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Arnold School of Public Health Office for the Study of Aging

North Carolina Conference on Aging Session 2C: Healthy Aging Plenary Emerging Opportunities to Promote Cognitive Health. Jim Laditka. Arnold School of Public Health Office for the Study of Aging. North Carolina AD Prevalence. Mild, Moderate, & Severe. Moderate, & Severe.

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Arnold School of Public Health Office for the Study of Aging

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  1. North Carolina Conference on AgingSession 2C: Healthy Aging PlenaryEmerging Opportunities to Promote Cognitive Health Jim Laditka Arnold School of Public Health Office for the Study of Aging

  2. North Carolina AD Prevalence Mild, Moderate, &Severe Moderate, &Severe North Carolina Division of Aging and Adult ServicesEstimates 31,171 Moderate & Severe in 1998, 54,168 in 2020 . (Rates from U.S. GAO, Jan. 1998.)

  3. Data Sources *Duplicates occur because individuals often use more than one name, social security number, or other identifying information when using health or social services. Arnold School of Public Health Office for the Study of Aging

  4. South Carolina AD Prevalence

  5. South Carolina AD Prevalence Arnold School of Public Health Office for the Study of Aging

  6. AD Prevalence in SC aNumbers are Registry n’s, the number with an Alzheimer’s Diagnosis.

  7. All Persons Age 65+, ADRD, South Carolina, 2002 Observed to Expected Ratio Arnold School of Public Health Office for the Study of Aging

  8. “Somehow, in all the confusion, I aged.” Arnold School of Public Health Office for the Study of Aging

  9. If you turn 65 today, your life expectancy is: Women: 84.4 Men: 81.4 SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 2003 Arnold School of Public Health Office for the Study of Aging

  10. One typical study… • Kivipelto et al., Archives of Neurology, Oct. 2005 • 21 year follow-up beginning at mid-life. • Obesity doubled the odds of developing AD. • High blood pressure doubled the odds of developing AD. • High total cholesterol doubled the odds of developing AD. • With all three factors, the odds of developing AD were more than 6 times greater. Arnold School of Public Health Office for the Study of Aging / CHSPR

  11. Adjusted rate of dementia, those who exercise the most,compared with those who exercise the least, followed 5 years

  12. Adjusted relative risk of developingcognitive impairment in those who exercise the most, compared with those who exercise the least, followed 5 years Arnold School of Public Health Office for the Study of Aging / CHSPR

  13. Adjusted relative risk of cognitive declinein those who exercise the most, compared with those who exercise the least, followed 5 years Rockwood et al.,Mech Ageing Dev, 2004; 125(7): 517-19 Arnold School of Public Health Office for the Study of Aging

  14. Adjusted rates of developing Alzheimer’s Disease in those who exercise the most, versus those who exercise the least, over 5 years of follow-up Arnold School of Public Health Office for the Study of Aging

  15. The association between mid-life physical activity and late-life dementia & Alzheimer’s Disease has been reported as enhanced in ApoE4 carriers e Rovio et al. Lancet Neurology 2005; 4: 705-11. Arnold School of Public Health Office for the Study of Aging

  16. What kind of exercise? How much? Arnold School of Public Health Office for the Study of Aging

  17. Exercise Type and Intensity • Frequency: • 3x/wk is better than <3x/wk (Laurin et al. 2001) • 5x/wk may offer little additional benefit (Lytle et al. 2004) • Intensity: • more intense activity is associated with less cognitive decline (Flicker et al. 2005, van Gelder et al. 2004) • Duration: • 30min appears to be adequate • >30min & >60 min may offer little additional protection (Schuit et al. 2001) Arnold School of Public Health Office for the Study of Aging

  18. Study Design & Population • Prospective observational study, Aerobics Center Longitudinal Study (ACLS). • Baseline: 45,140 men, 14,820 women. • Ages 20-88. • Examined 1970-2001. • Average 17 years of follow up. • 1,012,125 person-years of observation.

  19. Metabolic Equivalents (METs) ActivityMETsInactive (lying quietly) 1.0Walking, household 2.0Walking, 3.0 MPH* 3.3Walking, 3.5 MPH* 3.8Walking, 4.0 MPH* 5.0Walk or Run, 5.0 MPH* 8.0Running, 6.0 MPH* 10.0*Level, firm surface (See Ainsworth et al., Med & Sci in Sports & Exercise, 2000)

  20. Adjusted HRs of total dementia mortalityper 1-MET increase, by sex 1.0 0.8 P =0.04 P=0.009 Adjusted for: age, exam year, BMI, smoking, alcohol intake, abnormal exercise ECG responses, HTN, DM, hypercholesterolemia, and health status.

  21. ACLS Maximal MET Tertiles WomenMenLow < 5.8 < 7.2Medium 5.8 - 7.6 7.2 - 9.5High > 7.6 > 9.5

  22. Sex and Examination Year-adjustedTotal Dementia Mortality Ratesby CRF Tertiles & Age at Baseline P < 0.0001 P = 0.07

  23. Colcombe & Kramer (2003) Heyn, Abreu & Ottenbacher (2004) Netz, Wu, Becker & Tenebaum (2005) Hendrie et al (2006) All found positive effects of exercise on cognition 4 Recent meta-analyses Arnold School of Public Health Office for the Study of Aging

  24. Adjusted Odds Ratios for Depression at follow-up Adjusted for: age, baseline examination year and survey response year. stressful occupation (yes or no), current smoking (yes or no), alcohol consumption (≥ 5 drinks/week or not), body mass index, hypertension, diabetes (present or not for each), and abnormal exercise ECG responses (present or not).

  25. Factors Related to Maintenance of Cognitive Health • Avoid Vascular Damage • “Heart Healthy” is “Brain Healthy” • Blood pressure • Cholesterol • Diabetes • Weight • Smoking • Physical activity

  26. “The Healthy Brain Initiative: A Roadmap to Maintaining Cognitive Health” • CDC • Alzheimer’s Association • NIH • AARP • The Healthy Aging Research Network • Other partners Arnold School of Public Health Office for the Study of Aging

  27. Invitational Expert Consensus Summit on Wellness for Persons with Dementia Oct 20-21, 2005 • Physical Activity • Diet • Cognitive stimulation • Environmental enrichment Arnold School of Public Health Office for the Study of Aging

  28. Physician Focus Groups, 2007 “What do you say to your patients about maintaining brain health?” Arnold School of Public Health Office for the Study of Aging

  29. Physician Focus Groups, 2007 Preliminary result: “Nothing” Arnold School of Public Health Office for the Study of Aging

  30. Physician Focus Groups, 2007 “Why is it that you do not discuss brain health with your patients?” Arnold School of Public Health Office for the Study of Aging

  31. Physician Focus Groups, 2007 Preliminary result: “There isn’t any evidence that there is anything they can do about it. It would be a waste of time.” Arnold School of Public Health Office for the Study of Aging

  32. Sex and Examination Year-adjustedTotal Dementia Mortality Ratesby CRF Tertiles & Age at Baseline P < 0.0001 P = 0.07

  33. “Epidemiology Cannot Establish Causation” • Causal inferences are usually uncertain • Causal inference is strengthened by evidence from all branches of medical science--pathophysiology, epidemiology, and controlled experiments • Established causal inferences not relying on experimental evidence in humans • Thalidomide and birth defects • Radiation and cancer • Cigarette smoking and lung cancer

  34. North Carolina Conference on AgingSession 2C: Healthy Aging PlenaryEmerging Opportunities to Promote Cognitive Health Jim Laditka Arnold School of Public Health Office for the Study of Aging

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