a scientist, I can tell you that the field is very interested in prevention.

And a lot of these sort of folk wisdom things that our mothers told us are turning out to be born out scientifically.

The number one way to protect your brain is to become active.

So, this seems very common sense, but there's not actually been quite a few studies showing that people who lead active lifestyles age better.

They have less cognitive decline.

And, in fact, even if you've already been diagnosed with a memory problem, starting up an exercise program can help you maintain your memory longer.

And so what do I mean by an exercise program?

Does that mean that you have to go to the gym for 30 minutes or an hour or more every day?

In fact, it turns out that just starting a walking program is beneficial.

In this bar graph I'm showing you here, this is actually groups of people, and it's looking at the size of the brain structure I mentioned before, the hippocampus.

And this, this bar here, is actually a group of people who walked about 10 blocks a day.

Ten blocks a day and they had the largest hippocampal size.

And the good news is those people that walked more than 10 blocks a day didn't show any advantages.

So 10 blocks a day is enough.

How about just very light physical activity?

Some of you may have heard that being sedentary is not good for our health.

So we don't want to spend a lot of time sitting.

And, in fact, it may be the case that 30 minutes of vigorous physical activity might not provide you that much benefit compared to just having light physical activity throughout the day.

So even just the act of standing up or engaging in very light physical activity will normalize your body's glucose and insulin levels.

And as you know in diabetes, glucose and insulin levels are affected.

So glucose goes up.

Now, when you just stand up and engage in light physical activity, your blood sugar goes down.

And having normal glucose and insulin levels is good for your memory.

How about engaging in games.

This is something that I get asked a lot.

So, should you be playing Sudoku?

There does seem to be some scientific evidence that if you engage in games, that this is good for your brain.

And what should those games be?

The studies that have looked at games don't pin it down to one game.

So Sudoku is not the number one.

And, in fact, we don't even know is it the act of keeping your brain active with playing the games, or is it important that we play games with other people?

So actually engaging with other people turns out to be very good for cognitive aging.

So getting together with someone to, say, play cards or do other activities together is very good for the brain and for cognitive aging.

How about diet?

This is another thing that has been studied for a long time.

We've always suspected it's important for the brain, and now scientists are trying to nail it down.

And in the most recent studies, it turns out that certain diets are protective.

So the two that I have up here are the dietary approach to stop hypertension, or the DASH diet.

This is a diet that's high in fruits and vegetables, low in fat, high fiber, whole grains, and low generally in red meats and sweets.

In clinical trials where patients have been told to adopt a certain diet, it reduced blood pressure, and it's also been shown to be protective for cognitive aging.

The other diet that some of you have heard about and we all wish we could be eating in this location here is inspired by Greece, Southern Italy, and Spain, and it's high in consumption of olive oil, legumes, and refined cereals, fruits and vegetables, moderate to high consumption of fish, moderate consumption of dairy, moderate wine consumption, and low consumption of meat.

So this particular diet and the diet I showed before have been shown to slow down cognitive change.

So what was done in these studies was actually to do questionnaires with older adults, figure out what diets people adopted.

Or even, if not completely adopted, just ate diets that were pretty high in fruits and vegetables, for example, and low in meat.

And in those people, they aged slower.

Their brain was aging slower.

They did better on tests of memory.

So, in conclusion, normal aging does involve cognitive changes and certainly changes in memory function, but Alzheimer's changes are more severe, and they interfere with your activities of daily living.

Early assessment is important because there are some treatments for Alzheimer's disease.

There are also reversible causes of memory loss.

And, finally, healthy lifestyle I think is a low risk approach for maintaining cognitive health.

And thank you for being here this afternoon.
[APPLAUSE]