1 00:00:06,107 --> 00:00:07,875 THANKS, EVERYONE, FOR GETTING 2 00:00:07,875 --> 00:00:14,682 TOGETHER FOR THE THIRD DAY OF 3 00:00:14,682 --> 00:00:17,351 OUR SUMMIT. 4 00:00:17,351 --> 00:00:18,419 AS WE'VE TALKED PREVIOUSLY, THIS 5 00:00:18,419 --> 00:00:22,390 IS INCREDIBLY IMPORTANT ACTIVITY 6 00:00:22,390 --> 00:00:25,726 FOR US AS IT GENERATES THE PLANS 7 00:00:25,726 --> 00:00:35,236 THAT WE USE TO FUND RESEARCH ON 8 00:00:35,236 --> 00:00:37,071 ALZHEIMER'S AND RELATED 9 00:00:37,071 --> 00:00:37,805 DEMENTIAS AND HAS BLOSSOMED DUE 10 00:00:37,805 --> 00:00:40,541 TO THE HELP OF THE SUMMIT AND 11 00:00:40,541 --> 00:00:41,842 THERE'S BEEN CONSIDERABLE 12 00:00:41,842 --> 00:00:46,213 FUNDING TO CAME TO NINDS AND 13 00:00:46,213 --> 00:00:47,314 AGING INSTITUTE. 14 00:00:47,314 --> 00:00:51,452 WE AT NINDS MANAGE ABOUT 10% OF 15 00:00:51,452 --> 00:00:54,188 THOSE FUNDS FOR ALZHEIMER'S 16 00:00:54,188 --> 00:00:57,725 DISEASE/RELATED DEMENTIAS, AND 17 00:00:57,725 --> 00:00:59,093 IT'S CONSIDERABLE INVESTMENT 18 00:00:59,093 --> 00:01:00,828 THAT HAS ALLOWED US TO DO 19 00:01:00,828 --> 00:01:02,496 INNOVATIVE THINGS BUT WE REQUIRE 20 00:01:02,496 --> 00:01:04,098 YOUR INPUT TO STAY INNOVATIVE AS 21 00:01:04,098 --> 00:01:10,471 WE MOVE INTO THE FUTURE. 22 00:01:10,471 --> 00:01:14,809 THE SESSION TODAY FOCUSES ON 23 00:01:14,809 --> 00:01:18,379 HEALTH DISPARITIES IN 24 00:01:18,379 --> 00:01:19,413 ALZHEIMER'S DISEASE-RELATED 25 00:01:19,413 --> 00:01:24,552 DEMENTIAS WHICH INCLUDES MIXED 26 00:01:24,552 --> 00:01:27,021 DEMENTIAS BUT CONTRIBUTORS. 27 00:01:27,021 --> 00:01:27,988 THERE HAS BEEN CONSIDERABLE 28 00:01:27,988 --> 00:01:31,659 CHANGES HERE AT NIH, BUT IT'S 29 00:01:31,659 --> 00:01:33,694 BEEN UNDERLINED MULTIPLE TIMES 30 00:01:33,694 --> 00:01:36,197 BY DR. BHATTACHARYA, OUR NIH 31 00:01:36,197 --> 00:01:38,499 DIRECTOR, THAT TRYING TO SOLVE 32 00:01:38,499 --> 00:01:40,568 THE PROBLEMS OF HEALTH 33 00:01:40,568 --> 00:01:42,269 DISPARITIES IN THIS COUNTRY 34 00:01:42,269 --> 00:01:44,805 REMAINS A VERY HIGH PRIORITY, 35 00:01:44,805 --> 00:01:49,977 CERTAINLY FOR NINDS A VERY HIGH 36 00:01:49,977 --> 00:01:51,345 PRIVATE IN THE ALZHEIMER'S 37 00:01:51,345 --> 00:01:51,979 DISEASE-RELATED DEMENTIA SPACE. 38 00:01:51,979 --> 00:01:56,417 I WANT TO THANK YOU FOR THE WORK 39 00:01:56,417 --> 00:02:00,821 YOU'VE DONE, KATE, FOR OVERALL 40 00:02:00,821 --> 00:02:05,826 CHAIRING THE SUMMIT AND MARIA 41 00:02:05,826 --> 00:02:10,030 GLYMOUR AND KACIE DETERS FOR THE 42 00:02:10,030 --> 00:02:16,837 SESSION 8 AND FARAH AND JONATHAN 43 00:02:16,837 --> 00:02:17,571 FOR SESSION 9. 44 00:02:17,571 --> 00:02:25,746 LET ME TURN IT OVER TO KATE WITH 45 00:02:25,746 --> 00:02:26,247 THAT. 46 00:02:26,247 --> 00:02:27,615 >> I'M REALLY EXCITED TO BE HERE 47 00:02:27,615 --> 00:02:31,352 FOR THE THIRD AND FINAL DAY OF 48 00:02:31,352 --> 00:02:32,820 THE 2025 SUMMIT. 49 00:02:32,820 --> 00:02:36,190 WE HELD OUR FIRST TWO SESSIONS 50 00:02:36,190 --> 00:02:38,659 ON APRIL 29th AND APRIL 51 00:02:38,659 --> 00:02:38,859 30th. 52 00:02:38,859 --> 00:02:42,429 AND TO REVIEW BRIEFLY THE TOPICS 53 00:02:42,429 --> 00:02:47,034 WE COVERED, WE TALKED ABOUT 54 00:02:47,034 --> 00:02:48,168 MULTIPLE DEMENTIAS, RESEARCH FOR 55 00:02:48,168 --> 00:02:53,374 IMPLEMENT OF DISCOVERIES INTO 56 00:02:53,374 --> 00:02:54,108 PRACTICE, FRONTOTEMPORAL 57 00:02:54,108 --> 00:02:55,409 DEMENTIAS, POST-TRAUMATIC BRAIN 58 00:02:55,409 --> 00:03:00,481 INJURY, WE TALKED ABOUT LATE OR 59 00:03:00,481 --> 00:03:03,684 TDP-43 IN COMMON LATE-ONSET 60 00:03:03,684 --> 00:03:03,951 DEMENTIA. 61 00:03:03,951 --> 00:03:06,353 SECOND DAY WE COVERED MED BASIC 62 00:03:06,353 --> 00:03:12,626 AND CLINICAL DISCOVERY RESEARCH, 63 00:03:12,626 --> 00:03:15,663 LEWY BODYING DEMENTIA, VASCULAR 64 00:03:15,663 --> 00:03:16,430 CONTRIBUTIONS AND COGNITIVE 65 00:03:16,430 --> 00:03:18,566 IMPAIRMENTS AND HAD WONDERFUL 66 00:03:18,566 --> 00:03:19,667 PUBLIC ENGAGEMENT ACROSS BOTH 67 00:03:19,667 --> 00:03:20,868 DAYS, LISTENING AND 68 00:03:20,868 --> 00:03:22,069 INCORPORATING INPUT WE'VE 69 00:03:22,069 --> 00:03:23,070 RECEIVED SO FAR. 70 00:03:23,070 --> 00:03:26,640 IF YOU MISSED THE FIRST TWO 71 00:03:26,640 --> 00:03:29,043 DAYS, YOU CAN WATCH AT THE LINKS 72 00:03:29,043 --> 00:03:29,310 PROVIDED. 73 00:03:29,310 --> 00:03:32,146 TODAY WE HAVE OUR TWO FINAL 74 00:03:32,146 --> 00:03:33,781 REALLY EXCITING AND 75 00:03:33,781 --> 00:03:34,915 CROSS-CUTTING SESSIONS THAT 76 00:03:34,915 --> 00:03:36,083 YOU'LL HEAR ABOUT AND THERE WILL 77 00:03:36,083 --> 00:03:37,851 BE A CHANCE FOR PUBLIC INPUT 78 00:03:37,851 --> 00:03:40,854 AFTER EACH OF THE SESSIONS, AS 79 00:03:40,854 --> 00:03:42,856 WELL AS A FURTHER PUBLIC INPUT 80 00:03:42,856 --> 00:03:45,759 SESSION AT THE END WHERE WE 81 00:03:45,759 --> 00:03:47,962 ENCOURAGE AND WELCOME INPUT ON 82 00:03:47,962 --> 00:03:49,430 ANY OF THE TOPICS DISCUSSED AT 83 00:03:49,430 --> 00:03:50,798 THIS MEETING. 84 00:03:50,798 --> 00:03:54,068 SO WITH THAT, I WILL TURN IT 85 00:03:54,068 --> 00:03:56,170 OVER TO MARIA GLYMOUR AND KACIE 86 00:03:56,170 --> 00:03:59,907 DETERS TO INTRODUCE OUR FIRST 87 00:03:59,907 --> 00:04:00,874 SESSION TODAY. 88 00:04:00,874 --> 00:04:02,977 >> THANK YOU, KATE, FOR THAT 89 00:04:02,977 --> 00:04:03,210 HANDOFF. 90 00:04:03,210 --> 00:04:06,046 IT'S A PLEASURE TO BE HERE. 91 00:04:06,046 --> 00:04:08,415 THANK YOU, EVERYONE, FOR JOINING 92 00:04:08,415 --> 00:04:09,683 THIS DISCUSSION. 93 00:04:09,683 --> 00:04:11,051 WE'VE HAD AN AMAZING TEAM. 94 00:04:11,051 --> 00:04:12,953 I WANT TO ACKNOWLEDGE IN 95 00:04:12,953 --> 00:04:14,788 PARTICULAR MY CO-CHAIR, DR. 96 00:04:14,788 --> 00:04:17,858 DIETERS, AND THE OTHER SPEAKERS 97 00:04:17,858 --> 00:04:18,459 TODAY. 98 00:04:18,459 --> 00:04:23,097 IT FALLS TO ME TO INTRODUCE 99 00:04:23,097 --> 00:04:26,233 MOTIVATION AND OVERARCHING 100 00:04:26,233 --> 00:04:27,635 MOTIVATION FOR THIS 101 00:04:27,635 --> 00:04:28,669 RECOMMENDATION GROUP, RESEARCH 102 00:04:28,669 --> 00:04:30,070 TO IMPROVE OUTCOMES FOR 103 00:04:30,070 --> 00:04:32,439 REPRESENTATIVE POPULATIONS AT 104 00:04:32,439 --> 00:04:35,442 RISK AND LIVING WITH ADRD. 105 00:04:35,442 --> 00:04:35,743 NEXT SLIDE. 106 00:04:35,743 --> 00:04:38,846 NEXT SLIDE. 107 00:04:38,846 --> 00:04:43,017 JUST DISCLOSURES, I RECEIVE 108 00:04:43,017 --> 00:04:44,785 FUNDING FROM NIH, ROBERT WOOD 109 00:04:44,785 --> 00:04:45,586 JOHNSON FOUNDATION, NO FUNDING 110 00:04:45,586 --> 00:04:47,821 FROM INDUSTRY. 111 00:04:47,821 --> 00:04:48,856 NEXT SLIDE. 112 00:04:48,856 --> 00:04:50,290 REALLY THE IMPORTANT MOTIVATIONS 113 00:04:50,290 --> 00:04:53,193 HERE ARE THAT SOME GROUPS OF 114 00:04:53,193 --> 00:04:57,364 PEOPLE HAVE SYSTEMATICALLY 115 00:04:57,364 --> 00:04:59,199 HIGHER RISK OF ALZHEIMER'S 116 00:04:59,199 --> 00:05:01,935 DISEASE AND RELATED DEMENTIA OR 117 00:05:01,935 --> 00:05:03,003 WORSE PROGNOSIS. 118 00:05:03,003 --> 00:05:05,139 SOME GROUPS FOR WHOM THIS IS 119 00:05:05,139 --> 00:05:06,473 DOCUMENTS, ALSO GROUP OF PEOPLE 120 00:05:06,473 --> 00:05:08,842 WITH VERY LIMITED ACCESS AND 121 00:05:08,842 --> 00:05:10,077 REPRESENTATION IN RESEARCH SO WE 122 00:05:10,077 --> 00:05:11,311 DON'T KNOW IF THEY HAVE ELEVATED 123 00:05:11,311 --> 00:05:17,051 RISK OR NOT. 124 00:05:17,051 --> 00:05:18,452 WE WILL BE INCLUDING BOTH 125 00:05:18,452 --> 00:05:24,925 INDIVIDUALS FROM GROUPS WITH 126 00:05:24,925 --> 00:05:26,694 ESTABLISHED UNEQUAL BURDEN AND 127 00:05:26,694 --> 00:05:31,498 FOR GROUPS WITH A GAP WE DON'T 128 00:05:31,498 --> 00:05:33,400 KNOW IF IT IS SUBSTANTIAL. 129 00:05:33,400 --> 00:05:35,502 RIGHT NOW THE EVIDENCE IS CLEAR 130 00:05:35,502 --> 00:05:39,473 IT AFFECTS EVERYONE, NOBODY IS 131 00:05:39,473 --> 00:05:40,641 LEFT UNSCATHED WHETHER DISEASE 132 00:05:40,641 --> 00:05:41,475 AFFECTS YOU INDIVIDUALLY OR 133 00:05:41,475 --> 00:05:42,509 PEOPLE YOU LOVE AND YOUR FAMILY, 134 00:05:42,509 --> 00:05:45,446 IT'S ONE OF THE MOST PROFOUND 135 00:05:45,446 --> 00:05:49,850 PUBLIC HEALTH CHALLENGES WE'RE 136 00:05:49,850 --> 00:05:50,551 FACING. 137 00:05:50,551 --> 00:05:53,654 ON TOP OF THIS, SOME GROUPS FACE 138 00:05:53,654 --> 00:05:56,156 SPECIAL AND ELEVATED RISK AND 139 00:05:56,156 --> 00:05:58,692 THOSE PATTERNS SUGGEST THOSE ARE 140 00:05:58,692 --> 00:05:59,460 SOCIAL DETERMINANTS OF 141 00:05:59,460 --> 00:06:01,562 ALZHEIMER'S DISEASE AND DEMENTIA 142 00:06:01,562 --> 00:06:02,062 RISK. 143 00:06:02,062 --> 00:06:04,631 WHETHER THOSE GROUPS ARE BASED 144 00:06:04,631 --> 00:06:06,500 ON EDUCATION, GEOGRAPHY, SEX, 145 00:06:06,500 --> 00:06:08,302 RACE AND ETHNICITY, AND OTHER 146 00:06:08,302 --> 00:06:08,869 DIMENSIONS. 147 00:06:08,869 --> 00:06:11,105 NEXT SLIDE PLEASE. 148 00:06:11,105 --> 00:06:12,172 AMONG THE MANY POSSIBLE SLIDES 149 00:06:12,172 --> 00:06:14,875 WE COULD HAVE SHOWN TO 150 00:06:14,875 --> 00:06:16,009 ILLUSTRATE THESE DISPARITIES 151 00:06:16,009 --> 00:06:20,781 ACROSS GROUPS, I LIKE THIS 152 00:06:20,781 --> 00:06:24,184 SLIDE, WORK USING DATA FROM THE 153 00:06:24,184 --> 00:06:24,852 KAISER PERMANENTE NORTHERN 154 00:06:24,852 --> 00:06:28,155 CALIFORNIA MEMBERSHIP FROM DR. 155 00:06:28,155 --> 00:06:28,388 MAYEDA. 156 00:06:28,388 --> 00:06:29,957 THIS SHOWS STARK DIFFERENCES IN 157 00:06:29,957 --> 00:06:30,991 INCIDENCE RATES OF DEMENTIA 158 00:06:30,991 --> 00:06:31,892 ACROSS GROUPS. 159 00:06:31,892 --> 00:06:33,460 I WANT TO DRAW YOUR ATTENTION TO 160 00:06:33,460 --> 00:06:35,462 THE GROUP ON THE RIGHT WHERE YOU 161 00:06:35,462 --> 00:06:37,664 SEE FOR ASIAN AMERICANS A 162 00:06:37,664 --> 00:06:39,166 MARKEDLY LOWER INCIDENCE RATE 163 00:06:39,166 --> 00:06:41,769 THAN FOR ANY OTHER RACIAL/ETHNIC 164 00:06:41,769 --> 00:06:45,105 GROUP IN THE COUNTRY. 165 00:06:45,105 --> 00:06:46,373 NEXT SLIDE. 166 00:06:46,373 --> 00:06:48,675 AND WHEN WE ASK WHY THESE ARE 167 00:06:48,675 --> 00:06:49,710 HAPPENING, WHY THESE 168 00:06:49,710 --> 00:06:51,512 INEQUALITIES ARE HAPPENING, WHAT 169 00:06:51,512 --> 00:06:53,180 IS DRIVING THESE DISPARITIES, 170 00:06:53,180 --> 00:06:54,448 IT'S IMPORTANT TO UNDERSTAND 171 00:06:54,448 --> 00:06:58,185 THAT MANY, MANY RISK FACTORS ARE 172 00:06:58,185 --> 00:06:58,886 DIFFERENTLY DISTRIBUTED, 173 00:06:58,886 --> 00:06:59,920 PROCESSES ARE DRIVING 174 00:06:59,920 --> 00:07:01,588 DISTRIBUTION OF RISK FACTORS, 175 00:07:01,588 --> 00:07:02,189 DIFFERENTIALLY, ACROSS GROUPS. 176 00:07:02,189 --> 00:07:06,627 AND SO ON THE LEFT YOU SEE THE 177 00:07:06,627 --> 00:07:08,295 VERY FAMOUS PICTURE FROM "THE 178 00:07:08,295 --> 00:07:13,300 LANCET," THE LIVINGSTON REPORT 179 00:07:13,300 --> 00:07:14,434 WITH ATTRIBUTING 45% ACROSS 180 00:07:14,434 --> 00:07:20,607 KNOWN RISK FACTORS STARTING WITH 181 00:07:20,607 --> 00:07:21,542 EDUCATION. 182 00:07:21,542 --> 00:07:22,409 EDUCATION IS SOCIALLY 183 00:07:22,409 --> 00:07:23,210 DISTRIBUTED RESOURCE BUT IF YOU 184 00:07:23,210 --> 00:07:26,647 THINK ABOUT EVERY ONE OF THOSE 185 00:07:26,647 --> 00:07:28,048 RISK FACTORS, WHETHER HEARING 186 00:07:28,048 --> 00:07:29,917 LOSS, TRAUMATIC BRAIN INJURY, 187 00:07:29,917 --> 00:07:30,517 DIABETES, HYPERTENSION, EVERY 188 00:07:30,517 --> 00:07:39,560 ONE OF THOSE IS ALSO ITSELF 189 00:07:39,560 --> 00:07:42,262 DIFFERENTIALLY DISTRIBUTED. 190 00:07:42,262 --> 00:07:45,432 THIS PICTURE SHOWS WORK 191 00:07:45,432 --> 00:07:47,467 EVALUATING RISK FACTORS ACROSS 192 00:07:47,467 --> 00:07:50,437 ASIAN SUBGROUPS, AND COMPARING 193 00:07:50,437 --> 00:07:50,871 TO EUROPEAN ANCESTRY 194 00:07:50,871 --> 00:07:53,807 INDIVIDUALS, AND BUT WE COULD DO 195 00:07:53,807 --> 00:07:55,042 THIS FOR ALMOST ANY PATTERN 196 00:07:55,042 --> 00:07:57,344 WHERE EVERY SINGLE RISK FACTOR 197 00:07:57,344 --> 00:07:57,945 IS DISTRIBUTED DIFFERENTIALLY 198 00:07:57,945 --> 00:07:58,612 ACROSS GROUPS. 199 00:07:58,612 --> 00:07:59,646 AND WHAT THAT REALLY MEANS IS 200 00:07:59,646 --> 00:08:02,583 THAT SOME GROUPS ARE AT HIGHER 201 00:08:02,583 --> 00:08:07,154 RISK SO WE CAN'T JUST START WITH 202 00:08:07,154 --> 00:08:10,691 THE MOST PROXIMAL RISK. 203 00:08:10,691 --> 00:08:13,760 WE HAVE TO ASK WHY THEY ARE 204 00:08:13,760 --> 00:08:14,328 DIFFERENTIALLY DISTRIBUTED. 205 00:08:14,328 --> 00:08:18,765 NEXT SLIDE PLEASE. 206 00:08:18,765 --> 00:08:19,967 HEALTH DISPARITIES ARE 207 00:08:19,967 --> 00:08:21,869 FRUSTRATING AND A CHALLENGE, I 208 00:08:21,869 --> 00:08:23,370 ALSO FEEL VERY STRONGLY THESE 209 00:08:23,370 --> 00:08:25,873 ARE AMONG OUR GREATEST 210 00:08:25,873 --> 00:08:26,440 OPPORTUNITIES FOR PROGRESS 211 00:08:26,440 --> 00:08:27,674 TOWARDS ELIMINATING DEMENTIA. 212 00:08:27,674 --> 00:08:29,343 WHEN WE SEE DISPARITIES OBSERVED 213 00:08:29,343 --> 00:08:31,345 BETWEEN GROUPS BASED ON SOCIALLY 214 00:08:31,345 --> 00:08:32,880 CREATED VARIABLES WITH NO BASIS 215 00:08:32,880 --> 00:08:34,548 IN BIOLOGY, IT MEANS WE CAN DO 216 00:08:34,548 --> 00:08:35,983 BETTER AND THAT WE MAY ALREADY 217 00:08:35,983 --> 00:08:37,584 HAVE THE SOLUTION WITHIN OUR 218 00:08:37,584 --> 00:08:40,053 REACH. 219 00:08:40,053 --> 00:08:41,255 IF EVERYONE IN THE UNITED STATES 220 00:08:41,255 --> 00:08:43,423 HAD THE SAME DEMENTIA RISK AT 221 00:08:43,423 --> 00:08:47,261 LOWEST RISK GROUP MAJORITY OF 222 00:08:47,261 --> 00:08:48,695 CASES WOULD BE ELIMINATED OR 223 00:08:48,695 --> 00:08:49,096 DELAYS. 224 00:08:49,096 --> 00:08:51,565 FOR MANY HEALTH OUTCOMES WE HAVE 225 00:08:51,565 --> 00:08:52,833 MADE TREMENDOUS PROGRESS 226 00:08:52,833 --> 00:08:53,867 REDUCING HEALTH DISPARITIES AND 227 00:08:53,867 --> 00:08:55,936 CAN DO THE SAME FOR DEMENTIA. 228 00:08:55,936 --> 00:08:58,705 OUR WORKING GROUP HAS FOCUSED ON 229 00:08:58,705 --> 00:09:00,707 THE TOP RESEARCH PRIORITIES TO 230 00:09:00,707 --> 00:09:02,242 MOVE TOWARDS THAT GOAL. 231 00:09:02,242 --> 00:09:04,177 NEXT SLIDE PLEASE. 232 00:09:04,177 --> 00:09:05,746 I WANT TO ACKNOWLEDGE THE GROUP, 233 00:09:05,746 --> 00:09:08,181 THIS HAS BEEN A LIVELY TIME TO 234 00:09:08,181 --> 00:09:09,483 BE FOCUSED ON THIS TOPIC AND I 235 00:09:09,483 --> 00:09:13,587 THINK THE GROUP DID A PHENOMENAL 236 00:09:13,587 --> 00:09:14,621 JOB TALKING ABOUT HOW TO 237 00:09:14,621 --> 00:09:16,790 PRIORITIZE IN AREAS AND 238 00:09:16,790 --> 00:09:17,891 DIRECTIONS THAT WE HAD THE MOST 239 00:09:17,891 --> 00:09:20,894 LIKELIHOOD OF MAKING PROGRESS 240 00:09:20,894 --> 00:09:22,529 AND MAKING A DIFFERENCE, KEEPING 241 00:09:22,529 --> 00:09:24,398 CORE VALUES CLOSE TO OUR HEARTS. 242 00:09:24,398 --> 00:09:28,402 THANK YOU TO MY AMAZING 243 00:09:28,402 --> 00:09:29,303 COLLEAGUES ESPECIALLY CO-CHAIR 244 00:09:29,303 --> 00:09:29,636 KACIE DETERS. 245 00:09:29,636 --> 00:09:30,504 NEXT SLIDE PLEASE. 246 00:09:30,504 --> 00:09:37,711 WITH THAT I WANT TO INTRODUCE 247 00:09:37,711 --> 00:09:39,680 THE FIRST TOP PRIORITY 248 00:09:39,680 --> 00:09:40,180 RECOMMENDATION. 249 00:09:40,180 --> 00:09:41,214 NEXT SLIDE. 250 00:09:41,214 --> 00:09:43,050 THE WORDING OF WHICH, THIS IS 251 00:09:43,050 --> 00:09:44,051 PRIORITY 1 RECOMMENDATION, IN 252 00:09:44,051 --> 00:09:47,788 THE ACCESS CARE AND TREATMENT 253 00:09:47,788 --> 00:09:49,189 DOMAIN, TO PRIORITIZE 254 00:09:49,189 --> 00:09:50,991 INFRASTRUCTURE AND POLICY 255 00:09:50,991 --> 00:09:53,126 RESEARCH TO UNDERSTAND 256 00:09:53,126 --> 00:09:53,827 INDIVIDUAL, COMMUNITY, SOCIETAL 257 00:09:53,827 --> 00:09:56,697 DRIVERS ACROSS CARE AND ACCESS 258 00:09:56,697 --> 00:09:58,799 TO TREATMENT OF CARE TO OPTIMIZE 259 00:09:58,799 --> 00:10:03,971 QUALITY OF LIFE AMONG AMONG 260 00:10:03,971 --> 00:10:04,271 INDIVIDUALS. 261 00:10:04,271 --> 00:10:06,306 HOW DO WE GO ABOUT THAT? 262 00:10:06,306 --> 00:10:09,609 THE KEY STEPS, ONE IS TO REALLY 263 00:10:09,609 --> 00:10:13,413 DEVELOP AND REVIEW NATIONAL 264 00:10:13,413 --> 00:10:14,915 STANDARDS FOR HOW WE QUANTIFY 265 00:10:14,915 --> 00:10:15,816 DEMENTIA COST AND OUTCOMES 266 00:10:15,816 --> 00:10:16,616 RELEVANT FOR EVERYONE IN THE 267 00:10:16,616 --> 00:10:17,484 UNITED STATES. 268 00:10:17,484 --> 00:10:20,220 AS WELL AS FOR POPULATIONS 269 00:10:20,220 --> 00:10:21,388 DISPROPORTIONATELY AFFECTED BY 270 00:10:21,388 --> 00:10:21,855 DEMENTIA. 271 00:10:21,855 --> 00:10:24,124 THE NEXT STEP IS AGREE ON COMMON 272 00:10:24,124 --> 00:10:26,393 DATA ELEMENTS WE CAN INCLUDE 273 00:10:26,393 --> 00:10:27,427 INTO A NATIONAL DATA REPOSITORY, 274 00:10:27,427 --> 00:10:28,495 YOU'LL HEAR THIS EMPHASIS ON 275 00:10:28,495 --> 00:10:30,464 DATA OVER AND OVER AGAIN TODAY 276 00:10:30,464 --> 00:10:33,934 AS WE GO THROUGH THE DIFFERENT 277 00:10:33,934 --> 00:10:34,701 RECOMMENDATIONS, SO KEY TO 278 00:10:34,701 --> 00:10:37,571 MAKING PROGRESS WE HAVE GOOD 279 00:10:37,571 --> 00:10:38,005 DATA INFRASTRUCTURE. 280 00:10:38,005 --> 00:10:39,373 SO, THE THIRD STEP TOWARDS THIS 281 00:10:39,373 --> 00:10:45,712 IS TO IDENTIFY DATA SOURCES, AND 282 00:10:45,712 --> 00:10:47,381 DATA GAPS, ESTABLISH A NATIONAL 283 00:10:47,381 --> 00:10:49,783 DATABASE ON SOCIAL, ECONOMIC, 284 00:10:49,783 --> 00:10:52,252 HEALTH-RELATED FACTORS THAT 285 00:10:52,252 --> 00:10:55,155 DRIVE ADRD TREATMENT AND HOW 286 00:10:55,155 --> 00:10:59,192 FACTORS IMPACT HEALTH AND 287 00:10:59,192 --> 00:11:01,495 NON-HEALTH OUTCOMES. 288 00:11:01,495 --> 00:11:05,098 THE CHALLENGE OF DATA IS REALLY 289 00:11:05,098 --> 00:11:07,634 MULTI-FACETED. 290 00:11:07,634 --> 00:11:08,168 NEXT SLIDE. 291 00:11:08,168 --> 00:11:10,303 WHEN WE THINK ABOUT THE DATA 292 00:11:10,303 --> 00:11:11,505 INFRASTRUCTURE, THIS IS 293 00:11:11,505 --> 00:11:12,773 ABSOLUTELY ESSENTIAL THAT WE 294 00:11:12,773 --> 00:11:13,907 CREATE THIS INFRASTRUCTURE AND 295 00:11:13,907 --> 00:11:16,076 INCLUDE MEASURES OF SOCIAL AND 296 00:11:16,076 --> 00:11:16,676 BEHAVIORAL RISK FACTORS. 297 00:11:16,676 --> 00:11:18,578 IF WE DON'T MEASURE IT, WE WON'T 298 00:11:18,578 --> 00:11:20,914 STUDY IT AND LEARN HOW TO MAKE 299 00:11:20,914 --> 00:11:21,181 PROGRESS. 300 00:11:21,181 --> 00:11:22,582 WE NEED A STRONG INFRASTRUCTURE 301 00:11:22,582 --> 00:11:24,851 THAT CAN SUPPORT THAT RESEARCH. 302 00:11:24,851 --> 00:11:26,653 HOWEVER, ANYBODY WHO HAS BEEN IN 303 00:11:26,653 --> 00:11:29,156 THE FIELD TRYING TO DO RESEARCH 304 00:11:29,156 --> 00:11:30,624 UNDERSTANDS NO DATASET IS 305 00:11:30,624 --> 00:11:31,091 PERFECT. 306 00:11:31,091 --> 00:11:33,026 THERE ARE INEVITABLE TRADEOFFS 307 00:11:33,026 --> 00:11:34,428 IN REAL DATA COLLECTION. 308 00:11:34,428 --> 00:11:37,697 AND SO WHEN WE THINK ABOUT THE 309 00:11:37,697 --> 00:11:40,267 GOALS OF CAUSAL INFERENCE, 310 00:11:40,267 --> 00:11:42,069 HAVING STATISTICAL POWER, 311 00:11:42,069 --> 00:11:42,869 EFFICIENT PRECISE ESTIMATES, 312 00:11:42,869 --> 00:11:46,073 HAVING HIGH QUALITY MEASURES 313 00:11:46,073 --> 00:11:49,176 WITH VERY CUTTING EDGE TOOLS, 314 00:11:49,176 --> 00:11:50,811 AND REPRESENTATION AND 315 00:11:50,811 --> 00:11:51,945 GENERALIZABILITY MAKING SURE 316 00:11:51,945 --> 00:11:53,580 EVERYONE CAN BE INCLUDED IN 317 00:11:53,580 --> 00:11:55,082 RESEARCH AND THE RESEARCH IS 318 00:11:55,082 --> 00:11:56,283 RELEVANT TO THEM ALL, DIFFERENT 319 00:11:56,283 --> 00:11:57,784 DATASETS WILL BE ADVANTAGEOUS 320 00:11:57,784 --> 00:11:58,985 FOR THESE DIFFERENT GOALS. 321 00:11:58,985 --> 00:12:02,989 NEXT SLIDE. 322 00:12:02,989 --> 00:12:05,592 FOR EXAMPLE, FOR STATISTICAL 323 00:12:05,592 --> 00:12:06,793 POWER, LARGE VOLUNTEER COHORTS 324 00:12:06,793 --> 00:12:08,562 LIKE "ALL OF US," LARGE RECORDS 325 00:12:08,562 --> 00:12:10,797 LIKE KAISER, MAY BE THE MOST 326 00:12:10,797 --> 00:12:11,098 APPROPRIATE. 327 00:12:11,098 --> 00:12:15,035 HOWEVER, WHEN WE THINK ABOUT TOP 328 00:12:15,035 --> 00:12:18,238 TIER MEASUREMENT QUALITY 329 00:12:18,238 --> 00:12:18,839 CLINIC-BASED STUDIES DEPLOYING 330 00:12:18,839 --> 00:12:21,541 EMERGING AND NEW MODALITIES MAY 331 00:12:21,541 --> 00:12:26,313 BE THE IDEAL SOURCE. 332 00:12:26,313 --> 00:12:26,713 REPRESENTATION AND 333 00:12:26,713 --> 00:12:27,814 GENERALIZABLE, WE'RE NEED TO 334 00:12:27,814 --> 00:12:30,984 THINK ABOUT COHORTS THAT MAKE 335 00:12:30,984 --> 00:12:33,053 SURE THEY INCLUDE COMMUNITIES 336 00:12:33,053 --> 00:12:38,158 SOMETIMES OMITTED FROM RESEARCH 337 00:12:38,158 --> 00:12:39,493 OR NOT REPRESENTED, LIKE HEALTH 338 00:12:39,493 --> 00:12:41,962 AND RETIREMENT STUDY, THE REGARD 339 00:12:41,962 --> 00:12:42,963 STUDY, AND FOR CAUSAL INFERENCE 340 00:12:42,963 --> 00:12:44,097 THERE ARE OTHER PRIORITIES. 341 00:12:44,097 --> 00:12:46,666 THE KEY IS THAT WE DEVELOP TOOLS 342 00:12:46,666 --> 00:12:48,635 TO TRIANGULATE ACROSS THESE DATA 343 00:12:48,635 --> 00:12:50,270 SOURCES, SO WE CAN WEAVE 344 00:12:50,270 --> 00:12:52,005 TOGETHER THE STRENGTH OF EACH 345 00:12:52,005 --> 00:12:55,509 TYPE OF DATA AND LEVERAGE THOSE 346 00:12:55,509 --> 00:12:57,944 TO ADDRESS EACH OF THESE GOALS. 347 00:12:57,944 --> 00:12:58,778 NEXT SLIDE. 348 00:12:58,778 --> 00:13:01,314 MOVING BACK TO THE STEPS TOWARDS 349 00:13:01,314 --> 00:13:03,950 THE OVERALL GOALS IN THE OVERALL 350 00:13:03,950 --> 00:13:05,819 RECOMMENDATION, THE COMMITTEE 351 00:13:05,819 --> 00:13:08,155 WANTED TO EMPHASIZE 352 00:13:08,155 --> 00:13:08,588 PHARMACOLOGIC AND 353 00:13:08,588 --> 00:13:09,422 NON-PHARMACOLOGIC APPROACHES 354 00:13:09,422 --> 00:13:11,024 INCLUDING MEDICAL AND SOCIAL 355 00:13:11,024 --> 00:13:12,425 SERVICE CARE INTERVENTIONS. 356 00:13:12,425 --> 00:13:14,794 AND CONSIDER EFFECTS ON COST AND 357 00:13:14,794 --> 00:13:15,695 HEALTH OUTCOMES, UNDERSTANDING 358 00:13:15,695 --> 00:13:17,164 THERE ARE REAL TRADEOFFS AND SO 359 00:13:17,164 --> 00:13:19,866 WE NEED TO THINK ABOUT COST AND 360 00:13:19,866 --> 00:13:20,267 HEALTH. 361 00:13:20,267 --> 00:13:23,470 WE DON'T THINK WE CAN DO THIS 362 00:13:23,470 --> 00:13:25,872 WITHOUT PAYING ATTENTION TO 363 00:13:25,872 --> 00:13:26,706 SUPPLY SIDE FACTORS, INCLUDING 364 00:13:26,706 --> 00:13:27,574 OWNERSHIP OF PHYSICIAN 365 00:13:27,574 --> 00:13:28,241 PRACTICES, LABOR MARKET 366 00:13:28,241 --> 00:13:29,943 CONDITIONS, IF THERE'S NOBODY IN 367 00:13:29,943 --> 00:13:30,644 THE LABOR MARKET TO PROVIDE CARE 368 00:13:30,644 --> 00:13:34,347 IT'S GOING TO BE VERY HARD TO 369 00:13:34,347 --> 00:13:40,487 DELIVER HIGH-QUALITY CARE. 370 00:13:40,487 --> 00:13:41,521 MEDICARE BENEFIT PLAN, IMPACT, 371 00:13:41,521 --> 00:13:42,989 ACCESS TO CARE AND TREATMENT. 372 00:13:42,989 --> 00:13:50,764 WE WANT TO EMPHASIZE THE ROLE OF 373 00:13:50,764 --> 00:13:52,199 SOCIOCULTURAL, ACCESS TO CARE 374 00:13:52,199 --> 00:13:54,534 FOR BOTH COGNITIVE AND 375 00:13:54,534 --> 00:13:55,969 BEHAVIORAL SYMPTOMS OF DEMENTIA. 376 00:13:55,969 --> 00:13:57,437 AND AN IMPORTANT PIECE OF THIS 377 00:13:57,437 --> 00:14:00,040 WHEN WE THINK ABOUT ACCESS TO 378 00:14:00,040 --> 00:14:02,709 CARE IS ADDRESSING MODALITIES OF 379 00:14:02,709 --> 00:14:04,311 DELIVERY, CARE DELIVERY, RURAL 380 00:14:04,311 --> 00:14:05,912 AMERICA, WHAT ARE THE BEST WAYS 381 00:14:05,912 --> 00:14:09,049 TO MEET THE NEEDS IN RURAL 382 00:14:09,049 --> 00:14:09,816 AMERICA VERSUS OTHER 383 00:14:09,816 --> 00:14:10,684 COMMUNITIES, WE NEED EVALUATE 384 00:14:10,684 --> 00:14:12,152 HOW PEOPLE ARE USING AND WHAT 385 00:14:12,152 --> 00:14:14,688 THEY PREFER WITH RESPECT TO 386 00:14:14,688 --> 00:14:16,223 TELEMEDICINE OR MOBILE HEALTH 387 00:14:16,223 --> 00:14:17,958 CARE AND ESPECIALLY 388 00:14:17,958 --> 00:14:20,026 DISPROPORTIONATELY AFFECTED 389 00:14:20,026 --> 00:14:20,493 POPULATIONS. 390 00:14:20,493 --> 00:14:20,860 NEXT SLIDE. 391 00:14:20,860 --> 00:14:22,829 AND I THINK THAT WRAPS IT UP AND 392 00:14:22,829 --> 00:14:26,366 I CAN HAND OFF FOR THE NEXT TOP 393 00:14:26,366 --> 00:14:28,034 PRIORITY RECOMMENDATION TO MY 394 00:14:28,034 --> 00:14:30,437 COLLEAGUE DR. DIETERS. 395 00:14:30,437 --> 00:14:32,906 TAKE IT AWAY, KACIE. 396 00:14:32,906 --> 00:14:35,508 >> THANK YOU, DR. GLYMOUR. 397 00:14:35,508 --> 00:14:40,180 I'D LIKE TO SAY THANK YOU TO 398 00:14:40,180 --> 00:14:46,019 EVERYONE FOR BEING HERE AND MY 399 00:14:46,019 --> 00:14:46,386 CO-CHAIR. 400 00:14:46,386 --> 00:14:49,990 I HAVING TO DISCLOSE OR 401 00:14:49,990 --> 00:14:50,323 DISCLAIM. 402 00:14:50,323 --> 00:14:51,858 NEXT SLIDE PLEASE. 403 00:14:51,858 --> 00:14:54,594 SO OUR FIRST AND TOP PRIORITY 404 00:14:54,594 --> 00:14:59,299 RECOMMENDATION IS TO ADVANCE 405 00:14:59,299 --> 00:15:00,033 COMMUNITY-DRIVEN ADRD RESEARCH 406 00:15:00,033 --> 00:15:03,069 TO IMPROVE HOW WE SAMPLE AND 407 00:15:03,069 --> 00:15:04,537 RETAIN POPULATIONS THAT ARE 408 00:15:04,537 --> 00:15:06,072 DISPROPORTIONATELY AFFECTED BY 409 00:15:06,072 --> 00:15:07,040 THESE DISEASES. 410 00:15:07,040 --> 00:15:10,110 THIS MEANS A NUMBER OF THINGS 411 00:15:10,110 --> 00:15:10,910 INCLUDING STANDARDIZE AND 412 00:15:10,910 --> 00:15:13,647 RECRUITMENT PRACTICES ACROSS 413 00:15:13,647 --> 00:15:14,714 RESEARCH GROUPS, RESEARCH 414 00:15:14,714 --> 00:15:16,182 PROGRAMS, AND INVESTIGATING 415 00:15:16,182 --> 00:15:17,884 CENTERS WITH A PROVEN TRACK 416 00:15:17,884 --> 00:15:19,619 RECORD IN REACHING UNDERSERVED 417 00:15:19,619 --> 00:15:20,220 COMMUNITIES. 418 00:15:20,220 --> 00:15:21,521 WE NEED ACCOUNTABILITY SYSTEMS 419 00:15:21,521 --> 00:15:27,160 THAT ENSURE WE'RE NOT RECRUITING 420 00:15:27,160 --> 00:15:28,261 PARTICIPANTS BUT MEETING 421 00:15:28,261 --> 00:15:29,296 MEANINGFUL BENCHMARKS. 422 00:15:29,296 --> 00:15:31,398 THAT MEANS FINDING NEW AND 423 00:15:31,398 --> 00:15:33,800 INNOVATIVE WAYS TO REMOVE 424 00:15:33,800 --> 00:15:36,002 PARTICIPATION BARRIERS LIKE 425 00:15:36,002 --> 00:15:37,237 TRANSPORTATION, MISTRUST, SIMPLY 426 00:15:37,237 --> 00:15:42,375 LACK OF TIME. 427 00:15:42,375 --> 00:15:46,913 WE NEED TO ENSURE TRUE 428 00:15:46,913 --> 00:15:49,416 REPRESENTATION TO IMPROVE THE 429 00:15:49,416 --> 00:15:52,952 SCIENCE ITSELF. 430 00:15:52,952 --> 00:15:54,621 NEXT SLIDE PLEASE. 431 00:15:54,621 --> 00:15:56,823 SO WHAT DO WE MEAN BY COMMUNITY 432 00:15:56,823 --> 00:15:57,590 DRIVEN RESEARCH? 433 00:15:57,590 --> 00:15:59,259 WE DEFINE IT AS RESEARCH THAT 434 00:15:59,259 --> 00:16:00,994 INCLUDES THE VOICES OF THOSE 435 00:16:00,994 --> 00:16:07,367 LIVING WITH OR AT RISK, 436 00:16:07,367 --> 00:16:08,668 ESPECIALLY FROM GROUPS 437 00:16:08,668 --> 00:16:10,437 DISPROPORTIONATELY IMPACTED, NOT 438 00:16:10,437 --> 00:16:13,873 JUST PASSIVE PARTICIPANTS BUT 439 00:16:13,873 --> 00:16:16,776 COLLABORATORS WHO SHAPE THE 440 00:16:16,776 --> 00:16:17,377 RESEARCH QUESTIONS, GUIDING 441 00:16:17,377 --> 00:16:18,778 IMPLEMENTATION, HELPING 442 00:16:18,778 --> 00:16:20,180 INTERPRET THE FINDINGS. 443 00:16:20,180 --> 00:16:21,715 WE'RE ESPECIALLY FOCUSED ON 444 00:16:21,715 --> 00:16:24,084 GROUPS THAT EITHER BEAR HIGHER 445 00:16:24,084 --> 00:16:25,552 BURDEN OF DISEASE OR ARE 446 00:16:25,552 --> 00:16:26,686 UNDERREPRESENTED IN RESEARCH 447 00:16:26,686 --> 00:16:29,222 THAT WE DON'T FULLY UNDERSTAND 448 00:16:29,222 --> 00:16:34,394 HOW ADRD AFFECTS THESE GROUPS. 449 00:16:34,394 --> 00:16:35,195 NEXT SLIDE PLEASE. 450 00:16:35,195 --> 00:16:37,964 ONE OF THE CLEAREST MODELS OF 451 00:16:37,964 --> 00:16:40,633 COMMUNITY DRIVEN RESEARCH IS 452 00:16:40,633 --> 00:16:43,670 COMMUNITY BASED PARTICIPATORY 453 00:16:43,670 --> 00:16:46,639 RESEARCH, AN EXAMPLE OF A 454 00:16:46,639 --> 00:16:47,774 FRAMEWORK THAT EMPHASIZES 455 00:16:47,774 --> 00:16:49,509 PARTNERSHIP BETWEEN RESEARCH AND 456 00:16:49,509 --> 00:16:51,144 COMMUNITY MEMBERS AT EVERY STAGE 457 00:16:51,144 --> 00:16:52,178 OF THE PROCESS. 458 00:16:52,178 --> 00:16:57,117 I REALLY LIKE THAT THIS IMAGE 459 00:16:57,117 --> 00:16:58,451 ILLUSTRATES HOW CBPR BRIDGES 460 00:16:58,451 --> 00:16:59,285 SCIENTIFIC INQUIRY WITH 461 00:16:59,285 --> 00:17:09,396 COMMUNITY RELEVANCE, MAKING THE 462 00:17:09,396 --> 00:17:16,469 WORK ETHICAL, FROM THE TIME OF 463 00:17:16,469 --> 00:17:17,637 INFORMING, EDUCATING AND WORKING 464 00:17:17,637 --> 00:17:18,938 WITH THE PUBLIC TO CREATE THIS 465 00:17:18,938 --> 00:17:22,675 IMPACTFUL RESEARCH. 466 00:17:22,675 --> 00:17:25,178 NEXT SLIDE PLEASE. 467 00:17:25,178 --> 00:17:26,880 STILL UNDER RECOMMENDATION 1 A 468 00:17:26,880 --> 00:17:28,882 CRITICAL SHIFT TO FACILITATE 469 00:17:28,882 --> 00:17:30,483 LIFE COURSE-FOCUSED RESEARCH, 470 00:17:30,483 --> 00:17:33,586 LOOKING AT BRAIN HEALTH MUCH 471 00:17:33,586 --> 00:17:35,388 EARLIER ESPECIALLY IN MID-LIFE 472 00:17:35,388 --> 00:17:37,490 WHEN MANY RISK FACTORS BEGIN. 473 00:17:37,490 --> 00:17:39,492 WE PROPOSE LOWERING AGE OF 474 00:17:39,492 --> 00:17:43,062 INCLUSION FOR RESEARCH TO MIDDLE 475 00:17:43,062 --> 00:17:43,463 AGE. 476 00:17:43,463 --> 00:17:47,400 THIS IS AN EXAMPLE OF AN IMAGE 477 00:17:47,400 --> 00:17:49,869 SHOWING DISPARITIES IN YEARS OF 478 00:17:49,869 --> 00:17:52,605 EDUCATION FROM EARLY 1900s TO 479 00:17:52,605 --> 00:17:53,506 1950. 480 00:17:53,506 --> 00:17:55,074 EDUCATION IS A STRONG PREDICTOR 481 00:17:55,074 --> 00:17:56,543 OF BRAIN HEALTH LATER IN LIFE 482 00:17:56,543 --> 00:17:59,179 YET THESE EARLY DIFFERENCES CAN 483 00:17:59,179 --> 00:18:00,113 HAVE LONG-TERM IMPLICATIONS AND 484 00:18:00,113 --> 00:18:03,116 SO THIS GRAPH IS SHOWING US THAT 485 00:18:03,116 --> 00:18:04,284 IF YOU WERE BLACK AND FROM THE 486 00:18:04,284 --> 00:18:07,020 SOUTH YOU HAD LESS YEARS OF 487 00:18:07,020 --> 00:18:08,054 EDUCATION RELATIVE TO WHITE 488 00:18:08,054 --> 00:18:10,290 INDIVIDUALS WHO LIVED IN THE 489 00:18:10,290 --> 00:18:11,758 NORTH. 490 00:18:11,758 --> 00:18:15,895 SO WHEN WE STUDY AD/ADRD, 491 00:18:15,895 --> 00:18:18,598 ESPECIALLY FOR POPULATIONS THAT 492 00:18:18,598 --> 00:18:20,200 FACE SYSTEMIC BARRIERS WE'RE AT 493 00:18:20,200 --> 00:18:22,802 RISK OF MISSING THE FULL 494 00:18:22,802 --> 00:18:23,503 PICTURE. 495 00:18:23,503 --> 00:18:25,071 NEXT SLIDE PLEASE. 496 00:18:25,071 --> 00:18:30,376 TURNING TO BIOMARKERS, ANOTHER 497 00:18:30,376 --> 00:18:33,046 AREA THAT HAS EVOLVED, WE 498 00:18:33,046 --> 00:18:35,815 RECOMMEND EXPANDING BIOMARKER 499 00:18:35,815 --> 00:18:36,516 DISCOVERY IN UNDERDESERVED 500 00:18:36,516 --> 00:18:38,618 GROUPS, WITHOUT THAT WE CANNOT 501 00:18:38,618 --> 00:18:40,920 BE CONFIDENT IN VALIDITY ACROSS 502 00:18:40,920 --> 00:18:42,922 DIVERSE POPULATIONS. 503 00:18:42,922 --> 00:18:46,559 WE ESPECIALLY EMPHASIZE SCALABLE 504 00:18:46,559 --> 00:18:47,494 BIOMARKERS LIKE BLOOD-BASED 505 00:18:47,494 --> 00:18:50,597 TESTS WHICH CAN REDUCE COST AND 506 00:18:50,597 --> 00:18:52,198 COMPLEXITY AND ENABLE BROADER 507 00:18:52,198 --> 00:18:52,832 INCLUSION. 508 00:18:52,832 --> 00:18:54,467 WE MUST ALSO RECOGNIZE THAT 509 00:18:54,467 --> 00:18:56,269 DISEASE PROGRESSION MAY VARY 510 00:18:56,269 --> 00:18:58,738 BASED ON SOCIAL AND VASCULAR 511 00:18:58,738 --> 00:19:00,206 FACTORS, FRAMEWORKS NEED TO 512 00:19:00,206 --> 00:19:02,175 ADAPT TO INCLUDE THIS. 513 00:19:02,175 --> 00:19:12,318 THIS INCLUDES COGNITIVE 514 00:19:12,318 --> 00:19:12,819 ASSESSMENTS. 515 00:19:12,819 --> 00:19:21,494 AND IMAGE HERE OF DR. BRICKMAN 516 00:19:21,494 --> 00:19:22,896 AT COLUMBIA SHOWS PLASMA 517 00:19:22,896 --> 00:19:26,199 BIOMARKERS CAN DIFFER OR BE THE 518 00:19:26,199 --> 00:19:28,334 SAME ACROSS RACIAL AND ETHNIC 519 00:19:28,334 --> 00:19:30,136 GROUPS, UNDERSCORING THE NEED 520 00:19:30,136 --> 00:19:32,872 FOR TAILORED INTERPRETATION. 521 00:19:32,872 --> 00:19:33,940 NEXT SLIDE PLEASE. 522 00:19:33,940 --> 00:19:36,242 HOWEVER, EVEN WHEN WE DO SAMPLE 523 00:19:36,242 --> 00:19:38,678 MORE INCLUSIVELY WE HAVE TO ASK 524 00:19:38,678 --> 00:19:41,080 IS OUR SAMPLE ACTUALLY 525 00:19:41,080 --> 00:19:41,915 REPRESENTATIVE? 526 00:19:41,915 --> 00:19:48,955 AND SO THIS IS FOCUSED ON 527 00:19:48,955 --> 00:19:50,557 SELECTION BIAS. 528 00:19:50,557 --> 00:19:52,158 WE MUST DEVELOP BETTER METHODS 529 00:19:52,158 --> 00:19:53,626 TO MEASURE AND REDUCE SELECTION 530 00:19:53,626 --> 00:19:56,729 BIAS, WHICH IS HOW WE IMPROVE 531 00:19:56,729 --> 00:19:58,698 GENERALIZABILITY OF FINDING AND 532 00:19:58,698 --> 00:20:00,466 ENSURE OUR RESULTS APPLY TO REAL 533 00:20:00,466 --> 00:20:02,602 WORLD, NOT JUST RESEARCH WORLD. 534 00:20:02,602 --> 00:20:06,639 SO THIS IMAGE CAPTURES THIS 535 00:20:06,639 --> 00:20:08,007 CONCEPT, TARGET POPULATION OF 536 00:20:08,007 --> 00:20:13,580 THOSE WITH HIGHER EDUCATION, YET 537 00:20:13,580 --> 00:20:15,615 STUDY SAMPLE IS MORE HIGHLY 538 00:20:15,615 --> 00:20:16,249 EDUCATED -- IS NOT 539 00:20:16,249 --> 00:20:18,685 REPRESENTATIVE OF THOSE THAT ARE 540 00:20:18,685 --> 00:20:24,157 MORE HIGHLY EDUCATED, SORRY, 541 00:20:24,157 --> 00:20:26,225 THOSE EDUCATED AROUND EDUCATION 542 00:20:26,225 --> 00:20:26,526 DIMENSIONS. 543 00:20:26,526 --> 00:20:28,995 SO HOW DOES THIS IMPACT THE 544 00:20:28,995 --> 00:20:32,799 STUDY CONCLUSION ABOUT EFFECT OF 545 00:20:32,799 --> 00:20:35,702 EDUCATION ON ALZHEIMER'S 546 00:20:35,702 --> 00:20:36,169 BIOMARKER? 547 00:20:36,169 --> 00:20:36,736 NEXT SLIDE PLEASE. 548 00:20:36,736 --> 00:20:38,638 FINALLY WE NEED MAP THE FUTURE 549 00:20:38,638 --> 00:20:42,208 OF BRAIN HEALTH WITH EXPANSIVE 550 00:20:42,208 --> 00:20:45,378 VIEW FROM GENES TO MICROBES, 551 00:20:45,378 --> 00:20:49,015 THAT MEANS EXPANDING MULTI-OMICS 552 00:20:49,015 --> 00:20:50,450 RESEARCH, SUCH AS METABOLOMICS, 553 00:20:50,450 --> 00:20:51,217 ESPECIALLY IN POPULATIONS THAT 554 00:20:51,217 --> 00:20:52,552 ARE LEFT OUT. 555 00:20:52,552 --> 00:20:54,120 PRIORITIZING EARLY MARKERS LIKE 556 00:20:54,120 --> 00:20:56,489 THE MICROBIOME COULD ALLOW FOR 557 00:20:56,489 --> 00:20:57,690 EARLIER MORE TAILORED 558 00:20:57,690 --> 00:20:58,024 INTERVENTIONS. 559 00:20:58,024 --> 00:20:59,959 WE ALSO NEED BETTER TOOLS TO 560 00:20:59,959 --> 00:21:02,095 ANALYZE DIVERSE AND LARGE 561 00:21:02,095 --> 00:21:02,362 DATASETS. 562 00:21:02,362 --> 00:21:04,564 AND MORE SUPPORT FOR INTEGRATING 563 00:21:04,564 --> 00:21:05,398 THEM. 564 00:21:05,398 --> 00:21:09,235 THIS IMAGE HERE SHOWS ANCESTRY 565 00:21:09,235 --> 00:21:11,904 REPRESENTATION IN GWAS STUDIES 566 00:21:11,904 --> 00:21:14,240 ILLUSTRATES A STARK IMBALANCE 567 00:21:14,240 --> 00:21:15,508 STILL GOING ON.. 568 00:21:15,508 --> 00:21:17,844 THEY ARE WORKING HARD TO CORRECT 569 00:21:17,844 --> 00:21:19,379 THE IMBALANCE WE'VE SEEN NOT 570 00:21:19,379 --> 00:21:21,981 ONLY IN SOCIAL FACTORS AND OUR 571 00:21:21,981 --> 00:21:26,653 RECRUITMENT EFFORTS, BUT ALSO IN 572 00:21:26,653 --> 00:21:28,988 OUR INCLUSION FOR THESE OMICS 573 00:21:28,988 --> 00:21:29,255 RESEARCH. 574 00:21:29,255 --> 00:21:31,724 ONLY BY EMBRACING COMPLEXITY AND 575 00:21:31,724 --> 00:21:33,960 INCLUSION CAN WE CREATE TRULY 576 00:21:33,960 --> 00:21:35,294 TRANSFORMATIVE BRAIN HEALTH 577 00:21:35,294 --> 00:21:35,561 RESEARCH. 578 00:21:35,561 --> 00:21:39,032 IN SUMMARY I WANT TO VOTE FOR 579 00:21:39,032 --> 00:21:40,233 THIS ADVANCE IN ADRD RESEARCH 580 00:21:40,233 --> 00:21:42,168 THAT'S REPRESENTATIVE OF ALL 581 00:21:42,168 --> 00:21:44,203 POPULATIONS AND WE MUST MOVE 582 00:21:44,203 --> 00:21:53,713 FROM INCLUSION AS AFTERTHOUGHT 583 00:21:53,713 --> 00:21:54,480 TO INCLUSION. 584 00:21:54,480 --> 00:21:58,584 CHANGE ARE KEY TO GETTING THERE. 585 00:21:58,584 --> 00:22:07,393 THAT'S IT FOR ME. 586 00:22:07,393 --> 00:22:10,897 NEXT SLIDE. 587 00:22:10,897 --> 00:22:11,364 >> HELLO, EVERYBODY. 588 00:22:11,364 --> 00:22:15,268 MY TURN, I'M EXCITED TO BE HERE. 589 00:22:15,268 --> 00:22:17,003 LIKE MARIA AND KACIE MENTIONED, 590 00:22:17,003 --> 00:22:19,439 IT WAS A PLEASURE TO WORK WITH 591 00:22:19,439 --> 00:22:21,040 EVERYBODY IN THE COMMITTEE TO 592 00:22:21,040 --> 00:22:26,245 WORK ON THESE RECOMMENDATIONS. 593 00:22:26,245 --> 00:22:29,849 SO I'M DR. MIGUEL ARCE-RENTERIA, 594 00:22:29,849 --> 00:22:32,218 COLUMBIA UNIVERSITY, MY WORK 595 00:22:32,218 --> 00:22:34,987 FOCUSES ON HEALTH DISPARITIES IN 596 00:22:34,987 --> 00:22:39,959 LATINOS AND ADVERSE POPULATIONS 597 00:22:39,959 --> 00:22:40,893 AROUND THE WORLD. 598 00:22:40,893 --> 00:22:46,966 AND SO EVERYBODY CAN SEE ME AND 599 00:22:46,966 --> 00:22:48,167 HEAR ME FINE. 600 00:22:48,167 --> 00:22:48,968 NEXT SLIDE. 601 00:22:48,968 --> 00:22:51,671 I'LL BE GOING OVER MY 602 00:22:51,671 --> 00:22:54,540 DISCLAIMERS AND DISCLOSURES, 603 00:22:54,540 --> 00:22:56,175 NOTHING REALLY TO REPORT. 604 00:22:56,175 --> 00:22:57,243 NEXT SLIDE. 605 00:22:57,243 --> 00:23:00,780 AND SO I'LL BE GOING OVER TWO 606 00:23:00,780 --> 00:23:01,714 RECOMMENDATIONS, PRIMARILY 607 00:23:01,714 --> 00:23:03,516 FOCUSING ON RECOMMENDATION 3 ON 608 00:23:03,516 --> 00:23:07,019 ENSURING STRONG WORK FORCE 609 00:23:07,019 --> 00:23:09,222 INVOLVING BIOMEDICAL, 610 00:23:09,222 --> 00:23:11,190 BEHAVIORAL, SOCIAL SCIENCE, 611 00:23:11,190 --> 00:23:13,593 RESEARCH IN HIGHEST RISK 612 00:23:13,593 --> 00:23:15,762 POPULATION, POPULATIONS THAT FOR 613 00:23:15,762 --> 00:23:16,596 HEALTH DISPARITIES, OUR 614 00:23:16,596 --> 00:23:19,298 RECOMMENDATIONS IN TERMS OF WHAT 615 00:23:19,298 --> 00:23:21,167 IS NEEDED FOR HIGH-QUALITY, 616 00:23:21,167 --> 00:23:24,103 HIGH-IMPACT HEALTH DISPARITIES 617 00:23:24,103 --> 00:23:28,174 WORK AS WELL AS COMBINING 618 00:23:28,174 --> 00:23:29,008 OVERLAPPING WITH RECOMMENDATION 619 00:23:29,008 --> 00:23:31,210 7 WITH PRIORITY 4 ON ENHANCING 620 00:23:31,210 --> 00:23:33,246 ACCESS TO RESEARCH TRAINING, 621 00:23:33,246 --> 00:23:35,948 ESPECIALLY FOR INDIVIDUALS WHO 622 00:23:35,948 --> 00:23:40,153 ENCOUNTER EDUCATIONAL BARRIERS 623 00:23:40,153 --> 00:23:42,722 TO ENSURING OUTSTANDING ADRD 624 00:23:42,722 --> 00:23:42,989 WORKFORCE. 625 00:23:42,989 --> 00:23:44,957 IT BLENDS ITSELF EASILY INTO A 626 00:23:44,957 --> 00:23:48,628 COMBINING THE SESSION OF THE TWO 627 00:23:48,628 --> 00:23:49,962 RECOMMENDATIONS TOGETHER, GIVEN 628 00:23:49,962 --> 00:23:52,331 THAT THOSE THAT WOULD BENEFIT 629 00:23:52,331 --> 00:23:53,833 FROM ENHANCED TRAINING LIKE 630 00:23:53,833 --> 00:23:55,334 INDIVIDUALS WHO ENCOUNTER 631 00:23:55,334 --> 00:23:57,203 EDUCATIONAL BEARERS ARE ALSO 632 00:23:57,203 --> 00:24:00,173 THOSE WITHIN THESE AT HIGH-RISK 633 00:24:00,173 --> 00:24:03,242 POPULATIONS, AT RISK FOR HEALTH 634 00:24:03,242 --> 00:24:07,079 DISPARITIES, AS MENTIONED BY MY 635 00:24:07,079 --> 00:24:07,580 COLLEAGUES ON PREVIOUS 636 00:24:07,580 --> 00:24:09,682 PRESENTATIONS, SO I'LL BE GOING 637 00:24:09,682 --> 00:24:11,317 INTO DETAIL FOR TRAINING FOR 638 00:24:11,317 --> 00:24:18,891 EARLY CAREER RESEARCHERS NEW TO 639 00:24:18,891 --> 00:24:20,560 LEARNING ABOUT ADRD RESEARCH, 640 00:24:20,560 --> 00:24:22,628 GRANTS PROPOSED IN TERMS OF 641 00:24:22,628 --> 00:24:23,162 RESEARCHING FOR HEALTH 642 00:24:23,162 --> 00:24:25,665 DISPARITIES WORK, AND AS WELL 643 00:24:25,665 --> 00:24:26,432 THINKING ABOUT MORE PROBLEMATIC 644 00:24:26,432 --> 00:24:29,602 STRUCTURAL CHANGES SUCH AS 645 00:24:29,602 --> 00:24:31,704 PROMOTING MEETINGS, FOR OPEN 646 00:24:31,704 --> 00:24:32,972 DIALOGUE, APPROACH TO ADRD 647 00:24:32,972 --> 00:24:37,043 RESEARCH, AS WELL AS BRINGING IN 648 00:24:37,043 --> 00:24:38,311 THE WORLD OF SCIENTISTS, 649 00:24:38,311 --> 00:24:41,113 BRINGING IN EXTERNAL GROUPS TO 650 00:24:41,113 --> 00:24:42,014 STRENGTHEN SUPPORT FOR 651 00:24:42,014 --> 00:24:47,620 RESEARCHERS IN THIS FIELD. 652 00:24:47,620 --> 00:24:49,088 SO NEXT SLIDE. 653 00:24:49,088 --> 00:24:49,288 GREAT. 654 00:24:49,288 --> 00:24:51,390 AND SO IN TERMS OF BROADLY 655 00:24:51,390 --> 00:24:53,559 SPEAKING, TRAINING FOR EARLY 656 00:24:53,559 --> 00:24:57,530 CAREER SCHOLARS IN ADRD, HEALTH 657 00:24:57,530 --> 00:25:00,166 DISPARITIES WORK, WHY TRAINING 658 00:25:00,166 --> 00:25:02,802 TO ADDRESS DISPARITIES, IT'S A 659 00:25:02,802 --> 00:25:04,537 FUNDAMENTAL RESEARCH SKILL. 660 00:25:04,537 --> 00:25:06,739 ULTIMATELY THE GOAL IS WITH THIS 661 00:25:06,739 --> 00:25:09,775 ADDITIONAL TRAINING IT WILL LEAD 662 00:25:09,775 --> 00:25:10,743 TO REDUCING, UNDOING HEALTH 663 00:25:10,743 --> 00:25:13,212 DISPARITIES WORK, IN TERMS OF 664 00:25:13,212 --> 00:25:16,949 COMBINING INCREASING ACCESS TO 665 00:25:16,949 --> 00:25:17,617 INDIVIDUALS WITH EDUCATIONAL 666 00:25:17,617 --> 00:25:20,186 BARRIERS, THEN ENHANCE TRAINING 667 00:25:20,186 --> 00:25:23,256 IN HEALTH DISPARITIES RESEARCH, 668 00:25:23,256 --> 00:25:25,658 WORK HAS SHOWN TEAMS WITH 669 00:25:25,658 --> 00:25:26,759 MEMBERS THAT INCLUDE MEMBERS 670 00:25:26,759 --> 00:25:30,062 FROM THE GROUP LEADS TO BETTER 671 00:25:30,062 --> 00:25:31,063 SCIENCE, SUCH AS PROVIDING 672 00:25:31,063 --> 00:25:35,534 MEANINGFUL CONTENT ON HEALTH 673 00:25:35,534 --> 00:25:36,168 DISPARITIES PATIENT POPULATION, 674 00:25:36,168 --> 00:25:38,004 BIOMEDICAL PROBLEMS, PUBLISH 675 00:25:38,004 --> 00:25:39,538 MORE FREQUENTLY, CITED MORE, 676 00:25:39,538 --> 00:25:40,373 INCREASES UNDERSTANDING AND 677 00:25:40,373 --> 00:25:41,641 COMMITMENT TO HEALTH DISPARITIES 678 00:25:41,641 --> 00:25:42,074 WORK. 679 00:25:42,074 --> 00:25:44,143 AND AS WELL AS ENCOURAGES THEM 680 00:25:44,143 --> 00:25:47,580 TO PUBLISH MORE, SECURE GRANTS, 681 00:25:47,580 --> 00:25:51,350 INDICATING A POSITIVE TRAJECTORY 682 00:25:51,350 --> 00:25:55,321 TOWARD INDEPENDENT GRANT 683 00:25:55,321 --> 00:25:55,655 FUNDING. 684 00:25:55,655 --> 00:25:56,789 ALL RIGHT. 685 00:25:56,789 --> 00:25:58,357 I JUST WANTED TO HIGHLIGHT ON 686 00:25:58,357 --> 00:26:00,393 THE RIGHT, IT'S IMPORTANT TO 687 00:26:00,393 --> 00:26:02,328 PROVIDE THIS EARLY TRAINING FOR 688 00:26:02,328 --> 00:26:05,798 CAREER SCHOLARS IN HEALTH 689 00:26:05,798 --> 00:26:08,167 DISPARITIES BROADLY SPEAKING, IN 690 00:26:08,167 --> 00:26:10,937 PARTICULAR INDIVIDUALS FROM 691 00:26:10,937 --> 00:26:13,873 HEALTH DISPARITIES DISPARITIES, 692 00:26:13,873 --> 00:26:14,774 MIGHT ENCOUNTER EDUCATIONAL 693 00:26:14,774 --> 00:26:16,142 DIFFICULTS, THESE INDIVIDUALS 694 00:26:16,142 --> 00:26:17,476 MIGHT PROVIDE INSIGHTS TO 695 00:26:17,476 --> 00:26:18,010 BENEFIT COMMUNITIES WE'RE 696 00:26:18,010 --> 00:26:18,978 INTERESTED IN WORKING WITH. 697 00:26:18,978 --> 00:26:20,579 ON THE RIGHT I WANTED TO 698 00:26:20,579 --> 00:26:21,647 HIGHLIGHT SOME PROGRAMS THAT 699 00:26:21,647 --> 00:26:23,582 HAVE EXISTED THAT WE CAN USE 700 00:26:23,582 --> 00:26:25,952 THIS TYPE OF FRAMEWORK THAT 701 00:26:25,952 --> 00:26:27,553 PROMOTE EARLY CAREER TRAINING 702 00:26:27,553 --> 00:26:30,089 BROADLY SPEAKING FOR INDIVIDUALS 703 00:26:30,089 --> 00:26:31,057 WITH DIFFICULTIES TO PROVIDE 704 00:26:31,057 --> 00:26:32,925 OPPORTUNITIES TO ENTER THE 705 00:26:32,925 --> 00:26:35,561 RESEARCH FIELD, AS WELL AS 706 00:26:35,561 --> 00:26:38,064 FOCUSING ON HEALTH DISPARITIES 707 00:26:38,064 --> 00:26:40,099 WORK ACROSS THE CAREER TIMELINE. 708 00:26:40,099 --> 00:26:42,935 FOR INSTANCE, AT THE TOP WE HAVE 709 00:26:42,935 --> 00:26:43,836 SUMMER RESEARCH PROGRAMS FUNDED 710 00:26:43,836 --> 00:26:47,306 BY THE NIH, SUCH AS THE ONE AT 711 00:26:47,306 --> 00:26:48,541 COLUMBIA UNIVERSITY ON THE 712 00:26:48,541 --> 00:26:51,344 SUMMER TRANSLATIONAL AGING 713 00:26:51,344 --> 00:26:55,014 RESEARCH FOR UNDERGRADUATES, A 714 00:26:55,014 --> 00:26:56,115 WONDERFUL SUMMER PROGRAM. 715 00:26:56,115 --> 00:26:57,750 TRAINING PROGRAMS ALL OVER THE 716 00:26:57,750 --> 00:26:59,118 COUNTRY, HIGHLIGHTING JUST ONE 717 00:26:59,118 --> 00:27:05,992 FROM SAN DIEGO STATE, FOCUSING 718 00:27:05,992 --> 00:27:06,926 ON ADVANCING DIVERSITY, 719 00:27:06,926 --> 00:27:10,496 HIGHLIGHTING SAN DIEGO STATE, I 720 00:27:10,496 --> 00:27:13,432 GRADUATED, SO I'M BIASED, I'VE 721 00:27:13,432 --> 00:27:15,001 WORKED WITH INDIVIDUALS FROM 722 00:27:15,001 --> 00:27:17,603 THAT PROGRAM, SUMMER PROGRAM AT 723 00:27:17,603 --> 00:27:18,771 COLUMBIA, WONDERFUL TRAINEES, 724 00:27:18,771 --> 00:27:21,207 AND THERE'S THAT LEVEL OF 725 00:27:21,207 --> 00:27:21,907 POSTDOCTORAL CONTINUING 726 00:27:21,907 --> 00:27:23,009 TRAININGS THAT HAVE BEEN A LOT 727 00:27:23,009 --> 00:27:26,979 OF TYPES OF OPPORTUNITIES THAT 728 00:27:26,979 --> 00:27:31,017 PROVIDE SUPPORT FOR INDIVIDUALS, 729 00:27:31,017 --> 00:27:32,785 SUCH AS RECENTLY THERE'S NOTICES 730 00:27:32,785 --> 00:27:35,521 EXPIRED ONLINE BUT HISTORICALLY 731 00:27:35,521 --> 00:27:38,724 WE HAD SUPPLEMENTS TO PROMOTE 732 00:27:38,724 --> 00:27:39,825 DIVERSITY AND HEALTH-RELATED 733 00:27:39,825 --> 00:27:40,693 RESEARCH WITH HEAVY TRAINING 734 00:27:40,693 --> 00:27:42,628 ELEMENTS FOR THESE INDIVIDUALS 735 00:27:42,628 --> 00:27:47,433 AS WELL AS OUTSIDE OF THE NIA, 736 00:27:47,433 --> 00:27:48,100 FELLOWSHIPS TO PROMOTE 737 00:27:48,100 --> 00:27:56,242 DIVERSITY, PHO -- AS WELL AS 738 00:27:56,242 --> 00:27:57,576 OTHER PROGRAMS FOR EARLY CAREER 739 00:27:57,576 --> 00:27:58,911 NOT JUST POSTDOCS BUT FACULTY 740 00:27:58,911 --> 00:28:02,848 SUCH AS WITH THE RCMARs. 741 00:28:02,848 --> 00:28:06,252 AS A PERSONAL NOTE THESE 742 00:28:06,252 --> 00:28:07,586 PROGRAMS ARE BENEFICIAL FOR 743 00:28:07,586 --> 00:28:08,421 ENCOURAGING INDIVIDUALS WHO 744 00:28:08,421 --> 00:28:11,057 DON'T HAVE USUAL ACCESS FOR 745 00:28:11,057 --> 00:28:11,657 EDUCATIONAL OPPORTUNITIES AND 746 00:28:11,657 --> 00:28:14,093 GET THEM ENGAGED IN RESEARCH 747 00:28:14,093 --> 00:28:15,494 BECAUSE I'VE BENEFITED FROM EACH 748 00:28:15,494 --> 00:28:17,730 OF THESE TYPES OF PROGRAMS, WHEN 749 00:28:17,730 --> 00:28:19,465 I WAS AN UNDERGRAD AT SAN DIEGO 750 00:28:19,465 --> 00:28:21,567 STATE, IN AN NIH PROGRAM FOR 751 00:28:21,567 --> 00:28:23,836 GETTING EXPOSED TO RESEARCH, I 752 00:28:23,836 --> 00:28:25,271 DID A SUMMER RESEARCH PROGRAM AT 753 00:28:25,271 --> 00:28:26,772 BOSTON UNIVERSITY FUNDED THROUGH 754 00:28:26,772 --> 00:28:27,406 THE NIH. 755 00:28:27,406 --> 00:28:31,343 THEN AS A GRADUATE STUDENT I 756 00:28:31,343 --> 00:28:33,079 RECEIVED A RESEARCH FELLOWSHIP 757 00:28:33,079 --> 00:28:34,914 PROGRAM ON THESE TOPICS, AS A 758 00:28:34,914 --> 00:28:37,850 POSTDOC AWARDED A DIVERSITY 759 00:28:37,850 --> 00:28:38,517 SUPPLEMENT, ALZHEIMER'S 760 00:28:38,517 --> 00:28:39,718 ASSOCIATION FELLOWSHIP AND 761 00:28:39,718 --> 00:28:43,422 FUNDING THROUGH RCMAR, NOW MY 762 00:28:43,422 --> 00:28:47,827 THIRD YEAR OF FACULTY TWO 763 00:28:47,827 --> 00:28:50,763 R01s, WRAPPING UP A K99/R00. 764 00:28:50,763 --> 00:28:52,531 I CAN'T STRESS ENOUGH HOW 765 00:28:52,531 --> 00:28:53,632 INFLUENTIAL THESE TRAINING 766 00:28:53,632 --> 00:28:55,801 OPPORTUNITIES HAVE BEEN FOR MY 767 00:28:55,801 --> 00:28:57,470 CAREER IN TERMS OF WORKING INTO 768 00:28:57,470 --> 00:28:59,238 HEALTH DISPARITIES WORK, WHICH I 769 00:28:59,238 --> 00:29:01,707 THINK WE NEED TO CONTINUE 770 00:29:01,707 --> 00:29:02,374 SUPPORTING THESE PROGRAMS IF WE 771 00:29:02,374 --> 00:29:04,777 WANT TO HELP CHANGE THE FIELD OF 772 00:29:04,777 --> 00:29:10,449 HEALTH DISPARITIES. 773 00:29:10,449 --> 00:29:10,850 NEXT SLIDE. 774 00:29:10,850 --> 00:29:14,353 ANOTHER RECOMMENDATION FOR US IS 775 00:29:14,353 --> 00:29:16,989 INCLUSION, ENCOURAGE GRANTS TO 776 00:29:16,989 --> 00:29:18,491 HAVE EXPERIENCED HEALTH 777 00:29:18,491 --> 00:29:20,059 DISPARITIES EXPERT AS 778 00:29:20,059 --> 00:29:20,626 NON-TRIVIAL COMPONENT AND 779 00:29:20,626 --> 00:29:25,164 EMBRACE CLEAR TIME TO ASSESS HOW 780 00:29:25,164 --> 00:29:26,198 PROPOSED RESEARCH WILL IMPACT 781 00:29:26,198 --> 00:29:27,099 POPULATIONS. 782 00:29:27,099 --> 00:29:29,101 THE IDEA BEHIND IT, INCLUSION OF 783 00:29:29,101 --> 00:29:29,768 INVESTIGATORS WITHOUT PRIOR 784 00:29:29,768 --> 00:29:32,104 EXPERIENCE OR COMMITMENT TO 785 00:29:32,104 --> 00:29:32,705 HEALTH DISPARITIES RESEARCH 786 00:29:32,705 --> 00:29:34,106 ATTEMPTING TO DO HEALTH 787 00:29:34,106 --> 00:29:35,741 DISPARITIES RESEARCH HAS BEEN 788 00:29:35,741 --> 00:29:38,444 SHOWN HAVE NEGATIVE CONSEQUENCES 789 00:29:38,444 --> 00:29:41,514 SUCH AS STUDIES CAN 790 00:29:41,514 --> 00:29:43,382 MISCHARACTERIZE ROOT CAUSES, 791 00:29:43,382 --> 00:29:45,384 CREATE UNCLEAR POTENTIAL 792 00:29:45,384 --> 00:29:46,018 SOLUTIONS FOR IMPORTANT ISSUES, 793 00:29:46,018 --> 00:29:48,187 MEMBERS OF THE HEALTH 794 00:29:48,187 --> 00:29:49,321 DISPARITIES SPACE AT RISK OF 795 00:29:49,321 --> 00:29:59,698 BEING OUTNUMBERED. 796 00:29:59,698 --> 00:30:02,101 AS WAS MENTIONED, IF WE CAN 797 00:30:02,101 --> 00:30:03,135 REDUCE THE RISK FOR EVERYBODY TO 798 00:30:03,135 --> 00:30:06,472 MATCH THE ONE WITH THE LOWEST 799 00:30:06,472 --> 00:30:07,540 RISK IT BENEFITS EVERYBODY IN 800 00:30:07,540 --> 00:30:09,008 THE POPULATION. 801 00:30:09,008 --> 00:30:13,479 SO, ULTIMATELY AS WELL, IF WE DO 802 00:30:13,479 --> 00:30:17,183 NOT INCLUDE HEALTH DISPARITIES, 803 00:30:17,183 --> 00:30:19,318 CAN REDUCE COMMUNITIES ENGAGING 804 00:30:19,318 --> 00:30:21,487 IN SCIENTIFIC EFFORT, WE SUGGEST 805 00:30:21,487 --> 00:30:22,254 FOR GRANTS FOCUSED ON HEALTH 806 00:30:22,254 --> 00:30:25,858 DISPARITIES THEY HAVE TO HAVE A 807 00:30:25,858 --> 00:30:27,359 STRONG HEALTH DISPARITIES EXPERT 808 00:30:27,359 --> 00:30:28,994 IN THE FIELD. 809 00:30:28,994 --> 00:30:34,300 >> THREE MINUTES. 810 00:30:34,300 --> 00:30:36,001 >> NEXT SLIDE PLEASE. 811 00:30:36,001 --> 00:30:40,739 IN ADDITION WE WOULD BENEFIT 812 00:30:40,739 --> 00:30:41,974 FROM ADDITIONAL PROMOTING ANNUAL 813 00:30:41,974 --> 00:30:45,010 OR REGULAR MEETINGS TO DISCUSS 814 00:30:45,010 --> 00:30:45,511 DISAGREEMENTS, AREAS OF 815 00:30:45,511 --> 00:30:51,383 CONSENSUS, GUIDELINES ON BEST 816 00:30:51,383 --> 00:30:53,452 PRACTICES FOR AD/ADRD HEALTH 817 00:30:53,452 --> 00:30:55,087 DISPARITIES RESEARCH, DIALOGUE 818 00:30:55,087 --> 00:30:56,755 FOR APPROACHES TO ADDRESS 819 00:30:56,755 --> 00:30:58,290 POPULATIONS IN AD/ADRD. 820 00:30:58,290 --> 00:31:00,459 THE GOAL IS THESE MEETINGS AND 821 00:31:00,459 --> 00:31:02,528 SUMMITS CAN SUPPORT RESEARCH 822 00:31:02,528 --> 00:31:03,028 COMMUNITIES INTRODUCING 823 00:31:03,028 --> 00:31:04,196 FRAMEWORKS OF SCIENCE PRACTICE 824 00:31:04,196 --> 00:31:05,164 AND POLICY TO SHAPE FUTURE 825 00:31:05,164 --> 00:31:07,566 RESEARCH SUCH AS SUMMIT WE'RE 826 00:31:07,566 --> 00:31:08,534 ATTENDING TODAY, PROVIDE 827 00:31:08,534 --> 00:31:09,768 RECOMMENDATIONS THAT BRIDGE 828 00:31:09,768 --> 00:31:11,704 SCIENCE PRACTICE AND POLICY 829 00:31:11,704 --> 00:31:12,504 TOGETHER, OFFER COMMUNITY 830 00:31:12,504 --> 00:31:15,374 ENGAGED STRATEGIES TO ENHANCE 831 00:31:15,374 --> 00:31:16,208 RECRUIT, EVERYBODY CAN HELP GROW 832 00:31:16,208 --> 00:31:19,411 FROM EACH OTHER AND LEARN FROM 833 00:31:19,411 --> 00:31:20,212 EACH OTHER. 834 00:31:20,212 --> 00:31:21,914 FACILITATE AND PROVIDE AREAS OF 835 00:31:21,914 --> 00:31:23,515 CONSENSUS AND GUIDELINES FOR 836 00:31:23,515 --> 00:31:26,585 BEST PRACTICES AND LEAD TO OPEN 837 00:31:26,585 --> 00:31:26,885 DISCUSSIONS. 838 00:31:26,885 --> 00:31:29,054 I'M HIGHLIGHTING ON THE RIGHT 839 00:31:29,054 --> 00:31:31,957 THAT THERE HAVE BEEN SOME 840 00:31:31,957 --> 00:31:33,525 MEETINGS THAT HAPPENED REGULARLY 841 00:31:33,525 --> 00:31:36,462 OR ONE TIME, WHICH HAVE BEEN 842 00:31:36,462 --> 00:31:36,895 WONDERFUL. 843 00:31:36,895 --> 00:31:38,397 I THINK IT WOULD BE HELPFUL TO 844 00:31:38,397 --> 00:31:41,634 ESTABLISH SOMETHING MORE OF A 845 00:31:41,634 --> 00:31:43,168 REGULAR MEETING THAT CAN THEN 846 00:31:43,168 --> 00:31:45,571 REALLY WE CAN ALL BE ON TOP OF 847 00:31:45,571 --> 00:31:46,472 EVERYTHING THAT'S HAPPENING WITH 848 00:31:46,472 --> 00:31:48,407 HEALTH DISPARITIES WORK, AND HOW 849 00:31:48,407 --> 00:31:51,377 TO CONTINUE IMPROVING THE WORK 850 00:31:51,377 --> 00:31:52,745 FORCE IN IMPROVING SCIENTISTS 851 00:31:52,745 --> 00:31:55,881 ENGAGING IN THIS RESEARCH TO 852 00:31:55,881 --> 00:31:57,149 OBVIOUSLY ULTIMATELY REDUCE 853 00:31:57,149 --> 00:32:00,085 HEALTH DISPARITIES. 854 00:32:00,085 --> 00:32:05,557 AND NEXT SLIDE. 855 00:32:05,557 --> 00:32:07,092 ADDITIONAL TRAINING GOALS WE 856 00:32:07,092 --> 00:32:08,527 HAVE, TO PROMOTE ONGOING 857 00:32:08,527 --> 00:32:09,795 TRAINING AND PROFESSIONAL 858 00:32:09,795 --> 00:32:13,732 DEVELOPMENT FOR RESEARCH STAFF, 859 00:32:13,732 --> 00:32:15,267 INCREASING AS WELL AS TRAINING 860 00:32:15,267 --> 00:32:17,236 ON PRACTICES FOR COMMUNITY 861 00:32:17,236 --> 00:32:18,037 ENGAGED RESEARCH THAT HELPS 862 00:32:18,037 --> 00:32:20,939 BUILDING COMMUNITY TRUST THROUGH 863 00:32:20,939 --> 00:32:21,840 HANDS-ON OUTREACH AND EDUCATION, 864 00:32:21,840 --> 00:32:23,709 I'M SHOWING HIGHLIGHT OF THE 865 00:32:23,709 --> 00:32:26,045 WORK THAT MY TEAM AND MYSELF 866 00:32:26,045 --> 00:32:27,446 HAVE DONE. 867 00:32:27,446 --> 00:32:28,414 THIS PROVIDES OPPORTUNITIES FOR 868 00:32:28,414 --> 00:32:31,917 CLINICIANS FOR FIELD EXPERTS TO 869 00:32:31,917 --> 00:32:33,152 SHARE INSIGHTS, CREATE DIALOGUE, 870 00:32:33,152 --> 00:32:36,188 START BUILDING TRUST, IN 871 00:32:36,188 --> 00:32:36,955 ADDITION PROVIDING ANOTHER 872 00:32:36,955 --> 00:32:41,894 OPPORTUNITY FOR EARLY CAREER 873 00:32:41,894 --> 00:32:44,196 TRAINEES, TO ENGAGE IN 874 00:32:44,196 --> 00:32:45,831 CULTURALLY RESPONSE TOOLS TO 875 00:32:45,831 --> 00:32:46,999 ENGAGE AND DEVELOP PROFESSIONAL 876 00:32:46,999 --> 00:32:49,601 WORKING WITH THE COMMUNITY AND 877 00:32:49,601 --> 00:32:51,136 THERE'S BEEN SEVERAL WORK TO 878 00:32:51,136 --> 00:32:52,938 SUPPORT BENEFITS OF COMMUNITY 879 00:32:52,938 --> 00:32:54,840 ENGAGED RESEARCH THAT WILL 880 00:32:54,840 --> 00:32:55,974 INCREASE RETENTION, RECRUITMENT 881 00:32:55,974 --> 00:32:57,009 AND RETENTION OF THESE 882 00:32:57,009 --> 00:33:02,081 INDIVIDUALS IN THESE STUDIES SO 883 00:33:02,081 --> 00:33:07,753 MAKING ADRD RESEARCH MUCH MORE 884 00:33:07,753 --> 00:33:09,521 GENERALIZABLE. 885 00:33:09,521 --> 00:33:10,723 NEXT SLIDE. 886 00:33:10,723 --> 00:33:13,692 AND THEN LASTLY, WE'RE ALSO 887 00:33:13,692 --> 00:33:15,127 SUGGESTING THAT WE CONVENE AN 888 00:33:15,127 --> 00:33:16,829 EXTERNAL WORKING GROUP WITH 889 00:33:16,829 --> 00:33:17,629 PUBLIC STAKEHOLDERS MEANING 890 00:33:17,629 --> 00:33:20,032 INDIVIDUALS FROM GROUPS THAT ARE 891 00:33:20,032 --> 00:33:21,834 MOST IMPACTED FROM ADRD, 892 00:33:21,834 --> 00:33:24,870 CAREGIVERS, INDIVIDUALS 893 00:33:24,870 --> 00:33:31,343 THEMSELVES WITH ADRD, AFFECTED 894 00:33:31,343 --> 00:33:33,779 BY ADRD TO SUPPORT 895 00:33:33,779 --> 00:33:34,546 INFRASTRUCTURE. 896 00:33:34,546 --> 00:33:37,216 THE GOAL IS LEVERAGING A WORKING 897 00:33:37,216 --> 00:33:39,651 GROUP OF PUBLIC STAKEHOLDERS, 898 00:33:39,651 --> 00:33:41,620 NOT NECESSARILY RELYING ON 899 00:33:41,620 --> 00:33:43,722 KNOWLEDGE, HERE I'M THINKING 900 00:33:43,722 --> 00:33:46,225 ABOUT THERE'S EFFORTS FROM 901 00:33:46,225 --> 00:33:49,561 SEVERAL INVESTIGATORS, DIFFERENT 902 00:33:49,561 --> 00:33:51,463 TYPES OF PROGRAMS, WHERE THEY 903 00:33:51,463 --> 00:33:52,364 HAVE COMMUNITY BOARDS, THOSE 904 00:33:52,364 --> 00:33:54,633 TYPES OF THINGS, THAT HAVE THAT 905 00:33:54,633 --> 00:33:56,969 GOAL IN MIND WHERE ENGAGING WITH 906 00:33:56,969 --> 00:33:57,970 STAKEHOLDERS CAN SUPPORT 907 00:33:57,970 --> 00:33:58,871 COMMUNITY RESEARCH INITIATIVES 908 00:33:58,871 --> 00:34:01,140 IN MUST BE WAYS SUCH AS HELPING 909 00:34:01,140 --> 00:34:01,707 DEVELOP RESEARCH THAT'S 910 00:34:01,707 --> 00:34:03,308 RESPONSIVE TO NEEDS OF THE 911 00:34:03,308 --> 00:34:05,210 COMMUNITIES THEY SERVE, PROMOTE 912 00:34:05,210 --> 00:34:07,146 AND FACILITATE ENGAGEMENT WITH 913 00:34:07,146 --> 00:34:08,046 COMMUNITY MEMBERS, HELP DESIGN 914 00:34:08,046 --> 00:34:09,548 RESEARCH PROJECTS, HELP WITH 915 00:34:09,548 --> 00:34:10,916 COLLECTION OF DATA, INTERPRETING 916 00:34:10,916 --> 00:34:14,253 DATA AS WELL, AND STAKEHOLDER 917 00:34:14,253 --> 00:34:16,221 COLLABORATIONS, SHIFTS, DYNAMICS 918 00:34:16,221 --> 00:34:17,222 OF EXPERTS, ACKNOWLEDGING THE 919 00:34:17,222 --> 00:34:19,525 VALUE AND LIVED EXPERIENCES 920 00:34:19,525 --> 00:34:21,927 VERSUS JUST FROM DIRECT FIELD 921 00:34:21,927 --> 00:34:23,529 TRAINING AND INCREASING SOCIAL 922 00:34:23,529 --> 00:34:24,963 AND CULTURAL RELEVANCE OF 923 00:34:24,963 --> 00:34:28,300 RESEARCH TO PROMOTE CHANGE IN 924 00:34:28,300 --> 00:34:29,802 LOCAL PRACTICES AND POLICY, 925 00:34:29,802 --> 00:34:31,170 ANOTHER CRITICAL COMPONENT OR 926 00:34:31,170 --> 00:34:32,704 RECOMMENDATION FOR WORKFORCE 927 00:34:32,704 --> 00:34:34,907 THAT WE NEED TO BRING INTO OUR 928 00:34:34,907 --> 00:34:37,242 WORKFORCE WITHIN THOSE OF US 929 00:34:37,242 --> 00:34:40,379 WITH OUR GOAL FOR HEALTH 930 00:34:40,379 --> 00:34:41,947 DISPARITIES WORK TO PARTNER WITH 931 00:34:41,947 --> 00:34:42,815 COMMUNITIES OUTSIDE OF WHAT 932 00:34:42,815 --> 00:34:45,517 WE'RE USED TO IN THE SCIENTIFIC 933 00:34:45,517 --> 00:34:48,187 FIELD BRINGING IN OTHER 934 00:34:48,187 --> 00:34:48,520 STAKEHOLDERS. 935 00:34:48,520 --> 00:34:51,790 AND I BELIEVE THAT'S IT. 936 00:34:51,790 --> 00:34:52,958 NEXT SLIDE. 937 00:34:52,958 --> 00:34:55,494 I THINK THAT'S IT. 938 00:34:55,494 --> 00:35:04,203 THANK YOU ALL VERY MUCH. 939 00:35:04,203 --> 00:35:06,839 >> HELLO, THANKS, APPRECIATE 940 00:35:06,839 --> 00:35:08,173 THOSE COMMENTS. 941 00:35:08,173 --> 00:35:13,612 HAVE AN AMAZING OPPORTUNITY WITH 942 00:35:13,612 --> 00:35:14,813 THIS GROUP, DISCUSSING 943 00:35:14,813 --> 00:35:17,182 RECOMMENDATIONS LED BY DR. 944 00:35:17,182 --> 00:35:18,550 GLYMOUR AND DR. DIETERS. 945 00:35:18,550 --> 00:35:22,688 THANK YOU FOR YOUR LEADERSHIP. 946 00:35:22,688 --> 00:35:24,857 I'LL SPEND A FEW MINUTES 947 00:35:24,857 --> 00:35:27,626 DISCUSSING ASSESSMENT, 948 00:35:27,626 --> 00:35:30,362 TREATMENT, AND CARE, AND HOW -- 949 00:35:30,362 --> 00:35:31,029 SOME RECOMMENDATIONS IN THESE 950 00:35:31,029 --> 00:35:32,998 AREAS THAT CAN LEAD TO RESEARCH 951 00:35:32,998 --> 00:35:36,201 TO IMPROVE OUTCOMES FOR 952 00:35:36,201 --> 00:35:36,969 REPRESENTATIVE POPULATIONS AT 953 00:35:36,969 --> 00:35:42,741 RISK AND LIVING WITH ADRD. 954 00:35:42,741 --> 00:35:44,176 NEXT SLIDE PLEASE. 955 00:35:44,176 --> 00:35:50,516 NOTHING TO DISCLOSE AND 956 00:35:50,516 --> 00:35:51,250 DISCLAIM. 957 00:35:51,250 --> 00:35:57,756 A KEY RECOMMENDATION, ROAM DAYS 958 00:35:57,756 --> 00:36:00,192 4, SOCIAL ASSESS SOCIAL, 959 00:36:00,192 --> 00:36:01,894 ECONOMIC, STRUCTURAL IMPEDIMENTS 960 00:36:01,894 --> 00:36:06,064 TO ACCESS TO AD/ADRD ASSESSMENT, 961 00:36:06,064 --> 00:36:07,933 DIAGNOSIS, AND REFERRALS, CARE, 962 00:36:07,933 --> 00:36:11,069 IMPACTS ON HEALTH AND ECONOMIC 963 00:36:11,069 --> 00:36:13,539 OUTCOMES, SO MY WORK WITH THE 964 00:36:13,539 --> 00:36:17,509 ALZHEIMER'S ASSOCIATION WHERE I 965 00:36:17,509 --> 00:36:22,915 LEAD DIVERSITY, EQUITY, 966 00:36:22,915 --> 00:36:27,886 INCLUSION THINKING STRATEGICALLY 967 00:36:27,886 --> 00:36:29,955 LEADING TO ACCESS, OUTCOMES, ALL 968 00:36:29,955 --> 00:36:37,062 TYPES OF THINGS THAT CAN REALLY 969 00:36:37,062 --> 00:36:38,897 ACT AS IMPEDIMENTS TO RECEIVING 970 00:36:38,897 --> 00:36:43,368 QUALITY CARE. 971 00:36:43,368 --> 00:36:44,236 SPECIFIC DISCUSSIONS, SPECIFIC 972 00:36:44,236 --> 00:36:46,838 RECOMMENDATIONS TO DEVELOP A 973 00:36:46,838 --> 00:36:51,376 TOOLBOX OF TAILORED INFORMATION 974 00:36:51,376 --> 00:37:00,185 FOR PARENTS -- PATIENTS, TO BE 975 00:37:00,185 --> 00:37:02,354 AFFECTED BY VARIABLES, 976 00:37:02,354 --> 00:37:03,221 EDUCATION, GEOGRAPHY, INCOME, 977 00:37:03,221 --> 00:37:07,859 RACIAL AND/OR ETHNIC IDENTITY. 978 00:37:07,859 --> 00:37:11,430 INFORMATION HERE WOULD INCLUDE 979 00:37:11,430 --> 00:37:14,199 VALIDITY OF TYPICAL DIAGNOSTIC 980 00:37:14,199 --> 00:37:17,102 TOOLS AND EVIDENCE ON MEDICATION 981 00:37:17,102 --> 00:37:18,337 EFFICACY, MAYBE EVEN SAFETY 982 00:37:18,337 --> 00:37:19,471 ACROSS GROUPS. 983 00:37:19,471 --> 00:37:25,577 WE ALSO TALKED ABOUT EXPANDING 984 00:37:25,577 --> 00:37:30,816 RESEARCH INTO KNOWN AND EMERGING 985 00:37:30,816 --> 00:37:33,619 SOCIOCULTURAL, BEHAVIORAL, 986 00:37:33,619 --> 00:37:35,520 PHYSICAL, BUILT ENVIRONMENTAL 987 00:37:35,520 --> 00:37:35,854 FACTORS. 988 00:37:35,854 --> 00:37:37,923 AND FACTORS RELATED TO ECONOMIC 989 00:37:37,923 --> 00:37:40,158 AND HEALTHCARE SYSTEMS ACROSS 990 00:37:40,158 --> 00:37:43,762 ALL LEVELS FROM THE COMMUNITY, 991 00:37:43,762 --> 00:37:44,396 VERY IMPORTANT COMMUNITY FACTORS 992 00:37:44,396 --> 00:37:49,668 THAT DR. DETERS MENTION TO 993 00:37:49,668 --> 00:37:53,138 SOCIETAL FACTORS THAT IMPEDE 994 00:37:53,138 --> 00:37:54,239 ASSESSMENT, DETECTION, 995 00:37:54,239 --> 00:37:55,474 DIAGNOSIS, REFERRALS, BARRIERS 996 00:37:55,474 --> 00:37:57,342 TO ASSESSMENT AND DIAGNOSIS. 997 00:37:57,342 --> 00:38:00,045 REALLY, YOU KNOW, SPENT A LOT OF 998 00:38:00,045 --> 00:38:03,582 TIME TALKING ABOUT STIGMA AND 999 00:38:03,582 --> 00:38:05,617 HOW TO ADDRESS STIGMA THROUGHOUT 1000 00:38:05,617 --> 00:38:08,153 THESE PATHWAYS OF ACCESS TO 1001 00:38:08,153 --> 00:38:08,954 CARE. 1002 00:38:08,954 --> 00:38:15,527 AND THEN THIRD, NEW RESEARCH. 1003 00:38:15,527 --> 00:38:18,430 YOU KNOW, MORE SUPPORT AND 1004 00:38:18,430 --> 00:38:21,233 TRAINING LIKE DR. RENTERIA 1005 00:38:21,233 --> 00:38:23,602 MENTIONED, FUNDING FOR NEW 1006 00:38:23,602 --> 00:38:26,638 RESEARCH ON EFFECTS OF 1007 00:38:26,638 --> 00:38:28,173 ASSESSMENT, DETECTION, 1008 00:38:28,173 --> 00:38:31,176 DIAGNOSIS, REFERRALS ON HEALTH, 1009 00:38:31,176 --> 00:38:33,145 SOCIAL AND ECONOMIC OUTCOMES, 1010 00:38:33,145 --> 00:38:38,817 AND THIS DIAGRAM REALLY PROVIDES 1011 00:38:38,817 --> 00:38:42,821 A VISUAL OF HOW DIVERSE NEEDS 1012 00:38:42,821 --> 00:38:45,891 ACROSS COMMUNITIES, ACROSS 1013 00:38:45,891 --> 00:38:49,261 POPULATIONS, THEY ARE ALL 1014 00:38:49,261 --> 00:38:50,262 CONTEXTUALIZED BY ACCESS TO 1015 00:38:50,262 --> 00:38:54,366 EDUCATION, HEALTH CARE, AND 1016 00:38:54,366 --> 00:38:56,201 QUALITY, NEIGHBORHOOD FACTORS, 1017 00:38:56,201 --> 00:38:58,970 COMMUNITY CONTEXT, AND OF COURSE 1018 00:38:58,970 --> 00:38:59,404 ECONOMIC STABILITY. 1019 00:38:59,404 --> 00:39:04,042 SO REALLY THINKING ABOUT A RANGE 1020 00:39:04,042 --> 00:39:07,879 OF FACTORS THAT MAY BE ACROSS A 1021 00:39:07,879 --> 00:39:10,215 NUMBER OF LEVELS OF ANALYSIS 1022 00:39:10,215 --> 00:39:12,184 THAT ARE IMPORTANT FOR GETTING 1023 00:39:12,184 --> 00:39:13,785 PEOPLE THE CARE AND TREATMENT 1024 00:39:13,785 --> 00:39:16,388 THEY NEED IN WAYS THAT CAN BE 1025 00:39:16,388 --> 00:39:20,392 EFFECTIVE, WHICH IS THE POINT 1026 00:39:20,392 --> 00:39:20,859 HERE. 1027 00:39:20,859 --> 00:39:22,861 NEXT SLIDE. 1028 00:39:22,861 --> 00:39:26,498 HERE'S A FRAMEWORK THAT I WAS A 1029 00:39:26,498 --> 00:39:28,133 PART OF, HELPED TO DEVELOP, 1030 00:39:28,133 --> 00:39:30,769 WHILE AT THE NATIONAL INSTITUTE 1031 00:39:30,769 --> 00:39:31,970 ON AGING. 1032 00:39:31,970 --> 00:39:33,905 AND MAYBE A CONSIDERATION OF 1033 00:39:33,905 --> 00:39:36,808 THIS TYPE OF FRAMEWORK, THIS 1034 00:39:36,808 --> 00:39:37,342 FRAMEWORK SPECIFICALLY, OR 1035 00:39:37,342 --> 00:39:42,247 EXTENDING THIS FRAMEWORK TO 2.0 1036 00:39:42,247 --> 00:39:44,716 GIVEN WHAT WE'VE KNOWN, HOW IT'S 1037 00:39:44,716 --> 00:39:46,284 BEEN USED SINCE 2015. 1038 00:39:46,284 --> 00:39:47,085 BUT THINKING ABOUT LEVELS OF 1039 00:39:47,085 --> 00:39:50,188 ANALYSIS THAT I JUST MENTIONED, 1040 00:39:50,188 --> 00:39:54,760 YOU KNOW, THAT ARE 1041 00:39:54,760 --> 00:39:55,827 ENVIRONMENTAL, SOCIOCULTURAL, 1042 00:39:55,827 --> 00:39:58,263 BEHAVIORAL, BIOLOGICAL, SPECIFIC 1043 00:39:58,263 --> 00:40:00,132 DETERMINANTS OF FACTORS WITHIN 1044 00:40:00,132 --> 00:40:02,000 THOSE LEVELS. 1045 00:40:02,000 --> 00:40:05,036 AND REAL INNOVATION HERE AS IT 1046 00:40:05,036 --> 00:40:09,641 PERTAINS TO THIS DISCUSSION IS 1047 00:40:09,641 --> 00:40:09,908 PATHWAYS. 1048 00:40:09,908 --> 00:40:15,247 WE KNOW THERE ARE BIOLOGICAL AND 1049 00:40:15,247 --> 00:40:17,582 GENETIC FACTORS, HOW DOES THAT 1050 00:40:17,582 --> 00:40:20,218 RELATE TO BEHAVIOR, HOW IS 1051 00:40:20,218 --> 00:40:21,620 BEHAVIOR SHAPED BY SOCIOCULTURAL 1052 00:40:21,620 --> 00:40:29,828 NORMS AND BELIEFS, SOCIAL 1053 00:40:29,828 --> 00:40:30,862 FACTORS LIKE INSTITUTIONAL 1054 00:40:30,862 --> 00:40:31,963 RACISM, HEALTH-SEEKING 1055 00:40:31,963 --> 00:40:33,665 BEHAVIORS, SHAPING THAT WAY, 1056 00:40:33,665 --> 00:40:35,867 THEN HOW THE ENVIRONMENT 1057 00:40:35,867 --> 00:40:37,969 PROVIDES A CONTEXT FOR THAT 1058 00:40:37,969 --> 00:40:38,170 PATH. 1059 00:40:38,170 --> 00:40:42,007 SO THAT PATHWAY THROUGH THESE 1060 00:40:42,007 --> 00:40:43,175 LEVELS OF ANALYSIS, KNOWING ALL 1061 00:40:43,175 --> 00:40:45,710 OF THESE FACTORS PLAY A ROLE, 1062 00:40:45,710 --> 00:40:49,147 AND CONSIDERING THE BEST WAYS TO 1063 00:40:49,147 --> 00:40:50,782 INTERVENE SO THAT PEOPLE CAN 1064 00:40:50,782 --> 00:40:55,654 HAVE ACCESS TO QUALITY CARE AND 1065 00:40:55,654 --> 00:40:57,055 TREATMENT, WAYS THAT ARE 1066 00:40:57,055 --> 00:41:01,493 EFFECTIVE, AND UNDERSTANDING 1067 00:41:01,493 --> 00:41:01,726 CONTEXT. 1068 00:41:01,726 --> 00:41:03,228 NEXT SLIDE. 1069 00:41:03,228 --> 00:41:05,664 SO, TO SUMMARIZE, AGAIN, OUR 1070 00:41:05,664 --> 00:41:12,137 RECOMMENDATION 4 WAS TO ASSESS 1071 00:41:12,137 --> 00:41:13,672 THE SOCIAL, ECONOMIC, AND 1072 00:41:13,672 --> 00:41:16,808 STRUCTURAL IMPEDIMENTS TO 1073 00:41:16,808 --> 00:41:19,945 ACCESS, TO AD/ADRD ASSESSMENT, 1074 00:41:19,945 --> 00:41:20,946 DIAGNOSIS, REFERRALS, CARE, 1075 00:41:20,946 --> 00:41:27,786 IMPACTS ON HEALTH AND ECONOMIC 1076 00:41:27,786 --> 00:41:30,255 OUTCOMES AND TO TARGET 2031 BUT 1077 00:41:30,255 --> 00:41:31,723 REALLY UNDERSTANDING THAT THAT'S 1078 00:41:31,723 --> 00:41:36,228 A LONG PROCESS TO UNDERSTAND THE 1079 00:41:36,228 --> 00:41:38,129 MULTI-LEVEL DETERMINANTS OF 1080 00:41:38,129 --> 00:41:40,165 LIKELIHOOD, QUALITY OF VALIDITY 1081 00:41:40,165 --> 00:41:42,767 OF ASSESSMENT AND DIAGNOSIS, 1082 00:41:42,767 --> 00:41:47,505 ESPECIALLY IN THOSE POPULATIONS 1083 00:41:47,505 --> 00:41:51,743 THAT ARE UNDERRESOURCED, AND 1084 00:41:51,743 --> 00:41:54,813 DISPROPORTIONATELY AFFECTED BY 1085 00:41:54,813 --> 00:41:55,247 AD/ADRD. 1086 00:41:55,247 --> 00:41:57,415 TO EVALUATE ACCESS TO SOURCES OF 1087 00:41:57,415 --> 00:42:00,018 SUPPORT AND CARE TO OPTIMIZE 1088 00:42:00,018 --> 00:42:03,388 QUALITY OF LIFE AFTER THE 1089 00:42:03,388 --> 00:42:04,656 DIAGNOSIS. 1090 00:42:04,656 --> 00:42:05,857 SO MANY SOCIOCULTURAL FACTORS, 1091 00:42:05,857 --> 00:42:09,127 YOU KNOW, PLAY A ROLE, CRITICAL 1092 00:42:09,127 --> 00:42:11,463 ROLE, IN ACCESS TO SOURCES OF 1093 00:42:11,463 --> 00:42:13,164 SUPPORT AND CARE. 1094 00:42:13,164 --> 00:42:15,166 YOU KNOW, TRUST, STIGMA, ALL THE 1095 00:42:15,166 --> 00:42:16,902 THINGS THAT CAN SERVE AS 1096 00:42:16,902 --> 00:42:20,071 BARRIERS WE WANT TO REALLY 1097 00:42:20,071 --> 00:42:24,175 UNDERSTAND AND WRAP UP THE 1098 00:42:24,175 --> 00:42:25,143 TRUST, IN COMMUNITY-DRIVEN 1099 00:42:25,143 --> 00:42:25,744 COMMUNITY-BASED PARTICIPATORY 1100 00:42:25,744 --> 00:42:27,679 RESEARCH LIKE DR. DETERS 1101 00:42:27,679 --> 00:42:28,213 MENTIONED. 1102 00:42:28,213 --> 00:42:31,283 THE HEART OF THAT BEING IN 1103 00:42:31,283 --> 00:42:34,185 COMMUNITY AND ASSESSING IT AND 1104 00:42:34,185 --> 00:42:35,787 ELEVATING TRUST SO THAT PEOPLE 1105 00:42:35,787 --> 00:42:39,758 CAN ACCESS IN WAYS THAT AGAIN 1106 00:42:39,758 --> 00:42:41,059 ARE EFFECTIVE. 1107 00:42:41,059 --> 00:42:42,227 NEXT SLIDE. 1108 00:42:42,227 --> 00:42:45,563 AND I WILL TURN IT OVER TO DR. 1109 00:42:45,563 --> 00:42:46,531 TURNEY. 1110 00:42:46,531 --> 00:42:49,901 GOOD TO BE WITH YOU TODAY. 1111 00:42:49,901 --> 00:42:51,202 >> THANKS, DR. HILL. 1112 00:42:51,202 --> 00:42:51,703 ALL RIGHT. 1113 00:42:51,703 --> 00:42:54,739 THANKS FOR STICKING IT OUT FOR 1114 00:42:54,739 --> 00:42:56,007 DAY 3. 1115 00:42:56,007 --> 00:42:57,709 I KNOW IT MEANS A LOT TO PAUSE 1116 00:42:57,709 --> 00:42:59,444 AND COME BACK, BUT THANKS FOR 1117 00:42:59,444 --> 00:42:59,911 SHOWING UP. 1118 00:42:59,911 --> 00:43:08,186 WE'LL START WITH THE NEXT SLIDE. 1119 00:43:08,186 --> 00:43:10,422 NO DISCLAIMERS. 1120 00:43:10,422 --> 00:43:10,822 NEXT SLIDE PLEASE. 1121 00:43:10,822 --> 00:43:13,158 ALL RIGHT. 1122 00:43:13,158 --> 00:43:14,626 SO, THIS RECOMMENDATION, 1123 00:43:14,626 --> 00:43:15,760 RECOMMENDATION 6, PRIORITY 3, TO 1124 00:43:15,760 --> 00:43:18,630 IDENTIFY LIFE COURSE AND 1125 00:43:18,630 --> 00:43:20,465 MULTI-LEVEL MECHANISMS AND 1126 00:43:20,465 --> 00:43:23,034 PATHWAYS TO A.D. AND A.D. R D 1127 00:43:23,034 --> 00:43:24,235 AND USE DISCOVERED TO REDUCE 1128 00:43:24,235 --> 00:43:28,740 DISPARITIES WHICH IS A REALLY 1129 00:43:28,740 --> 00:43:31,576 NICE SEGUE FROM DR. HILL. 1130 00:43:31,576 --> 00:43:32,877 I'VE DEDICATED MY WORK TO 1131 00:43:32,877 --> 00:43:35,246 UNDERSTAND HOW STRESS, 1132 00:43:35,246 --> 00:43:35,847 ENVIRONMENT, SOCIAL CONTEXT, 1133 00:43:35,847 --> 00:43:36,481 BIOLOGICALLY EMBEDDED OVER THE 1134 00:43:36,481 --> 00:43:38,350 LIFE COURSE AND FEEL LIKE THAT'S 1135 00:43:38,350 --> 00:43:39,751 IMPORTANT IN THE DIRECTION THAT 1136 00:43:39,751 --> 00:43:41,286 WE'RE GOING WITH THIS FIELD TO 1137 00:43:41,286 --> 00:43:44,189 SEE HOW PRACTICES SHAPE BRAIN 1138 00:43:44,189 --> 00:43:47,092 HEALTH AND A.D. AND ADRD RISK, 1139 00:43:47,092 --> 00:43:50,362 WHY SOME POPULATIONS ARE MORE 1140 00:43:50,362 --> 00:43:52,163 LIKELY EXPERIENCING EARLIER 1141 00:43:52,163 --> 00:43:54,065 AGING OR MORE SEVERE, LESS 1142 00:43:54,065 --> 00:43:56,234 TREATED FORMS OF DEMENTIA, OR 1143 00:43:56,234 --> 00:43:59,738 EVEN BETTER UNDERSTAND HOW SOME 1144 00:43:59,738 --> 00:44:02,741 PEOPLE ARE STILL RESISTANT OR 1145 00:44:02,741 --> 00:44:08,646 RESILIENT OR LESS SUSCEPTIBLE. 1146 00:44:08,646 --> 00:44:10,348 THIS RECOMMENDATION URGES US TO 1147 00:44:10,348 --> 00:44:12,283 MOVE UPSTREAM SO YOU CAN SEE 1148 00:44:12,283 --> 00:44:14,085 LIKE BEFORE THE SYMPTOMS EMERGE, 1149 00:44:14,085 --> 00:44:16,087 WE KNOW SOME THINGS HAPPEN 20 1150 00:44:16,087 --> 00:44:19,257 YEARS BEFORE WE SEE BRAIN 1151 00:44:19,257 --> 00:44:21,159 CHANGES, AMYLOID OR WHATEVER YOU 1152 00:44:21,159 --> 00:44:23,194 USE AS YOUR OUTCOME VARIABLE BUT 1153 00:44:23,194 --> 00:44:25,230 REALLY TO UNDERSTAND WHEN AND 1154 00:44:25,230 --> 00:44:27,365 HOW THESE RISK FACTORS BUILD UP 1155 00:44:27,365 --> 00:44:28,299 ACROSS THE LIFE COURSE. 1156 00:44:28,299 --> 00:44:30,468 AND SO WE MUST ASK WHERE DO 1157 00:44:30,468 --> 00:44:32,637 THESE RISKS BEGIN, WHO BEARS THE 1158 00:44:32,637 --> 00:44:34,773 BURDEN, AND TRY TO SEE HOW CAN 1159 00:44:34,773 --> 00:44:39,778 WE INTERVENE BEFORE THE DECLINE 1160 00:44:39,778 --> 00:44:40,845 ACTUALLY BEGINS. 1161 00:44:40,845 --> 00:44:44,182 NEXT SLIDE PLEASE. 1162 00:44:44,182 --> 00:44:45,350 ANOTHER CONCEPT TO HIGHLIGHT WAS 1163 00:44:45,350 --> 00:44:47,886 REALLY TOO OFTEN WE JUMP INTO 1164 00:44:47,886 --> 00:44:49,554 THE MEASUREMENT SIDE WITHOUT 1165 00:44:49,554 --> 00:44:50,722 UNDERSTANDING THE SYSTEMS THAT 1166 00:44:50,722 --> 00:44:53,691 WE'RE TRYING TO UNDERSTAND HERE. 1167 00:44:53,691 --> 00:44:55,427 AND THIS RECOMMENDATION CALLS 1168 00:44:55,427 --> 00:45:03,368 FOR CLEAR CONCEPTUAL MOD MODELT 1169 00:45:03,368 --> 00:45:07,238 ROOT OUT ROOT CAUSES, PATTERNED 1170 00:45:07,238 --> 00:45:08,006 AND PREDICTABLE. 1171 00:45:08,006 --> 00:45:13,111 WE MUST MAP OUT SOCIAL, 1172 00:45:13,111 --> 00:45:15,080 STRUCTURAL, BIOLOGICAL FACTORS 1173 00:45:15,080 --> 00:45:16,181 DRIVING OUTCOMES, INCLUDING 1174 00:45:16,181 --> 00:45:18,049 THINGS LIKE EARLY LIFE 1175 00:45:18,049 --> 00:45:19,384 EXPOSURES, PSYCHOSOCIAL TRAUMA, 1176 00:45:19,384 --> 00:45:23,288 ACCESS TO CARE, AND QUITE A FEW 1177 00:45:23,288 --> 00:45:26,191 OTHERS. 1178 00:45:26,191 --> 00:45:28,193 SO THESE MODELS GUIDE OUR DESIGN 1179 00:45:28,193 --> 00:45:31,696 FROM THE BEGINNING, HYPOTHESES, 1180 00:45:31,696 --> 00:45:32,964 ANALYSES, HOW WE ANALYZE DATA, 1181 00:45:32,964 --> 00:45:34,265 WE MENTIONED OVER AND OVER SO 1182 00:45:34,265 --> 00:45:35,900 FAR, AND DO THIS FROM THE 1183 00:45:35,900 --> 00:45:39,871 BEGINNING AND SHOULD LET THAT BE 1184 00:45:39,871 --> 00:45:43,241 THE RULE. 1185 00:45:43,241 --> 00:45:45,343 NEXT SLIDE PLEASE. 1186 00:45:45,343 --> 00:45:48,046 >> TWO MINUTES LEFT. 1187 00:45:48,046 --> 00:45:48,813 >> OKAY. 1188 00:45:48,813 --> 00:45:50,115 WE MUST MEASURE LIKE DR. HILL 1189 00:45:50,115 --> 00:45:54,986 SAID BROADEN WHAT WE MEASURE AND 1190 00:45:54,986 --> 00:45:56,054 FOR WHOM. 1191 00:45:56,054 --> 00:45:57,388 THIS INCLUDES POLICY LEVEL 1192 00:45:57,388 --> 00:45:59,357 FACTORS, LIKE EDUCATION, 1193 00:45:59,357 --> 00:46:00,692 ENVIRONMENTAL TOXINS, 1194 00:46:00,692 --> 00:46:02,894 NEIGHBORHOOD SAFETY, AND AS 1195 00:46:02,894 --> 00:46:04,762 WE'VE MENTIONED OVER AND OVER A 1196 00:46:04,762 --> 00:46:07,966 LOT ARE MODIFIABLE, 45% AT LEAST 1197 00:46:07,966 --> 00:46:09,467 ARE MODIFIABLE FACTORS, 1198 00:46:09,467 --> 00:46:11,002 INCLUDING CLINICAL MODIFIABLE 1199 00:46:11,002 --> 00:46:11,936 FACTORS, BEHAVIORAL RISK 1200 00:46:11,936 --> 00:46:12,804 FACTORS, EVEN MORE CRITICALLY 1201 00:46:12,804 --> 00:46:15,673 STARTING EARLIER WITH SOME EARLY 1202 00:46:15,673 --> 00:46:16,074 LIFE EXPERIENCES. 1203 00:46:16,074 --> 00:46:18,343 AND SO I DO BELIEVE THAT WE'RE 1204 00:46:18,343 --> 00:46:19,844 TRYING TO EMPHASIZE WE MUST 1205 00:46:19,844 --> 00:46:21,880 MEASURE NOT ONLY WHAT HAPPENS TO 1206 00:46:21,880 --> 00:46:23,982 PEOPLE BUT WHEN, WHERE, UNDER 1207 00:46:23,982 --> 00:46:25,350 WHAT CONDITIONS, ALL THESE 1208 00:46:25,350 --> 00:46:27,218 THINGS GIVE UNIQUE PERSPECTIVE 1209 00:46:27,218 --> 00:46:29,287 IF WE'RE LEADING TO PRECISION 1210 00:46:29,287 --> 00:46:30,421 MEDICINE. 1211 00:46:30,421 --> 00:46:32,924 SO THIS MEANS CAPTURING OUTCOMES 1212 00:46:32,924 --> 00:46:34,759 BEYOND TYPICAL COGNITION OR 1213 00:46:34,759 --> 00:46:37,495 AMYLOID TAU BUT GETTING 1214 00:46:37,495 --> 00:46:39,097 BEHAVIORAL, FUNCTIONAL CHANGES, 1215 00:46:39,097 --> 00:46:40,064 DOING THIS ACROSS DIFFERENT 1216 00:46:40,064 --> 00:46:41,366 POPULATIONS THAT ACTUALLY 1217 00:46:41,366 --> 00:46:42,700 REPRESENT THE PEOPLE AND 1218 00:46:42,700 --> 00:46:47,205 COMMUNITIES THAT ARE AFFECTED. 1219 00:46:47,205 --> 00:46:48,173 NEXT SLIDE PLEASE. 1220 00:46:48,173 --> 00:46:51,209 AND WHEN WE THINK OF THESE RISK 1221 00:46:51,209 --> 00:46:52,177 FACTORS, I WANT TO EMPHASIZE 1222 00:46:52,177 --> 00:46:54,512 THIS IS NOT JUST ONE RISK 1223 00:46:54,512 --> 00:46:54,779 FACTOR. 1224 00:46:54,779 --> 00:46:56,814 YOU CAN SEE IT'S MULTIPLE, 1225 00:46:56,814 --> 00:46:57,882 LAYERED EXPOSURES THAT INTERACT 1226 00:46:57,882 --> 00:46:58,583 OVER TIME. 1227 00:46:58,583 --> 00:47:02,720 SO WE FEEL LIKE IF WE FAIL TO 1228 00:47:02,720 --> 00:47:04,822 EVALUATE SOME INTERACTIONS OR 1229 00:47:04,822 --> 00:47:06,591 INTERSECTIONS YOU'LL MISS THE 1230 00:47:06,591 --> 00:47:08,193 OPPORTUNITY TO IDENTIFY WHERE 1231 00:47:08,193 --> 00:47:10,295 THE PREVENTIONS CAN BE IMPACTFUL 1232 00:47:10,295 --> 00:47:12,797 AND SO THE PSYCHOSOCIAL STRESS, 1233 00:47:12,797 --> 00:47:13,898 ENVIRONMENTAL TOXINS, STRUCTURAL 1234 00:47:13,898 --> 00:47:15,867 BARRIERS, THEY DON'T JUST 1235 00:47:15,867 --> 00:47:20,205 COEXIST BUT OFTEN SOMETIMES 1236 00:47:20,205 --> 00:47:21,239 AMPLIFY EACH OTHER. 1237 00:47:21,239 --> 00:47:22,207 THIS RECOMMENDATION CHALLENGES 1238 00:47:22,207 --> 00:47:24,809 US TO DESIGN THE STUDIES AND 1239 00:47:24,809 --> 00:47:30,848 ANALYSIS THAT REFLECT HOW PEOPLE 1240 00:47:30,848 --> 00:47:32,784 ACTUALLY LIVE. 1241 00:47:32,784 --> 00:47:34,852 NEXT SLIDE PLEASE. 1242 00:47:34,852 --> 00:47:36,621 AND WRAPPING UP HERE, 1243 00:47:36,621 --> 00:47:38,656 EMPHASIZING USE OF METHODS BUT 1244 00:47:38,656 --> 00:47:40,525 TO STUDY LIFE COURSE AND 1245 00:47:40,525 --> 00:47:42,360 MULTI-LEVEL PATHWAYS WE NEED THE 1246 00:47:42,360 --> 00:47:45,129 RIGHT DATA SO THAT STARTS WITH 1247 00:47:45,129 --> 00:47:46,998 STARTING AND LINKING EXISTING 1248 00:47:46,998 --> 00:47:48,833 COHORT DATA, WE HAVE AMAZING 1249 00:47:48,833 --> 00:47:50,134 COHORTS WITH BEAUTIFUL DATA, 1250 00:47:50,134 --> 00:47:52,337 LET'S LINK THEM, FIGURE OUT 1251 00:47:52,337 --> 00:47:54,505 WHICH COHORTS ARE MISSING WHAT, 1252 00:47:54,505 --> 00:47:56,407 COME TOGETHER, EXPAND TO REFLECT 1253 00:47:56,407 --> 00:47:59,010 ACTUAL TRUE POPULATION AND 1254 00:47:59,010 --> 00:47:59,644 COMMUNITIES AFFECTED. 1255 00:47:59,644 --> 00:48:01,746 HARMONIZING THE DATASETS TO 1256 00:48:01,746 --> 00:48:07,485 INCREASE POWER ESPECIALLY FOR 1257 00:48:07,485 --> 00:48:09,120 UNDERREPRESENTED POPULATIONS, 1258 00:48:09,120 --> 00:48:11,122 DEEPER DIVE INTO THE DATA, GET 1259 00:48:11,122 --> 00:48:16,661 DATA ABOUT LIFESTYLE, LIVED 1260 00:48:16,661 --> 00:48:17,395 EXPERIENCE, OMICS, BIOMARKERS, 1261 00:48:17,395 --> 00:48:18,930 AND I THINK IS ESSENTIAL FOR 1262 00:48:18,930 --> 00:48:20,698 WHAT WE WANT TO UNDERSTAND AND 1263 00:48:20,698 --> 00:48:24,736 ACT ON THESE DISPARITIES. 1264 00:48:24,736 --> 00:48:26,804 MY LAST SLIDE, I THINK. 1265 00:48:26,804 --> 00:48:28,740 OH, OKAY. 1266 00:48:28,740 --> 00:48:32,410 WE ALSO NEED TO POWER UP THE 1267 00:48:32,410 --> 00:48:33,378 METHODS, USE METHODS 1268 00:48:33,378 --> 00:48:37,682 APPROPRIATE, STUDY RIGHT METHODS 1269 00:48:37,682 --> 00:48:40,485 FOR GENE-ENVIRONMENT 1270 00:48:40,485 --> 00:48:41,953 INTERACTION, CAUSAL EFFECTS, 1271 00:48:41,953 --> 00:48:42,253 TRANSLATING. 1272 00:48:42,253 --> 00:48:43,254 WE DON'T HAVE LIMITATIONS, THESE 1273 00:48:43,254 --> 00:48:46,157 HAVE A LOT OF DATA, WE SHOULD 1274 00:48:46,157 --> 00:48:47,358 ALSO DEVELOP METHODS TO ANSWER 1275 00:48:47,358 --> 00:48:49,093 THE QUESTIONS THAT WE HAVE 1276 00:48:49,093 --> 00:48:50,795 BECAUSE WITHOUT THESE WE RISK 1277 00:48:50,795 --> 00:48:51,763 DRAWING CONCLUSIONS THAT DON'T 1278 00:48:51,763 --> 00:48:52,830 APPLY TO EVERY GROUP. 1279 00:48:52,830 --> 00:48:56,301 THEY ARE THE ONES THAT ARE MOST 1280 00:48:56,301 --> 00:48:57,702 AFFECTED BY AD/ADRD. 1281 00:48:57,702 --> 00:49:00,104 WHY ARE WE DOING OUR SCIENCE IF 1282 00:49:00,104 --> 00:49:03,908 IT'S NOT GOING TO INCLUDE PEOPLE 1283 00:49:03,908 --> 00:49:05,910 MOST AFFECTED? 1284 00:49:05,910 --> 00:49:07,445 AND LAST SLIDE. 1285 00:49:07,445 --> 00:49:10,048 NEXT SLIDE PLEASE. 1286 00:49:10,048 --> 00:49:14,052 AND SO LASTLY FOR ME JUST A CALL 1287 00:49:14,052 --> 00:49:15,920 TO ACTION TO RETHINK PREVENTION, 1288 00:49:15,920 --> 00:49:17,855 REMINDS US THAT PREVENTION IS 1289 00:49:17,855 --> 00:49:21,526 NOT ABOUT TIMING, IT'S ACCESS, 1290 00:49:21,526 --> 00:49:22,894 INCLUSION, TAKING ACTION, SO 1291 00:49:22,894 --> 00:49:23,995 RESULTS SHOULD BE TANGIBLE 1292 00:49:23,995 --> 00:49:24,228 ACTIONS. 1293 00:49:24,228 --> 00:49:26,064 IF WE DON'T HAVE THE RIGHT DATA, 1294 00:49:26,064 --> 00:49:33,538 THE RIGHT PEOPLE, THE RESULTS 1295 00:49:33,538 --> 00:49:34,605 ARE -- SCIENCE IS NOT MUTUAL 1296 00:49:34,605 --> 00:49:37,442 IF YOU WANT TO REDUCE 1297 00:49:37,442 --> 00:49:38,643 DISPARITIES RESEARCH MUST BE 1298 00:49:38,643 --> 00:49:40,411 DESIGNED WITH EQUITY IN MIND 1299 00:49:40,411 --> 00:49:42,947 FROM WHO WE STUDY, QUESTIONS WE 1300 00:49:42,947 --> 00:49:45,416 ANSWER, QUESTIONS WE ASK, THE 1301 00:49:45,416 --> 00:49:47,151 WAY WE MEASURE CERTAIN 1302 00:49:47,151 --> 00:49:49,220 CONSTRUCTS, HOW WE APPLY 1303 00:49:49,220 --> 00:49:49,487 FINDINGS. 1304 00:49:49,487 --> 00:49:53,024 I ENCOURAGE US TO MOVE FROM 1305 00:49:53,024 --> 00:49:54,158 DISCOVERY TO COMMUNITY-DRIVEN 1306 00:49:54,158 --> 00:49:55,727 PREVENTION STRATEGIES THAT ARE 1307 00:49:55,727 --> 00:49:57,729 INFORMED BY REAL DRIVERS OF THE 1308 00:49:57,729 --> 00:50:00,965 DISEASE BY ACTUALLY MAKING BOLD 1309 00:50:00,965 --> 00:50:02,533 EQUITY-INFORMED PREVENTION AND 1310 00:50:02,533 --> 00:50:03,935 AS A STANDARD AND NOT, YOU KNOW, 1311 00:50:03,935 --> 00:50:05,403 THE EXCEPTION ONLY A FEW PEOPLE 1312 00:50:05,403 --> 00:50:06,738 ARE DOING IT. 1313 00:50:06,738 --> 00:50:09,907 I LOOK FORWARD TO SEEING HOW WE 1314 00:50:09,907 --> 00:50:12,143 TACKLE THAT. 1315 00:50:12,143 --> 00:50:19,817 THANK YOU. 1316 00:50:19,817 --> 00:50:24,155 >> I'M PLEASED TO PRESENT OUR 1317 00:50:24,155 --> 00:50:28,226 FINAL RECOMMENDATION, MONITORING 1318 00:50:28,226 --> 00:50:28,760 PROGRESS. 1319 00:50:28,760 --> 00:50:29,894 NEXT SLIDE. 1320 00:50:29,894 --> 00:50:35,133 I HAVE NOTHING TO DISCLAIM OR 1321 00:50:35,133 --> 00:50:36,033 DISCLOSE. 1322 00:50:36,033 --> 00:50:38,169 NEXT SLIDE PLEASE. 1323 00:50:38,169 --> 00:50:42,340 THIS RECOMMENDATION IS TO 1324 00:50:42,340 --> 00:50:43,808 MONITOR PROGRESS IN ALZHEIMER'S 1325 00:50:43,808 --> 00:50:45,977 DISEASE RELATED DEMENTIAS AND IN 1326 00:50:45,977 --> 00:50:48,179 DISPARITIES WITH RESPECT TO 1327 00:50:48,179 --> 00:50:49,046 PREVALENCE, INCIDENCE, 1328 00:50:49,046 --> 00:50:51,149 DIAGNOSIS, TREATMENT AND CARE BY 1329 00:50:51,149 --> 00:50:54,485 APPLYING EXISTING METHODS AS 1330 00:50:54,485 --> 00:50:55,753 WELL AS INNOVATING AND NOVEL 1331 00:50:55,753 --> 00:50:57,622 SURVEILLANCE METHODS. 1332 00:50:57,622 --> 00:50:58,589 I KNOW SURVEILLANCE DOESN'T 1333 00:50:58,589 --> 00:51:01,626 SOUND LIKE THE MOST EXCITING 1334 00:51:01,626 --> 00:51:03,161 AREA BUT HOPEFULLY I CAN MAKE 1335 00:51:03,161 --> 00:51:05,997 THE CASE THIS IS KEY FOR 1336 00:51:05,997 --> 00:51:06,764 UNDERSTANDING THE EXTENT TO 1337 00:51:06,764 --> 00:51:08,199 WHICH THERE ARE DISPARITIES 1338 00:51:08,199 --> 00:51:09,467 BECAUSE WE CAN'T ELIMINATE 1339 00:51:09,467 --> 00:51:11,402 DISPARITIES IF WE DON'T KNOW TO 1340 00:51:11,402 --> 00:51:12,937 WHAT EXTENT THEY EXIST AND WE 1341 00:51:12,937 --> 00:51:14,439 ALSO NEED TO TRACK THEM OVER 1342 00:51:14,439 --> 00:51:16,741 TIME TO UNDERSTAND WHETHER WE'RE 1343 00:51:16,741 --> 00:51:20,845 MAKING PROGRESS OR EVEN 1344 00:51:20,845 --> 00:51:22,914 POTENTIALLY LOSING GROUND. 1345 00:51:22,914 --> 00:51:26,350 OUR RECOMMENDATION IS TO 1346 00:51:26,350 --> 00:51:27,418 PERIODICALLY FIELD NATIONALLY 1347 00:51:27,418 --> 00:51:29,854 REPRESENTATIVE SAMPLES, HIGH 1348 00:51:29,854 --> 00:51:30,621 QUALITY COGNITIVE 1349 00:51:30,621 --> 00:51:31,355 CHARACTERIZATION AND 1350 00:51:31,355 --> 00:51:33,191 OVERREPRESENTATION OF 1351 00:51:33,191 --> 00:51:33,758 DISPROPORTIONATELY AFFECTED 1352 00:51:33,758 --> 00:51:38,329 POPULATIONS TO MONITOR TRENDS IN 1353 00:51:38,329 --> 00:51:40,364 DISPARITIES OVER TIME. 1354 00:51:40,364 --> 00:51:43,534 SO, POTENTIALLY EMBED THIS, 1355 00:51:43,534 --> 00:51:45,403 THESE SAMPLES, WITHIN ONGOING 1356 00:51:45,403 --> 00:51:45,903 REPRESENTATIVE COHORTS. 1357 00:51:45,903 --> 00:51:46,971 AND WHAT I WANT TO DRAW YOUR 1358 00:51:46,971 --> 00:51:51,142 ATTENTION TO IS THIS POINT WE 1359 00:51:51,142 --> 00:51:52,510 NEED TO OVERREPRESENT 1360 00:51:52,510 --> 00:51:54,145 DISPROPORTIONATELY AFFECTED 1361 00:51:54,145 --> 00:51:56,047 POPULATIONS BECAUSE IF WE DON'T 1362 00:51:56,047 --> 00:51:58,349 CONSCIOUSLY DO THIS, MANY OF 1363 00:51:58,349 --> 00:51:59,584 THESE POPULATIONS WILL BE 1364 00:51:59,584 --> 00:52:03,154 REPRESENTED IN NUMBERS JUST TOO 1365 00:52:03,154 --> 00:52:05,356 SMALL TO FACILITATE PRECISE 1366 00:52:05,356 --> 00:52:07,992 ESTIMATES WHICH MEANS 1367 00:52:07,992 --> 00:52:09,994 ESSENTIALLY WON'T BE 1368 00:52:09,994 --> 00:52:10,928 REPRESENTED. 1369 00:52:10,928 --> 00:52:13,431 TO HAVE TRUE REPRESENTATION OF 1370 00:52:13,431 --> 00:52:14,098 MANY DISPROPORTIONATELY AFFECTED 1371 00:52:14,098 --> 00:52:16,868 GROUPS IN OUR SCIENCE WE NEED TO 1372 00:52:16,868 --> 00:52:19,437 OVERSAMPLE THOSE GROUPS TO HAVE 1373 00:52:19,437 --> 00:52:21,672 THEM BE FULLY REPRESENTED. 1374 00:52:21,672 --> 00:52:23,107 FOR EXAMPLE, ASIAN AMERICANS 1375 00:52:23,107 --> 00:52:25,243 REPRESENT ABOUT 5% OF THE OLDER 1376 00:52:25,243 --> 00:52:26,410 ADULT POPULATION IN THE UNITED 1377 00:52:26,410 --> 00:52:31,215 STATES, SO PROBABLY NEED MORE 1378 00:52:31,215 --> 00:52:33,251 THAN 5% OF OUR SAMPLE FOR THEM 1379 00:52:33,251 --> 00:52:36,053 TO BE REPRESENTED IN OUR 1380 00:52:36,053 --> 00:52:38,155 ESTIMATES OF THE PREVALENCE AND 1381 00:52:38,155 --> 00:52:43,761 INCIDENCE OF ALZHEIMER'S DISEASE 1382 00:52:43,761 --> 00:52:47,231 AND RELATED DEMENTIAS. 1383 00:52:47,231 --> 00:52:48,599 WE NEED TO INNOVATE AND 1384 00:52:48,599 --> 00:52:50,334 POTENTIALLY BORROW METHODS FROM 1385 00:52:50,334 --> 00:52:54,305 OTHER FIELDS TO TRY AND CAPTURE 1386 00:52:54,305 --> 00:52:56,807 OR TRY TO ESTIMATE POPULATION 1387 00:52:56,807 --> 00:52:57,875 AND SUBPOPULATION ESTIMATES OF 1388 00:52:57,875 --> 00:52:58,976 THESE RARE DEMENTIAS THAT ARE 1389 00:52:58,976 --> 00:53:03,014 NOT GOING TO BE REPRESENTED IN 1390 00:53:03,014 --> 00:53:03,614 THESE NATIONAL REPRESENTATIVE 1391 00:53:03,614 --> 00:53:08,152 SAMPLES SO WE MIGHT THINK ABOUT 1392 00:53:08,152 --> 00:53:09,120 METHODS LIKE MULTI-SYSTEM 1393 00:53:09,120 --> 00:53:10,588 ESTIMATION, WHICH IS DEVELOPED 1394 00:53:10,588 --> 00:53:15,893 IN THE FIELD OF ECOLOGY FOR 1395 00:53:15,893 --> 00:53:17,128 POPULATION ESTIMATES. 1396 00:53:17,128 --> 00:53:18,062 NEXT SLIDE PLEASE. 1397 00:53:18,062 --> 00:53:21,299 SO WHEN WE THINK ABOUT 1398 00:53:21,299 --> 00:53:23,401 ESTIMATING POPULATION AND 1399 00:53:23,401 --> 00:53:24,368 SUBPOPULATION ESTIMATES FOR 1400 00:53:24,368 --> 00:53:25,970 ALZHEIMER'S DISEASE AND RELATED 1401 00:53:25,970 --> 00:53:28,906 DEMENTIAS WE NEED TO THINK ABOUT 1402 00:53:28,906 --> 00:53:30,808 CAREFUL PLANNING, IN TERMS OF 1403 00:53:30,808 --> 00:53:32,743 WHEN WE'RE DESIGNING THE SAMPLE 1404 00:53:32,743 --> 00:53:35,580 AND HOW WE PROCESS THE DATA ONCE 1405 00:53:35,580 --> 00:53:36,948 WE HAVE IT. 1406 00:53:36,948 --> 00:53:37,648 >> TWO MINUTES. 1407 00:53:37,648 --> 00:53:38,015 >> THANK YOU. 1408 00:53:38,015 --> 00:53:41,619 THE VERY FIRST STEP IS CLEARLY 1409 00:53:41,619 --> 00:53:42,720 DEFINING TARGET POPULATION OR 1410 00:53:42,720 --> 00:53:44,956 TARGET POPULATIONS THAT WE WANT 1411 00:53:44,956 --> 00:53:46,257 TO CAPTURE SO OVERALL 1412 00:53:46,257 --> 00:53:49,193 POPULATION, U.S. POPULATION OF 1413 00:53:49,193 --> 00:53:53,230 OLDER ADULTS, SUBPOPULATIONS WE 1414 00:53:53,230 --> 00:54:01,005 WANT TO CAPTURE. 1415 00:54:01,005 --> 00:54:02,540 SO OUR SAMPLE REPRESENTS THE 1416 00:54:02,540 --> 00:54:03,975 TARGET POPULATION TO THE EXTENT 1417 00:54:03,975 --> 00:54:05,610 WE CAN POSSIBLY CAPTURE THAT. 1418 00:54:05,610 --> 00:54:07,144 AND WE WANT TO MEASURE 1419 00:54:07,144 --> 00:54:08,145 CHARACTERISTICS OF THE STUDY 1420 00:54:08,145 --> 00:54:10,848 SAMPLE SO WE CAN COMPARE 1421 00:54:10,848 --> 00:54:12,583 SYSTEMATICALLY HOW THE SAMPLE 1422 00:54:12,583 --> 00:54:15,820 DIFFERS FROM TARGET POPULATION 1423 00:54:15,820 --> 00:54:17,622 AND APPLY STATISTICAL METHODS TO 1424 00:54:17,622 --> 00:54:19,824 EXTEND FROM STUDY SAMPLE TO 1425 00:54:19,824 --> 00:54:24,161 TARGET POPULATION WE WANT TO 1426 00:54:24,161 --> 00:54:27,765 ESTIMATE THE PREVALENCE AND 1427 00:54:27,765 --> 00:54:28,032 INCIDENCE. 1428 00:54:28,032 --> 00:54:29,667 NEXT SLIDE PLEASE. 1429 00:54:29,667 --> 00:54:32,236 SO HERE IS NICE WORK BY DR. 1430 00:54:32,236 --> 00:54:34,438 LARSON AT UNIVERSITY OF SOUTHERN 1431 00:54:34,438 --> 00:54:36,674 CALIFORNIA, WHERE SHE ESTIMATED 1432 00:54:36,674 --> 00:54:37,375 PREVALENCE OF COGNITIVE 1433 00:54:37,375 --> 00:54:40,077 IMPAIRMENT IN THE U.S., OR 1434 00:54:40,077 --> 00:54:41,278 CALIFORNIA POPULATION OF OLDER 1435 00:54:41,278 --> 00:54:43,447 ADULTS USING DATA FROM THE 1436 00:54:43,447 --> 00:54:47,652 KAISER HEALTHY AGING AND DIVERSE 1437 00:54:47,652 --> 00:54:51,355 LIFE EXPERIENCES STUDY. 1438 00:54:51,355 --> 00:54:53,958 YOU SEE IN GRAY ESTIMATES, AND 1439 00:54:53,958 --> 00:54:57,595 IN BLUE AFTER DR. LARSON APPLIED 1440 00:54:57,595 --> 00:54:58,896 WEIGHT TO EXTEND THE ESTIMATES 1441 00:54:58,896 --> 00:55:00,631 TO THE CALIFORNIA POPULATION OF 1442 00:55:00,631 --> 00:55:04,168 OLDER ADULTS. 1443 00:55:04,168 --> 00:55:06,237 NEXT SLIDE PLEASE. 1444 00:55:06,237 --> 00:55:07,772 SO, IN CLOSING HEALTH 1445 00:55:07,772 --> 00:55:10,207 DISPARITIES ARE PERSISTENT BUT 1446 00:55:10,207 --> 00:55:14,445 THEY ARE NOT INEVITABLE. 1447 00:55:14,445 --> 00:55:15,980 WE'VE OBSERVED REDUCTIONS IN 1448 00:55:15,980 --> 00:55:18,215 DISPARITY OVER TIME IN CERTAIN 1449 00:55:18,215 --> 00:55:21,318 DOMAINS AS WELL AS LOST GROUND 1450 00:55:21,318 --> 00:55:23,054 AND SEEING WIDENING OF 1451 00:55:23,054 --> 00:55:24,188 DISPARITIES IN CERTAIN DOMAINS 1452 00:55:24,188 --> 00:55:27,058 OVER TIME. 1453 00:55:27,058 --> 00:55:29,660 IF WE'RE SERIOUS ABOUT REDUCING 1454 00:55:29,660 --> 00:55:36,701 DISPARITIES AND DEMENTIA WE HE 1455 00:55:36,701 --> 00:55:38,936 TO TRACK OVER TIME TO UNDERSTAND 1456 00:55:38,936 --> 00:55:40,604 WHETHER WE'RE MAKING PROGRESS OR 1457 00:55:40,604 --> 00:55:41,639 POSSIBLY LOSING GROUND. 1458 00:55:41,639 --> 00:55:52,016 THANK YOU VERY MUCH. 1459 00:56:14,371 --> 00:56:14,739 >> OKAY. 1460 00:56:14,739 --> 00:56:17,041 IS THERE AN ECHO? 1461 00:56:17,041 --> 00:56:17,308 THANK YOU. 1462 00:56:17,308 --> 00:56:22,113 SO WE'RE GOING TO GO TO PUBLIC 1463 00:56:22,113 --> 00:56:23,781 COMMENTS IN THE PANEL 1464 00:56:23,781 --> 00:56:27,852 DISCUSSION, 15 MINUTES FOR 1465 00:56:27,852 --> 00:56:28,519 QUESTIONS FROM EVERYBODY. 1466 00:56:28,519 --> 00:56:32,790 I WANT TO TAKE A MINUTE TO 1467 00:56:32,790 --> 00:56:34,024 ORIENT YOU FOR THE PUBLIC 1468 00:56:34,024 --> 00:56:36,026 COMMENT TIMES. 1469 00:56:36,026 --> 00:56:37,294 YOU'RE GOING TO -- IF YOU WANT 1470 00:56:37,294 --> 00:56:39,897 TO ASK A QUESTION, RAISE YOUR 1471 00:56:39,897 --> 00:56:42,800 HAND USING THE "RAISE HAND" 1472 00:56:42,800 --> 00:56:48,105 FEATURE, ALONG THE TOP OF THE 1473 00:56:48,105 --> 00:56:50,674 TEAMS, WEBSITE IF YOU'RE ON THE 1474 00:56:50,674 --> 00:56:51,675 BROWSER, OR APP. 1475 00:56:51,675 --> 00:56:54,845 WE'LL TAKE THE QUESTIONS IN 1476 00:56:54,845 --> 00:56:55,279 IN THE 1477 00:56:55,279 --> 00:56:57,715 ORDER THEY COME. 1478 00:56:57,715 --> 00:56:59,416 ONCE YOUR HAND IS RAISED, WE 1479 00:56:59,416 --> 00:57:02,887 WILL ENABLE YOUR MICROPHONE AND 1480 00:57:02,887 --> 00:57:03,120 CAMERA. 1481 00:57:03,120 --> 00:57:05,956 PLEASE WATCH FOR THAT. 1482 00:57:05,956 --> 00:57:06,991 WATCH FOR THE PROMPT. 1483 00:57:06,991 --> 00:57:09,126 AGREE AND THEN GO AHEAD AND TURN 1484 00:57:09,126 --> 00:57:14,165 ON USUAL CAMERA -- YOUR CAMERA 1485 00:57:14,165 --> 00:57:16,033 TO ASK THE QUESTION. 1486 00:57:16,033 --> 00:57:17,802 IF THERE'S A PROBLEM, WE'LL JUST 1487 00:57:17,802 --> 00:57:21,605 GO TO THE NEXT QUESTION AND COME 1488 00:57:21,605 --> 00:57:21,806 BACK. 1489 00:57:21,806 --> 00:57:23,641 THERE'S ALSO ANOTHER WAY TO 1490 00:57:23,641 --> 00:57:27,711 SUBMIT QUESTIONS TO US, IF 1491 00:57:27,711 --> 00:57:29,547 YOU'RE WATCHING ON VIDEOCAST, 1492 00:57:29,547 --> 00:57:31,982 THERE'S A SEND LIVE FEEDBACK 1493 00:57:31,982 --> 00:57:32,216 BUTTON. 1494 00:57:32,216 --> 00:57:33,417 I WILL RECEIVE AN E-MAIL WITH 1495 00:57:33,417 --> 00:57:37,788 THAT QUESTION SO I CAN ASK THE 1496 00:57:37,788 --> 00:57:39,323 QUESTION ON YOUR BEHALF. 1497 00:57:39,323 --> 00:57:44,161 LET'S GIVE IT A TRY. 1498 00:57:44,161 --> 00:57:47,331 AND MARIA, WE HAVE THE FIRST 1499 00:57:47,331 --> 00:57:48,532 QUESTION FROM DALE. 1500 00:57:48,532 --> 00:57:51,068 AND THEN ANYONE ELSE WHO WANTS 1501 00:57:51,068 --> 00:57:54,004 TO JOIN THE -- THINK OF IT AS A 1502 00:57:54,004 --> 00:57:55,439 VIRTUAL MICROPHONE LINE TO JOIN. 1503 00:57:55,439 --> 00:57:56,340 OKAY. 1504 00:57:56,340 --> 00:57:59,777 I'LL HAND OFF TO YOU GUYS. 1505 00:57:59,777 --> 00:58:04,148 DALE, ARE YOU ABLE TO UNMUTE AND 1506 00:58:04,148 --> 00:58:13,657 TURN ON YOUR CAMERA? 1507 00:58:13,657 --> 00:58:14,792 >> IS IT WORKING? 1508 00:58:14,792 --> 00:58:16,093 >> WE GOT YOU. 1509 00:58:16,093 --> 00:58:17,628 >> OKAY, GOOD. 1510 00:58:17,628 --> 00:58:19,897 THANK YOU VERY MUCH. 1511 00:58:19,897 --> 00:58:20,898 THIS HAS BEEN FASCINATING. 1512 00:58:20,898 --> 00:58:23,601 ALL OF THE THINGS THAT NEED TO 1513 00:58:23,601 --> 00:58:27,071 BE CONSIDERED, I WOULD LIKE TO 1514 00:58:27,071 --> 00:58:28,239 ASK A QUESTION, AFTER YOU APPLY 1515 00:58:28,239 --> 00:58:31,508 ALL THIS WHAT HAVE YOU FOUND 1516 00:58:31,508 --> 00:58:31,675 OUT? 1517 00:58:31,675 --> 00:58:32,810 WHAT'S BEEN THE OUTCOME? 1518 00:58:32,810 --> 00:58:36,780 YOU HAVE ALL THESE THINGS THAT 1519 00:58:36,780 --> 00:58:43,220 YOU DO, BUT THE END PRODUCT IS 1520 00:58:43,220 --> 00:58:46,490 HOW DID THE VARIOUS VARIABLES 1521 00:58:46,490 --> 00:58:48,893 YOU'RE LOOKING AT AFFECT THE 1522 00:58:48,893 --> 00:58:54,031 PERCENTAGE OF PEOPLE THAT WILL 1523 00:58:54,031 --> 00:58:57,468 GET THE VARIOUS DIMENSIONS AND 1524 00:58:57,468 --> 00:58:58,335 ATTENDANCE TO ALZHEIMER'S, 1525 00:58:58,335 --> 00:59:01,639 THAT'S MY QUESTION. 1526 00:59:01,639 --> 00:59:02,706 >> I CAN TAKE AN INITIAL 1527 00:59:02,706 --> 00:59:05,976 RESPONSE AND PEOPLE CAN CHIME 1528 00:59:05,976 --> 00:59:07,011 IN. 1529 00:59:07,011 --> 00:59:08,612 I THINK ONE OF THE BEST NEW 1530 00:59:08,612 --> 00:59:10,247 STORIES WE SHOULD REALLY BE 1531 00:59:10,247 --> 00:59:13,517 TALKING ABOUT MORE IS THE CHANGE 1532 00:59:13,517 --> 00:59:15,519 IN AGE-SPECIFIC INCIDENCE RATES 1533 00:59:15,519 --> 00:59:15,853 OF DEMENTIA. 1534 00:59:15,853 --> 00:59:18,489 AND WHAT WE'VE SEEN IN TRENDS 1535 00:59:18,489 --> 00:59:21,759 OVER THE LAST RECENT DECADES. 1536 00:59:21,759 --> 00:59:27,131 ALTHOUGH OUR POPULATION IS 1537 00:59:27,131 --> 00:59:29,633 GROWING OLDER, AND SO THERE'S AN 1538 00:59:29,633 --> 00:59:29,833 ECHO. 1539 00:59:29,833 --> 00:59:31,802 I WONDER IF SOMEBODY COULD MUTE. 1540 00:59:31,802 --> 00:59:35,606 SO OVER THE LAST FEW DECADES WE 1541 00:59:35,606 --> 00:59:37,808 HAVE SEEN TRENDS THAT THERE ARE 1542 00:59:37,808 --> 00:59:38,409 MORE AND MORE DEMENTIA CASES 1543 00:59:38,409 --> 00:59:40,678 BECAUSE THERE ARE MORE AND MORE 1544 00:59:40,678 --> 00:59:42,413 OLDER ADULTS, BUT IF YOU LOOK AT 1545 00:59:42,413 --> 00:59:44,181 ANY GIVEN AGE GROUP THE 1546 00:59:44,181 --> 00:59:47,418 INCIDENCE OF DEMENTIA IS 1547 00:59:47,418 --> 00:59:47,685 DECLINING. 1548 00:59:47,685 --> 00:59:48,519 NOW, THERE'S SOME DISCUSSION 1549 00:59:48,519 --> 00:59:49,687 ABOUT EXACTLY WHY THAT IS. 1550 00:59:49,687 --> 00:59:52,056 I THINK ONE OF THE BEST 1551 00:59:52,056 --> 00:59:53,657 EXPLANATIONS FOR THAT IS HUGE 1552 00:59:53,657 --> 00:59:54,291 INCREASES IN EDUCATIONAL 1553 00:59:54,291 --> 00:59:57,161 ATTAINMENT THAT HAS BEEN 1554 00:59:57,161 --> 00:59:58,495 ACHIEVED IN THE LAST 30 YEARS. 1555 00:59:58,495 --> 01:00:00,464 I THINK THAT'S A REALLY GOOD 1556 01:00:00,464 --> 01:00:05,002 NEWS STORY THAT HAS PAID OFF 1557 01:00:05,002 --> 01:00:06,370 THAT WE WOULD BE IN A WORSE 1558 01:00:06,370 --> 01:00:07,471 SITUATION WITH RESPECT TO BURDEN 1559 01:00:07,471 --> 01:00:12,409 OF DEMENTIA HAD IT NOT BEEN FOR 1560 01:00:12,409 --> 01:00:12,710 INVESTMENTS. 1561 01:00:12,710 --> 01:00:14,278 THOSE INVESTMENTS, KACIE SHOWED 1562 01:00:14,278 --> 01:00:19,216 A PICTURE SLOWING DIFFERENCE IN 1563 01:00:19,216 --> 01:00:21,952 TERM LENGTH IN THE COUNTRY, IN 1564 01:00:21,952 --> 01:00:23,520 THE TIME WHEN THERE WERE 1565 01:00:23,520 --> 01:00:26,523 RACIALLY SEGREGATED SCHOOLS. 1566 01:00:26,523 --> 01:00:28,158 INVESTMENTS TO GET EVERYBODY 1567 01:00:28,158 --> 01:00:31,328 ACCESS TO EDUCATION WERE 1568 01:00:31,328 --> 01:00:33,263 CHALLENGING, HUGE ACHIEVEMENT OF 1569 01:00:33,263 --> 01:00:35,332 OUR PARENTS, GRANDPARENTS, TO 1570 01:00:35,332 --> 01:00:36,500 GIVE PEOPLE EDUCATIONAL ACCESS. 1571 01:00:36,500 --> 01:00:38,702 THAT IS STILL PAYING OFF FOR US 1572 01:00:38,702 --> 01:00:40,738 IN TERMS OF DEMENTIA RISK. 1573 01:00:40,738 --> 01:00:43,974 I'LL HAND IT TO ANYBODY ELSE 1574 01:00:43,974 --> 01:00:46,110 THAT HAS ANYTHING TO ADD. 1575 01:00:46,110 --> 01:00:48,379 >> THANK YOU, MARIA. 1576 01:00:48,379 --> 01:00:49,580 THAT'S VERY HELPFUL. 1577 01:00:49,580 --> 01:00:52,383 AS AGE IS GOING ON, WE WOULD 1578 01:00:52,383 --> 01:00:55,285 EXPECT MORE DEMENTIA BUT WHAT 1579 01:00:55,285 --> 01:00:59,656 WE'RE GETTING IS LESS. 1580 01:00:59,656 --> 01:01:01,525 >> THAT'S RIGHT. 1581 01:01:01,525 --> 01:01:02,659 >> DUE TO EDUCATIONAL LEVEL. 1582 01:01:02,659 --> 01:01:04,361 >> THAT'S RIGHT. 1583 01:01:04,361 --> 01:01:07,231 THERE'S MORE DEMENTIA BUT IN ANY 1584 01:01:07,231 --> 01:01:09,833 GIVEN AGE GROUP THERE'S LESS, 1585 01:01:09,833 --> 01:01:13,070 IT'S GOING DOWN. 1586 01:01:13,070 --> 01:01:13,704 THEREFORE THE DEMENTIA BURDEN 1587 01:01:13,704 --> 01:01:19,777 WOULD BE MORE SUBSTANTIAL IF WE 1588 01:01:19,777 --> 01:01:21,912 DIDN'T HAVE THOSE INVESTMENTS. 1589 01:01:21,912 --> 01:01:32,423 THANKS FOR THE QUESTION ALSO. 1590 01:01:33,190 --> 01:01:35,893 >> NEXT PERSON, OR YOU CAN GO 1591 01:01:35,893 --> 01:01:41,131 THROUGH ONE BY ONE. 1592 01:01:41,131 --> 01:01:44,435 >> TRY TO USE YOUR MICROPHONE 1593 01:01:44,435 --> 01:01:51,075 AND CAMERA. 1594 01:01:51,075 --> 01:01:55,212 >> CAN YOU SEE OR HEAR ME? 1595 01:01:55,212 --> 01:01:55,479 >> YEP. 1596 01:01:55,479 --> 01:01:56,947 >> ALL RIGHT. 1597 01:01:56,947 --> 01:02:02,119 THANK YOU FOR THIS OPPORTUNITY. 1598 01:02:02,119 --> 01:02:03,053 THERE ARE SEVERAL THINGS. 1599 01:02:03,053 --> 01:02:06,090 ONE OF MY QUESTIONS IS THE 1600 01:02:06,090 --> 01:02:07,124 FOCUS -- DOES THE FOCUS STILL 1601 01:02:07,124 --> 01:02:10,994 REMAIN ON THE MEDICAL MODEL OF 1602 01:02:10,994 --> 01:02:11,361 CARE? 1603 01:02:11,361 --> 01:02:12,763 THE WORDS OR TERMINOLOGY I'VE 1604 01:02:12,763 --> 01:02:16,166 HEARD IN THE RECOMMENDATIONS ARE 1605 01:02:16,166 --> 01:02:17,000 ACCESS TO CARE, TREATMENT, 1606 01:02:17,000 --> 01:02:19,303 DIAGNOSIS, AND THEN THERE WAS A 1607 01:02:19,303 --> 01:02:21,872 FOCUS ON PREVENTION BUT IT 1608 01:02:21,872 --> 01:02:24,341 WASN'T CLEAR TO ME HOW MUCH 1609 01:02:24,341 --> 01:02:27,211 EMPHASIS STILL REMAINS ON 1610 01:02:27,211 --> 01:02:27,845 PREVENTION VERSUS TREATMENT 1611 01:02:27,845 --> 01:02:30,581 WHICH OCCURS DOWNSTREAM SO FROM 1612 01:02:30,581 --> 01:02:32,549 A PUBLIC HEALTH PERSPECTIVE I 1613 01:02:32,549 --> 01:02:35,786 WAS WANTING TO KIND OF LEARN 1614 01:02:35,786 --> 01:02:37,921 MORE ABOUT HOW MUCH IS THE FOCUS 1615 01:02:37,921 --> 01:02:41,358 ON PREVENTION IN TERMS OF 1616 01:02:41,358 --> 01:02:43,093 PERCENTAGE, VERSUS THE 1617 01:02:43,093 --> 01:02:44,228 DOWNSTREAM FACTORS OR OUTCOMES, 1618 01:02:44,228 --> 01:02:48,132 AND THEN IN THE WORKFORCE, I 1619 01:02:48,132 --> 01:02:50,400 LIVE IN RURAL AREA, THERE'S NO 1620 01:02:50,400 --> 01:02:52,603 UNIVERSITY CLOSE TO ME. 1621 01:02:52,603 --> 01:02:53,971 I WORK IN HYBRID MODEL. 1622 01:02:53,971 --> 01:02:57,441 I'VE DONE THAT FOR THE LAST 1623 01:02:57,441 --> 01:02:58,208 SEVEN YEARS. 1624 01:02:58,208 --> 01:03:00,711 I'VE PUBLISHED, DONE MORE 1625 01:03:00,711 --> 01:03:02,012 RESEARCH IN MY LIFETIME DOING 1626 01:03:02,012 --> 01:03:03,580 THAT THAN SPENDING THREE HOURS 1627 01:03:03,580 --> 01:03:04,681 COMMUTING IN TEXAS WHICH I DID 1628 01:03:04,681 --> 01:03:07,384 FOR 23 YEARS OF MY LIFE. 1629 01:03:07,384 --> 01:03:11,421 AND IN REALITY SUCH POSITIONS 1630 01:03:11,421 --> 01:03:13,857 ARE PART TIME, IT'S BEEN 1631 01:03:13,857 --> 01:03:15,425 CHALLENGING TO FIND A FULL-TIME 1632 01:03:15,425 --> 01:03:16,160 POSITION. 1633 01:03:16,160 --> 01:03:18,562 NIH CAREER AWARDS REQUIRE 1634 01:03:18,562 --> 01:03:20,531 FULL-TIME POSITION, ALZHEIMER'S 1635 01:03:20,531 --> 01:03:21,532 ASSOCIATION REQUIRES FULL-TIME 1636 01:03:21,532 --> 01:03:26,103 POSITION, EVEN SOME OF THE 1637 01:03:26,103 --> 01:03:27,304 DIVERSITY PROGRAM REQUIRES YOU 1638 01:03:27,304 --> 01:03:31,208 TO BE NOT ASIAN, BLACK AND 1639 01:03:31,208 --> 01:03:32,676 HISPANIC COLLEAGUES I'M HAPPY 1640 01:03:32,676 --> 01:03:34,511 FOR HAD BETTER SUCCESS IN 1641 01:03:34,511 --> 01:03:35,078 WORKFORCE DEVELOPMENT 1642 01:03:35,078 --> 01:03:36,713 OPPORTUNITIES SO IT'S BEEN A 1643 01:03:36,713 --> 01:03:40,117 CHALLENGE, SOMEONE LIKE ME, 1644 01:03:40,117 --> 01:03:42,719 LIVING IN RURAL AMERICA, AND 1645 01:03:42,719 --> 01:03:44,621 SUBGROUP OF ASIAN AMERICANS THAT 1646 01:03:44,621 --> 01:03:47,257 JUST CANNOT FIND A PLACE TO 1647 01:03:47,257 --> 01:03:47,558 SUSTAIN. 1648 01:03:47,558 --> 01:03:50,127 I WAS HOPING TO LEARN HOW -- 1649 01:03:50,127 --> 01:03:52,629 WHAT ARE SOME MECHANISMS IN THE 1650 01:03:52,629 --> 01:03:53,597 WORKFORCE DEVELOPMENT PLAN THAT 1651 01:03:53,597 --> 01:03:56,733 WILL ALLOW FOR ME TO REMAIN 1652 01:03:56,733 --> 01:03:58,035 ENGAGED IN THIS WORK I'M SO 1653 01:03:58,035 --> 01:04:00,070 PASSIONATE ABOUT SO THANK YOU 1654 01:04:00,070 --> 01:04:01,905 FOR LISTENING. 1655 01:04:01,905 --> 01:04:03,006 >> THANK YOU FOR THAT QUESTION. 1656 01:04:03,006 --> 01:04:05,075 WHY DON'T WE START WITH THE 1657 01:04:05,075 --> 01:04:07,077 PREVENTION PART OF THE QUESTION. 1658 01:04:07,077 --> 01:04:09,012 I CAN START, OTHER PEOPLE -- 1659 01:04:09,012 --> 01:04:12,149 I'LL START, I HOPE THE REST OF 1660 01:04:12,149 --> 01:04:15,252 THE TEAM WILL CHIME IN. 1661 01:04:15,252 --> 01:04:17,087 I THINK WE ALL FEEL STRONGLY 1662 01:04:17,087 --> 01:04:20,524 THAT WE NEED A COMBINATION OF 1663 01:04:20,524 --> 01:04:23,260 BOTH WHAT ARE CLASSICALLY UNDER 1664 01:04:23,260 --> 01:04:25,762 THE REPERTOIRE OF MEDICAL CARE 1665 01:04:25,762 --> 01:04:27,898 AND NON-MEDICAL CARE RESOURCES 1666 01:04:27,898 --> 01:04:28,398 AND APPROACHES. 1667 01:04:28,398 --> 01:04:31,435 I THINK THE ISSUE OF PREVENTION 1668 01:04:31,435 --> 01:04:34,705 WITH DEMENTIA IS ACTUALLY REALLY 1669 01:04:34,705 --> 01:04:35,973 FUZZY BECAUSE THE PERIOD WHERE 1670 01:04:35,973 --> 01:04:37,741 BETWEEN WHEN THE VERY EARLY 1671 01:04:37,741 --> 01:04:41,011 KINDS OF DISEASE AND WHEN PEOPLE 1672 01:04:41,011 --> 01:04:44,047 GET DIAGNOSED IS SO LONG. 1673 01:04:44,047 --> 01:04:46,183 I THINK THERE'S REALLY A 1674 01:04:46,183 --> 01:04:48,151 DECADE-LONG PERIOD WHEN PEOPLE 1675 01:04:48,151 --> 01:04:49,720 ARE DEVELOPING UNDERLYING 1676 01:04:49,720 --> 01:04:51,154 DISEASE PROCESSES AND THERE IS A 1677 01:04:51,154 --> 01:04:52,723 MOMENT WHEN WE CAN INTERVENE ON 1678 01:04:52,723 --> 01:04:56,593 THOSE THINGS WE CONSIDER RISK 1679 01:04:56,593 --> 01:05:03,934 FACTORS, BUT ARE EXACERBATING 1680 01:05:03,934 --> 01:05:04,968 PROGRESSION, EXTREMELY 1681 01:05:04,968 --> 01:05:06,370 IMPORTANT. 1682 01:05:06,370 --> 01:05:09,106 WE DIDN'T SAY 40% THIS, 50% 1683 01:05:09,106 --> 01:05:11,108 THAT, THERE'S NO QUESTION THE 1684 01:05:11,108 --> 01:05:12,509 COMMITTEE FEELS WE REALLY NEED 1685 01:05:12,509 --> 01:05:16,179 TO HOLD ATTENTION TO BOTH SIDES 1686 01:05:16,179 --> 01:05:17,547 OF THAT EQUATION, PREVENTING AND 1687 01:05:17,547 --> 01:05:18,448 DELAYING DEMENTIA BUT ALSO 1688 01:05:18,448 --> 01:05:20,550 MAKING SURE PEOPLE WHO ARE ON 1689 01:05:20,550 --> 01:05:22,286 THE DEMENTIA SPECTRUM ARE 1690 01:05:22,286 --> 01:05:24,321 GETTING CARE AND RESEARCH THEY 1691 01:05:24,321 --> 01:05:27,357 NEED TO LIVE FULFILLING LIVES AT 1692 01:05:27,357 --> 01:05:29,393 THE MAXIMUM POSSIBLE LEVEL OF 1693 01:05:29,393 --> 01:05:30,227 SOCIAL ENGAGEMENT. 1694 01:05:30,227 --> 01:05:31,995 DOES ANYBODY WANT TO ADD 1695 01:05:31,995 --> 01:05:32,262 ANYTHING? 1696 01:05:32,262 --> 01:05:35,932 >> YEAH, THANK YOU SO MUCH, DR. 1697 01:05:35,932 --> 01:05:36,333 GLYMOUR. 1698 01:05:36,333 --> 01:05:38,702 IT MAY NOT BE AS APPARENT BUT I 1699 01:05:38,702 --> 01:05:40,470 WOULD SAY MAJORITY OF OUR 1700 01:05:40,470 --> 01:05:42,005 RECOMMENDATIONS ACTUALLY ARE FOR 1701 01:05:42,005 --> 01:05:44,775 PREVENTION AND CARE, FOR 1702 01:05:44,775 --> 01:05:46,476 EXAMPLE, WE DON'T ADEQUATELY 1703 01:05:46,476 --> 01:05:48,845 TRAIN INDIVIDUALS, WE MAY BE 1704 01:05:48,845 --> 01:05:50,681 MISSING SOME OF THESE THINGS 1705 01:05:50,681 --> 01:05:53,817 THAT ARE LEADING TO DEMENTIA. 1706 01:05:53,817 --> 01:05:56,019 AS DR. GLYMOUR STATED, THERE'S 1707 01:05:56,019 --> 01:05:58,322 THIS EARLY DEVELOPMENT THAT 1708 01:05:58,322 --> 01:06:00,691 WE'RE NOT ACCOUNTING FOR, 1709 01:06:00,691 --> 01:06:03,427 BECAUSE WE'RE UNSURE WHEN TO 1710 01:06:03,427 --> 01:06:05,162 ACTUALLY START TARGETING AND 1711 01:06:05,162 --> 01:06:05,929 MEASURE, WHERE THE MID-LIFE 1712 01:06:05,929 --> 01:06:07,764 RECOMMENDATION CAME IN AS WELL. 1713 01:06:07,764 --> 01:06:09,766 THE FACTORS THAT LEAD TO 1714 01:06:09,766 --> 01:06:12,269 DEMENTIA OCCUR OVER A LIFE 1715 01:06:12,269 --> 01:06:14,705 COURSE AND THAT'S WHY A LOT OF 1716 01:06:14,705 --> 01:06:18,608 THIS HAS TO DO WITH LIFE COURSE 1717 01:06:18,608 --> 01:06:22,212 PERSPECTIVE RATHER THAN JUST THE 1718 01:06:22,212 --> 01:06:26,049 ADDRESSING 65 AND OLDER FOR THE 1719 01:06:26,049 --> 01:06:26,249 GROUP. 1720 01:06:26,249 --> 01:06:28,418 >> DOES ANYBODY WANT TO RESPOND 1721 01:06:28,418 --> 01:06:30,287 ABOUT THE CAREER DEVELOPMENT 1722 01:06:30,287 --> 01:06:31,021 MECHANISMS? 1723 01:06:31,021 --> 01:06:32,823 >> YEAH, I'M HAPPY TO START THE 1724 01:06:32,823 --> 01:06:33,724 CONVERSATION. 1725 01:06:33,724 --> 01:06:35,759 I WANT TO SAY FIRST, THANK YOU 1726 01:06:35,759 --> 01:06:39,496 SO MUCH FOR BRINGING THAT TO OUR 1727 01:06:39,496 --> 01:06:41,131 ATTENTION, FOR SHARING YOUR 1728 01:06:41,131 --> 01:06:41,431 EXPERIENCE. 1729 01:06:41,431 --> 01:06:42,933 YEAH, I THINK, YOU KNOW, YOU 1730 01:06:42,933 --> 01:06:46,403 BRING UP VERY GOOD POINTS WHICH 1731 01:06:46,403 --> 01:06:48,105 HIGHLIGHT SOME -- LIKE THE 1732 01:06:48,105 --> 01:06:50,107 OVERALL BROAD THEME ABOUT 1733 01:06:50,107 --> 01:06:51,375 PROVIDING ADDITIONAL TRAINING 1734 01:06:51,375 --> 01:06:53,310 OPPORTUNITIES FOR EARLY CAREER 1735 01:06:53,310 --> 01:06:54,778 INDIVIDUALS AND AS WELL AS 1736 01:06:54,778 --> 01:06:57,981 PEOPLE ENGAGED IN THIS KIND OF 1737 01:06:57,981 --> 01:07:00,083 WORK THAT WE MEAN BROAD ASPECTS 1738 01:07:00,083 --> 01:07:02,519 NOT NECESSARILY BASED ON 1739 01:07:02,519 --> 01:07:03,520 SOMEONE'S RACE OR ETHNICITY, YOU 1740 01:07:03,520 --> 01:07:04,788 MENTIONED YOU'RE WORKING IN A 1741 01:07:04,788 --> 01:07:06,723 RURAL SETTING THAT COMES WITH 1742 01:07:06,723 --> 01:07:07,724 ITS OWN LIMITATIONS. 1743 01:07:07,724 --> 01:07:09,192 I THINK WE WILL WORK ON I THINK 1744 01:07:09,192 --> 01:07:12,529 AS MUCH AS WE CAN TO DOUBLECHECK 1745 01:07:12,529 --> 01:07:13,563 RECOMMENDATIONS THAT MIGHT BE 1746 01:07:13,563 --> 01:07:15,365 MORE APPLICABLE TO THAT. 1747 01:07:15,365 --> 01:07:17,901 SOME OF THE THINGS WE WERE 1748 01:07:17,901 --> 01:07:20,203 THINKING ABOUT FOR THE ENHANCING 1749 01:07:20,203 --> 01:07:22,372 TRAINING, WE'RE TRYING TO PUSH 1750 01:07:22,372 --> 01:07:23,907 THAT TO SUPPORT PROGRAMMATIC 1751 01:07:23,907 --> 01:07:27,411 INFRASTRUCTURE AND RESOURCES TO 1752 01:07:27,411 --> 01:07:29,045 PROMOTE HIGHLY SKILLED 1753 01:07:29,045 --> 01:07:31,715 WORKFORCE, CREATING STRUCTURES 1754 01:07:31,715 --> 01:07:33,016 FOR BRIDGE FUNDING, GRANTS, 1755 01:07:33,016 --> 01:07:36,153 INVESTING IN RESOURCES TO 1756 01:07:36,153 --> 01:07:37,053 OVERCOME BARRIERS, PROMISING 1757 01:07:37,053 --> 01:07:39,055 SCHOLARS FROM SUCCEEDING IN 1758 01:07:39,055 --> 01:07:40,323 RESEARCH CAREERS WHICH YOU 1759 01:07:40,323 --> 01:07:43,727 HIGHLIGHTED A FEW, ESPECIALLY 1760 01:07:43,727 --> 01:07:45,829 WITH MENTIONING HOW BACKGROUNDS 1761 01:07:45,829 --> 01:07:47,798 FROM SOUTH ASIAN DESCENT WHICH I 1762 01:07:47,798 --> 01:07:49,733 THINK THANK YOU FOR SHARING, WE 1763 01:07:49,733 --> 01:07:52,202 WOULD WORK TO MAKE SURE THAT 1764 01:07:52,202 --> 01:07:53,637 SOME OF THESE RECOMMENDATIONS 1765 01:07:53,637 --> 01:08:00,210 CAN BE BE A ACCOUNTABLE -- CAN 1766 01:08:00,210 --> 01:08:02,479 BE APPLICABLE TO WHAT YOU'RE 1767 01:08:02,479 --> 01:08:03,547 BRINGING UP. 1768 01:08:03,547 --> 01:08:05,682 >> A LOT OF MECHANISMS RELATED 1769 01:08:05,682 --> 01:08:07,250 TO PROMOTING DIVERSITY IN 1770 01:08:07,250 --> 01:08:09,920 SCIENCE HAVE BEEN RECENTLY 1771 01:08:09,920 --> 01:08:11,855 CANCELED, AND IT IS ON THE ONE 1772 01:08:11,855 --> 01:08:14,090 HAND BREAKING MY HEART BECAUSE I 1773 01:08:14,090 --> 01:08:16,560 THINK THOSE HAVE BEEN REALLY 1774 01:08:16,560 --> 01:08:18,261 VALUABLE FOR ALLOWING FANTASTIC 1775 01:08:18,261 --> 01:08:20,163 SCIENTISTS TO LAUNCH CAREERS AND 1776 01:08:20,163 --> 01:08:20,497 BE SUCCESSFUL. 1777 01:08:20,497 --> 01:08:21,498 ON THE OTHER HAND, THINK ALL OF 1778 01:08:21,498 --> 01:08:25,368 US CAN LOOK AT THOSE MECHANISMS 1779 01:08:25,368 --> 01:08:27,771 AND IDENTIFY WAYS THEY COULD BE 1780 01:08:27,771 --> 01:08:28,038 IMPROVED. 1781 01:08:28,038 --> 01:08:29,673 I REALLY HOPE THAT THIS IS A 1782 01:08:29,673 --> 01:08:32,175 MOMENT WHEN WE CAN TRY TO TACKLE 1783 01:08:32,175 --> 01:08:35,378 SOME VERY CHALLENGES THAT YOU 1784 01:08:35,378 --> 01:08:37,814 RAISE, AND COME BACK WITH BETTER 1785 01:08:37,814 --> 01:08:39,316 STRUCTURES AND MECHANISMS TO 1786 01:08:39,316 --> 01:08:41,618 SUPPORT EVERYONE WHO WANTS TO DO 1787 01:08:41,618 --> 01:08:43,386 GREAT SCIENCE TO REDUCE 1788 01:08:43,386 --> 01:08:49,860 DEMENTIA, TO JOIN THE FIELD AND 1789 01:08:49,860 --> 01:08:50,193 CONTRIBUTE. 1790 01:08:50,193 --> 01:08:51,228 >> THANK YOU VERY MUCH. 1791 01:08:51,228 --> 01:08:53,430 THANK YOU. 1792 01:08:53,430 --> 01:08:55,699 BEST WISHES. 1793 01:08:55,699 --> 01:08:56,900 >> THANK YOU. 1794 01:08:56,900 --> 01:08:58,235 LET'S TRY TO BE CONCISE IN THE 1795 01:08:58,235 --> 01:09:00,170 QUESTIONS AND ANSWERS SO WE CAN 1796 01:09:00,170 --> 01:09:02,439 GET THROUGH EVERYBODY. 1797 01:09:02,439 --> 01:09:04,174 WE'RE GOING TO END -- WE'RE 1798 01:09:04,174 --> 01:09:06,142 GOING OVER TIME BUT WE'RE GOING 1799 01:09:06,142 --> 01:09:09,412 TO GO INTO THE BREAK. 1800 01:09:09,412 --> 01:09:13,016 AND WE'LL END THE MICROPHONE 1801 01:09:13,016 --> 01:09:14,017 TIME AT 2:15. 1802 01:09:14,017 --> 01:09:15,752 WE HAVE FIVE MORE MINUTES. 1803 01:09:15,752 --> 01:09:23,960 AND WE'LL TAKE THE NEXT QUESTION 1804 01:09:23,960 --> 01:09:25,095 FROM MITCHELL. 1805 01:09:25,095 --> 01:09:28,164 >> THESE ARE ALL VERY IMPORTANT 1806 01:09:28,164 --> 01:09:33,403 POINTS IN TERMS OF IDENTIFYING 1807 01:09:33,403 --> 01:09:34,271 DIFFERENT POPULATIONS AND 1808 01:09:34,271 --> 01:09:36,172 OVERREPRESENTING AND SO ON. 1809 01:09:36,172 --> 01:09:40,443 I WANTED TO RAISE THE ISSUE THAT 1810 01:09:40,443 --> 01:09:41,878 DIFFERENT POPULATIONS MAY 1811 01:09:41,878 --> 01:09:45,382 HAVE -- BECAUSE WE KNOW NOW 1812 01:09:45,382 --> 01:09:47,450 INCREASINGLY WE'RE AWARE THAT IN 1813 01:09:47,450 --> 01:09:51,321 ANY GIVEN PATIENT WITH A 1814 01:09:51,321 --> 01:09:52,322 COGNITIVE IMPAIRMENT OR 1815 01:09:52,322 --> 01:09:53,924 DEMENTIAS THERE ARE LIKELY 1816 01:09:53,924 --> 01:09:55,091 MULTIPLE ETIOLOGIES IN ANY GIVEN 1817 01:09:55,091 --> 01:09:58,128 PERSON AND THAT MAY VARY, THAT 1818 01:09:58,128 --> 01:09:59,663 MIX OF POSSIBLE ETIOLOGIES, 1819 01:09:59,663 --> 01:10:01,798 LIKELIHOOD OF THOSE MAY VARIABLE 1820 01:10:01,798 --> 01:10:02,899 ACROSS DIFFERENT POPULATIONS SO 1821 01:10:02,899 --> 01:10:08,171 I WANTED TO MAKE SURE THOSE 1822 01:10:08,171 --> 01:10:09,639 THOSE POSSIBLE DIFFERENCES, MIX 1823 01:10:09,639 --> 01:10:11,641 OF HETEROGENEITY IN PATHOLOGY IS 1824 01:10:11,641 --> 01:10:14,945 TAKEN INTO ACCOUNT WHEN STUDYING 1825 01:10:14,945 --> 01:10:15,612 DIFFERENT POPULATIONS. 1826 01:10:15,612 --> 01:10:15,879 THANK YOU. 1827 01:10:15,879 --> 01:10:16,546 >> THANK YOU. 1828 01:10:16,546 --> 01:10:20,183 GREAT POINT. 1829 01:10:20,183 --> 01:10:26,856 WE AGREE. 1830 01:10:26,856 --> 01:10:30,694 >> SOMEBODY ELSE? 1831 01:10:30,694 --> 01:10:30,994 >> CLIFF? 1832 01:10:30,994 --> 01:10:31,394 >> HI, EVERYONE. 1833 01:10:31,394 --> 01:10:34,297 THANK YOU TO THE COMMITTEE. 1834 01:10:34,297 --> 01:10:34,798 FANTASTIC PRESENTATION. 1835 01:10:34,798 --> 01:10:37,067 I HAVE A QUESTION WHICH IS ON 1836 01:10:37,067 --> 01:10:41,504 THE PRACTICAL SIDE ABOUT DATA 1837 01:10:41,504 --> 01:10:42,038 HARMONIZATION, POTENTIALLY 1838 01:10:42,038 --> 01:10:44,574 DEVELOPING SYNTHETIC LIFE COURSE 1839 01:10:44,574 --> 01:10:44,774 DATA. 1840 01:10:44,774 --> 01:10:48,111 WHEN WE WORK WITH DISAGGREGATED 1841 01:10:48,111 --> 01:10:50,313 RACIAL AND ETHNIC DATA IN THESE 1842 01:10:50,313 --> 01:10:51,815 NATIONAL LEVEL DATASETS THOSE 1843 01:10:51,815 --> 01:10:53,450 OFTEN COME WITH ADDITIONAL 1844 01:10:53,450 --> 01:10:55,085 PROTECTIONS AS THEY SHOULD AND 1845 01:10:55,085 --> 01:10:58,488 RESTRICTIONS TO DATA ACCESS AND 1846 01:10:58,488 --> 01:11:03,526 ALSO HAVE THEIR OWN ENVIRONMENTS 1847 01:11:03,526 --> 01:11:12,469 WE CAN CONNECT WITH RESTRICTED 1848 01:11:12,469 --> 01:11:13,570 DATA, A HUB DOESN'T HAVE 1849 01:11:13,570 --> 01:11:15,105 CONNECTION TO EARLY LIFE COURSE 1850 01:11:15,105 --> 01:11:16,306 DATA, FOR EXAMPLE. 1851 01:11:16,306 --> 01:11:19,109 I WONDER IF THE COMMITTEE 1852 01:11:19,109 --> 01:11:21,711 THOUGHT THROUGH PRACTICALITIES 1853 01:11:21,711 --> 01:11:24,981 OR A PROJECT TO DEVELOP 1854 01:11:24,981 --> 01:11:26,116 INFRASTRUCTURE TO FACILITATE 1855 01:11:26,116 --> 01:11:28,118 HARMONIZATION PROCESS? 1856 01:11:28,118 --> 01:11:29,819 THANK YOU VERY MUCH. 1857 01:11:29,819 --> 01:11:31,221 >> JUST LAUGHING BECAUSE THAT'S 1858 01:11:31,221 --> 01:11:34,491 LIKE IT WOULD TAKE A COUPLE 1859 01:11:34,491 --> 01:11:36,159 YEARS OF RESPONSE. 1860 01:11:36,159 --> 01:11:38,595 GREAT POINT. 1861 01:11:38,595 --> 01:11:40,363 WE'RE WORKING ON MULTIPLE 1862 01:11:40,363 --> 01:11:41,498 EFFORTS TO SOLVE THIS CHALLENGE 1863 01:11:41,498 --> 01:11:44,401 AND WITHOUT GOING INTO THE 1864 01:11:44,401 --> 01:11:48,605 TECHNICAL DETAILS THEY RELY 1865 01:11:48,605 --> 01:11:53,143 VARIOUSLY ON STRATEGIES LIKE 1866 01:11:53,143 --> 01:11:55,345 SYNTHETIC DATASETS, IMPUTATION, 1867 01:11:55,345 --> 01:11:56,846 MOVING SUMMARY DATA ACROSS 1868 01:11:56,846 --> 01:11:59,249 BARRIERS, AND FINDING PATHWAYS 1869 01:11:59,249 --> 01:12:02,852 TO COMBINE DATA, AND WHILE 1870 01:12:02,852 --> 01:12:03,887 PRESERVING PRIVACY. 1871 01:12:03,887 --> 01:12:05,588 I AGREE, THERE ARE BIG TECHNICAL 1872 01:12:05,588 --> 01:12:07,457 CHALLENGES BUT ALSO THESE ARE 1873 01:12:07,457 --> 01:12:10,593 SOLVABLE PROBLEMS IF WE HAVE THE 1874 01:12:10,593 --> 01:12:11,494 RESOURCES TO DO IT. 1875 01:12:11,494 --> 01:12:17,767 ANYBODY WANT TO ADD TO THAT? 1876 01:12:17,767 --> 01:12:20,203 THANK YOU FOR RAISING THAT SUPER 1877 01:12:20,203 --> 01:12:20,704 IMPORTANT ISSUE, PRETTY 1878 01:12:20,704 --> 01:12:22,806 IMPORTANT WORK TO BE DONE THERE. 1879 01:12:22,806 --> 01:12:27,510 I'M HAPPY TO TALK MORE ABOUT IT. 1880 01:12:27,510 --> 01:12:34,517 I'M AWARE OF OTHER PEOPLE. 1881 01:12:34,517 --> 01:12:41,591 >> THANK YOU. 1882 01:12:41,591 --> 01:12:42,292 PENNY, YOU'RE NEXT. 1883 01:12:42,292 --> 01:12:44,094 >> I WANTED TO ACKNOWLEDGE, I 1884 01:12:44,094 --> 01:12:45,295 THOUGHT THE BIOMARKERS 1885 01:12:45,295 --> 01:12:46,963 RECOMMENDATION WAS ON POINT, 1886 01:12:46,963 --> 01:12:48,798 CREATING SCALABLE BIOMARKERS 1887 01:12:48,798 --> 01:12:52,001 THAT COULD DETECT ACCESS OR 1888 01:12:52,001 --> 01:12:52,969 DETECT DEMENTIA, EXCUSE ME. 1889 01:12:52,969 --> 01:12:54,304 WE TALKED ABOUT DIFFERENT KINDS 1890 01:12:54,304 --> 01:12:55,305 OF DEMENTIA. 1891 01:12:55,305 --> 01:12:57,440 AND WE KNOW AT THE END OF THE 1892 01:12:57,440 --> 01:13:00,477 DAY DISPARITIES ARE OFTEN CAUSED 1893 01:13:00,477 --> 01:13:02,746 BY COST, COST OF HEALTH CARE. 1894 01:13:02,746 --> 01:13:04,147 NOT TO MENTION AVAILABILITY OF 1895 01:13:04,147 --> 01:13:05,215 SPECIALIZED NEUROLOGY CLINICS 1896 01:13:05,215 --> 01:13:07,450 THAT CAN OFTEN HAVE LONG 1897 01:13:07,450 --> 01:13:09,452 WAITLISTS SO ONE THING TO 1898 01:13:09,452 --> 01:13:11,287 SUGGEST IS SIMILAR TO THAT 1899 01:13:11,287 --> 01:13:12,021 SCALABLE BIOMARKERS 1900 01:13:12,021 --> 01:13:14,424 RECOMMENDATION, SOMETHING THAT'S 1901 01:13:14,424 --> 01:13:15,558 A NON-SPECIFIC SCREENING 1902 01:13:15,558 --> 01:13:18,094 BIOMARKER, BECAUSE RESEARCHERS 1903 01:13:18,094 --> 01:13:20,163 ALMOST INEVITABLY WANT TO GO AT 1904 01:13:20,163 --> 01:13:21,431 SPECIFIC RESEARCHERS, WE WANT TO 1905 01:13:21,431 --> 01:13:22,298 UNDERSTAND, TO DOCUMENT WHAT 1906 01:13:22,298 --> 01:13:27,637 THESE PEOPLE HAVE SO WE CAN 1907 01:13:27,637 --> 01:13:30,573 FIGURE OUT HOW TO CARE. 1908 01:13:30,573 --> 01:13:32,242 WE HAVE TO IDENTIFY WITH LOW 1909 01:13:32,242 --> 01:13:34,344 COST TOOLS WHO NEEDS TO BE SEEN 1910 01:13:34,344 --> 01:13:36,012 BY A NEUROLOGIST AND FOR SOME 1911 01:13:36,012 --> 01:13:37,714 THEY ARE NOT GETTING THERE. 1912 01:13:37,714 --> 01:13:39,415 AND I THINK THERE ARE POTENTIAL 1913 01:13:39,415 --> 01:13:40,984 FOR THOSE TYPES OF BIOMARKERS TO 1914 01:13:40,984 --> 01:13:41,551 BE DEVELOPED. 1915 01:13:41,551 --> 01:13:43,553 SO THANK YOU FOR YOUR WORK. 1916 01:13:43,553 --> 01:13:47,223 IT'S REALLY EXCITING TO SEE 1917 01:13:47,223 --> 01:13:47,757 THESE RECOMMENDATIONS MOVE 1918 01:13:47,757 --> 01:13:48,057 FORWARD. 1919 01:13:48,057 --> 01:13:50,126 >> THANK YOU FOR YOUR COMMENT. 1920 01:13:50,126 --> 01:13:51,628 EVERYONE HERE, YOU SAW 1921 01:13:51,628 --> 01:13:53,830 EVERYONE'S HEAD SHAKING UP AND 1922 01:13:53,830 --> 01:13:54,364 DOWN. 1923 01:13:54,364 --> 01:13:56,499 WE FULLY AGREE AND UNDERSTAND 1924 01:13:56,499 --> 01:13:57,567 THAT'S A NECESSARY DIRECTION. 1925 01:13:57,567 --> 01:14:02,405 THANK YOU FOR YOUR COMMENT. 1926 01:14:02,405 --> 01:14:03,072 WE APPRECIATE IT. 1927 01:14:03,072 --> 01:14:06,009 >> WE HAVE TIME FOR ONE MORE 1928 01:14:06,009 --> 01:14:06,442 QUESTION, PROBABLY. 1929 01:14:06,442 --> 01:14:08,545 DALE, WOULD YOU MIND IF WE GO TO 1930 01:14:08,545 --> 01:14:10,480 BERNARD SO WE CAN GIVE HIM A 1931 01:14:10,480 --> 01:14:16,152 CHANCE TO ASK A QUESTION? 1932 01:14:16,152 --> 01:14:18,755 >> YES, I WOULD, THANK YOU. 1933 01:14:18,755 --> 01:14:21,958 THIS HAS TO DO WITH THE 1934 01:14:21,958 --> 01:14:23,560 DEMENTIAS GOING ON WITHOUT US 1935 01:14:23,560 --> 01:14:27,630 BEING ABLE TO DETECT IT. 1936 01:14:27,630 --> 01:14:29,165 YOU HAD MENTIONED THAT EARLIER. 1937 01:14:29,165 --> 01:14:30,333 MY QUESTION IS THIS. 1938 01:14:30,333 --> 01:14:34,370 WITH THE BLOOD TEST YOU CAN DO 1939 01:14:34,370 --> 01:14:39,142 BLOOD TESTS TO CHECK BETA 1940 01:14:39,142 --> 01:14:40,543 AMYLOID AND MAYBE TAU 1941 01:14:40,543 --> 01:14:40,844 PERCENTAGES. 1942 01:14:40,844 --> 01:14:44,514 IF YOU DO THAT BLOOD TEST ON A 1943 01:14:44,514 --> 01:14:47,550 REGULAR CHECKUP, ANNUAL CHECKUP, 1944 01:14:47,550 --> 01:14:50,119 FOR EXAMPLE, WOULD IT BE -- IS 1945 01:14:50,119 --> 01:14:55,358 THAT TEST SENSITIVE ENOUGH TO 1946 01:14:55,358 --> 01:14:57,927 SAY, UH-OH, YOU GOT POTENTIAL 1947 01:14:57,927 --> 01:14:59,562 HERE OF BEING AT HIGH RISK WITH 1948 01:14:59,562 --> 01:15:02,599 THE DATA WE READ AND CATCH IT 1949 01:15:02,599 --> 01:15:04,434 SOONER AND GET IT INTO YOUR 1950 01:15:04,434 --> 01:15:08,204 SYSTEM TO BE ABLE TO FOLLOW 1951 01:15:08,204 --> 01:15:11,908 THOSE INDIVIDUALS, YOUR RESPONSE 1952 01:15:11,908 --> 01:15:12,642 PLEASE? 1953 01:15:12,642 --> 01:15:13,743 >> I CAN START. 1954 01:15:13,743 --> 01:15:15,278 I THINK THERE MIGHT BE A 1955 01:15:15,278 --> 01:15:19,682 CONFLICT ON THIS ANSWER 1956 01:15:19,682 --> 01:15:22,752 ACTUALLY, BETWEEN SCIENTISTS. 1957 01:15:22,752 --> 01:15:25,388 MY PERSPECTIVE, YES AND NO. 1958 01:15:25,388 --> 01:15:26,589 UNFORTUNATELY, JUST BECAUSE YOU 1959 01:15:26,589 --> 01:15:29,692 HAVE HIGHER LEVELS OF AMYLOID 1960 01:15:29,692 --> 01:15:31,728 DOES NOT MEAN THAT YOU ARE GOING 1961 01:15:31,728 --> 01:15:33,329 TO GET DEMENTIA. 1962 01:15:33,329 --> 01:15:36,633 IN FACT, WE SEE THAT LIKE AROUND 1963 01:15:36,633 --> 01:15:38,668 30-ISH PER CENT OF THOSE 1964 01:15:38,668 --> 01:15:39,636 COMPLETELY HEALTHY COGNITIVELY 1965 01:15:39,636 --> 01:15:43,339 NORMAL AND OVER THE AGE OF 65 1966 01:15:43,339 --> 01:15:44,307 HAVE AMYLOID. 1967 01:15:44,307 --> 01:15:46,276 WE AGE AND THINGS GO WRONG IN 1968 01:15:46,276 --> 01:15:47,377 OUR BRAIN, RIGHT? 1969 01:15:47,377 --> 01:15:49,012 SO JUST BECAUSE YOU HAVE THAT 1970 01:15:49,012 --> 01:15:51,180 DOES NOT MEAN THAT YOU ARE GOING 1971 01:15:51,180 --> 01:15:52,649 TO GET DEMENTIA. 1972 01:15:52,649 --> 01:15:54,684 BUT IT CAN BE A SIGN, RIGHT 1973 01:15:54,684 --> 01:15:59,622 OBVIOUSLY THIS IS WHAT WE HAVE 1974 01:15:59,622 --> 01:16:00,723 AS AN ALZHEIMER'S DISEASE MARKER 1975 01:16:00,723 --> 01:16:03,760 SO IT'S HARD TO DIRECTLY INPUT 1976 01:16:03,760 --> 01:16:05,962 THIS I THINK INTO CLINICAL 1977 01:16:05,962 --> 01:16:07,297 PRACTICE FOR THAT REASON 1978 01:16:07,297 --> 01:16:08,498 BECAUSE, YES, IT CAN BE A SIGN 1979 01:16:08,498 --> 01:16:10,667 AND MIGHT BE A GOOD IDEA TO 1980 01:16:10,667 --> 01:16:13,870 FOLLOW PEOPLE FOR A LENGTH OF 1981 01:16:13,870 --> 01:16:16,205 TIME TO SEE. 1982 01:16:16,205 --> 01:16:19,409 AND IT CAN BE DEFINED AS 1983 01:16:19,409 --> 01:16:20,143 PRE-CLINICAL MARKER BUT YOU'RE 1984 01:16:20,143 --> 01:16:23,746 GOING TO GET A VARIABLE ANSWER. 1985 01:16:23,746 --> 01:16:25,014 DOES ANYONE ELSE WANT TO SPEAK 1986 01:16:25,014 --> 01:16:25,581 TO THAT? 1987 01:16:25,581 --> 01:16:29,953 >> I WANT TO ADD JUST THE THEME 1988 01:16:29,953 --> 01:16:32,121 FOR SECTION IN GENERAL THAT I 1989 01:16:32,121 --> 01:16:34,924 GUESS PREVENTION, TO GET AT 1990 01:16:34,924 --> 01:16:36,592 PREVENTION WE'RE RECOMMENDING 1991 01:16:36,592 --> 01:16:38,094 THINGS NOT CURRENTLY BEING DONE 1992 01:16:38,094 --> 01:16:39,929 OR NOT ENOUGH ACROSS THE FIELD 1993 01:16:39,929 --> 01:16:41,698 WHICH IS WHY WE DON'T HAVE A 1994 01:16:41,698 --> 01:16:43,433 CURE, DON'T ANSWER AS BECAUSE 1995 01:16:43,433 --> 01:16:44,634 WE'RE NOT STUDYING THE RIGHT 1996 01:16:44,634 --> 01:16:46,202 PEOPLE, NOT ASKING THE RIGHT 1997 01:16:46,202 --> 01:16:47,904 QUESTION, LOOKING AT ONE 1998 01:16:47,904 --> 01:16:49,238 VARIABLE AT A TIME, NOT 1999 01:16:49,238 --> 01:16:50,039 MULTI-LEVEL FACTORS. 2000 01:16:50,039 --> 01:16:51,841 UNLESS WE HAVE ANSWERS TO 2001 01:16:51,841 --> 01:16:53,076 RECOMMENDATIONS THAT WE'RE 2002 01:16:53,076 --> 01:16:54,644 GIVING TODAY WE WON'T HAVE 2003 01:16:54,644 --> 01:16:56,446 PREVENTION, WE WON'T HAVE CURE. 2004 01:16:56,446 --> 01:17:02,652 BUT I THINK IN THE PROCESS IT'S 2005 01:17:02,652 --> 01:17:04,253 WHAT WE'RE WORKING TOWARDS. 2006 01:17:04,253 --> 01:17:05,254 >> THANK YOU. 2007 01:17:05,254 --> 01:17:07,824 WE'RE GOING TO TAKE A 2008 01:17:07,824 --> 01:17:13,396 THREE-MINUTE BREAK AND, BERNARD, 2009 01:17:13,396 --> 01:17:18,034 BRING YOUR QUESTION TO THE INPUT 2010 01:17:18,034 --> 01:17:18,601 SESSION AT 3:05. 2011 01:17:18,601 --> 01:17:20,169 >> LET ME WRITE IT DOWN. 2012 01:17:20,169 --> 01:17:21,137 >> THANK YOU. 2013 01:17:21,137 --> 01:17:23,539 >> OR TYPE IT IN, THAT WOULD BE 2014 01:17:23,539 --> 01:17:24,674 SUPER HELPFUL. 2015 01:17:24,674 --> 01:17:32,181 AMBER, THEY HAVE ACCESS TO CHAT? 2016 01:17:32,181 --> 01:17:33,916 >> THEY DO NOT. 2017 01:17:33,916 --> 01:17:35,485 WE'LL LET EVERYBODY GO ON BREAK 2018 01:17:35,485 --> 01:17:38,354 AT START AGAIN AT 2:20. 2019 01:17:38,354 --> 01:17:39,756 >> GREAT, I'LL COME BACK. 2020 01:17:39,756 --> 01:17:44,193 >> THANK YOU. 2021 01:17:44,193 --> 01:17:48,297 2022 01:17:48,297 --> 01:17:58,341 2023 01:19:44,447 --> 01:19:47,183 >> WE'LL TRY TO GET STARTED AT 2024 01:19:47,183 --> 01:19:56,692 2:20 WITH THE NEXT SESSION. 2025 01:19:56,692 --> 01:19:57,260 >> READY TO GO? 2026 01:19:57,260 --> 01:20:00,196 >> IF YOU ARE. 2027 01:20:00,196 --> 01:20:01,697 I CAN'T SEE. 2028 01:20:01,697 --> 01:20:05,234 >> I'M FARAH LUBIN, PROFESSOR AT 2029 01:20:05,234 --> 01:20:10,139 UAB, AND I AM ONE OF THE CHAIRS 2030 01:20:10,139 --> 01:20:12,175 FOR THE EXPOSOME COMMITTEE, 2031 01:20:12,175 --> 01:20:14,577 INTRODUCING THE OVERALL CONCEPT 2032 01:20:14,577 --> 01:20:15,978 OF THE NEURAL EXPOSOME. 2033 01:20:15,978 --> 01:20:18,915 AND THEN INTRODUCE THE FIRST 2034 01:20:18,915 --> 01:20:19,282 RECOMMENDATION. 2035 01:20:19,282 --> 01:20:20,716 IT'S BEEN A PLEASURE TO WORK 2036 01:20:20,716 --> 01:20:22,685 WITH EVERYONE ON THE 2037 01:20:22,685 --> 01:20:27,290 SUBCOMMITTEE AND WE HOPE TO HAVE 2038 01:20:27,290 --> 01:20:29,392 VIGOROUS RESPONSE TO OUR 2039 01:20:29,392 --> 01:20:34,697 RECOMMENDATIONS. 2040 01:20:34,697 --> 01:20:35,798 NEXT SLIDE PLEASE. 2041 01:20:35,798 --> 01:20:39,135 OKAY, NEXT SLIDE PLEASE. 2042 01:20:39,135 --> 01:20:40,603 I HAVE NO DISCLAIMERS OR 2043 01:20:40,603 --> 01:20:40,903 DISCLOSURES. 2044 01:20:40,903 --> 01:20:46,275 NEXT SLIDE PLEASE. 2045 01:20:46,275 --> 01:20:50,546 WHILE THE ROLE OF HUMAN GENETIC 2046 01:20:50,546 --> 01:20:52,181 PREDISPOSITION SUCH AS APOE4 2047 01:20:52,181 --> 01:20:53,783 PROVIDED UNPRECEDENTED INSIGHT 2048 01:20:53,783 --> 01:20:56,519 INTO THE ETIOLOGIES OF 2049 01:20:56,519 --> 01:20:57,853 ALZHEIMER'S DISEASE WE CAN AGREE 2050 01:20:57,853 --> 01:21:01,224 THE MAJORITY OF RISK FACTORS 2051 01:21:01,224 --> 01:21:08,231 CANNOT BE EXPLAINED BY GENETICS 2052 01:21:08,231 --> 01:21:08,431 ALONE. 2053 01:21:08,431 --> 01:21:09,999 IT'S IMPORTANT TO UNDERSTAND 2054 01:21:09,999 --> 01:21:12,868 INTERACTION BETWEEN GENES AND 2055 01:21:12,868 --> 01:21:21,978 OUR ENVIRONMENT PLAYS A ROLE IN 2056 01:21:21,978 --> 01:21:22,345 ONSET. 2057 01:21:22,345 --> 01:21:24,580 OUR ENVIRONMENT FROM THE AIR WE 2058 01:21:24,580 --> 01:21:27,149 BREATHE, FOOD WE EAT, AND WATER 2059 01:21:27,149 --> 01:21:30,886 WE DRINK TO CHEMICALS WE INGEST, 2060 01:21:30,886 --> 01:21:33,356 STRESS WE EXPERIENCE, INDEED 2061 01:21:33,356 --> 01:21:35,291 INFLUENCE OUR HEALTH. 2062 01:21:35,291 --> 01:21:38,628 SCIENTISTS STRIVE TO MEASURE THE 2063 01:21:38,628 --> 01:21:41,597 EXPOSOME WHICH COMPRISES ALL 2064 01:21:41,597 --> 01:21:42,131 NON-HERITABLE FACTORS THAT 2065 01:21:42,131 --> 01:21:44,233 AFFECT GENE EXPRESSION ACROSS 2066 01:21:44,233 --> 01:21:46,202 THE LIFESPAN. 2067 01:21:46,202 --> 01:21:48,504 IMPORTANTLY, MOST OF THESE 2068 01:21:48,504 --> 01:21:50,139 EXPOSOME FACTORS THAT INFLUENCES 2069 01:21:50,139 --> 01:21:53,542 OUR BODY'S RESPONSE ARE 2070 01:21:53,542 --> 01:21:54,443 MODIFIABLE. 2071 01:21:54,443 --> 01:21:57,680 SO INDEED STUDY OF EXPOSOME, 2072 01:21:57,680 --> 01:21:58,581 KNOWN AS EXPOSOMICS, HAS 2073 01:21:58,581 --> 01:22:00,983 POTENTIAL TO PERHAPS UNLOCK A 2074 01:22:00,983 --> 01:22:03,052 MORE HOLISTIC APPROACH TO 2075 01:22:03,052 --> 01:22:05,655 DISEASE PREVENTION AND MORE 2076 01:22:05,655 --> 01:22:08,190 EFFECTIVE AND PERSONALIZED 2077 01:22:08,190 --> 01:22:10,760 INTERVENTION. 2078 01:22:10,760 --> 01:22:12,128 NEXT SLIDE PLEASE. 2079 01:22:12,128 --> 01:22:14,196 RESEARCH INDICATES ENVIRONMENTAL 2080 01:22:14,196 --> 01:22:16,966 FACTORS SUCH AS AIR POLLUTION, 2081 01:22:16,966 --> 01:22:20,202 AND OTHER TOXINS, IMPACT 2082 01:22:20,202 --> 01:22:20,836 A.D.-RELATED COGNITIVE DECLINE. 2083 01:22:20,836 --> 01:22:24,106 ON THE OTHER HAND, A BALANCED 2084 01:22:24,106 --> 01:22:25,841 DIET AND PROPER NUTRITION AND 2085 01:22:25,841 --> 01:22:26,909 REGULAR PHYSICAL ACTIVITY HAVE 2086 01:22:26,909 --> 01:22:29,645 BEEN SHOWN TO BE BENEFICIAL FOR 2087 01:22:29,645 --> 01:22:29,979 BRAIN HEALTH. 2088 01:22:29,979 --> 01:22:33,182 AND CAN REDUCE THE RISK OF 2089 01:22:33,182 --> 01:22:33,916 COGNITIVE DECLINE ASSOCIATED 2090 01:22:33,916 --> 01:22:36,419 WITH A.D. THUS A GROWING BODY 2091 01:22:36,419 --> 01:22:40,389 OF EVIDENCE SUPPORTS THAT 2092 01:22:40,389 --> 01:22:41,924 MODIFIABLE RISK FACTORS FOR 2093 01:22:41,924 --> 01:22:43,459 DEMENTIA ACCOUNT FOR AROUND 40% 2094 01:22:43,459 --> 01:22:45,895 OF CASES, WHICH COULD BE 2095 01:22:45,895 --> 01:22:52,568 PREVENTED OR DELAYED. 2096 01:22:52,568 --> 01:22:53,436 NEXT SLIDE PLEASE. 2097 01:22:53,436 --> 01:22:55,805 IN REGARDS TO LIFESTYLE FACTORS 2098 01:22:55,805 --> 01:22:58,774 AND IMPACT ON RISK, RESEARCH 2099 01:22:58,774 --> 01:23:00,109 SUGGEST SMOKING AND/OR ALCOHOL 2100 01:23:00,109 --> 01:23:02,978 CONSUMPTION CAN INCREASE RISK OF 2101 01:23:02,978 --> 01:23:05,014 DEMENTIA WITH A.D., SOCIAL 2102 01:23:05,014 --> 01:23:07,450 ENGAGEMENT AND MENTAL 2103 01:23:07,450 --> 01:23:09,185 STIMULATION CAN ALSO -- ARE 2104 01:23:09,185 --> 01:23:10,519 CRUCIAL FOR MAINTAINING BRAIN 2105 01:23:10,519 --> 01:23:12,455 HEALTH AND MAY HELP SLOW 2106 01:23:12,455 --> 01:23:13,923 PROGRESSION OF A.D. SLEEP 2107 01:23:13,923 --> 01:23:16,192 QUALITY IS CRITICAL FOR BRAIN 2108 01:23:16,192 --> 01:23:19,795 HEALTH AND CHANGES IN SLEEP 2109 01:23:19,795 --> 01:23:21,230 PATTERNS AND NEURONAL ACTIVITY 2110 01:23:21,230 --> 01:23:23,332 CAN PERHAPS SERVE AS BIOMARKERS 2111 01:23:23,332 --> 01:23:26,268 FOR A.D. AND INDEED ALL OF 2112 01:23:26,268 --> 01:23:32,775 THESE FACTORS WHEN DISRUPTED CAN 2113 01:23:32,775 --> 01:23:33,843 ACCELERATE COGNITIVE DECLINE AND 2114 01:23:33,843 --> 01:23:35,611 MAY BE ASSOCIATED WITH FASTER 2115 01:23:35,611 --> 01:23:39,181 MEMORY LOSS WITH A.D. NEXT 2116 01:23:39,181 --> 01:23:40,116 SLIDE PLEASE. 2117 01:23:40,116 --> 01:23:41,751 SO WE'RE PRESENTED WITH A GREAT 2118 01:23:41,751 --> 01:23:44,186 NUMBER OF CHALLENGES WHEN IT 2119 01:23:44,186 --> 01:23:46,021 COMES TO MEASURING THE EXPOSOME, 2120 01:23:46,021 --> 01:23:48,491 AND ITS IMPLICATIONS FOR 2121 01:23:48,491 --> 01:23:49,825 PREVENTION AND INTERVENTION IN 2122 01:23:49,825 --> 01:23:53,763 A.D. OUR METHODS THAT WE USE 2123 01:23:53,763 --> 01:23:56,565 ARE -- NEED TO BE REVISED AND 2124 01:23:56,565 --> 01:23:59,735 CONSIDERED IN REGARDS TO 2125 01:23:59,735 --> 01:24:00,169 LIFETIME EXPOSURES. 2126 01:24:00,169 --> 01:24:03,372 THE NEED FOR INTEGRATED 2127 01:24:03,372 --> 01:24:04,974 APPROACHES, POTENTIAL FOR 2128 01:24:04,974 --> 01:24:05,908 PERSONALIZED AND PREVENTION 2129 01:24:05,908 --> 01:24:08,043 STRATEGIES BY STUDYING THE 2130 01:24:08,043 --> 01:24:10,379 EXPOSOMES IS POSSIBLE. 2131 01:24:10,379 --> 01:24:13,182 IT'S IMPORTANT FOR US TO 2132 01:24:13,182 --> 01:24:13,983 UNDERSTAND EARLY LIFE 2133 01:24:13,983 --> 01:24:18,854 INTERVENTIONS, WAYS WE CAN 2134 01:24:18,854 --> 01:24:20,523 INTERVENE AND REDUCE AND MODIFY 2135 01:24:20,523 --> 01:24:22,792 ENVIRONMENTAL RISK FACTORS. 2136 01:24:22,792 --> 01:24:25,060 AND PUBLIC HEALTH POLICIES 2137 01:24:25,060 --> 01:24:25,694 TARGETING MODIFIABLE RISK 2138 01:24:25,694 --> 01:24:34,670 FACTORS NEED TO BE CONSIDERED. 2139 01:24:34,670 --> 01:24:38,174 THE SUBCOMMITTEE HAS PROVIDED A 2140 01:24:38,174 --> 01:24:38,874 SERIES OF RECOMMENDATIONS THAT 2141 01:24:38,874 --> 01:24:39,975 WE'LL PRESENT. 2142 01:24:39,975 --> 01:24:40,976 I'LL PRESENT THE FIRST 2143 01:24:40,976 --> 01:24:45,714 RECOMMENDATION AND PASS IT OVER 2144 01:24:45,714 --> 01:24:48,150 FOR THE NEXT. 2145 01:24:48,150 --> 01:24:49,118 NEXT SLIDE PLEASE. 2146 01:24:49,118 --> 01:24:56,192 FIRST RECOMMENDATION, NEXT SLIDE 2147 01:24:56,192 --> 01:25:02,398 PLEASE, INVOLVES EXPLORING THE 2148 01:25:02,398 --> 01:25:04,200 IDEA OF INVESTIGATING HOW 2149 01:25:04,200 --> 01:25:07,069 EXPOSOME AND HUMAN BODY INTERACT 2150 01:25:07,069 --> 01:25:12,174 TO INFLUENCE A.D. THE IDEA OF 2151 01:25:12,174 --> 01:25:16,011 THE MAIN HALLMARKS OF FEATURES 2152 01:25:16,011 --> 01:25:20,616 OF A.D. INVOLVE AMYLOID BAIT 2153 01:25:20,616 --> 01:25:21,550 PLAQUES AND NEUROINFLAMMATION 2154 01:25:21,550 --> 01:25:25,688 AND SO FORT, HOWEVER MECHANISMS 2155 01:25:25,688 --> 01:25:28,657 HYPED FORMATION REMAINS UNCLEAR. 2156 01:25:28,657 --> 01:25:30,259 IT IS SUGGESTED PERHAPS 2157 01:25:30,259 --> 01:25:32,027 BACTERIAL POPULATIONS IN THE 2158 01:25:32,027 --> 01:25:37,433 BODY MAY CONTRIBUTE TO THESE 2159 01:25:37,433 --> 01:25:40,469 FEATURES BY PROMOTING 2160 01:25:40,469 --> 01:25:42,972 NEUROINFLAMMATION AND PLAQUE 2161 01:25:42,972 --> 01:25:45,407 FORMATION. 2162 01:25:45,407 --> 01:25:48,777 NEXT SLIDE PLEASE. 2163 01:25:48,777 --> 01:25:52,548 FOCUSING ON THE MICROBIOME AND 2164 01:25:52,548 --> 01:25:54,083 INFECTIOUS DISEASES, HOW PERHAPS 2165 01:25:54,083 --> 01:25:56,185 BY MANIPULATING THESE FACTORS WE 2166 01:25:56,185 --> 01:25:58,921 MIGHT ALTER RISK OR PROGRESSION 2167 01:25:58,921 --> 01:26:03,993 OF A.D. NEXT SLIDE PLEASE. 2168 01:26:03,993 --> 01:26:06,495 ANIMAL MODELS ARE VALUABLE FOR 2169 01:26:06,495 --> 01:26:08,964 STUDYING IMPACT OF INFECTIOUS 2170 01:26:08,964 --> 01:26:10,900 DISEASES ON LIFESPAN AND A.D. 2171 01:26:10,900 --> 01:26:11,433 PROGRESSION. 2172 01:26:11,433 --> 01:26:14,003 THESE ANIMAL MODELS ALLOW 2173 01:26:14,003 --> 01:26:17,439 RESEARCHERS TO EXPLORE THE 2174 01:26:17,439 --> 01:26:24,113 COMPLEX INTERPLAY BETWEEN 2175 01:26:24,113 --> 01:26:28,150 INFECTIOUS AGENTS AND 2176 01:26:28,150 --> 01:26:28,450 PATHOLOGIES. 2177 01:26:28,450 --> 01:26:31,954 ANIMAL MODELS SHOULD BE 2178 01:26:31,954 --> 01:26:33,522 UTILIZED, AND TECHNOLOGIES THAT 2179 01:26:33,522 --> 01:26:36,825 ENABLE MEASUREMENTS TO 2180 01:26:36,825 --> 01:26:37,693 INVESTIGATE HOW INFECTIOUS 2181 01:26:37,693 --> 01:26:43,966 DISEASES INFLUENCE ONSET AND 2182 01:26:43,966 --> 01:26:45,968 PROGRESSION OF AD/ADRD. 2183 01:26:45,968 --> 01:26:47,369 IN CONSIDERATION OF MICROBIOME, 2184 01:26:47,369 --> 01:26:50,072 FOR EXAMPLE, THE GUT MICROBIOME, 2185 01:26:50,072 --> 01:26:55,344 IT PLAYS A SIGNIFICANT ROLE IN 2186 01:26:55,344 --> 01:27:03,586 A.D. WITH ALTERED COMPOSITION. 2187 01:27:03,586 --> 01:27:06,255 CHANGES IN THE GUT MICROBIOME 2188 01:27:06,255 --> 01:27:09,892 MAY OCCUR BEFORE CLINICAL 2189 01:27:09,892 --> 01:27:12,194 SYMPTOMS OF A.D. 2190 01:27:12,194 --> 01:27:13,262 >> TWO MINUTES. 2191 01:27:13,262 --> 01:27:19,001 >> OF A.D. APPEARANCE. 2192 01:27:19,001 --> 01:27:19,468 NEXT. 2193 01:27:19,468 --> 01:27:21,837 INFECTIOUS AGENTS MAY PLAY A 2194 01:27:21,837 --> 01:27:25,474 ROLE POTENTIALLY CONTRIBUTING TO 2195 01:27:25,474 --> 01:27:26,075 NEUROINFLAMMATION ACCELERATING 2196 01:27:26,075 --> 01:27:32,481 AMYLOID DEPOSITION. 2197 01:27:32,481 --> 01:27:39,188 NEXT SLIDE PLEASE. 2198 01:27:39,188 --> 01:27:42,591 SO IN DYSREGULATION WITH 2199 01:27:42,591 --> 01:27:43,792 CIRCULATING CELLS, INFLUENCING 2200 01:27:43,792 --> 01:27:44,994 DISEASE PATHOLOGY IT'S IMPORTANT 2201 01:27:44,994 --> 01:27:47,429 TO DETERMINE WHETHER THERE ARE 2202 01:27:47,429 --> 01:27:49,365 DIFFERENCES IN IMMUNE RESPONSES 2203 01:27:49,365 --> 01:27:50,899 BETWEEN DIFFERENT STAGES OF A.D. 2204 01:27:50,899 --> 01:27:58,173 AND ADRD CLINICALLY AND 2205 01:27:58,173 --> 01:27:58,540 PATHOLOGICALLY. 2206 01:27:58,540 --> 01:28:00,009 NEXT SLIDE PLEASE. 2207 01:28:00,009 --> 01:28:02,945 IT'S IMPORTANT TO CONSIDER THAT 2208 01:28:02,945 --> 01:28:10,953 DISRUPTED SLEEP AND CIRCADIAN 2209 01:28:10,953 --> 01:28:16,659 RHYTHMS CAN WORSEN WHILE GUT 2210 01:28:16,659 --> 01:28:17,760 MICROBIOME IMBALANCES MAY HAVE 2211 01:28:17,760 --> 01:28:21,263 DIRECT EFFECT ON BRAIN FUNCTION. 2212 01:28:21,263 --> 01:28:23,866 NEXT SLIDE PLEASE. 2213 01:28:23,866 --> 01:28:26,702 FINALLY THE IDEA THAT A.D. MIGHT 2214 01:28:26,702 --> 01:28:29,371 HAVE AN INFECTIOUS ORIGIN IS A 2215 01:28:29,371 --> 01:28:31,040 GROWING AREA OF RESEARCH, THOUGH 2216 01:28:31,040 --> 01:28:32,875 NOT YET WIDELY ACCEPTED. 2217 01:28:32,875 --> 01:28:37,012 SO IT'S IMPORTANT TO INVESTIGATE 2218 01:28:37,012 --> 01:28:44,687 INFECTIOUS ETIOLOGY TO EXPLORE 2219 01:28:44,687 --> 01:28:47,256 NEUROPATHOLOGICAL INTERACTIONS 2220 01:28:47,256 --> 01:28:48,257 WITH COGNITIVE DEFICITS 2221 01:28:48,257 --> 01:28:51,093 ASSOCIATED WITH INFECTIOUS 2222 01:28:51,093 --> 01:28:51,493 DISEASES AND ADRD. 2223 01:28:51,493 --> 01:28:55,130 I'LL TURN IT OVER TO DR. LAMAR 2224 01:28:55,130 --> 01:28:57,733 TO INTRODUCE OUR SECOND 2225 01:28:57,733 --> 01:29:02,237 PRIORITY, RECOMMENDATION 2. 2226 01:29:02,237 --> 01:29:03,105 DR. LAMAR? 2227 01:29:03,105 --> 01:29:05,708 >> THANK YOU FOR THE OPPORTUNITY 2228 01:29:05,708 --> 01:29:08,711 TO REPRESENT THE SUBCOMMITTEE ON 2229 01:29:08,711 --> 01:29:10,012 THE NEXT RECOMMENDATION. 2230 01:29:10,012 --> 01:29:12,081 NEXT SLIDE PLEASE. 2231 01:29:12,081 --> 01:29:13,849 I DON'T HAVE DISCLAIMERS. 2232 01:29:13,849 --> 01:29:16,151 NO REAL DISCLOSURES. 2233 01:29:16,151 --> 01:29:20,556 I'M FUNDED TO DO EXPOSOME WORK. 2234 01:29:20,556 --> 01:29:22,958 NEXT SLIDE PLEASE. 2235 01:29:22,958 --> 01:29:25,060 SO FOR OUR SUBCOMMITTEE 2236 01:29:25,060 --> 01:29:26,628 RECOMMENDATION 2, REALLY TO 2237 01:29:26,628 --> 01:29:30,099 ADVANCE MECHANISTIC STUDIES ON 2238 01:29:30,099 --> 01:29:33,836 INTERACTION BETWEEN EXPOSOME AND 2239 01:29:33,836 --> 01:29:44,379 AD/ADRD NEUROPATHOLOGY EXPLORING 2240 01:29:45,848 --> 01:29:50,486 MECHANISMS BROKEN DOWN INTO FOUR 2241 01:29:50,486 --> 01:29:59,027 SUBCOMPONENTS THAT I'LL EXPLAIN 2242 01:29:59,027 --> 01:30:00,162 FURTHER. 2243 01:30:00,162 --> 01:30:05,334 2.1 IS INVESTIGATE THE ROLE OF 2244 01:30:05,334 --> 01:30:07,870 ENVIRONMENTAL EXPOSURES. 2245 01:30:07,870 --> 01:30:11,507 YOU CAN SEE IN THIS FIGURE 2246 01:30:11,507 --> 01:30:13,642 ADAPTED FROM ERICKSON 2016 PAPER 2247 01:30:13,642 --> 01:30:17,846 AND ALSO OUR CURRENT NIH 2248 01:30:17,846 --> 01:30:21,717 DIRECTOR'S 2022 PAPER, THERE ARE 2249 01:30:21,717 --> 01:30:25,821 EPIDEMIOLOGIC STUDIES IN HUMANS 2250 01:30:25,821 --> 01:30:28,190 AND ANIMALS THAT REINFORCED 2251 01:30:28,190 --> 01:30:29,258 ORIGINALS INSURE THAT ADVERSE 2252 01:30:29,258 --> 01:30:31,460 PERINATAL ENVIRONMENTS MAY LEAD 2253 01:30:31,460 --> 01:30:32,494 TO CHRONIC DISEASES IN 2254 01:30:32,494 --> 01:30:34,196 ADULTHOOD, SOME OF WHICH IN 2255 01:30:34,196 --> 01:30:37,599 TERMS OF ENDS ORGAN DAMAGE AND 2256 01:30:37,599 --> 01:30:39,334 RESULTING DIAGNOSES ARE SHOWN IN 2257 01:30:39,334 --> 01:30:39,635 THE FIGURE. 2258 01:30:39,635 --> 01:30:43,172 LESS WORK, NEXT SLIDE PLEASE, 2259 01:30:43,172 --> 01:30:45,574 HAS BEEN DONE EXAMINING HOW 2260 01:30:45,574 --> 01:30:50,112 EARLY LIFE INCLUDING IN UTERO 2261 01:30:50,112 --> 01:30:51,780 AND LATER LIFE EXPOSURES ON THE 2262 01:30:51,780 --> 01:30:58,120 LEFT WITH THE NINDS NEURAL 2263 01:30:58,120 --> 01:30:59,788 EXPOSOME IMPACTS PATHOLOGY, 2264 01:30:59,788 --> 01:31:01,757 COGNITIVE DECLINE, AGING PROCESS 2265 01:31:01,757 --> 01:31:02,124 MORE GENERALLY. 2266 01:31:02,124 --> 01:31:04,126 FURTHERMORE LESS WORK HAS BEEN 2267 01:31:04,126 --> 01:31:07,129 DONE IN IDENTIFYING SENSITIVE 2268 01:31:07,129 --> 01:31:07,930 PERIODS LIKE THOSE EXAMPLES ON 2269 01:31:07,930 --> 01:31:09,531 THE RIGHT-HAND SIDE OF YOUR 2270 01:31:09,531 --> 01:31:11,300 SCREEN WHEN INTERVENTIONS MIGHT 2271 01:31:11,300 --> 01:31:13,936 BE MOST EFFECTIVE TO MITIGATE 2272 01:31:13,936 --> 01:31:14,503 NEURODEGENERATION. 2273 01:31:14,503 --> 01:31:16,905 THERE IS AN EXAMPLE OF WORK WITH 2274 01:31:16,905 --> 01:31:18,907 THE HELIX PROJECT, CAPTURING 2275 01:31:18,907 --> 01:31:21,810 EXPOSOMIC INFORMATION ACROSS THE 2276 01:31:21,810 --> 01:31:26,448 PERINATAL PERIOD AND CHILDHOOD 2277 01:31:26,448 --> 01:31:29,051 IN SIX EUROPEAN COUNTRIES. 2278 01:31:29,051 --> 01:31:30,319 NEXT SLIDE PLEASE. 2279 01:31:30,319 --> 01:31:32,955 THAT SAME PROJECT CAN HELP 2280 01:31:32,955 --> 01:31:34,089 ILLUSTRATE THE SECONDS BULLET 2281 01:31:34,089 --> 01:31:37,693 POINT WHICH IS TO ELUCIDATE 2282 01:31:37,693 --> 01:31:39,228 SYNERGISTIC EFFECTS OF 2283 01:31:39,228 --> 01:31:40,896 ENVIRONMENTAL FACTORS ON 2284 01:31:40,896 --> 01:31:41,396 NEURODEGENERATION. 2285 01:31:41,396 --> 01:31:43,999 WE CAN AGREE ENVIRONMENTAL 2286 01:31:43,999 --> 01:31:46,435 FACTORS LIKE THOSE SHOWN IN THE 2287 01:31:46,435 --> 01:31:48,670 BLUE RECTANGLE ON THE LEFT 2288 01:31:48,670 --> 01:31:50,772 RARELY OCCUR IN ISOLATION. 2289 01:31:50,772 --> 01:31:51,940 ALTHOUGH THAT'S OFTEN HOW THEY 2290 01:31:51,940 --> 01:31:54,476 HAVE BEEN INVESTIGATED. 2291 01:31:54,476 --> 01:31:55,477 MEASURING MULTIPLE EXPOSURES 2292 01:31:55,477 --> 01:31:58,113 IDEALLY AT MULTIPLE TIME POINTS 2293 01:31:58,113 --> 01:31:59,681 IN THE LIFESPAN, ACTUALLY AN 2294 01:31:59,681 --> 01:32:02,217 EXAMPLE OF WHICH IS SHOWN HERE 2295 01:32:02,217 --> 01:32:07,289 WITH THE HELIX PROJECT, WHERE 2296 01:32:07,289 --> 01:32:08,056 THERE'S SAMPLING, MULTIPLE 2297 01:32:08,056 --> 01:32:09,691 EXPOSURES, THAT CAN ALLOW FOR 2298 01:32:09,691 --> 01:32:11,593 UNDERSTANDING OF HOW EXPOSURES 2299 01:32:11,593 --> 01:32:13,729 MAY BE GROUPED TOGETHER, BASED 2300 01:32:13,729 --> 01:32:14,630 ON COMMON INFLUENCES AS 2301 01:32:14,630 --> 01:32:16,164 REPRESENTED ON THE RIGHT-HAND 2302 01:32:16,164 --> 01:32:19,568 SIDE OF THE SCREEN. 2303 01:32:19,568 --> 01:32:21,069 NEXT SLIDE PLEASE. 2304 01:32:21,069 --> 01:32:22,871 OUR SUBCOMMITTEE IS ADVOCATING 2305 01:32:22,871 --> 01:32:24,539 FOR EXPLORATION NOT JUST IN 2306 01:32:24,539 --> 01:32:26,775 UTERO OR CHILDHOOD BUT REALLY 2307 01:32:26,775 --> 01:32:28,410 HOW COMBINATIONS OF EXPOSURES 2308 01:32:28,410 --> 01:32:30,812 INTERACT TO ACCELERATE AGING AND 2309 01:32:30,812 --> 01:32:33,815 ADRD PROGRESSION USING MULTIPLE 2310 01:32:33,815 --> 01:32:34,449 EXPOSURE MODELS TO CAPTURE 2311 01:32:34,449 --> 01:32:38,120 COMPLEX REAL WORLD RISK FACTORS 2312 01:32:38,120 --> 01:32:40,722 AND ASSESS THEIR IMPACT ACROSS 2313 01:32:40,722 --> 01:32:46,662 THE ENTIRE LIFESPAN. 2314 01:32:46,662 --> 01:32:47,062 NEXT SLIDE PLEASE. 2315 01:32:47,062 --> 01:32:49,131 WE CALL FOR RESEARCHERS TO 2316 01:32:49,131 --> 01:32:50,866 ADVANCE DYNAMIC TECHNOLOGIES TO 2317 01:32:50,866 --> 01:33:01,343 STUDY ENVIRONMENTAL IMPACTS, 2318 01:33:06,081 --> 01:33:07,049 APPLYING REALTIME MONITORING 2319 01:33:07,049 --> 01:33:10,686 TOOLS, TO LEVERAGE THESE TOOLS 2320 01:33:10,686 --> 01:33:12,087 TO IDENTIFY BIOMARKERS ARE EARLY 2321 01:33:12,087 --> 01:33:15,724 PATHOLOGY AND TRACK DISEASE 2322 01:33:15,724 --> 01:33:17,192 PROGRESSION. 2323 01:33:17,192 --> 01:33:20,562 NEXT SLIDE PLEASE. 2324 01:33:20,562 --> 01:33:22,931 LASTLY, RECOMMENDATION 2, WE'RE 2325 01:33:22,931 --> 01:33:29,171 ALSO HIGHLIGHTING NEED TO TARGET 2326 01:33:29,171 --> 01:33:32,074 EPIGENETIC FOR THERAPEUTIC 2327 01:33:32,074 --> 01:33:32,708 INTERVENTIONS, SPECIFICALLY HOW 2328 01:33:32,708 --> 01:33:34,309 THE EXPOSOME AS REPRESENTED AT 2329 01:33:34,309 --> 01:33:36,478 THE TOP OF THE INTEGRATION OF 2330 01:33:36,478 --> 01:33:38,981 MULTI-OMICS DATA ON THE LEFT 2331 01:33:38,981 --> 01:33:40,482 AFFECTS NOT JUST EPIGENETIC 2332 01:33:40,482 --> 01:33:43,385 CLOCK BUT KEY PATHOGENIC 2333 01:33:43,385 --> 01:33:49,658 PATHWAYS SUCH AS AMYLOID-BETA 2334 01:33:49,658 --> 01:33:51,159 DEPOSITION AND WHEN INTEGRATED 2335 01:33:51,159 --> 01:33:54,730 BY THE FIGURE FROM THE 2024 2336 01:33:54,730 --> 01:33:56,031 PAPER MAY FACILITATE 2337 01:33:56,031 --> 01:33:56,832 UNDERSTANDING OF DISEASE 2338 01:33:56,832 --> 01:33:58,033 TRAJECTORIES AS REPRESENTED ON 2339 01:33:58,033 --> 01:33:59,534 THE RIGHT-HAND SIDE OF THE 2340 01:33:59,534 --> 01:34:02,170 SCREEN SO ULTIMATELY WE CAN 2341 01:34:02,170 --> 01:34:06,208 ASSESS WHETHER MANIPULATING 2342 01:34:06,208 --> 01:34:07,175 SPECIFIC EPIGENETIC FACTORS 2343 01:34:07,175 --> 01:34:11,046 ENHANCE ADRD RESILIENCE OR ALTER 2344 01:34:11,046 --> 01:34:13,682 DISEASE PROGRESSION. 2345 01:34:13,682 --> 01:34:14,082 NEXT SLIDE PLEASE. 2346 01:34:14,082 --> 01:34:17,552 NOW I'D LIKE TO HAND THINGS OVER 2347 01:34:17,552 --> 01:34:19,421 TO MY COLLEAGUE, AISHA 2348 01:34:19,421 --> 01:34:22,691 DICKERSON, TO TALK ABOUT 2349 01:34:22,691 --> 01:34:23,158 RECOMMENDATION 3. 2350 01:34:23,158 --> 01:34:25,761 >> THANK YOU FOR THE OPPORTUNITY 2351 01:34:25,761 --> 01:34:30,799 TO TELL YOU ABOUT OUR LAST 2352 01:34:30,799 --> 01:34:32,567 RECOMMENDATIONS, FOCUSING ON 2353 01:34:32,567 --> 01:34:33,869 BUILDING RESEARCH INFRASTRUCTURE 2354 01:34:33,869 --> 01:34:37,305 FOR THE STUDIES THAT WE'VE BEEN 2355 01:34:37,305 --> 01:34:37,839 DISCUSSING. 2356 01:34:37,839 --> 01:34:40,075 NEXT PLEASE. 2357 01:34:40,075 --> 01:34:40,442 NEXT SLIDE. 2358 01:34:40,442 --> 01:34:42,077 I HAVE NOTHING TO DISCLOSE. 2359 01:34:42,077 --> 01:34:43,612 NEXT SLIDE. 2360 01:34:43,612 --> 01:34:46,348 SO WE HAVE RECOMMENDATION 3 HERE 2361 01:34:46,348 --> 01:34:48,784 WHICH IS TO ESTABLISH RESEARCH 2362 01:34:48,784 --> 01:34:51,820 INFRASTRUCTURE TO FACILITATE 2363 01:34:51,820 --> 01:34:54,556 CLINICAL AND EPIDEMIOLOGICAL 2364 01:34:54,556 --> 01:34:57,125 STUDIES ON HOW EXPOSOME INTACTS 2365 01:34:57,125 --> 01:35:01,496 ADRD RISK AND COGNITIVE DECLINE 2366 01:35:01,496 --> 01:35:01,797 OUTCOMES. 2367 01:35:01,797 --> 01:35:03,598 NEXT SLIDE PLEASE. 2368 01:35:03,598 --> 01:35:04,800 NEXT SLIDE. 2369 01:35:04,800 --> 01:35:08,170 WE HAVE FOUR SUBBULLET POINTS 2370 01:35:08,170 --> 01:35:08,904 FOR THIS PARTICULAR 2371 01:35:08,904 --> 01:35:09,438 RECOMMENDATION. 2372 01:35:09,438 --> 01:35:13,842 I'LL GO THROUGH EACH ONE BY ONE. 2373 01:35:13,842 --> 01:35:16,945 SO FOR THE FIRST BULLET WE LIKE 2374 01:35:16,945 --> 01:35:19,548 TO FOCUS ON IDENTIFYING 2375 01:35:19,548 --> 01:35:21,850 ENVIRONMENTAL RISK SUCH AS 2376 01:35:21,850 --> 01:35:24,820 TOXICANT EXPOSURES AS WELL AS 2377 01:35:24,820 --> 01:35:26,988 IDENTIFY RESILIENCE FACTORS LIKE 2378 01:35:26,988 --> 01:35:28,223 NUTRITION, SLEEP, AND THINGS 2379 01:35:28,223 --> 01:35:31,526 LIKE THAT TO DETERMINE THE 2380 01:35:31,526 --> 01:35:33,562 PATHOGENIC CAUSALITY OF 2381 01:35:33,562 --> 01:35:39,267 ENVIRONMENTAL RISK FACTORS WITH 2382 01:35:39,267 --> 01:35:39,868 ADRD. 2383 01:35:39,868 --> 01:35:40,702 NEXT SLIDE. 2384 01:35:40,702 --> 01:35:43,438 AND SO FOR SUBBULLET 2 WE'D LIKE 2385 01:35:43,438 --> 01:35:45,307 TO IMPROVE CHARACTERIZATION OF 2386 01:35:45,307 --> 01:35:47,442 THE ENVIRONMENTAL EXPOSURES AND 2387 01:35:47,442 --> 01:35:50,345 CREATE NECESSARY TOOLS TO 2388 01:35:50,345 --> 01:35:51,746 PROPERLY IDENTIFY MOST HAZARDOUS 2389 01:35:51,746 --> 01:35:55,484 ENVIRONMENTAL EXPOSURES. 2390 01:35:55,484 --> 01:35:57,752 AS WELL AS MOST RESILIENT 2391 01:35:57,752 --> 01:36:00,188 FACTORS IN THE EXPOSOME FOR RISK 2392 01:36:00,188 --> 01:36:04,159 AND PROGRESSION. 2393 01:36:04,159 --> 01:36:05,927 NEXT SLIDE. 2394 01:36:05,927 --> 01:36:09,798 SO WE HAVE A SUB-SUBBULLET, WE 2395 01:36:09,798 --> 01:36:12,667 THINK THE BEST WAY TO 2396 01:36:12,667 --> 01:36:13,301 POTENTIALLY DO THIS WAS ALIGNED 2397 01:36:13,301 --> 01:36:15,537 WITH ONE OF THE QUESTIONS FROM 2398 01:36:15,537 --> 01:36:18,840 THE PREVIOUS SESSION TO 2399 01:36:18,840 --> 01:36:19,574 POTENTIALLY INITIATE CONSORTIUM 2400 01:36:19,574 --> 01:36:22,811 OF EXISTING AGING COHORTS TO 2401 01:36:22,811 --> 01:36:25,113 LEVERAGE ONGOING RESEARCH BOTH 2402 01:36:25,113 --> 01:36:27,949 IN AGING COHORTS BUT IN ADDITION 2403 01:36:27,949 --> 01:36:32,187 MIDDLE AGE COHORTS. 2404 01:36:32,187 --> 01:36:33,188 NEXT SLIDE. 2405 01:36:33,188 --> 01:36:34,756 SO THIS IS ALREADY BEING 2406 01:36:34,756 --> 01:36:35,824 IMPLEMENTED FOR CHILD HEALTH 2407 01:36:35,824 --> 01:36:36,791 THROUGH THE ENVIRONMENTAL 2408 01:36:36,791 --> 01:36:39,427 INFLUENCES ON CHILD HEALTH 2409 01:36:39,427 --> 01:36:41,496 OUTCOMES CONSORTIUM BUT WE THINK 2410 01:36:41,496 --> 01:36:43,665 WE COULD POTENTIALLY IMPLEMENT 2411 01:36:43,665 --> 01:36:52,174 THIS THROUGH BOTH AGING COHORTS 2412 01:36:52,174 --> 01:36:55,710 LIKE N-HATS, ALSO THROUGH MIDDLE 2413 01:36:55,710 --> 01:36:58,046 AGED COHORTS TO TRY TO GET MORE 2414 01:36:58,046 --> 01:37:04,186 IN LINE WITH THE LIFE COURSE 2415 01:37:04,186 --> 01:37:05,153 EXPOSURES. 2416 01:37:05,153 --> 01:37:05,921 NEXT SLIDE. 2417 01:37:05,921 --> 01:37:07,522 ON TOP OF USING COLLECTION OF 2418 01:37:07,522 --> 01:37:10,258 DATA WE ALSO WOULD LIKE TO 2419 01:37:10,258 --> 01:37:12,661 PROVIDE A NEW INFRASTRUCTURE AS 2420 01:37:12,661 --> 01:37:14,396 WELL AS BETTER TECHNOLOGY AND 2421 01:37:14,396 --> 01:37:16,364 EQUIPMENT FOR IMPROVING THE 2422 01:37:16,364 --> 01:37:21,436 EVALUATION OF THE EXPOSOME. 2423 01:37:21,436 --> 01:37:23,104 PRIMARILY THROUGH A PATHOLOGICAL 2424 01:37:23,104 --> 01:37:26,208 SUITE OF SAMPLES, NOT TYPICAL 2425 01:37:26,208 --> 01:37:28,176 BIOLOGICAL MARKERS LIKE BLOOD, 2426 01:37:28,176 --> 01:37:30,145 URINE, SALIVA AND TEETH, BUT 2427 01:37:30,145 --> 01:37:34,482 THIS IS DATA TO COLLECT BRAIN 2428 01:37:34,482 --> 01:37:37,752 SAMPLES DURING AUTOPSIES AS WELL 2429 01:37:37,752 --> 01:37:39,321 AS ORGAN SYSTEMS. 2430 01:37:39,321 --> 01:37:40,689 NEXT SLIDE. 2431 01:37:40,689 --> 01:37:43,091 WE BELIEVE THAT COLLECTING THESE 2432 01:37:43,091 --> 01:37:44,726 BIOLOGICAL SAMPLES IN REAL TIME 2433 01:37:44,726 --> 01:37:47,095 WOULD ALLOW US TO BETTER 2434 01:37:47,095 --> 01:37:51,633 HARMONIZE DATA FOR THESE AGING 2435 01:37:51,633 --> 01:37:53,168 AND MIDDLE-AGED COHORTS AND 2436 01:37:53,168 --> 01:37:55,604 BETTER HARMONIZE OR COME TO 2437 01:37:55,604 --> 01:38:01,443 CONSENSUS ON THE PROPER 2438 01:38:01,443 --> 01:38:03,578 PHENOTYPES FOR ADRD AND NEURO 2439 01:38:03,578 --> 01:38:06,381 COGNITIVE IMPAIRMENT. 2440 01:38:06,381 --> 01:38:06,715 NEXT SLIDE. 2441 01:38:06,715 --> 01:38:08,750 SO WE RECOGNIZE THAT WITH THESE 2442 01:38:08,750 --> 01:38:11,152 ONGOING COHORTS THERE HAVE BEEN 2443 01:38:11,152 --> 01:38:13,121 A VARIETY OF ASSESSMENTS USED 2444 01:38:13,121 --> 01:38:16,591 AND ABLE TO HARMONIZE THE DATA 2445 01:38:16,591 --> 01:38:27,002 FOR A COLLECTIVE POOLED 2446 01:38:32,374 --> 01:38:33,642 ANALYSIS, TO HAVE THIS 2447 01:38:33,642 --> 01:38:34,643 ENVIRONMENTAL EXPOSURE THAT 2448 01:38:34,643 --> 01:38:39,881 PEOPLE COULD COME IN CONTACT 2449 01:38:39,881 --> 01:38:40,181 WITH. 2450 01:38:40,181 --> 01:38:42,284 NEXT SLIDE. 2451 01:38:42,284 --> 01:38:43,184 IN ADDITION TO CHARACTERIZING 2452 01:38:43,184 --> 01:38:45,020 THE PRIORITY EXPOSURES WE ALSO 2453 01:38:45,020 --> 01:38:46,955 NEED TO ESTABLISH A CODE OF 2454 01:38:46,955 --> 01:38:50,191 EXPERTS TO IDENTIFY THE MOST 2455 01:38:50,191 --> 01:38:52,394 APPROPRIATE METHODS FOR 2456 01:38:52,394 --> 01:38:55,897 ASSESSMENT OF ADRD AND COGNITIVE 2457 01:38:55,897 --> 01:38:56,131 DECLINE. 2458 01:38:56,131 --> 01:38:58,566 I HAVE THESE PICTURES HERE TO 2459 01:38:58,566 --> 01:39:00,035 DEMONSTRATE VARIETY OF EXAMPLES 2460 01:39:00,035 --> 01:39:03,038 MUCH CURRENT ASSESSMENTS IN THE 2461 01:39:03,038 --> 01:39:04,673 ONGOING AGING AND MIDDLE AGE 2462 01:39:04,673 --> 01:39:07,275 COHORTS BUT NEED TO COME TO 2463 01:39:07,275 --> 01:39:12,047 CONSENSUS SO WE CAN ANALYZE DATA 2464 01:39:12,047 --> 01:39:12,480 COLLECTIVELY. 2465 01:39:12,480 --> 01:39:16,851 NEXT SLIDE. 2466 01:39:16,851 --> 01:39:20,055 OUR LAST SUBBULLET, 4, TO 2467 01:39:20,055 --> 01:39:23,124 PRIORITIZE RESEARCH AND TRIALS 2468 01:39:23,124 --> 01:39:23,692 IN POPULATIONS 2469 01:39:23,692 --> 01:39:25,327 DISPROPORTIONATELY EXPOSED TO 2470 01:39:25,327 --> 01:39:27,595 ENVIRONMENTAL AND SOCIAL 2471 01:39:27,595 --> 01:39:29,230 LIFESTYLE FACTORS THAT ADVERSELY 2472 01:39:29,230 --> 01:39:30,965 IMPACT RISK OF ADRD. 2473 01:39:30,965 --> 01:39:32,167 THIS WILL BE -- 2474 01:39:32,167 --> 01:39:32,534 >> TWO MINUTES. 2475 01:39:32,534 --> 01:39:33,068 >> THANK YOU. 2476 01:39:33,068 --> 01:39:34,969 THIS WILL BE THROUGH 2477 01:39:34,969 --> 01:39:37,539 ESTABLISHING A NEW AGING AND 2478 01:39:37,539 --> 01:39:40,208 DISABILITY RESOURCE CENTER. 2479 01:39:40,208 --> 01:39:45,747 WE HAVE SOME ONGOING CENTERS BUT 2480 01:39:45,747 --> 01:39:48,183 ESTABLISHING ONE THAT HAS A HIGH 2481 01:39:48,183 --> 01:39:48,817 EXPOSOME RISK AREAS WE BELIEVE 2482 01:39:48,817 --> 01:39:50,285 WILL BE BENEFICIAL. 2483 01:39:50,285 --> 01:39:51,953 WE ALSO WANT TO ENCOURAGE 2484 01:39:51,953 --> 01:39:55,056 STUDIES THAT USE STRESS EXPOSURE 2485 01:39:55,056 --> 01:39:56,758 TO THESE FRAMEWORKS TO 2486 01:39:56,758 --> 01:40:00,495 INVESTIGATE BOTH ENVIRONMENTAL 2487 01:40:00,495 --> 01:40:01,363 EXPOSURES AND PSYCHOSOCIAL 2488 01:40:01,363 --> 01:40:03,098 STRESSORS TO SEE HOW THEY CAN 2489 01:40:03,098 --> 01:40:07,969 COMPOUND ACROSS LIFE COURSE. 2490 01:40:07,969 --> 01:40:08,903 LAST SLIDE. 2491 01:40:08,903 --> 01:40:10,538 THE REASON WE WANT TO FOCUS ON 2492 01:40:10,538 --> 01:40:13,842 THIS IS WE KNOW THAT AREAS THAT 2493 01:40:13,842 --> 01:40:16,678 OFT HAVEN HIGH CONCENTRATION OF 2494 01:40:16,678 --> 01:40:17,979 LOWER INCOME RISK ALSO THE SAME 2495 01:40:17,979 --> 01:40:25,353 AREAS THAT HAVE A HIGHER 2496 01:40:25,353 --> 01:40:27,889 CONCENTRATION OF TOXICANTS, AIR 2497 01:40:27,889 --> 01:40:30,024 POLLUTION, LEAD-BASED PAINT, 2498 01:40:30,024 --> 01:40:31,593 INDUSTRIAL FACILITIES, ALSO 2499 01:40:31,593 --> 01:40:33,428 LARGE PROPORTION OF PSYCHOSOCIAL 2500 01:40:33,428 --> 01:40:37,499 STRESSORS, SUCH AS CRIME LEVEL, 2501 01:40:37,499 --> 01:40:38,700 NOISE POLLUTION, OFTEN THE AREAS 2502 01:40:38,700 --> 01:40:40,135 THAT ARE FOOD DESERTS. 2503 01:40:40,135 --> 01:40:43,171 KNOWING THAT THESE AREAS OFTEN 2504 01:40:43,171 --> 01:40:44,472 HAVE THESE CONCENTRATED 2505 01:40:44,472 --> 01:40:46,608 POTENTIAL RISK FACTORS FOR ADRD 2506 01:40:46,608 --> 01:40:49,611 WE WOULD LIKE TO PRIORITIZE 2507 01:40:49,611 --> 01:40:50,445 FOCUSING ON THESE COMMUNITIES 2508 01:40:50,445 --> 01:40:52,180 WHEN WE EVENTUALLY GET THE 2509 01:40:52,180 --> 01:40:55,984 INFRASTRUCTURE HOPEFULLY TO 2510 01:40:55,984 --> 01:40:58,720 IMPLEMENT THESE STUDIES. 2511 01:40:58,720 --> 01:40:59,020 NEXT SLIDE. 2512 01:40:59,020 --> 01:41:07,562 I'M GOING TO PASS IT OFF TO THE 2513 01:41:07,562 --> 01:41:13,835 NEXT SPEAKER. 2514 01:41:13,835 --> 01:41:20,909 >> MEG SMITH TALKING ABOUT THE 2515 01:41:20,909 --> 01:41:21,376 FOURTH RECOMMENDATION. 2516 01:41:21,376 --> 01:41:21,976 NEXT SLIDE PLEASE. 2517 01:41:21,976 --> 01:41:24,179 I WANT TO THANK EVERYBODY FOR 2518 01:41:24,179 --> 01:41:26,181 YOUR ATTENTION TODAY, TO THE 2519 01:41:26,181 --> 01:41:29,217 NINDS, MY FELLOW COMMITTEE 2520 01:41:29,217 --> 01:41:31,553 MEMBERS, I'M WITH AN 2521 01:41:31,553 --> 01:41:32,487 ORGANIZATION THAT FUNDS RESEARCH 2522 01:41:32,487 --> 01:41:34,956 WITH HIGHEST POTENTIAL FOR 2523 01:41:34,956 --> 01:41:36,458 ENDING ALZHEIMER'S, NO CONFLICTS 2524 01:41:36,458 --> 01:41:41,563 TO DISCLOSE. 2525 01:41:41,563 --> 01:41:43,731 NEXT SLIDE PLEASE. 2526 01:41:43,731 --> 01:41:44,999 RECOMMENDATION 4, ALSO PRIORITY 2527 01:41:44,999 --> 01:41:47,235 4, DEVELOP COUNTERMEASURES AND 2528 01:41:47,235 --> 01:41:47,769 THERAPEUTICS INFORMED BY 2529 01:41:47,769 --> 01:41:54,309 MECHANIC KNITS -- MECHANISTIC 2530 01:41:54,309 --> 01:41:56,044 UNDERSTANDING FOCUSING ON EARLY 2531 01:41:56,044 --> 01:41:58,980 TRIALS FOR BENEFICIAL EFFECTS, 2532 01:41:58,980 --> 01:42:00,849 INDIVIDUAL AND COMMUNITY LEVELS. 2533 01:42:00,849 --> 01:42:03,218 THANKS TO EPIDEMIOLOGICAL AND 2534 01:42:03,218 --> 01:42:03,852 LONGITUDINAL OBSERVATIONAL 2535 01:42:03,852 --> 01:42:07,555 STUDIES WE KNOW OF POSITIVE 2536 01:42:07,555 --> 01:42:08,957 EXPOSURES THAT CAN REDUCE RISK 2537 01:42:08,957 --> 01:42:10,225 AT POPULATION LEVEL. 2538 01:42:10,225 --> 01:42:11,426 THE COMMITTEE WAS FOCUSED ON 2539 01:42:11,426 --> 01:42:15,063 THAT IN THIS RECOMMENDATION. 2540 01:42:15,063 --> 01:42:16,364 NEXT SLIDE PLEASE. 2541 01:42:16,364 --> 01:42:18,299 HOWEVER WE DON'T KNOW AS MUCH AS 2542 01:42:18,299 --> 01:42:19,934 WE NEED TO ABOUT THESE EXPOSURES 2543 01:42:19,934 --> 01:42:22,670 TO OPTIMIZE HOW WE ACT ON THEM 2544 01:42:22,670 --> 01:42:25,607 IN TERMS OF OF OBSERVATIONS AND 2545 01:42:25,607 --> 01:42:25,940 ASSOCIATIONS. 2546 01:42:25,940 --> 01:42:28,042 TO MAKE EVIDENCE FROM 2547 01:42:28,042 --> 01:42:28,610 EPIDEMIOLOGICAL STUDIES MORE 2548 01:42:28,610 --> 01:42:31,179 ACTIONABLE WE NEED TO MOVE 2549 01:42:31,179 --> 01:42:34,649 TOWARDS SPECIFIC UNDERSTANDING. 2550 01:42:34,649 --> 01:42:35,149 CONTINUING AND EXPANDING 2551 01:42:35,149 --> 01:42:37,118 LONGITUDINAL COHORTS AS WAS 2552 01:42:37,118 --> 01:42:40,154 DISCUSSED IN THE PREVIOUS 2553 01:42:40,154 --> 01:42:40,722 PRESENTATION, EXTENDING 2554 01:42:40,722 --> 01:42:41,723 EPIDEMIOLOGICAL TRIALS IS VITAL 2555 01:42:41,723 --> 01:42:44,092 TO THIS KIND OF UNDERSTANDING 2556 01:42:44,092 --> 01:42:48,596 BUT SO WILL DESIGNING RIGOROUS 2557 01:42:48,596 --> 01:42:49,898 TRIALS THAT COMBINE EXPOSOME 2558 01:42:49,898 --> 01:42:52,000 VARIABLES WITH PROFILING. 2559 01:42:52,000 --> 01:42:53,735 USE OF DIGITAL TRACKING AND 2560 01:42:53,735 --> 01:42:58,172 COMPUTATIONAL AND A.I. TOOLS CAN 2561 01:42:58,172 --> 01:42:59,440 HELP UNCOVER ATTRIBUTES AND 2562 01:42:59,440 --> 01:43:01,643 MECHANISMS OF BENEFITS. 2563 01:43:01,643 --> 01:43:02,277 NEXT SLIDE PLEASE. 2564 01:43:02,277 --> 01:43:03,678 SO THIS PICTURE IS GOING TO BE 2565 01:43:03,678 --> 01:43:06,648 VERY FAMILIAR TO EVERYBODY WHO 2566 01:43:06,648 --> 01:43:08,182 HAS BEEN WATCHING "THE LANCET" 2567 01:43:08,182 --> 01:43:09,617 COMMISSION RECORD SHOWED A 2568 01:43:09,617 --> 01:43:11,119 NUMBER OF EXPOSURES WHAT WE 2569 01:43:11,119 --> 01:43:13,254 ALREADY KNOW ENOUGH TO RECOMMEND 2570 01:43:13,254 --> 01:43:14,322 INDIVIDUAL ACTIONS INDIVIDUALS 2571 01:43:14,322 --> 01:43:22,764 CAN ADOPT AND INTERVENTION 2572 01:43:22,764 --> 01:43:22,997 TRIALS. 2573 01:43:22,997 --> 01:43:23,598 COMMUNICATIONS AND STRATEGIES 2574 01:43:23,598 --> 01:43:26,734 MUST RECOGNIZE EACH PERSON FACES 2575 01:43:26,734 --> 01:43:29,871 DIFFERENT CONSTRAINTS AND ACCESS 2576 01:43:29,871 --> 01:43:32,740 TO EXPOSURES DEPENDING ON HEALTH 2577 01:43:32,740 --> 01:43:33,074 CONTEXT. 2578 01:43:33,074 --> 01:43:34,676 EXISTING DATA SUGGESTS DIFFERENT 2579 01:43:34,676 --> 01:43:36,444 INDIVIDUALS WILL SEE DIFFERENT 2580 01:43:36,444 --> 01:43:38,346 BENEFITS FROM INTERVENTIONS 2581 01:43:38,346 --> 01:43:42,317 DEPENDING ON GENETICS AND HEALTH 2582 01:43:42,317 --> 01:43:42,917 STATUS. 2583 01:43:42,917 --> 01:43:43,818 IDENTIFYINGWHICH WILL SEE THE 2584 01:43:43,818 --> 01:43:46,054 MOST WILL BE IMPORTANT FOR 2585 01:43:46,054 --> 01:43:47,255 OPTIMIZING IMPACT. 2586 01:43:47,255 --> 01:43:50,658 DRILLING DOWN DETAILS CAN HELP 2587 01:43:50,658 --> 01:43:57,332 PUBLIC HEALTH CAMPAIGNS BECOME 2588 01:43:57,332 --> 01:43:59,267 EFFICIENT AND EFFECTIVE. 2589 01:43:59,267 --> 01:44:01,536 SO, STRONG DATA SUPPORTS POWER 2590 01:44:01,536 --> 01:44:03,805 OF HUMAN INTERACTION ONE ON ONE 2591 01:44:03,805 --> 01:44:05,873 AND WITHIN COMMUNITIES, FOR 2592 01:44:05,873 --> 01:44:06,674 BENEFITS REDUCING RISK, 2593 01:44:06,674 --> 01:44:08,710 IMPROVING LIFE EXPERIENCE OF 2594 01:44:08,710 --> 01:44:10,044 THOSE EXPERIENCING COGNITIVE 2595 01:44:10,044 --> 01:44:10,278 DECLINE. 2596 01:44:10,278 --> 01:44:11,245 OUR COMMITTEE DECIDED TO FOCUS 2597 01:44:11,245 --> 01:44:16,718 ON THESE TWO FOR THE NEXT 2598 01:44:16,718 --> 01:44:17,885 RECOMMENDATIONS, 2599 01:44:17,885 --> 01:44:18,319 SUBRECOMMENDATIONS. 2600 01:44:18,319 --> 01:44:19,921 LONELINESS, ISOLATION, LOSS OF 2601 01:44:19,921 --> 01:44:22,056 SENSE OF PURPOSE, NOT UNIQUE TO 2602 01:44:22,056 --> 01:44:24,692 INDIVIDUALS AT RISK OF AND WITH 2603 01:44:24,692 --> 01:44:28,496 COGNITIVE DECLINE BUT WORSEN 2604 01:44:28,496 --> 01:44:30,365 PROGNOSIS AND MANY COMMUNITIES 2605 01:44:30,365 --> 01:44:31,566 MAY LOSE PARTICIPATION EARLIER 2606 01:44:31,566 --> 01:44:33,434 THAN OTHERWISE. 2607 01:44:33,434 --> 01:44:34,268 UNDERSTANDING BIOLOGICAL IMPACT 2608 01:44:34,268 --> 01:44:35,503 OF HUMAN RELATIONSHIPS IS 2609 01:44:35,503 --> 01:44:37,138 CHALLENGING BUT UNDERSTANDING 2610 01:44:37,138 --> 01:44:39,140 THAT IS IMPORTANT TO 2611 01:44:39,140 --> 01:44:46,547 STRENGTHENING RELATIONSHIPS AND 2612 01:44:46,547 --> 01:44:46,914 COMMUNITIES. 2613 01:44:46,914 --> 01:44:51,486 INTERVENTIONS WILL BE GOOD FOR 2614 01:44:51,486 --> 01:44:56,557 ALL OF US, NOT JUST FACING 2615 01:44:56,557 --> 01:44:59,260 COGNITIVE DECLINE. 2616 01:44:59,260 --> 01:45:02,330 REMOVING BARRIERS SHOULD HAVE 2617 01:45:02,330 --> 01:45:04,198 DEEPER STUDY. 2618 01:45:04,198 --> 01:45:05,533 NEXT SLIDE PLEASE. 2619 01:45:05,533 --> 01:45:08,169 SO WE TOUCHED ON INDIVIDUAL 2620 01:45:08,169 --> 01:45:08,803 ACTIONS AND SOCIAL INTERACTIONS 2621 01:45:08,803 --> 01:45:11,406 ON THE PREVIOUS SLIDES AND MOVE 2622 01:45:11,406 --> 01:45:13,074 TO UNDERSTANDING OF EXPOSURES 2623 01:45:13,074 --> 01:45:14,108 AND INDIVIDUAL EXPERIENCES IN 2624 01:45:14,108 --> 01:45:16,110 THE WORLD. 2625 01:45:16,110 --> 01:45:16,944 GROWING EVIDENCE SUPPORTS ROLE 2626 01:45:16,944 --> 01:45:21,983 FOR AIR POLLUTION, HEAT AND 2627 01:45:21,983 --> 01:45:25,119 PROCESSED FOODS BUT WE NEED 2628 01:45:25,119 --> 01:45:26,821 RESEARCH TO VALIDATE 2629 01:45:26,821 --> 01:45:27,622 ASSOCIATIONS, IDENTIFY 2630 01:45:27,622 --> 01:45:29,057 BIOLOGICAL MECHANISMS AND 2631 01:45:29,057 --> 01:45:30,892 POTENTIAL INTERVENTIONS. 2632 01:45:30,892 --> 01:45:32,360 EFFECTIVE POLICIES TO REDUCE 2633 01:45:32,360 --> 01:45:33,361 EXPOSURES WOULD STRENGTHEN ALL 2634 01:45:33,361 --> 01:45:36,064 OUR HEALTH BUT WE NEED TO MAKE 2635 01:45:36,064 --> 01:45:37,065 THEM SPECIFIC. 2636 01:45:37,065 --> 01:45:40,835 STRESS ACROSS THE LIFESPAN FROM 2637 01:45:40,835 --> 01:45:41,402 POVERTY, VIOLENCE AND SOCIAL 2638 01:45:41,402 --> 01:45:42,437 DETERMINANTS OF HEALTH IS 2639 01:45:42,437 --> 01:45:43,504 ASSOCIATED WITH HIGHER RISK OF 2640 01:45:43,504 --> 01:45:44,739 DEMENTIA AND EARLIER AGE OF 2641 01:45:44,739 --> 01:45:55,283 ONSET BUT THE MECHANISMS AND HOW 2642 01:45:56,217 --> 01:46:06,694 WE REDRESS NEED FURTHER STUDIES. 2643 01:46:07,161 --> 01:46:07,929 OUR COMMITTEE WANTED TO 2644 01:46:07,929 --> 01:46:10,865 REITERATE IMPORTANCE OF RISK 2645 01:46:10,865 --> 01:46:12,166 FACTORS OUTSIDE AN INDIVIDUAL'S 2646 01:46:12,166 --> 01:46:13,901 CONTROL AND RECOMMEND 2647 01:46:13,901 --> 01:46:16,170 IDENTIFYING AND TESTING 2648 01:46:16,170 --> 01:46:18,906 COMPENSATORY INTERVENTIONS TO 2649 01:46:18,906 --> 01:46:26,314 ADDRESS IMPACT OF RISK AND 2650 01:46:26,314 --> 01:46:27,515 EXPOSURES. 2651 01:46:27,515 --> 01:46:27,915 >> TWO MINUTES. 2652 01:46:27,915 --> 01:46:30,284 >> AS DISCUSSED TODAY ONE OF THE 2653 01:46:30,284 --> 01:46:30,785 BEST SUPPORTED POSITIVE 2654 01:46:30,785 --> 01:46:33,121 EXPOSURES FOR RISK REDUCTION IS 2655 01:46:33,121 --> 01:46:34,522 GREATER ACCESS TO EDUCATION, 2656 01:46:34,522 --> 01:46:35,623 PARTICULARLY IN EARLY LIFE. 2657 01:46:35,623 --> 01:46:37,959 AS SUCH AS A SOCIETY WE SHOULD 2658 01:46:37,959 --> 01:46:41,028 CONTINUE TO PRIORITIZE AND 2659 01:46:41,028 --> 01:46:42,964 EXPAND ACCESS FOR EVERYONE. 2660 01:46:42,964 --> 01:46:45,366 HOWEVER, WE KNOW LITTLE ABOUT 2661 01:46:45,366 --> 01:46:50,838 WHAT SPECIFIC ATTRIBUTES MATTER 2662 01:46:50,838 --> 01:46:53,307 MOST. 2663 01:46:53,307 --> 01:46:55,576 DEEPER ANALYSIS ALONG WITH 2664 01:46:55,576 --> 01:47:00,114 DECONVOLUTION WITH WHICH IT IS 2665 01:47:00,114 --> 01:47:02,550 ACCESSED CAN HELP GET TO 2666 01:47:02,550 --> 01:47:02,984 SPECIFICS. 2667 01:47:02,984 --> 01:47:04,685 WE CAN USE RESEARCH MODELS TO 2668 01:47:04,685 --> 01:47:06,020 DETERMINE WHAT ALTERATIONS TO 2669 01:47:06,020 --> 01:47:08,856 THE BRAIN AND FUNCTIONS ARE 2670 01:47:08,856 --> 01:47:10,358 DURABLY ACHIEVED WITH 2671 01:47:10,358 --> 01:47:10,792 ENRICHMENT. 2672 01:47:10,792 --> 01:47:11,993 TRANSLATION OF LEARNINGS TO 2673 01:47:11,993 --> 01:47:13,427 HUMANS WILL BE CHALLENGING BUT 2674 01:47:13,427 --> 01:47:16,664 IMPORTANT AS WE TRY TO OPTIMIZE 2675 01:47:16,664 --> 01:47:18,466 EDUCATION INTERVENTIONS. 2676 01:47:18,466 --> 01:47:19,967 WHILE WE PRIORITIZE IMPROVING 2677 01:47:19,967 --> 01:47:22,069 HIGH QUALITY EDUCATION FOR 2678 01:47:22,069 --> 01:47:23,037 EVERYONE WE SHOULD INITIATE 2679 01:47:23,037 --> 01:47:24,605 INTERVENTION STUDIES TO EVALUATE 2680 01:47:24,605 --> 01:47:26,474 IMPACT OF DIFFERENT EDUCATIONAL 2681 01:47:26,474 --> 01:47:29,310 MODELS AND TOOLS AT DIFFERENT 2682 01:47:29,310 --> 01:47:30,812 POINTS IN THE LIFESPAN ON 2683 01:47:30,812 --> 01:47:32,446 DEMENTIA RISK AND PROGRESSION. 2684 01:47:32,446 --> 01:47:34,448 AND THAT IS MY LAST SLIDE. 2685 01:47:34,448 --> 01:47:44,926 NOW IF WE COULD GET THE FULL 2686 01:47:49,764 --> 01:47:59,941 LIST PLEASE. 2687 01:48:02,243 --> 01:48:02,810 >> ALL THE RECOMMENDATIONS ARE 2688 01:48:02,810 --> 01:48:13,020 TOGETHER ON THE NEXT SLIDE. 2689 01:48:13,020 --> 01:48:15,022 >> THERE THEY ARE. 2690 01:48:15,022 --> 01:48:20,127 THANK YOU. 2691 01:48:20,127 --> 01:48:29,604 GROUP DISCUSSION? 2692 01:48:29,604 --> 01:48:31,706 >> I THANK THE PRESENTERS FOR 2693 01:48:31,706 --> 01:48:34,008 PRESENTING THESE 2694 01:48:34,008 --> 01:48:34,375 RECOMMENDATIONS. 2695 01:48:34,375 --> 01:48:37,678 I'LL INVITE THE MEMBERS OF THE 2696 01:48:37,678 --> 01:48:40,448 SUBCOMMITTEE TO FEEL FREE TO 2697 01:48:40,448 --> 01:48:45,219 COME ON CAMERA AND AS WE DISCUSS 2698 01:48:45,219 --> 01:48:46,554 THE -- OR TAKE QUESTIONS FROM 2699 01:48:46,554 --> 01:48:56,797 THE AUDIENCE. 2700 01:49:14,582 --> 01:49:23,624 IT'S FAIR TO START WITH BERNARD. 2701 01:49:23,624 --> 01:49:23,925 >> GREAT. 2702 01:49:23,925 --> 01:49:28,162 >> I'LL BE RIGHT WITH YOU. 2703 01:49:28,162 --> 01:49:28,429 >> OKAY. 2704 01:49:28,429 --> 01:49:30,564 LET ME START WITH THE QUESTION I 2705 01:49:30,564 --> 01:49:32,233 HAD AT THE END OF THE FIRST 2706 01:49:32,233 --> 01:49:34,702 SESSION, A LOT IS GOING TO APPLY 2707 01:49:34,702 --> 01:49:37,004 TO THE SECOND SESSION AS WELL. 2708 01:49:37,004 --> 01:49:38,506 THE FIRST QUESTION I HAVE, I 2709 01:49:38,506 --> 01:49:42,243 HAVE TWO IF I MAY, TWO STREAMS. 2710 01:49:42,243 --> 01:49:44,512 THE FIRST ONE IS I'M INTERESTED 2711 01:49:44,512 --> 01:49:48,015 IN WHAT OUTREACH STEPS ARE BEING 2712 01:49:48,015 --> 01:49:49,850 TAKEN TO DISSEMINATE THIS WORK 2713 01:49:49,850 --> 01:49:53,421 AND THESE RECOMMENDATIONS TO THE 2714 01:49:53,421 --> 01:49:57,525 LAY RESEARCH AND PATIENT VOICE 2715 01:49:57,525 --> 01:49:59,427 ADVOCATE COMMUNITY, SINCE WE'RE 2716 01:49:59,427 --> 01:50:02,063 ADVOCATING FOR MANY STUDIES, 2717 01:50:02,063 --> 01:50:03,764 BETTER RESEARCH, REPRESENTED 2718 01:50:03,764 --> 01:50:05,166 COMMUNITY VOICE WHAT STEPS 2719 01:50:05,166 --> 01:50:10,137 BEYOND PUBLICATION ON THE NIH 2720 01:50:10,137 --> 01:50:12,173 WEBSITE ARE BEING TAKEN TO MEET 2721 01:50:12,173 --> 01:50:17,678 ADVOCATE COMMUNITIES WHERE THEY 2722 01:50:17,678 --> 01:50:18,980 ARE? 2723 01:50:18,980 --> 01:50:22,650 >> I'M NOT SURE IN TERMS OF HOW 2724 01:50:22,650 --> 01:50:24,151 WIDESPREAD DISTRIBUTION OF THIS 2725 01:50:24,151 --> 01:50:27,421 VIDEO, FOR EXAMPLE, OR ANY OTHER 2726 01:50:27,421 --> 01:50:29,056 PUBLICATIONS BEYOND NIH THAT 2727 01:50:29,056 --> 01:50:29,824 CURRENTLY EXIST. 2728 01:50:29,824 --> 01:50:33,794 úBUE 2729 01:50:33,794 --> 01:50:34,795 WILLING TO OUTREACH TO OUR 2730 01:50:34,795 --> 01:50:39,333 COMMUNITIES AND HAPPY TO TALK TO 2731 01:50:39,333 --> 01:50:39,934 ANY GROUPS. 2732 01:50:39,934 --> 01:50:41,669 I DON'T KNOW, NEIL, IF YOU WOULD 2733 01:50:41,669 --> 01:50:44,972 LIKE TO JUMP IN AND EXPLAIN MORE 2734 01:50:44,972 --> 01:50:47,341 ABOUT HOW WE SPREAD THE WORD 2735 01:50:47,341 --> 01:50:50,611 ABOUT THE WORK AND OUR 2736 01:50:50,611 --> 01:50:51,379 RECOMMENDATIONS? 2737 01:50:51,379 --> 01:50:57,785 >> YEAH, WELL, I THINK I'LL PASS 2738 01:50:57,785 --> 01:50:59,720 THAT TO AMBER. 2739 01:50:59,720 --> 01:51:01,188 >> RECOMMENDATIONS ARE BEING 2740 01:51:01,188 --> 01:51:03,491 PRESENTED TODAY AS DRAFT 2741 01:51:03,491 --> 01:51:04,992 RECOMMENDATIONS. 2742 01:51:04,992 --> 01:51:07,261 AND THEY ARE RECEIVING PUBLIC 2743 01:51:07,261 --> 01:51:08,796 INPUT FROM EVERYONE HERE. 2744 01:51:08,796 --> 01:51:11,432 AND RECOMMENDATIONS WILL BE THEN 2745 01:51:11,432 --> 01:51:14,702 FINALIZED AFTER INTEGRATING THE 2746 01:51:14,702 --> 01:51:17,972 PUBLIC INPUT. 2747 01:51:17,972 --> 01:51:21,609 THIS WILL LEAD TO A REPORT THAT 2748 01:51:21,609 --> 01:51:25,279 THE SCIENTIFIC CHAIR OF THE 2749 01:51:25,279 --> 01:51:29,784 SUMMIT WILL PRESENT TO THE NINDS 2750 01:51:29,784 --> 01:51:32,386 ADVISORY COUNCIL AND THEY WILL 2751 01:51:32,386 --> 01:51:33,654 VOTE TO ACCEPT IT. 2752 01:51:33,654 --> 01:51:40,294 ONCE IT'S APPROVED, IT WILL 2753 01:51:40,294 --> 01:51:43,464 BECOME PART OF THE NATIONAL PLAN 2754 01:51:43,464 --> 01:51:45,699 IF APPROVED BY THE NAPA COUNCIL 2755 01:51:45,699 --> 01:51:47,134 AS WELL. 2756 01:51:47,134 --> 01:51:47,768 RECOMMENDATIONS BECOME INTEGRAL 2757 01:51:47,768 --> 01:51:51,172 INTO THE NATIONAL PLAN, THE 2758 01:51:51,172 --> 01:51:52,706 REPORT WILL BE AVAILABLE ON THE 2759 01:51:52,706 --> 01:51:54,608 WEBSITE AND THE RECOMMENDATIONS 2760 01:51:54,608 --> 01:52:00,147 WILL BE INTEGRATED INTO THE NIA 2761 01:52:00,147 --> 01:52:01,816 DATABASE FOR MILESTONE 2762 01:52:01,816 --> 01:52:07,788 IMPLEMENTATION UNDER THE 2763 01:52:07,788 --> 01:52:08,989 ALZHEIMER'S DISEASE AND RELATED 2764 01:52:08,989 --> 01:52:09,657 DEMENTIA. 2765 01:52:09,657 --> 01:52:11,358 WHAT ABOUT BEYOND THE WEBSITE? 2766 01:52:11,358 --> 01:52:11,659 >> RIGHT. 2767 01:52:11,659 --> 01:52:12,993 >> WE NEED HELP WITH THAT FOR 2768 01:52:12,993 --> 01:52:16,630 SURE, AND ALL OF YOU ARE THE 2769 01:52:16,630 --> 01:52:17,364 CHAMPIONS OF THE INFORMATION. 2770 01:52:17,364 --> 01:52:22,036 >> I THINK I COULD JUST ADD, 2771 01:52:22,036 --> 01:52:23,070 BERNARD, YOU MENTIONED 2772 01:52:23,070 --> 01:52:23,471 PUBLICATIONS. 2773 01:52:23,471 --> 01:52:25,906 I CAN'T SPEAK FOR EVERY STUDY 2774 01:52:25,906 --> 01:52:26,740 SPOKEN ABOUT TODAY BUT MANY 2775 01:52:26,740 --> 01:52:29,143 INCLUDING SOME OUR OWN HERE AT 2776 01:52:29,143 --> 01:52:30,277 RUSH IN ADDITION TO PUBLICATIONS 2777 01:52:30,277 --> 01:52:31,712 WE GO OUT IN THE COMMUNITIES AND 2778 01:52:31,712 --> 01:52:34,748 SHARE THE RESULTS OF WHAT WE'RE 2779 01:52:34,748 --> 01:52:36,317 DOING, NOT JUST THE STUDIES 2780 01:52:36,317 --> 01:52:38,052 THEMSELVES BUT ALL OF THE WEALTH 2781 01:52:38,052 --> 01:52:39,587 OF INFORMATION THAT OUR 2782 01:52:39,587 --> 01:52:43,190 PARTICIPANTS GIVE, THEIR TIME, 2783 01:52:43,190 --> 01:52:43,958 TREASURE, FEEDBACK, HOW WE'RE 2784 01:52:43,958 --> 01:52:46,627 DOING, AND THOSE ARE EVERYDAY 2785 01:52:46,627 --> 01:52:49,463 WAYS THAT HAPPENS BUT I THINK 2786 01:52:49,463 --> 01:52:50,965 AMBER'S ALSO TELLING YOU A BIT 2787 01:52:50,965 --> 01:52:53,267 ABOUT HOW THE NEXT SET OF 2788 01:52:53,267 --> 01:52:54,168 RECOMMENDATIONS MAY BE 2789 01:52:54,168 --> 01:52:54,935 DISSEMINATED. 2790 01:52:54,935 --> 01:52:56,470 HOPEFULLY THAT ANSWERS YOUR 2791 01:52:56,470 --> 01:52:56,737 QUESTION. 2792 01:52:56,737 --> 01:52:58,572 >> THERE'S BEEN SUCH VALUABLE 2793 01:52:58,572 --> 01:53:02,943 WORK HERE, I'D HATE TO SEE IT, 2794 01:53:02,943 --> 01:53:05,246 YOU KNOW, RESISTANCE, LACK OF 2795 01:53:05,246 --> 01:53:06,347 TRACTION, ET CETERA. 2796 01:53:06,347 --> 01:53:09,083 HAVE THIS FAIL TO GET OUT IN THE 2797 01:53:09,083 --> 01:53:10,351 COMMUNITY WHERE THIS CAN BECOME 2798 01:53:10,351 --> 01:53:13,154 PART OF THE DAY TO DAY AS 2799 01:53:13,154 --> 01:53:15,556 OPPOSED TO TRAPPED IN ACADEMIA 2800 01:53:15,556 --> 01:53:17,324 OR IN THE AGENCY. 2801 01:53:17,324 --> 01:53:20,127 I THINK THAT'S AN IMPORTANT 2802 01:53:20,127 --> 01:53:22,062 PIECE I'D LIKE TO TOSS FROM THE 2803 01:53:22,062 --> 01:53:23,564 ADVOCATE WORLD THAT WE COULD USE 2804 01:53:23,564 --> 01:53:25,866 MORE OF THIS, MORE INSIGHT, MORE 2805 01:53:25,866 --> 01:53:26,200 UNDERSTANDING. 2806 01:53:26,200 --> 01:53:29,236 I'D ALSO LIKE TO SEE IT 2807 01:53:29,236 --> 01:53:30,137 DISSEMINATED TO PATIENT 2808 01:53:30,137 --> 01:53:33,374 ACADEMIES, ET CETERA, WHERE THE 2809 01:53:33,374 --> 01:53:36,043 VOICES ARE BEING TRAINED BECAUSE 2810 01:53:36,043 --> 01:53:37,378 THEY ARE NOT LIKELY TO SEE THIS 2811 01:53:37,378 --> 01:53:39,880 UNLESS ONE OF YOU ENDS UP ON THE 2812 01:53:39,880 --> 01:53:42,716 BOARD WHERE THE CURRICULUM IS 2813 01:53:42,716 --> 01:53:43,250 BEING DEVELOPED. 2814 01:53:43,250 --> 01:53:45,119 I THINK THAT'S A BIG LOSS. 2815 01:53:45,119 --> 01:53:47,221 LET ME SWITCH TO THE LAST 2816 01:53:47,221 --> 01:53:47,888 QUESTION. 2817 01:53:47,888 --> 01:53:51,425 OH, I'M SORRY. 2818 01:53:51,425 --> 01:53:53,060 >> BERNARD, I'M WRITING IT DOWN. 2819 01:53:53,060 --> 01:53:54,929 SOMETHING THAT WE CAN CONTINUE 2820 01:53:54,929 --> 01:53:56,430 TO DISCUSS. 2821 01:53:56,430 --> 01:53:58,566 >> YOU CAN GET BACK AND I CAN 2822 01:53:58,566 --> 01:54:00,367 GIVE YOU A WEALTH ON THAT. 2823 01:54:00,367 --> 01:54:03,304 ALL RIGHT. 2824 01:54:03,304 --> 01:54:06,373 THE LAST ONE, OKAY. 2825 01:54:06,373 --> 01:54:09,076 THE LAST QUESTION WAS A NUMBER 2826 01:54:09,076 --> 01:54:13,314 OF TIMES I HEARD MENTIONED IN 2827 01:54:13,314 --> 01:54:14,582 THESE STUDIES OVERSAMPLING AND 2828 01:54:14,582 --> 01:54:17,551 I'D LIKE TO SUGGEST SOMETHING. 2829 01:54:17,551 --> 01:54:22,590 AND THAT IS THAT THE VOCABULARY 2830 01:54:22,590 --> 01:54:25,626 SWITCH AND THINK TIME BE PUT 2831 01:54:25,626 --> 01:54:30,931 INTO AS OPPOSED TO STRICTLY 2832 01:54:30,931 --> 01:54:33,467 REFERRING TO SOMETHING THAT'S 2833 01:54:33,467 --> 01:54:34,868 NOW TABOO, DIVERSITY AND 2834 01:54:34,868 --> 01:54:37,471 INCLUSION, WHAT STEPS ARE BEING 2835 01:54:37,471 --> 01:54:39,006 TAKEN TO ESTABLISH THRESHOLDS 2836 01:54:39,006 --> 01:54:42,109 FOR SCIENTIFIC ACCURACY AND 2837 01:54:42,109 --> 01:54:42,509 EFFICACY? 2838 01:54:42,509 --> 01:54:45,913 SO LOOKING AT THIS INSTEAD OF 2839 01:54:45,913 --> 01:54:48,449 SAYING OVERSAMPLING, LOOKING AT 2840 01:54:48,449 --> 01:54:55,322 WHAT TERMINOLOGY SHIFTS THE 2841 01:54:55,322 --> 01:54:57,725 THRESHOLD FOR GREATER ACCESS ON 2842 01:54:57,725 --> 01:54:59,059 SUBPOPULATIONS, I.E. YOUR STUDY 2843 01:54:59,059 --> 01:55:01,061 IS NOT ADEQUATE UNLESS YOU HAVE 2844 01:55:01,061 --> 01:55:05,599 MADE SURE YOU HAVE TAKEN HIGHLY 2845 01:55:05,599 --> 01:55:07,468 IMPACTED POPULATION AND INCLUDED 2846 01:55:07,468 --> 01:55:10,471 THAT IN YOUR ANALYSIS AND YOUR 2847 01:55:10,471 --> 01:55:13,774 RESULTS, AND DON'T TAKE THIS 2848 01:55:13,774 --> 01:55:15,476 COMMENT AS STRICTLY ACCOUNT, 2849 01:55:15,476 --> 01:55:18,812 IT'S OF MY COMMENT GOES BEYOND 2850 01:55:18,812 --> 01:55:26,487 THAT TO -- BEYOND QUANTITATE I 2851 01:55:26,487 --> 01:55:26,820 QUANTITATIVE 2852 01:55:26,820 --> 01:55:27,588 MEASURES BUT REQUIRES INCLUSION 2853 01:55:27,588 --> 01:55:29,223 OF THE TYPES OF STUDIES YOU'RE 2854 01:55:29,223 --> 01:55:31,025 CALLING FOR IN THESE 2855 01:55:31,025 --> 01:55:32,026 RECOMMENDATIONS TO BE A SUBSET 2856 01:55:32,026 --> 01:55:37,031 OR A PART OF THE ANALYSIS OF 2857 01:55:37,031 --> 01:55:39,066 FUTURE APPROVED GRANTS, REPORTS, 2858 01:55:39,066 --> 01:55:40,167 STUDIES, ET CETERA, SO IN OTHER 2859 01:55:40,167 --> 01:55:45,673 WORDS THEY HAVE DONE THE JOB OF 2860 01:55:45,673 --> 01:55:47,274 INCLUDING, YOU KNOW, VARIOUS 2861 01:55:47,274 --> 01:55:49,176 OTHER RESEARCH THAT WE'RE ASKING 2862 01:55:49,176 --> 01:55:51,345 FOR IN THEIR STUFF IN ORDER FOR 2863 01:55:51,345 --> 01:55:57,584 IT TO GET, YOU KNOW, MORE 2864 01:55:57,584 --> 01:55:59,820 RECOGNITION, MORE SCIENTIFIC 2865 01:55:59,820 --> 01:56:04,892 CERTIFICATION. 2866 01:56:04,892 --> 01:56:07,127 >> I THINK IT'S A GREAT QUESTION 2867 01:56:07,127 --> 01:56:11,932 BUT I DON'T DO THAT TYPE OF WORK 2868 01:56:11,932 --> 01:56:14,468 SO AISHA, MEG, MELISSA, ANY ONE 2869 01:56:14,468 --> 01:56:14,868 OF YOU? 2870 01:56:14,868 --> 01:56:16,537 >> I WASN'T SURE IF IT WAS A 2871 01:56:16,537 --> 01:56:17,538 QUESTION SO MUCH AS A 2872 01:56:17,538 --> 01:56:17,938 SUGGESTION. 2873 01:56:17,938 --> 01:56:20,207 I THOUGHT IT WAS AN EXCELLENT 2874 01:56:20,207 --> 01:56:21,742 SUGGESTION. 2875 01:56:21,742 --> 01:56:25,546 IS THAT WHAT IT WAS? 2876 01:56:25,546 --> 01:56:26,380 >> YEAH, I CHEATED. 2877 01:56:26,380 --> 01:56:28,315 [LAUGHTER] 2878 01:56:28,315 --> 01:56:30,617 >> I THINK YOU POSED IT AT A 2879 01:56:30,617 --> 01:56:30,918 QUESTION. 2880 01:56:30,918 --> 01:56:33,620 >> I SAID WHAT STEPS, BUT 2881 01:56:33,620 --> 01:56:35,622 OBVIOUSLY WHAT I MEANT WAS HOW 2882 01:56:35,622 --> 01:56:37,958 DO WE MAKE THIS WHAT YOU'RE 2883 01:56:37,958 --> 01:56:39,426 CALLING FOR EFFECTIVE? 2884 01:56:39,426 --> 01:56:40,160 >> RIGHT. 2885 01:56:40,160 --> 01:56:47,634 >> HOW DO WE GET PRACTICAL 2886 01:56:47,634 --> 01:56:48,001 IMPLEMENTATION? 2887 01:56:48,001 --> 01:56:49,503 AND THAT NEEDS TO BE THOUGHT 2888 01:56:49,503 --> 01:56:50,904 THROUGH OTHERWISE IT'S ON THE 2889 01:56:50,904 --> 01:56:51,305 SHELF. 2890 01:56:51,305 --> 01:56:55,642 WE NEED TO GET BEYOND NICE TO 2891 01:56:55,642 --> 01:56:57,911 HAVE, TO, HEY, THIS IS WHAT OUR 2892 01:56:57,911 --> 01:56:59,613 BEST MINDS ARE TELLING YOU, THIS 2893 01:56:59,613 --> 01:57:01,482 IS WHAT WE NEED. 2894 01:57:01,482 --> 01:57:02,483 >> OKAY. 2895 01:57:02,483 --> 01:57:05,786 TO ANSWER THAT QUESTION, I THINK 2896 01:57:05,786 --> 01:57:08,155 PART OF WHAT WE SUGGESTED STOP 2897 01:57:08,155 --> 01:57:12,059 LOOKING AT ONE-TO-ONE EXPOSURES 2898 01:57:12,059 --> 01:57:13,994 TO OUTCOME DISEASE ASSOCIATION 2899 01:57:13,994 --> 01:57:14,561 KNOWING THERE ARE JOINT 2900 01:57:14,561 --> 01:57:16,530 EXPOSURES PEOPLE EXPERIENCE ON A 2901 01:57:16,530 --> 01:57:19,533 REGULAR BASIS. 2902 01:57:19,533 --> 01:57:21,668 WHAT WE'RE SUGGESTING IS AMONGST 2903 01:57:21,668 --> 01:57:24,037 JOINT EXPOSURES WE NEED TO 2904 01:57:24,037 --> 01:57:25,572 IDENTIFY PRIORITY AREAS, ONCE WE 2905 01:57:25,572 --> 01:57:27,775 IDENTIFY THAT PRIORITY WE CAN 2906 01:57:27,775 --> 01:57:29,410 BETTER IMPLEMENT SOME KIND OF 2907 01:57:29,410 --> 01:57:30,611 MITIGATING STRATEGY BECAUSE YOU 2908 01:57:30,611 --> 01:57:33,914 CAN'T JUST GO A POLITICIAN AND 2909 01:57:33,914 --> 01:57:35,682 SAY EVERYTHING'S KILLING US. 2910 01:57:35,682 --> 01:57:37,518 YOU HAVE TO SAY THIS IS WHAT WE 2911 01:57:37,518 --> 01:57:40,621 NEED TO FOCUS ON FIRST AND THEN 2912 01:57:40,621 --> 01:57:42,990 WE NEED TO FOCUS, A STEP-WISE 2913 01:57:42,990 --> 01:57:44,958 PROCESS, I HOPE THROUGH THE 2914 01:57:44,958 --> 01:57:45,759 SUGGESTIONS THAT WE PROVIDED 2915 01:57:45,759 --> 01:57:47,728 TODAY WE'LL BE ABLE TO GET TO 2916 01:57:47,728 --> 01:57:48,595 THAT POINT. 2917 01:57:48,595 --> 01:57:50,030 I HOPE THAT ANSWERS YOUR 2918 01:57:50,030 --> 01:57:50,297 QUESTION. 2919 01:57:50,297 --> 01:57:51,198 >> IT DOES. 2920 01:57:51,198 --> 01:57:52,966 I APPLAUD ALL THE WORK YOU'VE 2921 01:57:52,966 --> 01:57:53,167 DOING. 2922 01:57:53,167 --> 01:57:55,202 I WANT TO SEE IT COME TO 2923 01:57:55,202 --> 01:57:55,469 FRUITION. 2924 01:57:55,469 --> 01:57:57,638 >> I WANT TO SEE IT COME TO 2925 01:57:57,638 --> 01:57:57,971 FRUITION TOO. 2926 01:57:57,971 --> 01:58:01,308 >> WE ALL WANT TO SEE IT COME TO 2927 01:58:01,308 --> 01:58:02,743 FRUITION. 2928 01:58:02,743 --> 01:58:03,043 DEFINITELY. 2929 01:58:03,043 --> 01:58:03,610 GREAT SUGGESTION, BERNARD. 2930 01:58:03,610 --> 01:58:06,380 THANK YOU SO MUCH. 2931 01:58:06,380 --> 01:58:07,948 >> THANKS VERY MUCH. 2932 01:58:07,948 --> 01:58:14,588 NEXT WE CAN GO TO PENNY DAX. 2933 01:58:14,588 --> 01:58:15,322 >> THANK YOU ALL. 2934 01:58:15,322 --> 01:58:17,624 THE WHOLE AREA OF THE EXPOSOME 2935 01:58:17,624 --> 01:58:19,092 IS JUST SO FOUNDATIONALLY 2936 01:58:19,092 --> 01:58:19,927 IMPORTANT FOR PUBLIC INVESTMENT 2937 01:58:19,927 --> 01:58:26,133 BECAUSE IT IS THE KIND OF THING 2938 01:58:26,133 --> 01:58:27,401 THAT CAN BE TRANSFORMATIONAL, 2939 01:58:27,401 --> 01:58:29,369 YET VERY DIFFICULT TO GET PUBLIC 2940 01:58:29,369 --> 01:58:32,139 OR RATHER PRIVATE INVESTMENT FOR 2941 01:58:32,139 --> 01:58:34,408 THESE TYPES OF INTERVENTIONS. 2942 01:58:34,408 --> 01:58:37,177 MY QUESTION FOR ALL OF YOU IS 2943 01:58:37,177 --> 01:58:38,178 ABOUT PARTICULARLY ON THE 2944 01:58:38,178 --> 01:58:40,147 INFRASTRUCTURE SIDE HOW ARE YOU 2945 01:58:40,147 --> 01:58:40,881 CONSIDERING DIFFERENCES OF 2946 01:58:40,881 --> 01:58:42,382 DIFFERENT TYPES OF DEMENTIA? 2947 01:58:42,382 --> 01:58:43,317 BECAUSE WHAT CAUSES OR WHAT 2948 01:58:43,317 --> 01:58:51,024 MIGHT BE A RISK FOR THE TAU 2949 01:58:51,024 --> 01:58:57,731 PATHOLOGY VERSUS TDP-43 OR 2950 01:58:57,731 --> 01:58:58,832 ALPHA-SYNUCLEIN, SOME PSP CASES 2951 01:58:58,832 --> 01:59:00,701 HAVE BEEN ASSOCIATED WITH 2952 01:59:00,701 --> 01:59:01,268 AGRICULTURAL PESTICIDES BUT 2953 01:59:01,268 --> 01:59:03,070 THAT'S NOT GLOBAL FOR ALL TYPES 2954 01:59:03,070 --> 01:59:04,137 OF DEMENTIA. 2955 01:59:04,137 --> 01:59:05,939 AND PARTICULARLY ON THE 2956 01:59:05,939 --> 01:59:09,176 INFRASTRUCTURE SIDE, IF YOU WANT 2957 01:59:09,176 --> 01:59:11,245 TO BE ABLE TO ASSESS THESE YOU 2958 01:59:11,245 --> 01:59:12,613 NEED VERY LARGE NUMBERS WHICH 2959 01:59:12,613 --> 01:59:13,580 MEANS YOU'RE PROBABLY GOING TO 2960 01:59:13,580 --> 01:59:15,983 GO TO THE MEDICAL RECORDS AND 2961 01:59:15,983 --> 01:59:16,984 CLAIMS DATABASES AND THEN YOU'RE 2962 01:59:16,984 --> 01:59:20,587 GOING TO BE HAVING MANY, MANY 2963 01:59:20,587 --> 01:59:24,157 TYPES OF DEMENTIA, PRETTY MUCH 2964 01:59:24,157 --> 01:59:27,160 ANYTHING THAT'S NOT ALZHEIMER'S, 2965 01:59:27,160 --> 01:59:28,595 IT'S INCONSISTENTLY DIAGNOSED. 2966 01:59:28,595 --> 01:59:29,730 MAYBE DEMENTIA NOT OTHERWISE 2967 01:59:29,730 --> 01:59:30,597 SPECIFIED, MAYBE IT'S CALLED 2968 01:59:30,597 --> 01:59:35,269 ALZHEIMER'S AND THERE'S A 2969 01:59:35,269 --> 01:59:41,842 CO-PATHOLOGY AND NOBODY KNOWS OR 2970 01:59:41,842 --> 01:59:44,144 MAYBE CALLED ALZHEIMER'S BECAUSE 2971 01:59:44,144 --> 01:59:49,216 IT'S MISDIAGNOSED. 2972 01:59:49,216 --> 01:59:51,184 WE LOOKED HEAVILY AND TALKED 2973 01:59:51,184 --> 01:59:52,886 ABOUT INFRASTRUCTURE NEEDED AND 2974 01:59:52,886 --> 01:59:54,688 RELIED HEAVILY ON WHAT'S KNOWN 2975 01:59:54,688 --> 01:59:56,590 ABOUT ALZHEIMER'S AND ALS, 2976 01:59:56,590 --> 02:00:02,529 BECAUSE PARTOLOGICALLY WE'RE AT 2977 02:00:02,529 --> 02:00:05,265 THOSE TWO INTERSECTIONS. 2978 02:00:05,265 --> 02:00:06,867 STEPPING BACK, THE QUESTION FOR 2979 02:00:06,867 --> 02:00:08,101 INFRASTRUCTURE IN PARTICULAR, 2980 02:00:08,101 --> 02:00:10,871 HOW ARE YOU THINKING NOT JUST 2981 02:00:10,871 --> 02:00:12,940 AD/ADRD COMBINED BUT HOW ARE YOU 2982 02:00:12,940 --> 02:00:14,841 THINKING ABOUT RESOLVING THE 2983 02:00:14,841 --> 02:00:16,777 INFRASTRUCTURE TO ANSWER THESE 2984 02:00:16,777 --> 02:00:24,685 QUESTIONS FOR THE DIFFERENT 2985 02:00:24,685 --> 02:00:28,589 PATHOLOGICAL CAUSES OF DEMENTIA? 2986 02:00:28,589 --> 02:00:30,190 >> I'M REMINDS OF MANY THINGS 2987 02:00:30,190 --> 02:00:32,059 THAT DR. DICKERSON TALKED ABOUT 2988 02:00:32,059 --> 02:00:34,361 IN RECOMMENDATION 3 IN TERMS OF 2989 02:00:34,361 --> 02:00:35,796 HARMONIZATION OF THE DATASETS TO 2990 02:00:35,796 --> 02:00:37,698 GET THOSE BIG NUMBERS THAT I 2991 02:00:37,698 --> 02:00:39,666 THINK ARE REQUIRED. 2992 02:00:39,666 --> 02:00:41,501 I'M ALSO REMINDED IN 2993 02:00:41,501 --> 02:00:44,638 RECOMMENDATION 2 THE IDEA OF 2994 02:00:44,638 --> 02:00:46,473 ACTUALLY TAPPING INTO MULTIPLE 2995 02:00:46,473 --> 02:00:50,644 EXPOSURES AND DOING A REALLY 2996 02:00:50,644 --> 02:00:51,178 KIND OF MULTIPLE EXPOSOME 2997 02:00:51,178 --> 02:00:54,114 MODELING SO THAT YOU CAN GET 2998 02:00:54,114 --> 02:00:59,252 GROUPS OF THESE TYPES OF FACTORS 2999 02:00:59,252 --> 02:01:03,457 THAT MAY BE INDICATIVE AND 3000 02:01:03,457 --> 02:01:05,659 THERE'S A WEALTH OF WORK WITH 3001 02:01:05,659 --> 02:01:07,394 MED CARB DATA TO UNDERSTAND IF 3002 02:01:07,394 --> 02:01:08,595 AND HOW YOU CAN TRUST DIAGNOSES 3003 02:01:08,595 --> 02:01:11,098 SO I THINK THAT PULLING IN THOSE 3004 02:01:11,098 --> 02:01:13,834 EXPERTS AS WELL CERTAINLY WOULD 3005 02:01:13,834 --> 02:01:15,068 BE NEEDED. 3006 02:01:15,068 --> 02:01:16,169 I WELCOME ADDITIONAL COMMENTS 3007 02:01:16,169 --> 02:01:17,571 FROM THE REST OF THE 3008 02:01:17,571 --> 02:01:19,272 SUBCOMMITTEE ON THIS GREAT 3009 02:01:19,272 --> 02:01:19,573 QUESTION. 3010 02:01:19,573 --> 02:01:24,144 THANK YOU. 3011 02:01:24,144 --> 02:01:26,413 >> I'M HOPING AS PART OF 3012 02:01:26,413 --> 02:01:28,148 RECOMMENDATION 3, SUBBULLET 3, 3013 02:01:28,148 --> 02:01:29,816 WE'LL BE ABLE TO DEVELOP 3014 02:01:29,816 --> 02:01:33,053 CONSENSUS ON THE PROPER 3015 02:01:33,053 --> 02:01:34,888 PROTOCOLS FOR IDENTIFYING 3016 02:01:34,888 --> 02:01:36,456 SUBTYPES OF DEMENTIAS SO THAT WE 3017 02:01:36,456 --> 02:01:41,361 CAN GET PAST, AS YOU SAID, ICD 3018 02:01:41,361 --> 02:01:41,595 CODES. 3019 02:01:41,595 --> 02:01:44,998 BUT ACTUALLY DO SOME ABSTRACTION 3020 02:01:44,998 --> 02:01:45,899 MEDICAL RECORD ABSTRACTION TO 3021 02:01:45,899 --> 02:01:47,567 SEE WHAT ARE SYMPTOMS SOMEONE 3022 02:01:47,567 --> 02:01:48,769 WAS DISPLAYING, WHAT BIOMARKERS 3023 02:01:48,769 --> 02:01:50,737 DO WE HAVE STORED THAT WE CAN 3024 02:01:50,737 --> 02:01:53,807 TEST TO DRILL DOWN ON THE 3025 02:01:53,807 --> 02:01:54,574 SPECIFIC SUBTYPES. 3026 02:01:54,574 --> 02:01:56,643 I HOPE ONCE WE DO THAT AND GET 3027 02:01:56,643 --> 02:02:00,847 SOME EXPOSURE DATA THEN WE CAN 3028 02:02:00,847 --> 02:02:01,848 PINPOINT THESE EXPOSURES MORE 3029 02:02:01,848 --> 02:02:03,583 ASSOCIATED WITH THESE TYPE OF 3030 02:02:03,583 --> 02:02:06,219 DEMENTIAS AND HOPEFULLY WE CAN 3031 02:02:06,219 --> 02:02:07,754 ANSWER THE QUESTION THAT YOU 3032 02:02:07,754 --> 02:02:08,288 POSED. 3033 02:02:08,288 --> 02:02:10,323 I BELIEVE THAT WOULD TAKE TIME 3034 02:02:10,323 --> 02:02:12,192 BUT MORE IMPORTANTLY WOULD 3035 02:02:12,192 --> 02:02:15,962 REQUIRE THE INFRASTRUCTURE THAT 3036 02:02:15,962 --> 02:02:16,730 WE'RE PROPOSING. 3037 02:02:16,730 --> 02:02:19,800 >> I'M ALSO GOING TO BE AN 3038 02:02:19,800 --> 02:02:22,903 OPTIMIST THAT WE WILL GET BETTER 3039 02:02:22,903 --> 02:02:25,539 DATA THAT SUGGESTS COGNITIVE 3040 02:02:25,539 --> 02:02:26,039 RESEARCH APPLIES ACROSS 3041 02:02:26,039 --> 02:02:26,339 DEMENTIAS. 3042 02:02:26,339 --> 02:02:28,742 AND TO THE DEGREE THAT WE CAN 3043 02:02:28,742 --> 02:02:29,543 FIND PROTECTIVE ELEMENTS LIKE 3044 02:02:29,543 --> 02:02:33,246 EDUCATION THEY ARE GOING TO 3045 02:02:33,246 --> 02:02:34,981 ACTUALLY PROMOTE COGNITIVE 3046 02:02:34,981 --> 02:02:35,882 RESEARCH THAT'S BENEFICIAL 3047 02:02:35,882 --> 02:02:36,817 REGARDLESS OF UNDERLYING 3048 02:02:36,817 --> 02:02:40,053 DIAGNOSIS, THAT'S NOT TO SAY WE 3049 02:02:40,053 --> 02:02:41,722 SHOULDN'T DRIVE BIOMARKERS AND 3050 02:02:41,722 --> 02:02:43,824 ANIMAL MODELS TO REALLY, REALLY 3051 02:02:43,824 --> 02:02:44,691 UNDERSTAND EACH SPECIFIC 3052 02:02:44,691 --> 02:02:47,194 BIOLOGICAL DRIVER OF DEMENTIA. 3053 02:02:47,194 --> 02:02:48,395 BUT THERE MAY BE SOME THINGS 3054 02:02:48,395 --> 02:02:50,797 THAT WE CAN DO THAT ARE GOING TO 3055 02:02:50,797 --> 02:02:52,232 BE HELPFUL ACROSS DEMENTIAS, AND 3056 02:02:52,232 --> 02:02:53,734 IN SOME WAYS PRIORITIZING THOSE 3057 02:02:53,734 --> 02:02:55,669 FIRST AND FOREMOST MIGHT BE THE 3058 02:02:55,669 --> 02:03:06,213 BEST AND EARLIER USE OF FUNDING 3059 02:03:06,213 --> 02:03:12,786 >> I THINK WE HAVE ADRIAN NEXT 3060 02:03:12,786 --> 02:03:13,553 WITH YOUR QUESTION PLEASE. 3061 02:03:13,553 --> 02:03:14,688 >> A MEMBER OF THE STEERING 3062 02:03:14,688 --> 02:03:17,791 COMMITTEE, CHAIR OF THE NAPA 3063 02:03:17,791 --> 02:03:18,024 COUNCIL. 3064 02:03:18,024 --> 02:03:19,426 GOING BACK TO BERNARD'S 3065 02:03:19,426 --> 02:03:22,429 QUESTION, HOW IS THIS GOING TO 3066 02:03:22,429 --> 02:03:29,669 BE DISSEMINATED, EVERY SUMMER 3067 02:03:29,669 --> 02:03:30,604 THE NAPA COUNCIL MAKES 3068 02:03:30,604 --> 02:03:32,038 RECOMMENDATIONS TO CONGRESS AND 3069 02:03:32,038 --> 02:03:34,508 FEDERAL AGENCIES, AND THAT WILL 3070 02:03:34,508 --> 02:03:37,377 BE A REPORT THAT IS GOING TO BE 3071 02:03:37,377 --> 02:03:40,046 PRESENTED ONLINE ALSO AND HAS A 3072 02:03:40,046 --> 02:03:40,747 VERY WIDE DISSEMINATION. 3073 02:03:40,747 --> 02:03:44,785 AND MANY OF US WHO ARE ON THERE 3074 02:03:44,785 --> 02:03:46,286 ALSO HIGHLIGHT THAT INFORMATION, 3075 02:03:46,286 --> 02:03:47,187 SO THE RECOMMENDATIONS THAT 3076 02:03:47,187 --> 02:03:49,790 YOU'RE HEARING FROM THE WHOLE 3077 02:03:49,790 --> 02:03:53,126 SUMMIT WILL BE LISTED IN A 3078 02:03:53,126 --> 02:03:54,528 PRESENTATION, NOT AS DETAILED AS 3079 02:03:54,528 --> 02:03:56,229 DURING THE SUMMIT BUT AT LEAST 3080 02:03:56,229 --> 02:03:58,465 LISTING ALL OF THE 3081 02:03:58,465 --> 02:04:00,066 RECOMMENDATIONS SO JUST TO 3082 02:04:00,066 --> 02:04:03,170 ASSURE YOU IT DOESN'T -- IT'S 3083 02:04:03,170 --> 02:04:04,504 NOT ONLY JUST THE ACADEMICS THAT 3084 02:04:04,504 --> 02:04:06,239 WILL BE AWARE OF IT. 3085 02:04:06,239 --> 02:04:07,040 THANK YOU. 3086 02:04:07,040 --> 02:04:09,876 >> THANK YOU FOR MAKING THAT 3087 02:04:09,876 --> 02:04:10,143 COMMENT. 3088 02:04:10,143 --> 02:04:11,077 REALLY APPRECIATE IT. 3089 02:04:11,077 --> 02:04:21,621 DO WE HAVE ANY OTHER QUESTIONS? 3090 02:04:26,960 --> 02:04:33,400 3091 02:04:33,400 --> 02:04:42,509 >> YES, I HAVE A QUESTION. 3092 02:04:42,509 --> 02:04:44,778 >> DALE, WE LOST YOUR AUDIO. 3093 02:04:44,778 --> 02:04:52,052 TRY TO UNMUTE AGAIN. 3094 02:04:52,052 --> 02:04:53,653 >> MY QUESTION HAS TO DO WITH 3095 02:04:53,653 --> 02:04:54,788 THE RELATIONSHIP NOW TO THE 3096 02:04:54,788 --> 02:04:59,025 TITLE OF ALL OF WHAT WE'VE BEEN 3097 02:04:59,025 --> 02:05:05,866 DOING THESE LAST THREE, FOUR 3098 02:05:05,866 --> 02:05:08,602 SESSIONS, PHASE, ALZHEIMER'S 3099 02:05:08,602 --> 02:05:09,769 DISEASE AND RELATED DEMENTIAS. 3100 02:05:09,769 --> 02:05:12,172 I'D LIKE TO ASK A QUESTION ABOUT 3101 02:05:12,172 --> 02:05:16,142 HOW ARE THEY RELATED NOW FROM 3102 02:05:16,142 --> 02:05:19,880 THE RESEARCH THAT WE'RE DOING? 3103 02:05:19,880 --> 02:05:23,483 I UNDERSTAND THAT THEY ARE 3104 02:05:23,483 --> 02:05:24,150 INVOLVED WITH RENEGADE PROTEINS 3105 02:05:24,150 --> 02:05:29,923 THAT ARE KIND OF CAUSING THE 3106 02:05:29,923 --> 02:05:30,156 PROBLEM. 3107 02:05:30,156 --> 02:05:34,327 OTHER THAN THAT, IF WE TAKE 3108 02:05:34,327 --> 02:05:37,330 ALZHEIMER'S AS THE BIGGIE, SO TO 3109 02:05:37,330 --> 02:05:43,303 SPEAK, AND UNDER THAT WE'VE GOT 3110 02:05:43,303 --> 02:05:46,373 LEWY BODY AND PARKINSON'S, 3111 02:05:46,373 --> 02:05:50,410 TEMPORAL AND SO FORTH, VASCULAR, 3112 02:05:50,410 --> 02:05:51,745 SO IT SAYS RELATED. 3113 02:05:51,745 --> 02:05:56,182 IS THAT KIND OF LIKE AN ANALOGY 3114 02:05:56,182 --> 02:05:58,885 OF RELATED IN A FAMILY LIKE WE 3115 02:05:58,885 --> 02:06:00,387 GOT COUSINS AND SO FORTH? 3116 02:06:00,387 --> 02:06:05,659 AND IF THAT'S THE CASE, THEY ARE 3117 02:06:05,659 --> 02:06:09,930 ALL DEALING WITH A PROTEIN 3118 02:06:09,930 --> 02:06:15,368 PROBLEM OF SOME SORT, AND ARE 3119 02:06:15,368 --> 02:06:18,204 THOSE PROTEINS AND THIS DISEASE 3120 02:06:18,204 --> 02:06:23,944 CONCENTRATED IN PARTICULAR AREAS 3121 02:06:23,944 --> 02:06:30,717 LIKE, FOR EXAMPLE, IN THE 3122 02:06:30,717 --> 02:06:32,385 HYPOTHALAMUS, YOU GOT ALSO THIS 3123 02:06:32,385 --> 02:06:33,920 NEWER ONE, I LEARNED ABOUT, 3124 02:06:33,920 --> 02:06:39,859 BEING LATE DEMENTIA WHICH COMES 3125 02:06:39,859 --> 02:06:41,361 ON, ROUND NUMBERS, AROUND 75? 3126 02:06:41,361 --> 02:06:42,595 ALL OF THOSE ARE RELATED. 3127 02:06:42,595 --> 02:06:48,535 WHAT IS IT ABOUT IT THAT MAKES 3128 02:06:48,535 --> 02:06:50,070 THEM RELATED? 3129 02:06:50,070 --> 02:06:52,172 >> DALE, THAT'S AN EXCELLENT 3130 02:06:52,172 --> 02:06:52,639 QUESTION. 3131 02:06:52,639 --> 02:06:54,874 I'LL JUMP IN HERE. 3132 02:06:54,874 --> 02:06:56,242 YOU HAVE HELPED US TO UNDERSTAND 3133 02:06:56,242 --> 02:07:00,613 THAT WHEN WE USE THE TERM 3134 02:07:00,613 --> 02:07:03,683 "RELATED DEMENTIAS" THAT CAN BE 3135 02:07:03,683 --> 02:07:05,285 MISPERCEIVED THAT THEY HAVE THE 3136 02:07:05,285 --> 02:07:07,287 SAME ETIOLOGY OR CAUSE. 3137 02:07:07,287 --> 02:07:09,489 THAT'S NOT HOW WE MEAN RELATED. 3138 02:07:09,489 --> 02:07:11,791 WHAT WE MEAN BY RELATED 3139 02:07:11,791 --> 02:07:15,395 DEMENTIAS IS THAT AS THOSE 3140 02:07:15,395 --> 02:07:17,030 DISEASES PROGRESS, TOWARD THEIR 3141 02:07:17,030 --> 02:07:19,666 END STAGE, HOW THEY IMPACT THE 3142 02:07:19,666 --> 02:07:21,034 HEALTH CARE SYSTEM, THAT 3143 02:07:21,034 --> 02:07:23,937 PERSON'S LIFE, THEIR ABILITY TO 3144 02:07:23,937 --> 02:07:26,039 FUNCTION INDEPENDENTLY, THEY ARE 3145 02:07:26,039 --> 02:07:27,674 WORKING WITH THEIR CAREGIVERS, 3146 02:07:27,674 --> 02:07:28,908 IS VERY SIMILAR. 3147 02:07:28,908 --> 02:07:30,410 SO WHEN WE'RE SAYING RELATED 3148 02:07:30,410 --> 02:07:34,547 DEMENTIAS WE'RE TALKING ABOUT 3149 02:07:34,547 --> 02:07:37,117 THE COGNITIVE -- PEOPLE WILL 3150 02:07:37,117 --> 02:07:38,618 HAVE DECLINE IN BRAIN FUNCTION. 3151 02:07:38,618 --> 02:07:39,786 WE'RE NOT SAYING THEY HAVE THE 3152 02:07:39,786 --> 02:07:40,954 SAME REASON FOR IT. 3153 02:07:40,954 --> 02:07:46,059 THANK YOU FOR BRINGING THAT UP. 3154 02:07:46,059 --> 02:07:46,693 >> OKAY. 3155 02:07:46,693 --> 02:07:49,462 THAT HELPS ME. 3156 02:07:49,462 --> 02:07:50,430 >> ONE MORE, DR. KOROSHETZ WOULD 3157 02:07:50,430 --> 02:07:51,531 LIKE TO COMMENT TOO. 3158 02:07:51,531 --> 02:08:01,041 ARE YOU ABLE TO USE YOUR AUDIO? 3159 02:08:01,041 --> 02:08:04,177 WE'RE HAVING A TECH -- GOT IT. 3160 02:08:04,177 --> 02:08:07,414 >> GAIL, CAN YOU HEAR ME? 3161 02:08:07,414 --> 02:08:10,050 >> YES, I CAN HEAR YOU. 3162 02:08:10,050 --> 02:08:11,384 >> THANKS, ADRIAN. 3163 02:08:11,384 --> 02:08:16,189 I WOULD THROW ON TOP OF THAT, 3164 02:08:16,189 --> 02:08:20,860 MAYBE WHEN THE LIST WAS FIRST 3165 02:08:20,860 --> 02:08:21,394 DETERMINED, PEOPLE DIDN'T 3166 02:08:21,394 --> 02:08:24,030 REALIZE THAT, YOU KNOW, AS YOU 3167 02:08:24,030 --> 02:08:25,265 MENTIONED ALZHEIMER'S IS THE BIG 3168 02:08:25,265 --> 02:08:28,735 ONE IN TERMS OF DIAGNOSES, BUT 3169 02:08:28,735 --> 02:08:31,171 IN FACT ALL THE 3170 02:08:31,171 --> 02:08:32,172 ALZHEIMER'S-RELATED DEMENTIA 3171 02:08:32,172 --> 02:08:34,808 PATHOLOGIES ARE INCLUDED IN MANY 3172 02:08:34,808 --> 02:08:39,112 PEOPLE WITH ALZHEIMER'S. 3173 02:08:39,112 --> 02:08:42,082 SO 30% OF PEOPLE HAVE DEFINITION 3174 02:08:42,082 --> 02:08:46,653 OF ALZHEIMER'S HAVE SYNUCLEIN, 3175 02:08:46,653 --> 02:08:52,992 40 OR 50% HAVE TDB 43, AND AS 3176 02:08:52,992 --> 02:08:56,196 GET OLDER 80 OR 90 ADVISORY HAVE 3177 02:08:56,196 --> 02:08:57,330 VASCULAR CHANGES. 3178 02:08:57,330 --> 02:08:58,998 THEY ARE RELATED, OCCUR IN 3179 02:08:58,998 --> 02:09:00,166 CONCERT WITH EACH OTHER, LARGE 3180 02:09:00,166 --> 02:09:05,905 PROPORTION OF PEOPLE WHO HAVE 3181 02:09:05,905 --> 02:09:06,206 DEMENTIA. 3182 02:09:06,206 --> 02:09:08,174 >> WELL, I LIKE TO LOOK AT 3183 02:09:08,174 --> 02:09:10,710 ANALOGIES TO HELP ME. 3184 02:09:10,710 --> 02:09:13,546 THINK OF AN ORCHESTRA, THEY ALL 3185 02:09:13,546 --> 02:09:17,951 PLAY, YOU GOT VIOLINS, CELLOS, 3186 02:09:17,951 --> 02:09:21,421 THE BRASS, BUT ALL DIFFERENT. 3187 02:09:21,421 --> 02:09:23,990 BUT THEY FALL TOGETHER, YOU GOT 3188 02:09:23,990 --> 02:09:26,159 A HARMONIZING PLEASURE TO LISTEN 3189 02:09:26,159 --> 02:09:26,960 TO. 3190 02:09:26,960 --> 02:09:27,994 THIS IS NOT A PLEASURE. 3191 02:09:27,994 --> 02:09:33,066 THIS IS A KICK IN THE HEAD 3192 02:09:33,066 --> 02:09:33,299 REALLY. 3193 02:09:33,299 --> 02:09:36,469 AND THERE IS NO CURE. 3194 02:09:36,469 --> 02:09:40,807 SO, WHEN WE'RE LOOKING AT THE 3195 02:09:40,807 --> 02:09:41,708 MEDICATIONS FOR THE PERSON ON 3196 02:09:41,708 --> 02:09:47,413 THE STREET WHICH I CONSIDER 3197 02:09:47,413 --> 02:09:50,850 MYSELF, YOU HEAR THIS DEMENTIA, 3198 02:09:50,850 --> 02:09:52,452 SO FORTH, IS PREDOMINANTLY WHAT 3199 02:09:52,452 --> 02:09:55,255 IT DOES IS DELAYS IT SOME. 3200 02:09:55,255 --> 02:09:56,189 AND THAT'S IT. 3201 02:09:56,189 --> 02:09:59,025 WHEN YOU GET A DIAGNOSIS OF 3202 02:09:59,025 --> 02:10:00,260 DEMENTIA, IT'S A DEATH SENTENCE. 3203 02:10:00,260 --> 02:10:01,995 YOU'RE GOING TO DIE FROM IT. 3204 02:10:01,995 --> 02:10:05,832 THAT'S ALL THERE IS TO IT. 3205 02:10:05,832 --> 02:10:10,403 NOW, WHEN YOU LOOK AT THE 3206 02:10:10,403 --> 02:10:12,805 RELATIONSHIP THEN OF THESE 3207 02:10:12,805 --> 02:10:14,374 DIFFERENT DEMENTIAS, THEY PRETTY 3208 02:10:14,374 --> 02:10:17,010 MUCH HAVE THE SAME EFFECT IN THE 3209 02:10:17,010 --> 02:10:21,381 LONG RUN, AS FAR AS THE 3210 02:10:21,381 --> 02:10:24,584 LONGEVITY OF THE AFFECTED 3211 02:10:24,584 --> 02:10:26,286 PERSON. 3212 02:10:26,286 --> 02:10:28,321 IS THAT CORRECT? 3213 02:10:28,321 --> 02:10:29,022 >> NOT EXACTLY. 3214 02:10:29,022 --> 02:10:36,095 I THINK THEY ARE A LITTLE 3215 02:10:36,095 --> 02:10:37,163 DIFFERENT. 3216 02:10:37,163 --> 02:10:37,564 IT DEPENDS. 3217 02:10:37,564 --> 02:10:40,667 >> I WOULDN'T SAY THAT IT GOES 3218 02:10:40,667 --> 02:10:41,968 FASTER OR SLOWER. 3219 02:10:41,968 --> 02:10:43,903 THE END RESULT IS THE SAME. 3220 02:10:43,903 --> 02:10:46,639 IT TAKES A DIFFERENT AMOUNT OF 3221 02:10:46,639 --> 02:10:48,041 TIME. 3222 02:10:48,041 --> 02:10:50,777 SOME PEOPLE EIGHT YEARS, SOME 3223 02:10:50,777 --> 02:10:52,145 PEOPLE 15 AND 20. 3224 02:10:52,145 --> 02:10:54,380 THAT'S RARE BUT NEVERTHELESS IT 3225 02:10:54,380 --> 02:10:56,816 DOES HAPPEN. 3226 02:10:56,816 --> 02:10:58,651 I'M JUST TRYING TO EXPLORE WHAT 3227 02:10:58,651 --> 02:11:00,620 YOU KNOW AND WHAT YOU HAVE FOUND 3228 02:11:00,620 --> 02:11:04,791 OUT AND WHAT YOU CAN HELP ME 3229 02:11:04,791 --> 02:11:05,391 WHEN I'M TALKING WITH FRIENDS 3230 02:11:05,391 --> 02:11:05,992 AND SO FORTH. 3231 02:11:05,992 --> 02:11:06,993 WE HAVE LUNCH. 3232 02:11:06,993 --> 02:11:10,530 WE TALK ABOUT THIS KIND OF 3233 02:11:10,530 --> 02:11:11,231 THING. 3234 02:11:11,231 --> 02:11:15,568 I CAN SAY, WELL, I JUST WAS AT 3235 02:11:15,568 --> 02:11:16,736 NIH, ZOOM MEETING AND SO FORTH, 3236 02:11:16,736 --> 02:11:18,171 WE TALKED ABOUT THIS. 3237 02:11:18,171 --> 02:11:19,906 HERE IS YOUR RESULT. 3238 02:11:19,906 --> 02:11:25,011 AND THAT'S IT IN A NUTSHELL 3239 02:11:25,011 --> 02:11:26,846 REALLY. 3240 02:11:26,846 --> 02:11:30,483 >> THANK YOU FOR THOSE COMMENTS, 3241 02:11:30,483 --> 02:11:30,783 DALE. 3242 02:11:30,783 --> 02:11:32,518 I THINK THIS CONVERSATION TODAY 3243 02:11:32,518 --> 02:11:33,853 IS CERTAINLY ABOUT WHERE THE 3244 02:11:33,853 --> 02:11:36,889 NEXT FIVE TO TEN YEARS SHOULD 3245 02:11:36,889 --> 02:11:37,290 GO. 3246 02:11:37,290 --> 02:11:39,525 AND THE TYPES OF RESEARCH THAT 3247 02:11:39,525 --> 02:11:42,095 SHOULD BE DONE TO MAYBE HELP FIX 3248 02:11:42,095 --> 02:11:44,130 MORE PARTS OF THAT ORCHESTRA SO 3249 02:11:44,130 --> 02:11:46,199 THAT IT WILL ULTIMATELY PLAY 3250 02:11:46,199 --> 02:11:47,400 TOGETHER SO ALL OF THESE 3251 02:11:47,400 --> 02:11:48,234 SUGGESTIONS AND ALL OF THESE 3252 02:11:48,234 --> 02:11:49,535 THOUGHTS ABOUT WHERE WE ARE AND 3253 02:11:49,535 --> 02:11:51,471 WHERE WE NEED TO BE INCLUDING 3254 02:11:51,471 --> 02:11:54,107 YOUR OWN ARE APPRECIATED. 3255 02:11:54,107 --> 02:11:55,775 SO THANK YOU. 3256 02:11:55,775 --> 02:11:58,044 >> I REALLY APPRECIATE YOU. 3257 02:11:58,044 --> 02:12:00,113 AND ALL YOUR COLLEAGUES. 3258 02:12:00,113 --> 02:12:03,816 WHAT YOU'RE DOING IS ABSOLUTELY 3259 02:12:03,816 --> 02:12:04,083 WONDERFUL. 3260 02:12:04,083 --> 02:12:07,220 AND TO HAVE SOMEBODY THAT IS 3261 02:12:07,220 --> 02:12:09,822 DWHEEG YOU DO IS A FOUNDATION OF 3262 02:12:09,822 --> 02:12:16,796 WHICH I FIND A LOT OF COMFORT 3263 02:12:16,796 --> 02:12:17,063 IN. 3264 02:12:17,063 --> 02:12:18,564 JUST KNOWING THERE ARE FOLKS 3265 02:12:18,564 --> 02:12:20,566 LIKE YOU DOING YOUR PIECES AND 3266 02:12:20,566 --> 02:12:21,834 PART TRYING TO FIGURE OUT WHAT 3267 02:12:21,834 --> 02:12:24,937 IN THE WORLD IS GOING ON HERE 3268 02:12:24,937 --> 02:12:31,444 AND HOW WE CAN BEST DEAL WITH 3269 02:12:31,444 --> 02:12:31,611 IT. 3270 02:12:31,611 --> 02:12:32,178 THANK YOU. 3271 02:12:32,178 --> 02:12:33,479 A GREAT BIG THANK YOU. 3272 02:12:33,479 --> 02:12:35,014 >> THANK YOU FOR YOUR QUESTIONS 3273 02:12:35,014 --> 02:12:39,886 AND YOUR PARTICIPATION AS WELL. 3274 02:12:39,886 --> 02:12:47,093 >> VERY WELL PUT, DALE. 3275 02:12:47,093 --> 02:12:52,031 >> IT MIGHT BE TIME TO OPEN IT 3276 02:12:52,031 --> 02:12:55,501 UP REALLY FOR INPUT ON ANYTHING 3277 02:12:55,501 --> 02:12:57,670 THAT YOU HEARD, SAW, THOUGHT 3278 02:12:57,670 --> 02:13:00,440 ABOUT FROM THESE THREE DAYS OF 3279 02:13:00,440 --> 02:13:01,841 THE SUMMIT. 3280 02:13:01,841 --> 02:13:03,743 IF AMBER AGREES, I WOULD 3281 02:13:03,743 --> 02:13:05,845 ENCOURAGE ANY OF THE COMMITTEE 3282 02:13:05,845 --> 02:13:06,913 MEMBERS WHO ARE PRESENT TODAY, 3283 02:13:06,913 --> 02:13:09,482 PLEASE DO TURN ON YOUR CAMERA 3284 02:13:09,482 --> 02:13:13,019 AND HELP FIELD WHAT I HOPE WILL 3285 02:13:13,019 --> 02:13:14,921 BE SOME ONGOING REALLY IMPORTANT 3286 02:13:14,921 --> 02:13:17,090 INPUT AND DISCUSSION. 3287 02:13:17,090 --> 02:13:18,658 SO IF YOU HAVE A COMMENT, AGAIN 3288 02:13:18,658 --> 02:13:22,328 IT CAN BE ON ANYTHING FROM THE 3289 02:13:22,328 --> 02:13:24,097 ENTIRE SUMMIT, ANY 3290 02:13:24,097 --> 02:13:27,333 RECOMMENDATIONS TODAY OR APRIL, 3291 02:13:27,333 --> 02:13:28,568 RAISE YOUR HAND. 3292 02:13:28,568 --> 02:13:29,535 >> THANK YOU, KATE. 3293 02:13:29,535 --> 02:13:33,573 I'M GOING TO GO FIRST TO RICHARD 3294 02:13:33,573 --> 02:13:34,640 BENSON, THE LEAD FOR THE 3295 02:13:34,640 --> 02:13:38,244 SESSION, THE FIRST SESSION OF 3296 02:13:38,244 --> 02:13:38,444 TODAY. 3297 02:13:38,444 --> 02:13:40,780 AND HE'S GOING TO SHARE A COUPLE 3298 02:13:40,780 --> 02:13:44,684 QUESTIONS WE RECEIVED ON THE 3299 02:13:44,684 --> 02:13:48,755 VIDEOCAST E-MAIL. 3300 02:13:48,755 --> 02:13:50,223 >> THANK YOU, AM BERG. 3301 02:13:50,223 --> 02:13:52,825 REALLY GREAT DISCUSSION FROM 3302 02:13:52,825 --> 02:13:53,760 BOTH PANELS TODAY. 3303 02:13:53,760 --> 02:13:57,630 THERE WERE TWO QUESTIONS PUT IN 3304 02:13:57,630 --> 02:14:00,566 THE VIDEOCAST FOR THE PREVIOUS 3305 02:14:00,566 --> 02:14:00,767 PANEL. 3306 02:14:00,767 --> 02:14:05,338 I'M GOING ASK IF YOU CAN TURN 3307 02:14:05,338 --> 02:14:07,006 YOUR CAMERAS ON AGAIN. 3308 02:14:07,006 --> 02:14:09,108 THE FIRST QUESTION, ACTUALLY IN 3309 02:14:09,108 --> 02:14:12,145 MULTIPLE PARTS, I'M GOING TO TRY 3310 02:14:12,145 --> 02:14:13,613 TO READ IT SLOWLY. 3311 02:14:13,613 --> 02:14:16,182 WHAT SPECIFICALLY IS BEING DONE 3312 02:14:16,182 --> 02:14:17,917 TO ENCOURAGE THE USE OF 3313 02:14:17,917 --> 02:14:22,789 BIOMARKER TESTING AS A LOW COST 3314 02:14:22,789 --> 02:14:24,490 NON-INVASIVE SCREENING TOOL, FOR 3315 02:14:24,490 --> 02:14:27,427 EXAMPLE IS GUIDANCE GIVEN TO 3316 02:14:27,427 --> 02:14:30,830 PRIMARY CARE PROVIDERS ON 3317 02:14:30,830 --> 02:14:32,165 APPROPRIATE USE OF TEST 3318 02:14:32,165 --> 02:14:36,102 INCLUDING AGE GUIDELINES AND WHO 3319 02:14:36,102 --> 02:14:37,637 IS GIVEN GUIDANCE VIA WHAT 3320 02:14:37,637 --> 02:14:38,838 CHANNELS, AND IS THE ALZHEIMER'S 3321 02:14:38,838 --> 02:14:45,178 ASSOCIATION TAKE AC -- TAKING A 3322 02:14:45,178 --> 02:14:46,746 LEAD, ENCOURAGING PARTICIPATION 3323 02:14:46,746 --> 02:14:47,113 AS APPROPRIATE? 3324 02:14:47,113 --> 02:14:50,883 I DON'T KNOW IF ANYONE FROM THE 3325 02:14:50,883 --> 02:14:53,886 PREVIOUS PANEL, IF YOU ALL ARE 3326 02:14:53,886 --> 02:15:04,063 STILL ON. 3327 02:15:07,266 --> 02:15:08,100 >> I'M HERE. 3328 02:15:08,100 --> 02:15:17,443 I'M NOT SURE HOW TO ANSWER THE 3329 02:15:17,443 --> 02:15:18,411 QUESTION. 3330 02:15:18,411 --> 02:15:21,047 THIS IS SUCH AN IMPORTANT 3331 02:15:21,047 --> 02:15:21,347 QUESTION. 3332 02:15:21,347 --> 02:15:23,182 BLOOD TESTS ARE GETTING TO 3333 02:15:23,182 --> 02:15:24,984 BECOME AVAILABLE, EVEN FDA 3334 02:15:24,984 --> 02:15:27,286 APPROVED. 3335 02:15:27,286 --> 02:15:31,557 AND SO WE NEED TO PROVIDE 3336 02:15:31,557 --> 02:15:32,525 ETHICAL, RESPONSIBLE, SOUND 3337 02:15:32,525 --> 02:15:35,094 GUIDANCE FOR PRIMARY CARE 3338 02:15:35,094 --> 02:15:35,361 PROVIDERS. 3339 02:15:35,361 --> 02:15:36,162 THIS IS ACTUALLY SOMETHING THAT 3340 02:15:36,162 --> 02:15:42,768 ONE OF THE SESSIONS FROM THE 3341 02:15:42,768 --> 02:15:43,903 FIRST DAY, MED TRANSLATIONS 3342 02:15:43,903 --> 02:15:45,605 DISCOVERIES INTO PRACTICE, THIS 3343 02:15:45,605 --> 02:15:47,373 IS PART OF ONE OF OUR 3344 02:15:47,373 --> 02:15:50,576 RECOMMENDATIONS TO THINK ABOUT 3345 02:15:50,576 --> 02:15:51,978 HOW TO -- RESEARCH THAT NEEDS TO 3346 02:15:51,978 --> 02:15:54,247 HAPPEN SO USE OF THESE 3347 02:15:54,247 --> 02:15:56,182 BIOMARKERS IN EVERYDAY CLINICAL 3348 02:15:56,182 --> 02:15:57,750 SETTINGS IS APPROPRIATE AND 3349 02:15:57,750 --> 02:15:58,184 ETHICAL. 3350 02:15:58,184 --> 02:15:59,752 AND SO I'M MAKING NOTE OF YOUR 3351 02:15:59,752 --> 02:16:03,189 COMMENT TO MAKE SURE WE'RE FULLY 3352 02:16:03,189 --> 02:16:11,631 ADDRESSING IT IN THAT SESSION. 3353 02:16:11,631 --> 02:16:12,198 >> FROM THE ALZHEIMER'S 3354 02:16:12,198 --> 02:16:14,267 ASSOCIATION, BY ALL MEANS, YES, 3355 02:16:14,267 --> 02:16:17,003 THE ALZHEIMER'S IS TAKING A LEAD 3356 02:16:17,003 --> 02:16:20,206 ON ENGAGING HEALTH SYSTEMS TO 3357 02:16:20,206 --> 02:16:25,111 EDUCATE PRIMARY CARE AND OTHER 3358 02:16:25,111 --> 02:16:27,446 PHYSICIANS AND DEVELOPING DR. 3359 02:16:27,446 --> 02:16:31,150 MARIA CARILLO AND HER TEAM 3360 02:16:31,150 --> 02:16:32,652 WORKING TO DEVELOP GUIDELINES 3361 02:16:32,652 --> 02:16:33,886 FOR BIOMARKER APPROPRIATE USE, 3362 02:16:33,886 --> 02:16:35,788 SO MORE TO COME BUT THE 3363 02:16:35,788 --> 02:16:37,356 ALZHEIMER'S ASSOCIATION 3364 02:16:37,356 --> 02:16:46,465 CERTAINLY IS COMMITTED TO THESE 3365 02:16:46,465 --> 02:16:47,099 AVENUES. 3366 02:16:47,099 --> 02:16:48,868 >> AMERICAN GERIATRIC SOCIETY 3367 02:16:48,868 --> 02:16:53,472 ALSO PROVIDED COMMENT ON CURRENT 3368 02:16:53,472 --> 02:16:55,541 USE OF BIOMARKERS, WE'RE EARLY 3369 02:16:55,541 --> 02:16:56,876 IN THE FIELD SO THERE'S CAUTION 3370 02:16:56,876 --> 02:17:05,384 THAT NEEDS TO OCCUR 3371 02:17:05,384 --> 02:17:14,460 REQUEST ARE CAN RESPECT TO 3372 02:17:14,460 --> 02:17:15,261 PRIMARY CARE. 3373 02:17:15,261 --> 02:17:16,162 THANK YOU. 3374 02:17:16,162 --> 02:17:17,697 >> THANK YOU. 3375 02:17:17,697 --> 02:17:18,564 THAT CREATED A THOROUGH RESPONSE 3376 02:17:18,564 --> 02:17:22,501 TO THE QUESTION. 3377 02:17:22,501 --> 02:17:25,204 THE NEXT QUESTION IS WHAT ARE 3378 02:17:25,204 --> 02:17:28,174 TOP PRIORITIES IN GENOMIC 3379 02:17:28,174 --> 02:17:29,642 RESEARCH, HEALTH DISPARITIES AND 3380 02:17:29,642 --> 02:17:30,543 POPULATION-SPECIFIC KNOWLEDGE, 3381 02:17:30,543 --> 02:17:34,680 IS IT JUST MORE DATA OR ARE 3382 02:17:34,680 --> 02:17:36,215 THERE PARTICULAR METHODOLOGIES 3383 02:17:36,215 --> 02:17:37,650 OR APPROACHES TO ACCELERATE 3384 02:17:37,650 --> 02:17:42,855 CLOSURE OF GAP IN TERMS OF 3385 02:17:42,855 --> 02:17:45,758 STATISTICAL POWER BETWEEN 3386 02:17:45,758 --> 02:17:50,262 WESTERN EUROPEAN WHITES AND 3387 02:17:50,262 --> 02:17:51,330 OTHER GENETIC ANCESTRY GROUPS 3388 02:17:51,330 --> 02:17:53,265 AND THIS AREA OF RESEARCH FOR 3389 02:17:53,265 --> 02:17:53,699 THE PREVIOUS PANEL. 3390 02:17:53,699 --> 02:17:58,137 >> I CAN ANSWER THE QUESTION. 3391 02:17:58,137 --> 02:18:00,206 I'M NOT A GENETICS EXPERT BUT 3392 02:18:00,206 --> 02:18:01,874 PASSIONATE ABOUT MY RESEARCH 3393 02:18:01,874 --> 02:18:04,176 GOES INTO THIS, THE AREAS OF 3394 02:18:04,176 --> 02:18:04,977 QUESTION. 3395 02:18:04,977 --> 02:18:08,180 AND SO FIRST OF ALL, SOMETHING I 3396 02:18:08,180 --> 02:18:11,784 SPOKE ABOUT WE DEFINITELY NEED 3397 02:18:11,784 --> 02:18:12,885 MORE REPRESENTATION OF THESE 3398 02:18:12,885 --> 02:18:13,919 GROUPS WITH GENETIC DATA. 3399 02:18:13,919 --> 02:18:15,287 THE COMMENT ABOUT POWER WAS 3400 02:18:15,287 --> 02:18:17,456 CRUCIAL AND IMPORTANT, SOMETHING 3401 02:18:17,456 --> 02:18:18,758 THAT IS DEFINITELY LACKING IF 3402 02:18:18,758 --> 02:18:20,893 YOU COMPARE, FOR EXAMPLE, 3403 02:18:20,893 --> 02:18:23,195 STUDIES OF EUROPEAN DESCENT 3404 02:18:23,195 --> 02:18:23,863 VERSUS OTHER GROUPS. 3405 02:18:23,863 --> 02:18:25,998 THERE'S THOUSANDS AND THOUSANDS 3406 02:18:25,998 --> 02:18:30,369 VERSUS ONLY A FEW THOUSAND WHEN 3407 02:18:30,369 --> 02:18:32,838 IT COMES TO UNDERREPRESENTED 3408 02:18:32,838 --> 02:18:33,606 GROUPS. 3409 02:18:33,606 --> 02:18:35,341 SO I THINK THIS GOES BACK TO 3410 02:18:35,341 --> 02:18:36,976 SOMETHING I SPOKE TO AND THAT 3411 02:18:36,976 --> 02:18:38,644 WAS MAKING SURE THAT WE'RE 3412 02:18:38,644 --> 02:18:40,713 INCLUDING THE COMMUNITY FROM THE 3413 02:18:40,713 --> 02:18:41,113 BEGINNING, RIGHT? 3414 02:18:41,113 --> 02:18:43,149 I THINK PEOPLE WILL BE MORE 3415 02:18:43,149 --> 02:18:44,784 LIKELY TO WANT TO PARTICIPATE IN 3416 02:18:44,784 --> 02:18:46,385 OUR RESEARCH IF WE'RE INVOLVING 3417 02:18:46,385 --> 02:18:47,420 THEM FROM THE BEGINNING AND 3418 02:18:47,420 --> 02:18:50,856 THAT'S WHERE A BIG PIECE OF 3419 02:18:50,856 --> 02:18:51,957 EDUCATION COMES IN TOO, 3420 02:18:51,957 --> 02:18:53,659 INFORMING WHY WE NEED YOUR HELP. 3421 02:18:53,659 --> 02:18:58,030 AND WHY WE NEED THEIR HELP. 3422 02:18:58,030 --> 02:19:03,335 YEAH, I'LL KEEP GOING. 3423 02:19:03,335 --> 02:19:04,136 A SHORT ANSWER. 3424 02:19:04,136 --> 02:19:06,205 >> I THINK THERE ARE SOME 3425 02:19:06,205 --> 02:19:07,273 TECHNICAL CHALLENGES, 3426 02:19:07,273 --> 02:19:08,574 STATISTICAL CHALLENGES ABOUT HOW 3427 02:19:08,574 --> 02:19:10,209 WE APPROPRIATELY DEAL WITH 3428 02:19:10,209 --> 02:19:11,877 SITUATIONS WHERE WE HAVE 3429 02:19:11,877 --> 02:19:13,846 UNBALANCED DATA AND TAKE 3430 02:19:13,846 --> 02:19:14,613 ADVANTAGE, BORROW INFORMATION 3431 02:19:14,613 --> 02:19:15,848 ACROSS GROUPS. 3432 02:19:15,848 --> 02:19:17,483 WHEN IT'S APPROPRIATE TO BORROW 3433 02:19:17,483 --> 02:19:18,718 INFORMATION AND NOT APPROPRIATE 3434 02:19:18,718 --> 02:19:20,553 TO BORROW INFORMATION SO I THINK 3435 02:19:20,553 --> 02:19:22,288 THERE ARE IN ADDITION TO GETTING 3436 02:19:22,288 --> 02:19:24,090 DATA THERE'S ALSO SOME 3437 02:19:24,090 --> 02:19:25,057 STATISTICAL QUESTIONS ABOUT HOW 3438 02:19:25,057 --> 02:19:32,164 WE BEST USE IT. 3439 02:19:32,164 --> 02:19:33,999 >> THANK YOU FOR THOSE 3440 02:19:33,999 --> 02:19:35,101 RESPONSES, THOSE ARE TWO 3441 02:19:35,101 --> 02:19:38,838 VIDEOCAST QUESTIONS SO I'LL HAND 3442 02:19:38,838 --> 02:19:44,176 IT BACK TO AMBER. 3443 02:19:44,176 --> 02:19:45,344 >> THANK YOU. 3444 02:19:45,344 --> 02:19:54,453 ONE HAND RAISED. 3445 02:19:54,453 --> 02:20:00,159 JOSEPH, ARE YOU ABLE TO UNMUTE 3446 02:20:00,159 --> 02:20:09,869 YOURSELF? 3447 02:20:09,869 --> 02:20:12,438 IF YOU ARE ABLE TO, LET US KNOW. 3448 02:20:12,438 --> 02:20:17,042 WE'LL TRY AGAIN. 3449 02:20:17,042 --> 02:20:18,778 LET'S GO TO ANN. 3450 02:20:18,778 --> 02:20:23,916 CAN YOU TRY TO USE YOUR 3451 02:20:23,916 --> 02:20:28,187 MICROPHONE AND CAMERA? 3452 02:20:28,187 --> 02:20:29,555 >> THANKS. 3453 02:20:29,555 --> 02:20:35,628 I'M ANNE MURRAY, IN MINNESOTA, A 3454 02:20:35,628 --> 02:20:42,368 MEMBER OF -- [ LOW AUDIO ] 3455 02:20:42,368 --> 02:20:52,411 , 3456 02:20:53,012 --> 02:20:54,980 >> YOUR AUDIO IS LOW, GET CLOSER 3457 02:20:54,980 --> 02:20:56,549 TO THE MICROPHONE OR SPEAK 3458 02:20:56,549 --> 02:21:00,152 LOUDER, IT'S HARD TO UNDERSTAND 3459 02:21:00,152 --> 02:21:00,319 YOU. 3460 02:21:00,319 --> 02:21:03,088 SORRY FOR THAT. 3461 02:21:03,088 --> 02:21:13,399 WE'LL TRY AGAIN. 3462 02:21:28,647 --> 02:21:39,091 >> I WANTED TO RAISE ALERT TO 3463 02:21:40,192 --> 02:21:41,927 THE ALZHEIMER'S -- [ LOW AUDIO ] 3464 02:21:41,927 --> 02:21:43,596 I DON'T KNOW IF IT'S BEEN 3465 02:21:43,596 --> 02:21:45,798 BROUGHT UP ALREADY BUT I'M A 3466 02:21:45,798 --> 02:21:52,171 MEMBER OF THAT LED BY JEFF 3467 02:21:52,171 --> 02:21:56,175 WILLIAMSON, WAKE FOREST, 3468 02:21:56,175 --> 02:21:58,777 MICHELLE NULTY, 15 OTHERS 3469 02:21:58,777 --> 02:22:00,512 MENTIONED BIOMARKER DATA TO THE 3470 02:22:00,512 --> 02:22:03,749 ADCC TO ESTIMATE EFFECTS OF 3471 02:22:03,749 --> 02:22:06,518 MORBIDITY AND ETHNICITY ON THE 3472 02:22:06,518 --> 02:22:08,153 DEMENTIA BIOMARKER LEVELS. 3473 02:22:08,153 --> 02:22:11,257 SO WE'RE HOPING THAT WILL HELP 3474 02:22:11,257 --> 02:22:14,827 PRIMARY CARE PHYSICIANS 3475 02:22:14,827 --> 02:22:20,366 INTERPRET, ONCE WE'VE ANALYZED 3476 02:22:20,366 --> 02:22:27,806 RESULTS AND DISTRIBUTED THEM. 3477 02:22:27,806 --> 02:22:29,141 >> THANK YOU SO MUCH, THAT'S 3478 02:22:29,141 --> 02:22:30,509 SUCH AN IMPORTANT INITIATIVE. 3479 02:22:30,509 --> 02:22:33,145 I'M GLAD THAT YOU HIGHLIGHTED 3480 02:22:33,145 --> 02:22:33,479 IT. 3481 02:22:33,479 --> 02:22:35,481 I DON'T THINK IT HAD BEEN 3482 02:22:35,481 --> 02:22:36,515 MENTIONED TODAY. 3483 02:22:36,515 --> 02:22:40,185 AGREED, AN IMPORTANT RESOURCE AS 3484 02:22:40,185 --> 02:22:49,929 WE TRY TO GUIDE BETTER CARE. 3485 02:22:49,929 --> 02:22:52,464 THAT'S NOTED. 3486 02:22:52,464 --> 02:22:54,967 SHOULD WE TRY JOSEPH THOMAS 3487 02:22:54,967 --> 02:23:05,110 AGAIN? 3488 02:23:05,878 --> 02:23:07,179 ANYONE LISTENING WHO HAS A 3489 02:23:07,179 --> 02:23:08,347 COMMENT OR QUESTION ABOUT 3490 02:23:08,347 --> 02:23:10,316 ANYTHING THAT YOU HEARD AT THE 3491 02:23:10,316 --> 02:23:13,419 SUMMIT, THIS IS YOUR CHANCE. 3492 02:23:13,419 --> 02:23:15,154 WE REALLY DO LISTEN VERY 3493 02:23:15,154 --> 02:23:16,288 CAREFULLY TO EVERY COMMENT 3494 02:23:16,288 --> 02:23:18,057 THAT'S GIVEN AND THINK ABOUT HOW 3495 02:23:18,057 --> 02:23:19,858 WE CAN USE THAT TO IMPROVE THE 3496 02:23:19,858 --> 02:23:20,526 RECOMMENDATIONS SO THIS IS YOUR 3497 02:23:20,526 --> 02:23:21,427 CHANCE FOR YOUR VOICE TO BE 3498 02:23:21,427 --> 02:23:31,570 HEARD. 3499 02:23:35,407 --> 02:23:38,644 >> WHILE THE MICROPHONE AND 3500 02:23:38,644 --> 02:23:39,745 CAMERA ARE ENABLED -- OKAY. 3501 02:23:39,745 --> 02:23:43,782 GIVE IT A TRY. 3502 02:23:43,782 --> 02:23:54,159 I BELIEVE IT'S ELLIS? 3503 02:24:05,270 --> 02:24:05,571 >> OKAY. 3504 02:24:05,571 --> 02:24:08,173 PERFECT. 3505 02:24:08,173 --> 02:24:10,042 THANK YOU SO MUCH. 3506 02:24:10,042 --> 02:24:12,011 A CALL FROM MGH. 3507 02:24:12,011 --> 02:24:14,146 I'M SO SORRY, I MISSED SOME OF 3508 02:24:14,146 --> 02:24:16,949 THE PARTS, MAYBE MY QUESTION HAS 3509 02:24:16,949 --> 02:24:23,655 BEEN ANSWERED ALREADY. 3510 02:24:23,655 --> 02:24:25,457 BUT I HAVE LISTENED FIRST TWO 3511 02:24:25,457 --> 02:24:30,529 DAYS WELL. 3512 02:24:30,529 --> 02:24:35,768 THERE ARE SOME DISCUSSIONS ABOUT 3513 02:24:35,768 --> 02:24:36,702 INTERACTIONS ESPECIALLY FOR 3514 02:24:36,702 --> 02:24:40,739 EXAMPLE THINGS ABOUT BLOOD 3515 02:24:40,739 --> 02:24:44,009 PRESSURE CONTROL, SLEEP HEALTH, 3516 02:24:44,009 --> 02:24:46,812 INTERVENTIONS ON THAT. 3517 02:24:46,812 --> 02:24:50,916 BUT I AM HAVING TROUBLE TO PUT 3518 02:24:50,916 --> 02:24:52,684 THIS IN EXPOSOME, SO HOW DO YOU 3519 02:24:52,684 --> 02:24:58,457 SAY THAT WHEN YOU SAY EXPOSOME, 3520 02:24:58,457 --> 02:25:03,495 ARE YOU GUYS ONLY TALKING ABOUT 3521 02:25:03,495 --> 02:25:04,530 GUT MICROBES OR ENVIRONMENTAL 3522 02:25:04,530 --> 02:25:10,135 TOXINS OR ARE YOU ALSO PUTTING 3523 02:25:10,135 --> 02:25:12,504 THIS FOR EXAMPLE SLEEP OR 3524 02:25:12,504 --> 02:25:18,544 EXERCISE BECAUSE THESE ARE KIND 3525 02:25:18,544 --> 02:25:21,780 OF MORE LIKE FEASIBLE TO DO 3526 02:25:21,780 --> 02:25:22,714 INTERVENTIONS, YOU KNOW, 3527 02:25:22,714 --> 02:25:24,550 MODIFIABLE, CAN YOU GUYS MAKE A 3528 02:25:24,550 --> 02:25:26,752 COMMENT ON THAT? 3529 02:25:26,752 --> 02:25:28,153 THANK YOU SO MUCH. 3530 02:25:28,153 --> 02:25:29,888 >> I'LL TAKE A SHOT AT THAT. 3531 02:25:29,888 --> 02:25:31,824 THANK YOU FOR YOUR QUESTION. 3532 02:25:31,824 --> 02:25:33,759 SO WHILE WE THINK ABOUT THE 3533 02:25:33,759 --> 02:25:36,662 EXPOSOME IT'S ALL COMPREHENSIVE. 3534 02:25:36,662 --> 02:25:39,832 IT'S MORE THAN JUST 3535 02:25:39,832 --> 02:25:42,067 ENVIRONMENTAL TOXINS OR AIR 3536 02:25:42,067 --> 02:25:43,335 POLLUTION. 3537 02:25:43,335 --> 02:25:46,205 WE'RE ALSO OF COURSE CONSIDERING 3538 02:25:46,205 --> 02:25:48,006 SLEEP AND CIRCADIAN RHYTHM 3539 02:25:48,006 --> 02:25:51,143 BECAUSE WHEN THESE FACTORS ARE 3540 02:25:51,143 --> 02:25:52,244 ALTERED, OR DISRUPTED, THEY HAVE 3541 02:25:52,244 --> 02:25:55,547 BEEN SHOWN TO CONTRIBUTE TO 3542 02:25:55,547 --> 02:25:57,182 COGNITIVE DECLINE. 3543 02:25:57,182 --> 02:26:02,121 SO, THE IDEA IS TO LOOK AT THE 3544 02:26:02,121 --> 02:26:03,122 OVERALL EXPOSOME, THROUGHOUT THE 3545 02:26:03,122 --> 02:26:06,458 LIFESPAN, AND TO ALSO LOOK AT 3546 02:26:06,458 --> 02:26:09,728 HOW SOME ACTIVITIES, PHYSICAL 3547 02:26:09,728 --> 02:26:12,097 ACTIVITIES, CHANGE IN DIET, CAN 3548 02:26:12,097 --> 02:26:14,533 HELP TO MAYBE SLOW THE 3549 02:26:14,533 --> 02:26:18,103 PROGRESSION OF A.D. AND RELATED 3550 02:26:18,103 --> 02:26:20,739 DEMENTIAS OR OTHER FACTORS THAT 3551 02:26:20,739 --> 02:26:21,507 MIGHT ACCELERATE COGNITIVE 3552 02:26:21,507 --> 02:26:23,609 DECLINE IN THE CONTEXT OF A.D. 3553 02:26:23,609 --> 02:26:27,246 SO ALL OF -- EVERYTHING THAT YOU 3554 02:26:27,246 --> 02:26:32,151 EXPERIENCE THAT CAN INFLUENCE 3555 02:26:32,151 --> 02:26:33,552 YOUR RESPONSE, IN REGARDS TO 3556 02:26:33,552 --> 02:26:36,021 MICROBIOME I GAVE EXAMPLE OF GUT 3557 02:26:36,021 --> 02:26:38,891 MICROBIOME BUT IT'S IMPORTANT TO 3558 02:26:38,891 --> 02:26:40,492 CONSIDER YOUR ENTIRE MICROBIOME 3559 02:26:40,492 --> 02:26:43,395 FLORA WHICH WOULD BE YOUR SKIN, 3560 02:26:43,395 --> 02:26:46,798 IN YOUR RESPIRATORY TRACT, 3561 02:26:46,798 --> 02:26:50,269 ANYTHING THAT MIGHT ASSOCIATE 3562 02:26:50,269 --> 02:26:52,137 WITH ACCELERATED PROGNOSIS OF 3563 02:26:52,137 --> 02:26:53,672 A.D. AND RELATED DEMENTIAS. 3564 02:26:53,672 --> 02:26:56,175 SO EVERYTHING THAT YOU'RE 3565 02:26:56,175 --> 02:26:57,910 EXPERIENCING THAT YOU'RE EXPOSED 3566 02:26:57,910 --> 02:27:01,780 TO CAN IMPACT YOUR GENETICS, 3567 02:27:01,780 --> 02:27:02,347 RIGHT? 3568 02:27:02,347 --> 02:27:05,918 BRING ABOUT MORE OF YOUR GENETIC 3569 02:27:05,918 --> 02:27:08,787 PREDISPOSITION. 3570 02:27:08,787 --> 02:27:11,924 I HOPE THAT HELPS CLARIFY WHAT 3571 02:27:11,924 --> 02:27:12,391 WE WERE TALKING ABOUT. 3572 02:27:12,391 --> 02:27:15,360 AND IT'S DIFFICULT TO MEASURE 3573 02:27:15,360 --> 02:27:16,128 THE EXPOSOME. 3574 02:27:16,128 --> 02:27:17,663 ESPECIALLY WHEN WE'RE NOT 3575 02:27:17,663 --> 02:27:19,331 EXACTLY SURE HOW TO -- 3576 02:27:19,331 --> 02:27:21,600 ESPECIALLY IN THE CASE OF THE 3577 02:27:21,600 --> 02:27:25,571 HUMAN, HOW TO MEASURE THE 3578 02:27:25,571 --> 02:27:25,837 EXPOSOME. 3579 02:27:25,837 --> 02:27:28,040 WHAT FACTORS TO CONSIDER. 3580 02:27:28,040 --> 02:27:32,177 AND WHAT IS CORRELATED OR 3581 02:27:32,177 --> 02:27:36,248 ASSOCIATED OR BRINGS ABOUT 3582 02:27:36,248 --> 02:27:46,625 ALZHEIMER'S DISEASE. 3583 02:27:48,060 --> 02:27:50,362 >> LOOKS LIKE WE HAVE A COUPLE 3584 02:27:50,362 --> 02:27:52,164 HANDS RAISED. 3585 02:27:52,164 --> 02:27:54,066 WE'LL GO DALE AND THEN MOLLY 3586 02:27:54,066 --> 02:27:59,404 RICHARDS. 3587 02:27:59,404 --> 02:28:06,678 >> THIS QUESTION IS FOR WALTER. 3588 02:28:06,678 --> 02:28:10,115 DO YOU PLAN TO DO THIS 3589 02:28:10,115 --> 02:28:12,150 CONTINUATION OF WHAT WE'VE BEEN 3590 02:28:12,150 --> 02:28:15,387 THE LAST THREE DAYS, I'VE BEEN 3591 02:28:15,387 --> 02:28:19,424 IN ALL FIVE THAT YOU'VE HAD SO 3592 02:28:19,424 --> 02:28:19,591 FAR. 3593 02:28:19,591 --> 02:28:21,226 AND THE CONTINUATION, HOW THEY 3594 02:28:21,226 --> 02:28:26,698 BUILD ON ONE ANOTHER, IS REALLY 3595 02:28:26,698 --> 02:28:28,133 HELPFUL TO ME. 3596 02:28:28,133 --> 02:28:30,669 DO YOU HAVE THE FUNDING GOING 3597 02:28:30,669 --> 02:28:32,804 FORWARD IN ORDER TO DO IT AGAIN? 3598 02:28:32,804 --> 02:28:35,307 MAYBE THAT'S NOT A QUESTION YOU 3599 02:28:35,307 --> 02:28:37,209 CAN ANSWER RIGHT NOW BUT I'M 3600 02:28:37,209 --> 02:28:41,113 CURIOUS AND I SURE WOULD HOPE 3601 02:28:41,113 --> 02:28:46,318 THAT YOU CAN CONTINUE THIS INTO 3602 02:28:46,318 --> 02:28:46,885 THE FUTURE. 3603 02:28:46,885 --> 02:28:48,654 NEXT YEAR IS THE FUTURE I'M 3604 02:28:48,654 --> 02:28:49,921 TALKING ABOUT, THEN THE YEAR 3605 02:28:49,921 --> 02:28:51,823 AFTER THAT AND SO FORTH. 3606 02:28:51,823 --> 02:28:56,094 AS YOU FOLKS LEARN, AND PEOPLE 3607 02:28:56,094 --> 02:29:00,165 LIKE MYSELF LEARN FROM YOU. 3608 02:29:00,165 --> 02:29:03,201 >> HEY, DALE. 3609 02:29:03,201 --> 02:29:08,640 SO ADRIENNE MENTIONED WE REPORT 3610 02:29:08,640 --> 02:29:12,177 OUT TO THE ALZHEIMER'S ON THE 3611 02:29:12,177 --> 02:29:12,644 REGULAR BASIS. 3612 02:29:12,644 --> 02:29:15,347 THIS SUMMIT OCCURS EVERY THREE 3613 02:29:15,347 --> 02:29:16,448 YEARS, INTERSPERSED IS ANOTHER 3614 02:29:16,448 --> 02:29:16,915 SUMMIT. 3615 02:29:16,915 --> 02:29:20,485 I THINK THE NEXT IS ON 3616 02:29:20,485 --> 02:29:21,353 CAREGIVING WITH DEMENTIA, 3617 02:29:21,353 --> 02:29:22,921 PATIENTS WITH DEMENTIA, AND THEN 3618 02:29:22,921 --> 02:29:25,390 THE ONE AFTER THAT IS ON 3619 02:29:25,390 --> 02:29:26,158 ALZHEIMER'S DISEASE. 3620 02:29:26,158 --> 02:29:29,561 AND THEN WE WOULD COME BACK 3621 02:29:29,561 --> 02:29:30,762 AGAIN THREE YEARS LATER. 3622 02:29:30,762 --> 02:29:36,168 SO THAT'S HOW IT'S BEEN GOING ON 3623 02:29:36,168 --> 02:29:37,536 FOR -- WHAT NUMBER IS THIS? 3624 02:29:37,536 --> 02:29:42,474 THIS IS THE FIFTH, SO 15 YEARS. 3625 02:29:42,474 --> 02:29:43,008 ABOUT 15 YEARS. 3626 02:29:43,008 --> 02:29:46,845 WHETHER WE HAVE MONEY TO DO THE 3627 02:29:46,845 --> 02:29:48,680 RESEARCH IS NOT UP TO US. 3628 02:29:48,680 --> 02:29:49,748 IT'S UP TO YOUR REPRESENTATIVES 3629 02:29:49,748 --> 02:29:51,283 THAT YOU VOTED FOR. 3630 02:29:51,283 --> 02:29:56,521 >> I'LL DO MY PART ON THAT END. 3631 02:29:56,521 --> 02:29:59,224 AND MY MEMBERS OF THE SENATE AND 3632 02:29:59,224 --> 02:30:01,093 HOUSE ARE VERY SYMPATHETIC AND 3633 02:30:01,093 --> 02:30:02,327 SUPPORTIVE OF THIS. 3634 02:30:02,327 --> 02:30:05,497 I WISH IT WAS THE SAME ALL UP 3635 02:30:05,497 --> 02:30:07,899 AND DOWN, THE CATEGORY THAT 3636 02:30:07,899 --> 02:30:08,500 WE'RE DEALING WITH. 3637 02:30:08,500 --> 02:30:12,170 IT WOULD BE REALLY UNFORTUNATE 3638 02:30:12,170 --> 02:30:15,407 IF YOU LOST THE FUNDS FOR THIS. 3639 02:30:15,407 --> 02:30:18,677 WE WON'T GET INTO THE POLITICS. 3640 02:30:18,677 --> 02:30:20,379 ANYWAY, THANK YOU. 3641 02:30:20,379 --> 02:30:23,115 I WOULD HOPE THAT WE CAN 3642 02:30:23,115 --> 02:30:26,051 CONTINUE IT BECAUSE I'D LIKE TO 3643 02:30:26,051 --> 02:30:26,685 LEARN SOME MORE. 3644 02:30:26,685 --> 02:30:27,919 AS LONG AS I'M AROUND I WANT TO 3645 02:30:27,919 --> 02:30:31,990 BE ABLE TO LISTEN TO YOU GUYS 3646 02:30:31,990 --> 02:30:32,257 AND LEARN. 3647 02:30:32,257 --> 02:30:36,728 THANK YOU, WALTER. 3648 02:30:36,728 --> 02:30:37,562 >> YOU TOO, DALE. 3649 02:30:37,562 --> 02:30:41,333 WELCOME TO THE CLUB. 3650 02:30:41,333 --> 02:30:44,169 >> YES, THANK YOU, DALE. 3651 02:30:44,169 --> 02:30:50,575 MOLLY RICHARDS AND PENNY DACKS 3652 02:30:50,575 --> 02:30:58,517 PLEASE. 3653 02:30:58,517 --> 02:31:02,020 CAN YOU UNMUTE AND TURN YOUR 3654 02:31:02,020 --> 02:31:12,230 CAMERA ON? 3655 02:31:17,102 --> 02:31:17,769 >> OKAY, YES. 3656 02:31:17,769 --> 02:31:19,404 THIS IS A GREAT CONFERENCE. 3657 02:31:19,404 --> 02:31:21,339 I THANK YOU ALL FOR ALL THE HARD 3658 02:31:21,339 --> 02:31:21,540 WORK. 3659 02:31:21,540 --> 02:31:24,009 THIS IS MY FIRST TIME 3660 02:31:24,009 --> 02:31:25,744 PARTICIPATING AND ATTENDING 3661 02:31:25,744 --> 02:31:25,944 THIS. 3662 02:31:25,944 --> 02:31:27,679 MY HUSBAND BROUGHT SOMETHING TO 3663 02:31:27,679 --> 02:31:31,783 MY ATTENTION THIS MORNING THAT'S 3664 02:31:31,783 --> 02:31:32,851 AN EXECUTIVE ORDER 13950, I 3665 02:31:32,851 --> 02:31:35,887 DON'T KNOW IF YOU ALL LISTEN OR 3666 02:31:35,887 --> 02:31:40,225 HEARD ANYTHING ABOUT THIS. 3667 02:31:40,225 --> 02:31:41,593 AND IT'S A BILL, EXECUTIVE ORDER 3668 02:31:41,593 --> 02:31:45,263 THAT'S PUT OUT THERE TO 3669 02:31:45,263 --> 02:31:46,198 ELIMINATE ANYTHING, ANY 3670 02:31:46,198 --> 02:31:50,769 EDUCATION, ANYTHING THAT HAS TO 3671 02:31:50,769 --> 02:31:53,905 DO WITH DIVERSITY, ELIMINATED 3672 02:31:53,905 --> 02:31:56,174 FROM SCHOOLS, ELIMINATED IT FROM 3673 02:31:56,174 --> 02:31:57,676 FEDERAL ORGANIZATIONS, ET 3674 02:31:57,676 --> 02:31:58,443 CETERA, ET CETERA, ET CETERA. 3675 02:31:58,443 --> 02:32:02,714 I DON'T KNOW IF YOU ALL HEARD 3676 02:32:02,714 --> 02:32:04,149 ANYTHING ABOUT THIS. 3677 02:32:04,149 --> 02:32:05,851 WE'RE WRITING TO OUR CONGRESSMAN 3678 02:32:05,851 --> 02:32:06,952 AND DOING EVERYTHING WE CAN BUT 3679 02:32:06,952 --> 02:32:11,356 I DON'T KNOW IF YOU ALL HEARD 3680 02:32:11,356 --> 02:32:11,823 ABOUT IT. 3681 02:32:11,823 --> 02:32:12,791 >> OH, YEAH, ABSOLUTELY, YEAH, I 3682 02:32:12,791 --> 02:32:15,360 WOULD SAY A NUMBER OF OUR GRANTS 3683 02:32:15,360 --> 02:32:16,161 WERE CANCELED BECAUSE OF THAT 3684 02:32:16,161 --> 02:32:22,734 EXECUTIVE ORDER. 3685 02:32:22,734 --> 02:32:23,134 >> OKAY. 3686 02:32:23,134 --> 02:32:25,103 >> MOLLY, THANKS FOR YOUR HELP 3687 02:32:25,103 --> 02:32:26,438 ON THE COMMITTEE. 3688 02:32:26,438 --> 02:32:29,274 IT'S GREAT TO HEAR YOUR VOICE. 3689 02:32:29,274 --> 02:32:30,809 I WILL SAY I THINK, YOU KNOW, AS 3690 02:32:30,809 --> 02:32:32,844 SOMEBODY WHO HAS BEEN DOING 3691 02:32:32,844 --> 02:32:34,145 DISPARITIES RESEARCH FOR A LONG 3692 02:32:34,145 --> 02:32:35,780 TIME, I THINK IT'S A CHALLENGE 3693 02:32:35,780 --> 02:32:38,950 TO US TO BE CLEAR ABOUT EXACTLY 3694 02:32:38,950 --> 02:32:40,685 WHAT THE BARRIERS ARE AND WHY WE 3695 02:32:40,685 --> 02:32:45,557 NEED TO WORK TO OVERCOME THOSE 3696 02:32:45,557 --> 02:32:47,559 BARRIERS, AND REALLY EXPLAIN HOW 3697 02:32:47,559 --> 02:32:53,698 THOSE BARRIERS HARM EVERYONE IN 3698 02:32:53,698 --> 02:32:53,932 AMERICA. 3699 02:32:53,932 --> 02:32:55,934 THAT'S A -- PEOPLE IN THE 3700 02:32:55,934 --> 02:32:57,869 DISPARITIES COMMUNITY, WE HAVE A 3701 02:32:57,869 --> 02:32:59,037 TENDENCY TO USE SHORT HAND, SOME 3702 02:32:59,037 --> 02:33:00,805 IDEAS ARE FAMILIAR, WE DON'T 3703 02:33:00,805 --> 02:33:02,207 HAVE TO EXPLAIN ALL THE TIME, 3704 02:33:02,207 --> 02:33:04,409 BUT I THINK IT'S A MOMENT WE 3705 02:33:04,409 --> 02:33:08,480 NEED TO BE MORE CLEAR ABOUT WHAT 3706 02:33:08,480 --> 02:33:10,582 THE CHALLENGES ARE IN ORDER TO 3707 02:33:10,582 --> 02:33:13,818 MAKE SURE THAT FIRST OF ALL 3708 02:33:13,818 --> 02:33:14,819 WE'RE CONSISTENT, OBVIOUSLY WITH 3709 02:33:14,819 --> 02:33:16,288 LEGAL GUIDELINES, ALSO TO MAKE 3710 02:33:16,288 --> 02:33:20,959 SURE EVERYONE WHO IS WATCHING 3711 02:33:20,959 --> 02:33:21,793 OUR RESEARCH UNDERSTANDS WHY 3712 02:33:21,793 --> 02:33:23,662 IT'S SO IMPORTANT. 3713 02:33:23,662 --> 02:33:34,039 >> OKAY, THANK YOU. 3714 02:33:34,372 --> 02:33:38,476 >> WE'LL TAKE A MOMENT AND JUST 3715 02:33:38,476 --> 02:33:39,911 CELEBRATE, CELEBRATE ALL OF THE 3716 02:33:39,911 --> 02:33:42,047 RESEARCHERS, ALL OF THE NIH 3717 02:33:42,047 --> 02:33:43,615 STAFF, ALL OF THE ADVOCATES, 3718 02:33:43,615 --> 02:33:45,050 BECAUSE I THINK IF YOU STEP BACK 3719 02:33:45,050 --> 02:33:47,519 AND THINK ABOUT WHERE WERE WE 15 3720 02:33:47,519 --> 02:33:49,821 YEARS AGO, WHEN NAPA FIRST 3721 02:33:49,821 --> 02:33:51,323 LAUNCHED, THOSE OF US WITH 3722 02:33:51,323 --> 02:33:53,525 DEMENTIA IN OUR FAMILIES, IS IT 3723 02:33:53,525 --> 02:33:55,994 WHERE WE WANT IT TO BE? 3724 02:33:55,994 --> 02:33:56,261 NO. 3725 02:33:56,261 --> 02:33:58,263 BUT THOSE INVOLVED WITH THE 3726 02:33:58,263 --> 02:34:01,833 RESEARCH FACED A BIG BLACK BOX 3727 02:34:01,833 --> 02:34:02,300 NOBODY UNDERSTOOD. 3728 02:34:02,300 --> 02:34:04,769 WE'VE MADE LIGHT YEARS IN 3729 02:34:04,769 --> 02:34:05,704 PROGRESS UNDERSTANDING WHAT IS 3730 02:34:05,704 --> 02:34:12,143 CAUSING AND HOW WE CAN 3731 02:34:12,143 --> 02:34:14,746 INTERVENE. 3732 02:34:14,746 --> 02:34:16,114 THE FAMILIES HAVE MORE HOPE. 3733 02:34:16,114 --> 02:34:18,283 DO THEY HAVE THE TREATMENT THEY 3734 02:34:18,283 --> 02:34:19,884 NEED? 3735 02:34:19,884 --> 02:34:20,151 NO. 3736 02:34:20,151 --> 02:34:21,019 IS EVERYBODY GETTING DIAGNOSED? 3737 02:34:21,019 --> 02:34:23,555 NOT EVEN A LITTLE BIT. 3738 02:34:23,555 --> 02:34:24,789 BUT WE'RE SO MUCH CLOSER TO 3739 02:34:24,789 --> 02:34:26,725 THOSE TYPES OF TOOLS THAT CAN 3740 02:34:26,725 --> 02:34:28,627 IMPROVE PEOPLE'S LIVES AND IT'S 3741 02:34:28,627 --> 02:34:30,829 THANKS TO THE BIPARTISAN SUPPORT 3742 02:34:30,829 --> 02:34:32,530 FOR NAPA THAT WAS VISIONARY, 3743 02:34:32,530 --> 02:34:35,367 THANKS TO THE ADVOCATES, THANKS 3744 02:34:35,367 --> 02:34:40,171 TO THE RESEARCHERS WHO PUT SWEAT 3745 02:34:40,171 --> 02:34:42,307 EQUITY INTO MAKING PROGRESS. 3746 02:34:42,307 --> 02:34:45,143 THERE'S STRESS. 3747 02:34:45,143 --> 02:34:48,146 WE WANT SOLUTIONS BUT I WANTED 3748 02:34:48,146 --> 02:34:50,915 TO SAY THANK YOU. 3749 02:34:50,915 --> 02:34:54,719 >> THANK YOU SO MUCH FOR THOSE 3750 02:34:54,719 --> 02:34:56,154 REALLY KIND COMMENTS. 3751 02:34:56,154 --> 02:34:59,157 COULD NOT AGREE MORE. 3752 02:34:59,157 --> 02:35:02,661 >> THANK YOU TO THE NIH AND 3753 02:35:02,661 --> 02:35:03,495 NINDS FOR SUPPORTING THIS 3754 02:35:03,495 --> 02:35:04,062 RESEARCH. 3755 02:35:04,062 --> 02:35:14,372 THANK YOU SO MUCH. 3756 02:35:21,913 --> 02:35:23,448 >> WE HAVE ABOUT TEN MORE 3757 02:35:23,448 --> 02:35:30,755 MINUTES, IS THAT RIGHT? 3758 02:35:30,755 --> 02:35:32,691 NINE MORE MINUTES FOR OPEN 3759 02:35:32,691 --> 02:35:36,528 MICROPHONE TIME BEFORE WE WILL 3760 02:35:36,528 --> 02:35:41,266 MOVE TO THE SCIENTIFIC CHAIR'S 3761 02:35:41,266 --> 02:35:42,434 HIGHLIGHTS, KATE POSSIN, AND 3762 02:35:42,434 --> 02:35:45,070 SUMMARIES. 3763 02:35:45,070 --> 02:35:55,346 I'LL JUST WAIT. 3764 02:36:00,852 --> 02:36:03,588 IF NO ONE ELSE RAISES A HAND 3765 02:36:03,588 --> 02:36:04,589 WE'LL GO AHEAD WITH YOUR 3766 02:36:04,589 --> 02:36:06,558 SESSION, YOUR SLIDES. 3767 02:36:06,558 --> 02:36:08,159 >> VERY GOOD, I AGREE. 3768 02:36:08,159 --> 02:36:08,460 >> OKAY. 3769 02:36:08,460 --> 02:36:09,828 I'LL GIVE THE TEAM A MINUTE TO 3770 02:36:09,828 --> 02:36:14,733 GET THE SLIDES UP. 3771 02:36:14,733 --> 02:36:14,966 AWESOME. 3772 02:36:14,966 --> 02:36:15,400 >> GREAT. 3773 02:36:15,400 --> 02:36:18,870 SO, IT'S BEEN A REAL HONOR FOR 3774 02:36:18,870 --> 02:36:20,705 ME TO WORK ON THIS SUMMIT, AND 3775 02:36:20,705 --> 02:36:23,341 RIGHT NOW I'M GOING TO GIVE YOU 3776 02:36:23,341 --> 02:36:25,310 A SUMMARY OF SOME OF THE 3777 02:36:25,310 --> 02:36:27,112 CROSS-CUTTING THEMES FROM THE 3778 02:36:27,112 --> 02:36:32,884 THREE DAYS THAT WE'VE SPENT 3779 02:36:32,884 --> 02:36:34,953 TOGETHER. 3780 02:36:34,953 --> 02:36:35,253 NEXT SLIDE. 3781 02:36:35,253 --> 02:36:35,453 GREAT. 3782 02:36:35,453 --> 02:36:41,926 THANK YOU SO MUCH TO THOSE WHO 3783 02:36:41,926 --> 02:36:42,727 PARTICIPATED IN CREATING 3784 02:36:42,727 --> 02:36:43,595 RECOMMENDATIONS, GIVING INPUT 3785 02:36:43,595 --> 02:36:48,166 BEING USED TO SHAPE THESE 3786 02:36:48,166 --> 02:36:48,800 RECOMMENDATIONS. 3787 02:36:48,800 --> 02:36:49,434 RECOMMENDATIONS WE'VE PRESENTED 3788 02:36:49,434 --> 02:36:53,338 WERE DRAFTED BY NINE COMMITTEES 3789 02:36:53,338 --> 02:36:55,740 WITH 135 MEMBERS, MOSTLY 3790 02:36:55,740 --> 02:36:58,076 SCIENTISTS BUT ALSO EVERY 3791 02:36:58,076 --> 02:36:58,777 COMMITTEE INCLUDING PEOPLE WITH 3792 02:36:58,777 --> 02:37:00,145 LIVED EXPERIENCE AS WELL AS 3793 02:37:00,145 --> 02:37:03,548 PEOPLE WHO WORK IN GOVERNMENT 3794 02:37:03,548 --> 02:37:04,949 AND POLICY. 3795 02:37:04,949 --> 02:37:08,887 WE'VE PRESENTED THESE 3796 02:37:08,887 --> 02:37:09,387 RECOMMENDATIONS. 3797 02:37:09,387 --> 02:37:11,956 DRAFT RECOMMENDATIONS FOR YOUR 3798 02:37:11,956 --> 02:37:14,292 INPUT, HAD 11 LIVE PUBLIC INPUT 3799 02:37:14,292 --> 02:37:14,559 SESSIONS. 3800 02:37:14,559 --> 02:37:16,161 OVERALL THERE'S BEEN A HIGH 3801 02:37:16,161 --> 02:37:19,130 LEVEL OF PARTICIPATION AT THIS 3802 02:37:19,130 --> 02:37:19,430 SUMMIT. 3803 02:37:19,430 --> 02:37:21,466 WE HAD 2500 PEOPLE REGISTER FOR 3804 02:37:21,466 --> 02:37:22,467 THE SUMMIT. 3805 02:37:22,467 --> 02:37:23,635 AT THE APRIL MEETINGS, ACROSS 3806 02:37:23,635 --> 02:37:27,605 BOTH THE TEAMS MEETINGS AND 3807 02:37:27,605 --> 02:37:28,740 VIDEOCAST, WE HAD ABOUT A 3808 02:37:28,740 --> 02:37:32,477 THOUSAND PEOPLE AT ANY ONE TIME. 3809 02:37:32,477 --> 02:37:33,812 TODAY PARTICIPATION WAS A LITTLE 3810 02:37:33,812 --> 02:37:35,814 BIT LOWER, QUITE A BIT LOWER, 3811 02:37:35,814 --> 02:37:38,249 BUT I THINK STILL REALLY GOOD 3812 02:37:38,249 --> 02:37:42,287 INPUT TODAY. 3813 02:37:42,287 --> 02:37:43,588 TODAY WE HAD ABOUT 360 PEOPLE 3814 02:37:43,588 --> 02:37:44,889 ACROSS PLATFORMS. 3815 02:37:44,889 --> 02:37:46,991 IF WE INCLUDE OPPORTUNITY TO 3816 02:37:46,991 --> 02:37:48,693 VIEW ON DEMAND A LOT MORE PEOPLE 3817 02:37:48,693 --> 02:37:50,762 WILL VIEW THE SUMMIT. 3818 02:37:50,762 --> 02:37:53,298 FOR EXAMPLE, INCLUDING ON-DEMAND 3819 02:37:53,298 --> 02:37:54,732 VIEWS SO FAR ABOUT 1200 PEOPLE 3820 02:37:54,732 --> 02:38:00,171 HAVE SEEN DAY 1. 3821 02:38:00,171 --> 02:38:04,709 NEXT SLIDE. 3822 02:38:04,709 --> 02:38:06,477 I'LL GET TO SUMMARIZE SOME OF 3823 02:38:06,477 --> 02:38:08,179 THE THEMES NOW THAT WE HEARD 3824 02:38:08,179 --> 02:38:11,883 ABOUT ACROSS ALL OF THE 3825 02:38:11,883 --> 02:38:12,951 DIFFERENT SESSIONS. 3826 02:38:12,951 --> 02:38:17,789 SO ONE WE HEARD TALKED ABOUT BY 3827 02:38:17,789 --> 02:38:20,158 PENNY DACKS, THANK YOU, AND 3828 02:38:20,158 --> 02:38:21,359 THROUGHOUT, TREMENDOUS PROGRESS 3829 02:38:21,359 --> 02:38:23,561 IN ADRD SCIENCE, SINCE EVEN JUST 3830 02:38:23,561 --> 02:38:28,099 THE LAST SUMMIT THREE YEARS AGO. 3831 02:38:28,099 --> 02:38:30,235 THERE IS STRONG APPRECIATION 3832 02:38:30,235 --> 02:38:31,903 WE'VE HEARD FOR NIH'S INVESTMENT 3833 02:38:31,903 --> 02:38:40,578 AND FOR THE SCIENTIFIC PROGRESS 3834 02:38:40,578 --> 02:38:43,348 IN THE NASEM REPORT ON DAY 2, 3835 02:38:43,348 --> 02:38:44,983 SIGNIFICANT CONTINUED INVESTMENT 3836 02:38:44,983 --> 02:38:46,417 IN PRIORITY RESEARCH AREAS MUST 3837 02:38:46,417 --> 02:38:48,152 ADDRESS THE KNOWLEDGE GAPS. 3838 02:38:48,152 --> 02:38:50,288 SO THERE'S BEEN INCREDIBLE 3839 02:38:50,288 --> 02:38:53,791 PROGRESS BUT ALSO URGENCY TO 3840 02:38:53,791 --> 02:38:54,792 KEEP MOVING. 3841 02:38:54,792 --> 02:38:56,728 WE ARE SO MUCH, AS PENNY SAID, 3842 02:38:56,728 --> 02:38:58,429 SO MUCH CLOSER TO THE TOOLS THAT 3843 02:38:58,429 --> 02:39:01,833 WE NEED TO IMPROVE PEOPLE'S 3844 02:39:01,833 --> 02:39:02,033 LIVES. 3845 02:39:02,033 --> 02:39:03,401 WHEN CHOOSING RESEARCH 3846 02:39:03,401 --> 02:39:04,869 PRIORITIES PLEASE KEEP THE 3847 02:39:04,869 --> 02:39:06,371 POTENTIAL IMPACT ON PATIENTS AND 3848 02:39:06,371 --> 02:39:07,872 FAMILIES AT THE TOP OF MIND. 3849 02:39:07,872 --> 02:39:11,175 IN OTHER WORDS, WE NEED 3850 02:39:11,175 --> 02:39:15,013 PRIORITIZE DIAGNOSIS AND 3851 02:39:15,013 --> 02:39:19,584 TREATMENTS BUT ALSO PREVENTION. 3852 02:39:19,584 --> 02:39:21,886 DEMENTIA IS NOT POLITICAL. 3853 02:39:21,886 --> 02:39:24,989 ADVANCING RESEARCH HELPS ALL 3854 02:39:24,989 --> 02:39:25,757 AMERICANS. 3855 02:39:25,757 --> 02:39:27,125 NEXT SLIDE. 3856 02:39:27,125 --> 02:39:27,825 EMBRACE COMPLEXITY. 3857 02:39:27,825 --> 02:39:29,594 SEARCH THIS IS SOMETHING THAT 3858 02:39:29,594 --> 02:39:31,329 WAS MENTIONED IN BOTH OF THE 3859 02:39:31,329 --> 02:39:33,531 SESSIONS TODAY, AS WELL AS FIRST 3860 02:39:33,531 --> 02:39:34,299 TWO DAYS. 3861 02:39:34,299 --> 02:39:37,769 DIAGNOSIS OF ADRD IS NOT A 3862 02:39:37,769 --> 02:39:39,737 YES/NO SITUATION. 3863 02:39:39,737 --> 02:39:42,974 ADRD HAS MANY CAUSES. 3864 02:39:42,974 --> 02:39:45,543 AND MIXED DEMENTIA IS IN FACT 3865 02:39:45,543 --> 02:39:48,146 MORE COMMON THAN SINGLE ETIOLOGY 3866 02:39:48,146 --> 02:39:48,446 DEMENTIA. 3867 02:39:48,446 --> 02:39:52,150 ADRD IS CAUSED BY MULTI-FACETED 3868 02:39:52,150 --> 02:39:53,952 INTERPLAY OF BIOLOGICAL, 3869 02:39:53,952 --> 02:39:55,653 GENETIC, ENVIRONMENTAL, SOCIAL, 3870 02:39:55,653 --> 02:39:56,087 BEHAVIORAL ELEMENTS. 3871 02:39:56,087 --> 02:39:57,355 UNDERSTANDING THESE DISEASES WE 3872 02:39:57,355 --> 02:40:01,059 NEED TO INTEGRATE DIVERSE DATA 3873 02:40:01,059 --> 02:40:02,627 SOURCES, PROSPECTIVES AND 3874 02:40:02,627 --> 02:40:02,860 METHODS. 3875 02:40:02,860 --> 02:40:06,664 MOST PATIENTS HAVE MIX THE 3876 02:40:06,664 --> 02:40:06,965 ETIOLOGIES. 3877 02:40:06,965 --> 02:40:08,166 POST TBI SESSION HIGHLIGHTED 3878 02:40:08,166 --> 02:40:12,971 THIS AS POST TBI IS AN MED. 3879 02:40:12,971 --> 02:40:16,107 WE NEED TO IMPROVE MED CODING IN 3880 02:40:16,107 --> 02:40:17,442 ELECTRONIC HEALTH RECORD TO 3881 02:40:17,442 --> 02:40:21,145 IMPROVE CARE AND DATA 3882 02:40:21,145 --> 02:40:22,347 HARMONIZATION, ADVANCE AND APPLY 3883 02:40:22,347 --> 02:40:23,481 ARTIFICIAL INTELLIGENCE METHODS 3884 02:40:23,481 --> 02:40:31,289 TO EMBRACE THIS COMPLEXITY. 3885 02:40:31,289 --> 02:40:32,657 NEXT SLIDE. 3886 02:40:32,657 --> 02:40:39,030 WE NEED COLLABORATIVE APPROACHES 3887 02:40:39,030 --> 02:40:40,164 AT MULTIPLE LEVELS, MOVE TO 3888 02:40:40,164 --> 02:40:41,499 BROAD DATA SHARING, MENTIONED IN 3889 02:40:41,499 --> 02:40:44,669 EVERY SESSION OF THE SUMMIT. 3890 02:40:44,669 --> 02:40:46,838 WE NEED INEXPENSIVE BIOMARKERS 3891 02:40:46,838 --> 02:40:50,942 THAT CAN BE WIDELY COLLECTED. 3892 02:40:50,942 --> 02:40:52,543 LEVERAGE PRIVATE/PUBLIC 3893 02:40:52,543 --> 02:40:53,244 PARTNERSHIPS IN DATA 3894 02:40:53,244 --> 02:40:55,346 REPOSITORIES AND MOVE TO COMMON 3895 02:40:55,346 --> 02:40:59,484 DEFINITIONS AND NOMENCLATURE. 3896 02:40:59,484 --> 02:41:01,652 WE NEED TO ENGAGE A VARIETY OF 3897 02:41:01,652 --> 02:41:03,788 STAKEHOLDERS IN ALL STAGES OF 3898 02:41:03,788 --> 02:41:08,159 RESEARCH INCLUDING PEOPLE WITH 3899 02:41:08,159 --> 02:41:09,127 LIVED EXPERIENCE. 3900 02:41:09,127 --> 02:41:14,198 WE NEED TO CONTINUE VALUED 3901 02:41:14,198 --> 02:41:16,167 PARTNERSHIPS ACROSS FEDERAL 3902 02:41:16,167 --> 02:41:16,667 AGENCIES, PUBLIC/PRIVATE 3903 02:41:16,667 --> 02:41:18,336 PARTNERSHIPS HAVE BEEN CRUCIAL 3904 02:41:18,336 --> 02:41:21,606 FOR ADVANCING SCIENCE AND MUST 3905 02:41:21,606 --> 02:41:24,008 CONTINUE, AND NIH SUPPORT IS 3906 02:41:24,008 --> 02:41:24,275 CRITICAL. 3907 02:41:24,275 --> 02:41:26,210 MULL DISCIPLINARY RESEARCH TO 3908 02:41:26,210 --> 02:41:27,812 TACKLE COMPLEX PROBLEMS IS 3909 02:41:27,812 --> 02:41:29,480 NEEDED, AND IMPORTANCE OF 3910 02:41:29,480 --> 02:41:31,315 COLLABORATION AND CARE PATHWAYS 3911 02:41:31,315 --> 02:41:35,920 IN IMPROVING ACCESS TO CARE IS 3912 02:41:35,920 --> 02:41:39,190 ALSO ESSENTIAL. 3913 02:41:39,190 --> 02:41:39,657 NEXT SLIDE. 3914 02:41:39,657 --> 02:41:42,693 BIOMARKERS IS A HUGE THEME, AN 3915 02:41:42,693 --> 02:41:44,362 AREA WITH TREMENDOUS PROGRESS IN 3916 02:41:44,362 --> 02:41:46,097 THE LAST FEW YEARS. 3917 02:41:46,097 --> 02:41:53,237 THEY ARE KEY TO DISENTANGLING 3918 02:41:53,237 --> 02:41:54,572 HETEROGENEITY FOR EVERYTHING 3919 02:41:54,572 --> 02:41:55,473 FROM DISEASE MECHANISMS TO 3920 02:41:55,473 --> 02:41:58,176 CLINICAL TRIALS. 3921 02:41:58,176 --> 02:42:00,945 THEY ARE CRITICAL FOR DIAGNOSIS. 3922 02:42:00,945 --> 02:42:03,214 AN IMPORTANT EXAMPLE IS THAT 3923 02:42:03,214 --> 02:42:07,051 LATE IS ONLY DIAGNOSED AT 3924 02:42:07,051 --> 02:42:07,318 AUTOPSY. 3925 02:42:07,318 --> 02:42:09,087 WE NEED BETTER BIOMARKERS SO WE 3926 02:42:09,087 --> 02:42:12,056 CAN DIAGNOSE PEOPLE IN LIFE TO 3927 02:42:12,056 --> 02:42:15,359 MAKE FASTER PROGRESS IN OUR 3928 02:42:15,359 --> 02:42:17,462 RESEARCH. 3929 02:42:17,462 --> 02:42:18,863 AND PEOPLE WITH POST-TBI, 3930 02:42:18,863 --> 02:42:20,364 ANOTHER AREA WE NEED BETTER 3931 02:42:20,364 --> 02:42:23,401 BIOMARKERS TO DISENTANGLE WHAT'S 3932 02:42:23,401 --> 02:42:25,336 GOING ON FOR EACH PATIENT. 3933 02:42:25,336 --> 02:42:29,574 BIOMARKERS ARE CRITICAL FOR 3934 02:42:29,574 --> 02:42:30,308 MONITORING, ESPECIALLY FOR 3935 02:42:30,308 --> 02:42:31,409 THERAPEUTIC AGENTS, AND ACCESS 3936 02:42:31,409 --> 02:42:34,612 TO BIOMARKERS IS PART OF 3937 02:42:34,612 --> 02:42:37,048 SCALABLE DIAGNOSTIC PATHWAYS IS 3938 02:42:37,048 --> 02:42:37,348 NEEDED. 3939 02:42:37,348 --> 02:42:40,084 WE HEARD TODAY ABOUT A COMMENT A 3940 02:42:40,084 --> 02:42:45,389 NEED FOR NON-SPECIFIC BIOMARKES 3941 02:42:45,389 --> 02:42:46,457 AND LOW COST TOOLS TO DETERMINE 3942 02:42:46,457 --> 02:42:48,159 WHO NEEDS TO BE SEEN BY A 3943 02:42:48,159 --> 02:42:52,530 SPECIAL IST. 3944 02:42:52,530 --> 02:42:54,732 THE FIFTH THEME IS THE LAST 3945 02:42:54,732 --> 02:42:57,135 THEME I'M HIGHLIGHTING NOW, 3946 02:42:57,135 --> 02:42:58,236 FOSTER INCLUSIVE RESEARCH AND 3947 02:42:58,236 --> 02:43:00,671 ACCESS TO CARE. 3948 02:43:00,671 --> 02:43:03,508 DISPARITIES RESEARCH HAS BEEN 3949 02:43:03,508 --> 02:43:05,243 AND CONTINUES TO BE A HIGH 3950 02:43:05,243 --> 02:43:05,776 PRIORITY FOR NIH. 3951 02:43:05,776 --> 02:43:09,981 WE NEED TO STUDY THE POPULATIONS 3952 02:43:09,981 --> 02:43:12,617 MOST AT RISK FOR ADRD. 3953 02:43:12,617 --> 02:43:15,453 DISPARITIES ARE AN OPPORTUNITY 3954 02:43:15,453 --> 02:43:17,288 FOR PROGRESS. 3955 02:43:17,288 --> 02:43:18,723 AND SOLUTIONS ARE WITHIN OUR 3956 02:43:18,723 --> 02:43:21,659 REACH, WE HEARD FROM DR. GLYMOUR 3957 02:43:21,659 --> 02:43:21,859 TODAY. 3958 02:43:21,859 --> 02:43:24,095 WE NEED REQUIRE INCLUSION OF 3959 02:43:24,095 --> 02:43:25,530 POPULATIONS MOST AT RISK. 3960 02:43:25,530 --> 02:43:28,366 THANK YOU FOR THAT COMMENT 3961 02:43:28,366 --> 02:43:29,333 DURING AN OPEN SESSION. 3962 02:43:29,333 --> 02:43:33,070 WE NEED TO ADVANCE RESEARCH TO 3963 02:43:33,070 --> 02:43:37,341 HELP THE MOST VULNERABLE ACCESS 3964 02:43:37,341 --> 02:43:41,212 THE CARE THEY NEED, WE NEED GENE 3965 02:43:41,212 --> 02:43:42,113 OILIC AND MULTI-OMIC DATA THAT 3966 02:43:42,113 --> 02:43:44,148 ARE REPRESENTATIVE AND THINK 3967 02:43:44,148 --> 02:43:47,084 ABOUT HOW WE DISSEMINATE WORK TO 3968 02:43:47,084 --> 02:43:48,352 THE COMMUNITIES AFFECTED 3969 02:43:48,352 --> 02:43:51,255 INCLUDING ADVOCACY GROUPS. 3970 02:43:51,255 --> 02:43:52,323 DISSEMINATION OF THE 3971 02:43:52,323 --> 02:43:54,091 RECOMMENDATIONS FROM THE SUMMIT 3972 02:43:54,091 --> 02:43:59,263 AS WELL AS OUR SCIENTIFIC 3973 02:43:59,263 --> 02:44:00,131 PROGRESS. 3974 02:44:00,131 --> 02:44:00,431 NEXT SLIDE. 3975 02:44:00,431 --> 02:44:03,034 WE HAD TWO FINAL SESSIONS TODAY, 3976 02:44:03,034 --> 02:44:03,935 I'M GOING TO SUMMARIZE SOME 3977 02:44:03,935 --> 02:44:06,404 COMMENTS THAT I HEARD THAT I 3978 02:44:06,404 --> 02:44:07,905 KNOW THAT THE COMMITTEES ARE 3979 02:44:07,905 --> 02:44:09,540 ALREADY THINKING ABOUT HOW WE 3980 02:44:09,540 --> 02:44:11,642 CAN MAKE SURE THESE COMMENTS ARE 3981 02:44:11,642 --> 02:44:14,445 ADDRESSED IN OUR 3982 02:44:14,445 --> 02:44:15,112 RECOMMENDATIONS. 3983 02:44:15,112 --> 02:44:16,247 SO, ONE OVERARCHING SET OF 3984 02:44:16,247 --> 02:44:17,281 COMMENTS WAS THAT THE RESEARCH 3985 02:44:17,281 --> 02:44:21,085 IN THIS AREA NEEDS TO EMPHASIZE 3986 02:44:21,085 --> 02:44:22,053 BOTH PREVENTION AND TREATMENT, 3987 02:44:22,053 --> 02:44:25,656 AS WELL AS MEDICAL AND 3988 02:44:25,656 --> 02:44:26,657 NON-MEDICAL RESOURCES AND 3989 02:44:26,657 --> 02:44:27,258 APPROACHES. 3990 02:44:27,258 --> 02:44:29,193 WE NEED BETTER STRUCTURES AND 3991 02:44:29,193 --> 02:44:30,161 MECHANISMS TO SUPPORT EVERYONE 3992 02:44:30,161 --> 02:44:34,332 WHO WANTS TO DO GOOD SCIENCE ON 3993 02:44:34,332 --> 02:44:34,599 DEMENTIA. 3994 02:44:34,599 --> 02:44:36,200 WE HEARD AN IMPORTANT EXPERIENCE 3995 02:44:36,200 --> 02:44:38,603 OF SOMEBODY WHO IS TRYING TO 3996 02:44:38,603 --> 02:44:42,506 ADVANCE RESEARCH BUT LIVING IN A 3997 02:44:42,506 --> 02:44:47,712 RURAL AREA, IDENTIFIES AS BEING 3998 02:44:47,712 --> 02:44:50,314 ASIAN AND DON'T FEEL LIKE PRIOR 3999 02:44:50,314 --> 02:44:52,149 STRUCTURES AND MECHANISMS WERE 4000 02:44:52,149 --> 02:44:53,517 ADEQUATE TO SUPPORT SOMEONE LIKE 4001 02:44:53,517 --> 02:44:54,252 HER. 4002 02:44:54,252 --> 02:44:55,186 WE WANT TO SUPPORT EVERYONE 4003 02:44:55,186 --> 02:44:58,856 INTERESTED IN DOING GOOD SCIENCE 4004 02:44:58,856 --> 02:44:59,090 ON ADRD. 4005 02:44:59,090 --> 02:45:00,157 UNDERSTAND MULTIPLE ETIOLOGIES 4006 02:45:00,157 --> 02:45:02,360 AND HOW THEY VARY ACROSS 4007 02:45:02,360 --> 02:45:03,761 DIFFERENT POPULATIONS WAS 4008 02:45:03,761 --> 02:45:04,895 ANOTHER COMMENT. 4009 02:45:04,895 --> 02:45:06,631 AND THEN AGAIN DATA 4010 02:45:06,631 --> 02:45:07,798 HARMONIZATION IS CRUCIAL. 4011 02:45:07,798 --> 02:45:13,771 WE NEED TO ADDRESS TECHNICAL BUT 4012 02:45:13,771 --> 02:45:15,806 SOLVABLE PROBLEMS ON DATA 4013 02:45:15,806 --> 02:45:19,477 HARMONIZATION, AND SESSION 9, ON 4014 02:45:19,477 --> 02:45:21,979 THE EXPOSOME, WE GOT A GOOD 4015 02:45:21,979 --> 02:45:23,881 COMMENT ABOUT HOW WE NEED TO 4016 02:45:23,881 --> 02:45:26,284 MAKE SURE THAT OUR 4017 02:45:26,284 --> 02:45:27,818 RECOMMENDATIONS ON THE EXPOSOME 4018 02:45:27,818 --> 02:45:30,655 CONSIDER DIFFERENT CAUSES OF 4019 02:45:30,655 --> 02:45:31,856 DEMENTIA BECAUSE THERE'S 4020 02:45:31,856 --> 02:45:33,591 DIFFERENT RISK FACTORS FOR 4021 02:45:33,591 --> 02:45:34,892 DIFFERENT CAUSES OF DEMENTIA SO 4022 02:45:34,892 --> 02:45:36,594 THERE ARE SOME RESEARCH 4023 02:45:36,594 --> 02:45:38,362 QUESTIONS WHERE IT'S APPROPRIATE 4024 02:45:38,362 --> 02:45:39,997 TO LUMP DEMENTIAS TOGETHER AND 4025 02:45:39,997 --> 02:45:41,299 OTHERS WHERE WE NEED TO TEASE 4026 02:45:41,299 --> 02:45:44,435 THEM APART BUT IN ORDER TO 4027 02:45:44,435 --> 02:45:46,504 UNDERSTAND THESE RELATIONSHIPS 4028 02:45:46,504 --> 02:45:47,705 WE NEED LARGE NUMBERS, A LOT OF 4029 02:45:47,705 --> 02:45:49,607 POWER, AND SO THAT DRIVES 4030 02:45:49,607 --> 02:45:52,176 SCIENTISTS TO USE DATASETS LIKE 4031 02:45:52,176 --> 02:45:54,845 CLAIMS WHICH UNFORTUNATELY ARE 4032 02:45:54,845 --> 02:45:57,214 AFFECTED BY INACCURACIES IN 4033 02:45:57,214 --> 02:45:57,481 DIAGNOSIS. 4034 02:45:57,481 --> 02:45:59,183 SO REALLY SOLUTIONS DISCUSSED 4035 02:45:59,183 --> 02:46:03,421 THAT WE NEED TO ADVANCE INCLUDE 4036 02:46:03,421 --> 02:46:04,055 DATASET HARMONIZATION, MULTIPLE 4037 02:46:04,055 --> 02:46:05,790 EXPOSOME MODELING THAT MAY BE 4038 02:46:05,790 --> 02:46:07,992 MORE INDICATIVE FOR CERTAIN 4039 02:46:07,992 --> 02:46:09,060 CAUSES OF DEMENTIA, AND ALSO OF 4040 02:46:09,060 --> 02:46:12,163 COURSE AGAIN WE NEED TO ALSO DO 4041 02:46:12,163 --> 02:46:13,230 RESEARCH THAT PRIORITIZE FACTORS 4042 02:46:13,230 --> 02:46:14,965 COMMON ACROSS DEMENTIAS WHERE 4043 02:46:14,965 --> 02:46:17,835 THERE MAY BE OPPORTUNITY FOR 4044 02:46:17,835 --> 02:46:19,937 HIGH IMPACT. 4045 02:46:19,937 --> 02:46:22,206 AND LAST SLIDE, I WANT TO THANK 4046 02:46:22,206 --> 02:46:24,842 EVERYBODY IN CLOSING WHO 4047 02:46:24,842 --> 02:46:25,943 PARTICIPATED IN DRAFTING THESE 4048 02:46:25,943 --> 02:46:27,111 RECOMMENDATIONS AND WHO TOOK THE 4049 02:46:27,111 --> 02:46:29,113 TIME TO LISTEN TO PART OR ALL OF 4050 02:46:29,113 --> 02:46:31,048 THE SUMMIT AND PROVIDE USUAL 4051 02:46:31,048 --> 02:46:31,515 INPUT. 4052 02:46:31,515 --> 02:46:34,885 THIS IS WHY WE ARE HERE. 4053 02:46:34,885 --> 02:46:37,154 I'M SO HONORED TO THINK ABOUT 4054 02:46:37,154 --> 02:46:39,390 ALL OF THE INPUT FROM MEMBERS OF 4055 02:46:39,390 --> 02:46:41,058 OUR COMMUNITY HERE TODAY AND AT 4056 02:46:41,058 --> 02:46:44,161 THE PRIOR TWO DAYS, AND TO WORK 4057 02:46:44,161 --> 02:46:46,097 WITH THE REST OF THE COMMITTEE 4058 02:46:46,097 --> 02:46:48,733 LEADS TO NOW REALLY BE 4059 02:46:48,733 --> 02:46:50,968 THOUGHTFUL ABOUT INCORPORATING 4060 02:46:50,968 --> 02:46:53,070 THAT INPUT AS WE FINALIZE 4061 02:46:53,070 --> 02:46:54,638 RECOMMENDATIONS THAT WILL BE 4062 02:46:54,638 --> 02:46:57,708 PRESENTED TO NIH COUNCIL. 4063 02:46:57,708 --> 02:47:01,345 I WANT TO THANK AGAIN OUR 4064 02:47:01,345 --> 02:47:03,647 AMAZING COLLEAGUES AT NIH, 4065 02:47:03,647 --> 02:47:08,352 NINDS, AND NIA WHO HAVE LED THIS 4066 02:47:08,352 --> 02:47:10,621 PROCESS TO DRAFT RECOMMENDATIONS 4067 02:47:10,621 --> 02:47:12,923 AND THAT CONTINUE TO WORK SO 4068 02:47:12,923 --> 02:47:15,226 HARD TO HELP SCIENTISTS TO KEEP 4069 02:47:15,226 --> 02:47:16,394 THIS WORK MOVING FORWARD. 4070 02:47:16,394 --> 02:47:18,629 SO THANK YOU ALL. 4071 02:47:18,629 --> 02:47:21,766 AND WITH THIS I WILL CLOSE THE 4072 02:47:21,766 --> 02:47:23,334 SUMMIT TODAY. 4073 02:47:23,334 --> 02:47:28,172 [END OF PROGRAM] 4074 02:47:28,172 --> 02:47:32,109 4075 02:47:32,109 --> 02:47:42,153