Alzheimer’s Disease: Answers to Frequently Asked Questions about RiskTreatmentPrevention Jessica L. Banko, Ph.D., M.S. Chief Officer Officer, Byrd Alzheimer Institute Associate Professor of Molecular Medicine, Morsani College of Medicine

Alzheimer’s disease The most common cause of dementia Affects 1 in 40 Floridians Over 5.4 million Americans presently By 2050, predicted to affect 16-20 million 6th leading cause of death in USA Costs the nation $200 Billion annually

What is Alzheimer’s disease really? Hallmark pathology of Alzheimer's disease. (Jefferson Hospital for Neuroscience)

What is my risk for developing Alzheimer’s disease? Advancing Age Head Trauma Family History Heart-Head Connection The greatest known risk factor for Alzheimer’s is advancing age. For example, while one in nine people over age 65 or older has Alzheimer’s, nearly one in three people age 85 or older has the disease. We have ideas for why this may be the case that I described on the previous slide. Those who have a parent, brother, sister or child with Alzheimer’s are more likely to develop the disease. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity or environmental factors, or both, may play a role. There may be a strong link between serious head injury and future risk of Alzheimer’s, especially when trauma occurs repeatedly or involves loss of consciousness. Growing evidence links brain health to heart health. The risk of developing Alzheimer’s or vascular dementia appears to be increased by many conditions that damage the heart or blood vessels. These include high blood pressure, heart disease, stroke, diabetes and high cholesterol.

How is Alzheimer’s inherited? Risk Genes Deterministic Genes Increase the likelihood of developing a disease, but do not guarantee it will happen Directly cause a disease, guaranteeing that anyone who inherits them will develop the disorder Risk Genes increase the likelihood of developing a disease, but do not guarantee it will happen. Scientists so far have identified several risk genes implicated in Alzheimer’s disease. The risk gene with the strongest influence is called apolipoprotein E (APOE). Scientists estimate that APOE may be a factor in 20 to 25 percent of Alzheimer's cases. APOE-e4 is one of three common forms of the APOE gene; the others are APOE-e2 and APOE-e3. Everyone inherits a copy of some form of APOE from each parent. Those who inherit APOE-e4 from one parent have an increased risk of Alzheimer’s. Those who inherit APOE-e4 from both parents have an even higher risk, but not a certainty. Scientists are not yet certain how APOE-e4 increases risk. In addition to raising risk, APOE-e4 may tend to make Alzheimer's symptoms appear at a younger age than usual. Deterministic genes directly cause a disease, guaranteeing that anyone who inherits them will develop the disorder. Scientists have discovered variations that directly cause Alzheimer’s disease in the genes coding three proteins: amyloid precursor protein (APP), presenilin-1 (PS-1) and presenilin-2 (PS-2). When Alzheimer’s disease is caused by these deterministic variations, it is called “autosomal dominant Alzheimer’s disease (ADAD)” or “familial Alzheimer’s disease,” and many family members in multiple generations are affected. Symptoms nearly always develop before age 60, and may appear as early as a person's 30s or 40s. Deterministic Alzheimer's variations have been found in only a few hundred extended families worldwide. True familial Alzheimer’s accounts for less than 5 percent of cases.

How do I know if my memory is normal?

How do I know if my memory is normal? Get routine memory screenings!

What is memory screening? IS a fairly quick way to determine if a person has a problem with his or her memory and should seek further evaluation by a specialist. IS NOT a diagnostic tool.

What is memory screening? Included in the Medicare reimbursement to your physician during annual wellness exams Should be done annually at minimum after age 60 Should use an evidence-based screening tool. Examples include: Mini Mental Status Exam (MMSE) Montreal Cognitive Assessment (MoCA)

Community-Based Memory Screening Community Led Initiative Free to the participant Byrd Institute training, support Health professional volunteers trained to: Review medical history and medication Administer the MoCA Provide results and recommendations Memory Care Registry

How can I minimize my risk for developing Alzheimer’s disease? Decrease risk of head trauma Social connections & intellectual engagement Eat a healthy diet limiting the intake of sugar and saturated fats and making sure to eat plenty of fruits, vegetables, and whole grains. No one diet is best. Two diets that have been studied and may be beneficial are the DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean diet. The DASH diet emphasizes vegetables, fruits and fat-free or low-fat dairy products; includes whole grains, fish, poultry, beans, seeds, nuts, and vegetable oils; and limits sodium, sweets, sugary beverages, and red meats. A Mediterranean diet includes relatively little red meat and emphasizes whole grains, fruits and vegetables, fish and shellfish, and nuts, olive oil and other healthy fats. Protect your brain by buckling your seatbelt, wearing your helmet when participating in sports, and fall proofing your home Physical exercise

What is a comprehensive memory evaluation? Medical history, Physical Exam and Blood test Interview with a caregiver Neuropsychological tests Imaging studies MRI

Diagnostic advances in Alzheimer’s disease: MRI

What is a comprehensive memory evaluation? Medical history, Physical Exam and Blood test Interview with a caregiver Neuropsychological tests Imaging studies MRI PET

Diagnostic advances in Alzheimer’s disease: FDG PET Fluorodeoxy-glucose (sugar) measures brain activity; decreased with dementia Normal Alzheimer’s

Diagnostic advances in Alzheimer’s disease: FDG PET Fluorodeoxy-glucose (sugar) measures brain activity; decreased with dementia Normal Alzheimer’s

Diagnostic advances in Alzheimer’s disease: Amyloid PET

What treatments are available for Alzheimer’s? Generic Name Brand Name Class Donepezil Aricpet Cholinesterase Inhibitor Galantamine Razadyne Rivastigmine Exelon Tacrine Cognex Memantine Namenda NMDA Receptor Antagonist Currently 5 FDA approved treatments 2 Drug Families Risk Genes increase the likelihood of developing a disease, but do not guarantee it will happen. Scientists so far have identified several risk genes implicated in Alzheimer’s disease. The risk gene with the strongest influence is called apolipoprotein E (APOE). Scientists estimate that APOE may be a factor in 20 to 25 percent of Alzheimer's cases. APOE-e4 is one of three common forms of the APOE gene; the others are APOE-e2 and APOE-e3. Everyone inherits a copy of some form of APOE from each parent. Those who inherit APOE-e4 from one parent have an increased risk of Alzheimer’s. Those who inherit APOE-e4 from both parents have an even higher risk, but not a certainty. Scientists are not yet certain how APOE-e4 increases risk. In addition to raising risk, APOE-e4 may tend to make Alzheimer's symptoms appear at a younger age than usual. Deterministic genes directly cause a disease, guaranteeing that anyone who inherits them will develop the disorder. Scientists have discovered variations that directly cause Alzheimer’s disease in the genes coding three proteins: amyloid precursor protein (APP), presenilin-1 (PS-1) and presenilin-2 (PS-2). When Alzheimer’s disease is caused by these deterministic variations, it is called “autosomal dominant Alzheimer’s disease (ADAD)” or “familial Alzheimer’s disease,” and many family members in multiple generations are affected. Symptoms nearly always develop before age 60, and may appear as early as a person's 30s or 40s. Deterministic Alzheimer's variations have been found in only a few hundred extended families worldwide. True familial Alzheimer’s accounts for less than 5 percent of cases.

What treatments are available for Alzheimer’s?

What treatments are available for Alzheimer’s?

What treatments are available for Alzheimer’s? Generic Name Brand Name Class Donepezil Aricpet Cholinesterase Inhibitor Galantamine Razadyne Rivastigmine Exelon Tacrine Cognex Memantine Namenda NMDA Receptor Antagonist

What treatments are available for Alzheimer’s? Generic Name Brand Name Class Donepezil Aricpet Cholinesterase Inhibitor Galantamine Razadyne Rivastigmine Exelon Tacrine Cognex Memantine Namenda NMDA Receptor Antagonist

What are the benefits of participating in clinical trials? Participants may have the opportunity to try a study medication that is not otherwise available. They receive the benefit of ongoing memory evaluations and follow-ups that may be more thorough and more frequent than what you might expect from regular doctor visits. They also will be in contact with clinicians who specialize in Alzheimer's disease, so they have access to more resources and information than other people might.

What if I do not have a medical center doing clinical trials nearby?

What if I do not have a medical center doing clinical trials nearby?

What is the most exciting current research?

What is the most exciting current research? Current Prevention Trials The A4 Study will see if researchers can prevent memory loss and possibly the progression to Alzheimer’s disease by treating older individuals who may be at higher risk with an antibody that helps remove amyloid from the brain. The A5 Study People ages 60 to 85 who have plaques but don't have dementia symptoms will be randomly assigned to get either a beta-secretase inhibitor—an oral drug designed to prevent additional amyloid plaques from developing—or placebo. ACTIVE People ages 60 to 85 with normal memory will engage in a prescribed cognitive training program to determine its effectiveness in delaying/preventing dementia Recently, analyses of 10 year data from the ACTIVE trial revealed that older adults randomized to SPT were 33% less likely to develop dementia. Moreover, those who completed additional training had a 48% reduced risk of dementia over 10 years.

Upcoming Events Caregiver Half-Day Seminar at Byrd Institute Memory Research Suite at Gulf View Square Mall, New Port Richey October 24-28th Caregiver Half-Day Seminar at Byrd Institute October 28th Brain Health Fair at Byrd Institute November 17th Excellence in Geriatric Healthcare 2017 Conference 18 CEUs June 13-15th …until Alzheimer’s is a memoryTM