1. Winning the war on Alzheimer's disease Dr Jeffrey N. Keller Director, Institute for Dementia Research and Prevention Director, Alzheimer’s Disease Cooperative Study Site (PBRC) Edward G. Schlieder/Hibernia National Bank Chair Professor, Pennington Biomedical Research Center

2. What is Alzheimer’s Disease?

3. Alzheimer's disease (initially): Slow/progressive disorder (No sudden onset) Significant enough to affect work and social life Loss of ability to learn or remember new things (Memory plus one) No psychosis, neurological abnormalities, or other neurological disturbances

4. AD is the major form of dementia in elderly but there are many more:

5. Thyroid deficiency (R) B12 deficiency (R) Depression (R) Infection (R) Stroke (R) Post anesthesia (onset) Traumatic brain injury (onset) Hippocampal sclerosis (Pathology) Parkinson’s disease with dementia (Pathology- Behavior) Dementia with Lewy Bodies (Pathology-Behavior) Frontotemporal dementia (Pathology-Behavior) Vascular dementia (Progression)

6. Progression of AD

7. Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment ~5-7 yrs ~1-2 yrs ~2 yrs ~3 yrs No impairment in ADL’s Increasing impairment in ADL’s

8. Progression of AD Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment ~5-7 yrs ~1-2 yrs ~2 yrs ~3 yrs No impairment in ADL’s Increasing impairment in ADL’s Increasingly dropping social, hobby, work activities Not capable of independent activities Increasing: psychosis behavioral disturbances

9. How Big Is The Enemy/Battlefield?

10. 1 in 7 in people over the age of 65 currently has AD 6 th leading cause of death regardless of age

11. 1 in 7 in people over the age of 65 currently has AD 6 th leading cause of death regardless of age Around 4.7 million people

12. 1 in 7 in people over the age of 65 currently has AD 6 th leading cause of death regardless of age Around 4.7 million people Then you have to also consider…..

13. Each Individual with AD has a family caregiver Average of 2.5 caregivers for every individuals with AD

14. Each Individual with AD has a family caregiver Average of 2.5 caregivers for every individuals with AD Meaning ~16 million people now directly impacted by AD

15. Impact on Caregivers

16. No Disease Modifying Medication

17. People with AD Have Other Medical Conditions

19. Alzheimer’s Increases Health Costs

20. The Impact Of AD Is Going To Be Even More Severe In Near Future

21. Tsunami

22. -Can see it coming -Devastating -Nothing can stop it

23. Age is Biggest Risk Factor ~10,000 people a day turn 65 in USA Data from 2013 US Census Report

24. Age is Biggest Risk Factor ~10,000 people a day turn 65 in USA Percentage population younger than 18 will go from 23.5 to 21.2 % from 2012-2060 Data from 2013 US Census Report

25. Age is Biggest Risk Factor ~10,000 people a day turn 65 in USA Percentage population younger than 18 will go from 23.5 to 21.2 % from 2012-2060 In 2056, for the first time, people aged 65 will outnumber people under 18. Data from 2013 US Census Report

27. We are faced with a mighty foe! We cannot afford to lose this battle!

28. We are faced with a mighty foe! We cannot afford to lose this battle!

29. So how are we going to combat the enemy??? Finding ways to prevent AD Finding ways to manage AD Keeping people in their home

30. Finding ways to prevent AD

31. Staying Physically Active

32. Walking and exercising are key! *5,000 steps or more a day *30 minutes exercise 3 – 4 days a week *gardening, chores, dancing, etc.

33. Proper Diet

34. American Heart Association Guidelines 1600-2000 calories a day Grains (1/2 whole grain) 6-8 servings/day bread, rice, cereal, etc. Vegetables (mixed colors)3-5 servings/dayleafy vegetables, squash, etc Fruits (mixed colors)4-5 servings/day oranges, apples, juices, etc Low-fat dairy2-3 servings/day Lean meats, poultry 3-5 servings/week Seafood Fats and oils2-3 servings/day Nuts, seed3-5 servings/week

35. Proper Diet (continued) Medium Chain Triglycerides (MCT) 20- 40g/day? 12 hour daily fast? Pro-biotics? NSAIDS? Antioxidants, DHA?

36. Managing Chronic Illnesses

37. Diabetes, hypercholesterolemia, obesity, hypertension, cardiovascular disease increase risk of dementia Hypothyroidism, B12, folate deficiency Depression increases progression/risk of dementia

38. Reducing Stress

39. Yoga Meditation Music Pets Socialize/Activities Hobbies

40. Sleeping

41. 8 hours/day sleep Good sleep hygiene Melatonin

42. The Topic Of Cognitive Remediation

43. Finding ways to manage AD

44. Early Testing/Screening

45. Early Testing/Screening Research Studies – 2011 Medicare Wellness

46. Early Testing/Screening Research Studies – 2011 Medicare Wellness Why do early detection?

47. Early Testing/Screening Research Studies – 2011 Medicare Wellness Why do early detection? Better potential for management May influence decision for trials Help plan for care, heightend attention to other chronic illnesses

48. Finding Pharmacological Treatments

49. Polypharmacy

50. Keeping people in their home

51. Caregiver Burnout Caregiver Training Medication Adherence Reducing Falls

52. Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment Prevention Detection Treatment Independence Programs

53. How to get involved?

54. Thank You! Dr Jeffrey Keller 225-763-3190 Jeffrey.keller@pbrc.edu IDRP dementia@pbrc.edu 1-877-276-8306

56. Alzheimer’s disease and resiliency Dr Jeffrey N. Keller Director, Institute for Dementia Research and Prevention Director, Alzheimer’s Disease Cooperative Study Site (PBRC) Edward G. Schlieder/Hibernia National Bank Chair Professor, Pennington Biomedical Research Center

57. Alzheimer’s disease and resiliency” What is AD, and what does it do to a person? What is known in regards to AD prevention and treatment? What is the importance of resiliency for AD patient and caregiver?

58. Alzheimer's disease (initially): Slow/progressive disorder (No sudden onset) Significant enough to affect work and social life Loss of ability to learn or remember new things Other areas of cognitive function affected No psychosis, neurological abnormalities, or other neurological disturbances

59. AD is the major form of dementia in elderly but there are many more:

60. Thyroid deficiency (R) B12 deficiency (R) Depression (R) Infection (R) Stroke (R) Post anesthesia (onset) Traumatic brain injury (onset) Hippocampal sclerosis (Pathology) Parkinson’s disease with dementia (Pathology- Behavior) Dementia with Lewy Bodies (Pathology-Behavior) Frontotemporal dementia (Pathology-Behavior) Vascular dementia (Progression)

61. Progression of AD Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment ~5-7 yrs ~1-2 yrs ~2 yrs ~3 yrs No impairment in ADL’s Increasing impairment in ADL’s

62. 1 in 7 in people over the age of 65 currently has AD 6 th leading cause of death regardless of age No Disease Modifying Medication

63. 1 in 7 in people over the age of 65 currently has AD 6 th leading cause of death regardless of age Around 4.7 million people Then you have to also consider…..

64. Each Individual with AD has a family caregiver Average of 2.5 caregivers for every individuals with AD

65. Each Individual with AD has a family caregiver Average of 2.5 caregivers for every individuals with AD Meaning ~16 million people now directly impacted by AD

66. What is known in regards to AD prevention and treatment?

67. Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment Prevention Detection Treatment Independence Programs

68. Early Testing/Screening Research Studies – 2011 Medicare Wellness Why do early detection?

69. Early Testing/Screening Research Studies – 2011 Medicare Wellness Why do early detection? Better potential for management May influence decision for trials Help plan for care, heightend attention to other chronic illnesses

70. What is the importance of resiliency for AD patient and caregiver?

71. Resiliency Ability to recover from adversity or illness

72. Resiliency For AD Patient

73. Staying Physically Active

74. Walking and exercising are key! *5,000 steps or more a day *30 minutes exercise 3 – 4 days a week *gardening, chores, dancing, etc.

75. Proper Diet

76. American Heart Association Guidelines 1600-2000 calories a day Grains (1/2 whole grain) 6-8 servings/day bread, rice, cereal, etc. Vegetables (mixed colors)3-5 servings/dayleafy vegetables, squash, etc Fruits (mixed colors)4-5 servings/day oranges, apples, juices, etc Low-fat dairy2-3 servings/day Lean meats, poultry 3-5 servings/week Seafood Fats and oils2-3 servings/day Nuts, seed3-5 servings/week

77. Proper Diet (continued) Medium Chain Triglycerides (MCT) 20- 40g/day? 12 hour daily fast? Pro-biotics? NSAIDS? Antioxidants, DHA?

78. Managing Chronic Illnesses

79. Diabetes, hypercholesterolemia, obesity, hypertension, cardiovascular disease increase risk of dementia Hypothyroidism, B12, folate deficiency Depression increases progression/risk of dementia

80. People with AD Have Other Medical Conditions

81. Alzheimer’s Increases Health Costs

82. Reducing Stress

83. Yoga Meditation Music Pets Socialize/Activities Hobbies

84. Sleeping

85. 8 hours/day sleep Good sleep hygiene Melatonin

86. The Topic Of Cognitive Remediation

87. Resiliency For AD Caregiver

88. Caregiver Burnout Caregiver Training: Medication Adherence Behavioral Management Reducing Falls

89. Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment Prevention Detection Treatment Independence Programs

90. How to get involved?

91. Thank You! Dr Jeffrey Keller 225-763-3190 Jeffrey.keller@pbrc.edu IDRP dementia@pbrc.edu 1-877-276-8306

92. Thank You! Dr Jeffrey Keller 225-763-3190 Jeffrey.keller@pbrc.edu IDRP dementia@pbrc.edu 1-877-276-8306

93. How Big Is The Enemy/Battlefield? Alzheimer’s disease (AD) Sixth leading cause of death. Only disease in top 10 without disease modifying medication

95. In Louisiana ~90,000 with dementia Average 2.5 family care providers for each patient Average care provider 10 hours a week Nearly 1 in 15 in State actively dealing with AD!

96. Age is the biggest risk factor for AD Nearly 8,500 people a day turn 65 so incidence of AD is going to be increasing

98. Louisiana will have people develop age-related diseases earlier, and people will die from them sooner

101. What Does The Enemy Look Like?

102. Alzheimer's disease (initially):

103. Slow/progressive disorder (No sudden onset)

104. Alzheimer's disease (initially): Slow/progressive disorder (No sudden onset) Significant enough to affect work and social life

105. Alzheimer's disease (initially): Slow/progressive disorder (No sudden onset) Significant enough to affect work and social life Loss of ability to learn or remember new things

106. Alzheimer's disease (initially): Slow/progressive disorder (No sudden onset) Significant enough to affect work and social life Loss of ability to learn or remember new things Other areas of function affected like ability to make new plans (executive function)

107. Alzheimer's disease (initially): Slow/progressive disorder (No sudden onset) Significant enough to affect work and social life Loss of ability to learn or remember new things Other areas of function affected like ability to make new plans (executive function) No psychosis, neurological abnormalities, or other neurological disturbances

108. Alzheimer's disease Diagnosis Neurological Assessment Cognitive Assessment MRI PET Lumbar puncture Blood

109. Alzheimer's disease Diagnosis Neurological Assessment: No loss of balance, normal motor control, maintenance of senses, normal reflexes Cognitive Assessment: Memory, Executive Function, Attention MRI PET Lumbar puncture Blood

110. Alzheimer's disease Diagnosis Neurological Assessment: No loss of balance, normal motor control, maintenance of senses, normal reflexes Cognitive Assessment: Memory, Executive Function, Attention MRI: Acceptable level infarcts, selected atrophy, no gross pathogenesis PET Lumbar puncture Blood

111. Alzheimer's disease Diagnosis Neurological Assessment: No loss of balance, normal motor control, maintenance of senses, normal reflexes Cognitive Assessment: Memory, Executive Function, Attention MRI: Acceptable level infarcts, selected atrophy, no gross pathogenesis PET: evidence of amyloid accumulation (amyvid), tau pathology (AV5), localized FDS changes (FDG) Lumbar puncture Blood

112. Alzheimer's disease Diagnosis Neurological Assessment: No loss of balance, normal motor control, maintenance of senses, normal reflexes Cognitive Assessment: Memory, Executive Function, Attention MRI: Acceptable level infarcts, selected atrophy, no gross pathogenesis PET: evidence of amyloid accumulation (amyvid), tau pathology (AV5), localized FDS changes (FDG) Lumbar puncture: no evidence of infection, changes in beta amyloid or tau Blood

113. Alzheimer's disease Diagnosis Neurological Assessment: No loss of balance, normal motor control, maintenance of senses, normal reflexes Cognitive Assessment: Memory, Executive Function, Attention MRI: Acceptable level infarcts, selected atrophy, no gross pathogenesis PET: evidence of amyloid accumulation (amyvid), tau pathology (AV5), localized FDS changes (FDG) Lumbar puncture: no evidence of infection, changes in beta amyloid or tau Blood: no evidence of infection

114. Progression of AD Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment

115. Progression of AD Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment ~5-7 yrs ~1-2 yrs ~2 yrs ~3 yrs

116. Progression of AD Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment ~5-7 yrs ~1-2 yrs ~2 yrs ~3 yrs No impairment in ADL’s Increasing impairment in ADL’s

117. Progression of AD Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment ~5-7 yrs ~1-2 yrs ~2 yrs ~3 yrs No impairment in ADL’s Increasing impairment in ADL’s Increasingly dropping social, hobby, work activities Not capable of independent activities Increasing: psychoses behavioral disturbances

118. AD is the major form of dementia in elderly but there are many more: Thyroid deficiency B12 deficiency Depression Infection Stroke Post anesthesia Traumatic brain injury Hippocampal sclerosis Parkinson’s disease with dementia Dementia with Lewy Bodies Frontotemporal dementia Vascular dementia

119. AD is the major form of dementia in elderly but there are many more: Thyroid deficiency (R) B12 deficiency (R) Depression (R) Infection (R) Stroke (R) Post anesthesia (onset) Traumatic brain injury (onset) Hippocampal sclerosis (Pathology) Parkinson’s disease with dementia (Pathology-Behavior) Dementia with Lewy Bodies (Pathology-Behavior) Frontotemporal dementia (Pathology-Behavior) Vascular dementia (Progression)

120. What Do We Need To Win The War?

121. Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment Prevention Detection Treatment Independence Programs

122. What Do We Have To Fight The War? Alzheimer’s Association (advocacy, education, research, trial match) Alzheimer’s Services of the Capital Area (respite, education, support groups) Council on Aging (programs and advocacy) Pennington Biomedical Research Center (Institute for Dementia Research and Prevention) acadiacoa1@bellsouth.net Phone: 337 788 1400 http://www.alzbr.org (800) 548-1211 http://www.alz.org 1.800.272.3900

123. How to get involved?

124. Aging Mild Cognitive Mild AD Moderate AD Severe AD Impairment Prevention Detection Treatment Independence Programs Coming Soon! Coming Soon! LABrainS JLDS Clinical Trials

125. Thank You! Dr Jeffrey Keller 225-763-3190 Jeffrey.keller@pbrc.edu IDRP dementia@pbrc.edu 1-877-276-8306