Ongoing Research With Vascular Risk Factors and the RAS in Individuals at Risk for AD Whitney Wharton, PhD Assistant Professor, Neurology Emory University

Funding, Disclosures No Disclosures Funding NIH / NIA, NINR Alzheimer’s Association ADCS VA Emory Neurology

Overarching Research Goal: Identify modifiable risk factors that may delay or prevent Alzheimer's disease in individuals at highest risk. Implement pharmaceutical and lifestyle interventions Blood Pressure Medications Caregiver Stress Tango for African American female AD family caregivers Painting / Photography for AD patients and family caregivers Exercise vs balance / yoga in MCI The gut – brain study

Early Detection MCI Mild AD Moderate AD Severe AD Increasing Age Normal Cognition MCI Mild AD Worse Cognitive Abilities  better Moderate AD Start Treatment HERE Severe AD 95 Years Increasing Age

Shifting the curve What factors can we identify that…. Are linked to cognitive decline Are linked to the pathological hallmarks of AD (plaques and tangles) Occur during Midlife TREATABLE / REVERSIBLE

Vascular Risk Factors and Alzheimer’s disease Alzheimer’s is associated with: Midlife Hypertension Midlife Hypercholesterolemia Obesity Diabetes Sedentary lifestyle Sleep Disturbances What are the environmental risk factors?

Who is most at risk for AD? African Americans Middle Age Female Increased Vascular risk Family History Caregiver To Help the Most people Possible, You Must Target Those Most at Risk!!

Women and Caregiving

Adult Child Caregiver: Caregiving Poor Nutrition Lack of exercise Sleep disturbances Stress Financial complications Healthcare neglect ….Can lead to serious health and cognitive problems

AD Caregiver Stress Caregivers report more depression and stress 60% of AD caregivers rate the stress of caregiving as high or very high and about 40% suffer from depression both are themselves independent risk factors for AD Different reports depending on Race, relationship to patient, age, in home vs. assisted living

Race and Caregiving In the general population, African Americans report more depression and stress Caregivers report more depression and stress. African American family caregivers Adult child Woman Increased vascular risk factors

The HEART Trial Study to determine if a blood pressure medication can help prevent AD. African Americans, 45-65, family history 5 visits over 8 months, $150 compensation MRI, blood, CSF, cognitive testing, ambulatory blood pressure, (sleep, exercise, nutrition, stress)