>> WELCOME TO TODAY'S FOCUS ON
AGING FEDERAL PARTNERS WEBINAR
SERIES WEBINAR.
NEXT SLIDE PLEASE.
OUR WEBINAR TODAY IS ENTITLED
PROMOTING HEALTHY AGING TO
REDUCE DEMENTIA RISK AS A NEW
NATIONAL GOAL.
IF YOU HAVE QUESTIONS TODAY THAT
YOU WOULD LIKE TO SUBMIT TO HAVE
THEM ANSWERED, PLEASE CLICK ON
THE LIVE FEEDBACK BUTTON AS YOU
SEE HERE ON THE SLIDE BESIDE
THIS BIG YELLOW ARROW AT THE
BOTTOM OF THE VIDEO CAST PAGE TO
SUBMIT YOUR QUESTION.
WE WILL TAKE ALL QUESTIONS AT
THE END OF THE SESSION AND WE
WILL DO OUR BEST TO GET LIEU AS
MANY OF THOSE AS POSSIBLE IN
ADDITION TO SOME OF THE
QUESTIONS YOU HAVE SUBMITTED TO
US IN ADVANCE.
NEXT SLIDE.
I'M DR. LISA MACGUIRE CENTERS
FOR DISEASE CONTROL AND
PREVENTION.
I WILL SERVE AS YOUR MODERATOR
TODAY.
NEXT SLIDE.
THE NATIONAL ALZHEIMER'S PLAN WE
SEE OPT RIGHT HAND SIDE OF THE
SCREEN HAS HAD UNTIL 2021 FIVE
VERY AMBITIOUS GOALS.
NEXT SLIDE PLEASE.
IN 2020, THE ADVISORY COUNCIL
ASKED MYSELF AS WELL AS MY
COLLEAGUES TO FORM AN AD HOC
SUBCOMMITTEE TO EXPLORE THE
EVIDENCE ON RISK REDUCTION AND
TO PRESENT OUR FINDINGS AND OUR
OUTCOMES TO THE ADVISORY COUNCIL
DURING THE JULY 2021 MEETING.
I SERVE AS THE FEDERAL ADVISORY
COUNCIL MEMBER TO LEAD THIS
EFFORT AND I ENLISTED A COUPLE
OF MY COLLEAGUES FROM OTHER
ORGANIZATIONS.
FIRST MATTHEW BOMB BART, VICE
PRESIDENT OF HEALTH AND POLICY
AT THE ALZHEIMER'S ASSOCIATION
AND KELLY O'BRIEN, DIRECTOR OF
BRAIN ECHO SYSTEMS AGAINST
ALZHEIMER'S DISEASE TO SERVE AS
CO-CHAIRS.
WE IDENTIFIED EIGHT WORK GROUP
CO-CHAIRS THAT I WILL SHOW YOU
IN A SECOND AND WE COLLECTIVELY
IDENTIFIED THE RISK FACTORS THAT
WE WANTED TO EXAMINE AS WELL AS
INVITED PEOPLE BASED ON THEIR
EXPERTISE TO JOIN THIS WORK
GROUP OR THESE WORK GROUPS.
NEXT SLIDE PLEASE.
THE FIRST WORK GROUP YOU SEE
HERE WAS LED BY DR. JOSHUA C
CHODES AND THEY LOOKED AT
OBESITY DIET SLEEP AND TRAUMATIC
BRAIN INJURY WITH A SERIES OF
EXPERTS THEY INVITED.
THE NEXT WORK GROUP WAS LED BY
DR. LOUR RA WETSALL AND CAROLINA
COATS AND THEY LOOK AT PHYSICAL
ACTIVITY TOBACCO USE AND
ALCOHOL.
NEXT SLIDE PLEASE.
THE THIRD WORK GROUP WAS LED
BYE-BYE JOE CHUNG AND MARILYN
ALBERT WHO LOOKED AT SOCIAL ICE
LAKES, DEPRESSION HEARING LOSS
AND COGNITIVE ACTIVITY.
NEXT SLIDE PLEASE.
THE FOURTH WORK GROUP WAS LED BY
(INDISCERNIBLE) DR. REBECCA
GOTTESMAN AND THEY LOOKED AT
HYPERTENSION, HYPERLIPIDEMIA AND
DIABETES.
WHILE WE DON'T KNOW FOR CERTAIN
WHAT IF ANYTHING CAN PREVENT
ALZHEIMER'S DISEASE, WE DO KNOW
THAT THERE'S SOME GOOD EVIDENCE
TO SUGGEST THAT THERE ARE
SEVERAL MODIFIABLE RISK FACTORS
THAT MIGHT LOWER PERSON'S CHANCE
IN DEVELOPING ALZHEIMER'S
DISEASE OR DELAY ONSET WHILE
PROMOTING HEALTHY AGING.
THESE TEN RISK FACTORS WERE THE
ONES IDENTIFYD BY OUR WORK GROUP
MEMBERS IN OUR AD HOC ADVISORY
COUNCIL MEETING HAVING EVIDENCE
AS BEING IMPACTFUL AND BEING
RIGHT FOR PUBLIC HEALTH
INTERVENTION.
THIS GRAPHIC SHOWS US THE
DIFFERENT GOALS OF THE NATIONAL
ALZHEIMER'S PROJECT ACT, THE
NATIONAL PLAN, 2021 UPDATE, IT
SHOWS US THE FIVE GOALS AND
ADDITION OF SIX GOAL THAT WAS
ADDED TO THE 2021 PLAN WHICH IS
ACCELERATE ACTION TO PROMOTE
HEALTHY AGING AND REDUCE RISK
FACTORS FOR ALLS MYOMERE'S
DISEASE AND PREVENTION.
THIS GRAPHIC SHOWS US ON THE
DISEASE TRAJECTORY OF
ALZHEIMER'S DISEASE AND RELATED
DEMENTIA WHERE THE RISK FACTORS
LIE.
IN JULY OF 2021, THE ADVISORY
COUNCIL UNANIMOUSLY SUPPORTED
THE ADDING OF A PERMANENT RISK
REDUCTION SUBCOMMITTEE TO THE
ADVISORY COUNCIL AS WELL AS NEW
GOAL 6.
THIS IS THE FIRST GOAL ADDED TO
THE PLAN SINCE FORMATION IN
2021.
OUR WEBINAR WILL EXPLORE THE
LATE eSCIENCE ADVANCES ON RISK
REDUCTION AND IMPORTANCE OF
INCLUSION OF RISK REDUCTION AS
NATIONAL PRIORITY.
PRESENTERS WILL SHARE ACTIONS
THAT CAN BE TAKEN BY PUBLIC
HEALTH PROFESSIONALS, HEALTHCARE
PROVIDERS, AND COMMUNITY SERVICE
ORGANIZATIONS.
THE CROSS CUTTING THEME OF
SOCIAL DETERMINANTS OF HEALTH
WILL ALSO BE ADDRESSED IN EACH
OF OUR PRESENTATIONS.
I HAVE A GROUP OF AMAZING
PRESENTERS THAT ARE GOING TO
SPEAK TO YOU TODAY.
OUR FIRST PRESENTERS DR. SHERRY,
SHE'S THE DEPUTY ASSISTANT
SECRETARY FOR BEHAVIORAL HEALTH
DISABILITY AND AGING POLICY
WITHIN THE OFFICE OF THE
ASSISTANT SECRETARY FOR PLANNING
AND EVALUATION OR ASPE AT U.S.
DEPARTMENT OF HEALTH AND YUM
SERVICES.
WITHIN HER ROLE AT ASPE HER
OFFICE OVERSEES THE
IMPLEMENTATION OF THE NATIONAL
ALZHEIMER'S PROJECT ACT AND
COORDINATES POLICY DEVELOPMENT
RELATED TO AGING AND DEMENTIA
ACROSS HHS.
OUR NEXT SPEAKER IS DR. LAURA
BAKER.
DR. BACKER IS PROFESSOR OF
INTERNAL MEDICINE NEUROLOGY AND
PUBLIC HEALTH SERVICES AND
ASSOCIATE DIRECTOR OF THE WAKE
FOREST ALZHEIMER'S DISEASE
RESEARCH CENTER.
HER WORK FOCUSES ON COGNITIVE
AGING AND NON-PHARMACOLOGICAL
INTERVENTIONS TO PROTECT BRAIN
HEALTH AND PREVENT COGNITIVE
DECLINE, ALZHEIMER'S DISEASE AND
OTHER DEMENTIAS.
CURRENTLY SHE IS THE PI OR CO-PI
OF FOUR LARGE NATIONAL CLINICAL
SETTINGS THAT COLLECTIVELY
ENROLLEENROLL NEARLY 10,000 OLDER ADULT
PARTICIPANTS.
OUR THIRD SPEAKER IS MR. MATTHEW
BOMGART, VICE PRESIDENT OF
PUBLIC POLICY ALZHEIMER'S
ASSOCIATION LEADING A RANGE OF
PROJECTS AT THE POLICY AND
HEALTH PROGRAMS.
HE HAS CENTER OF SELECTION ON
DEMENTIA RISK REDUCTION FUNDED
BY THE CDC.
IN ADDITION, MR. BOMGART LEADS
ASSOCIATION GLOBAL POLICY
EFFORTS AND WORKS ON THE
ASSOCIATIONS ECONOMIC DATA,
ECONOMIC DATA AND MODELING
PROJECTS.
PRIOR TO JOINING THE ASSOCIATION
HE SPENT NEARLY 20 YEARS WORKING
IN THE U.S. SENATE.
OUR NEXT SPEAKER, IS DR.
ANN-MARIE NAVARRE.
A PREVENTIVE CARDIOLOGIST IN
ASSOCIATE PROFESSOR OF MEDICINE
IN THE DIVISION OF CARDIOLOGY AT
THE UNIVERSITY OF TEXAS SOUTH
WESTERN MEDICAL CENTER.
HER RESEARCH FOCUSES ON BLOOD
PRESSURE AND CHOLESTEROL
LOWERING FOR CARDIOVASCULAR
DISEASE PREVENTION.
SHE IS A DEPUTY EDITOR AT THE
JAMA CARDIOLOGY AND BOARD MEMBER
OF THE AMERICAN SOCIETY OF
PREVENTATIVE CARDIOLOGY.
MR. DONALD SMITH PRIOR TO
JOINING TEXAS HEALTHY AGING AT
HOME AS CEO, HE WAS EMPLOYED AS
THE EXECUTIVE DIRECTOR OF THE
TARROT COUNTY AREA AGENCY ON
AGING, OUTED WAY OF TEAR RANT
COUNTY, IN FORT WORTH TEXAS FOR
15 YEARS, DEGREES IN GERONTOLOGY
AND URBAN AFFAIRS AND 35 YEARS
EXPERIENCE WORKING IN HEALTH
HUMAN SERVICE AND GOVERNMENTAL
ORGANIZATIONS IN FOUR AREA
AGENCIES ON AGING.
NOW, NEXT SLIDE PLEASE.
WE WILL THEN FOLLOW WITH A Q&A
SECTION.
HERE IS A LIST OF SOME RESOURCES
AND I THINK MANY PRESENTERS HAVE
ALSO LIST OF RESOURCES THAT THEY
HAVE INCLUDED IN THEIR
PRESENTATION.
BEFORE WE START WITH THE
PRESENTATIONS, I WANT TO THANK
THE PLANNING ECONOMY OF --
COMMITTEE, OF THIS SESSION, DR.
HELEN WATTS, DR. TOMOS, A AND
AARON LONG AND NATIONAL
INSTITUTE ON AGING, ELIZABETH
PICKETT GRAY SON DONLY AND NIA
TECHNOLOGICAL SUPPORT.
I ALSO WANT TO THANK EVA JEFFERS
A FELLOW AT CDC FOR HER
SIGNIFICANT INVOLVEMENT IN THE
DEVELOPMENT OF GOAL 6.
NEXT SLIDE.
I'M GOING TO TURN IT OVER TO OUR
NEXT SPEAKER.
DR. TISA MARIE SHERRY.
>> THANK YOU SO MUCH DR.
MACGUIRE.
MANY THANKS TO ALL OF YOU FOR
HAVING US HERE.
AS DR. MACGUIRE MENTIONED, I'M
DEPUTY ASSISTANT SECRETARY FOR
BEHAVIORAL HEALTH DISABILITY AND
AGING POLICY IN ASPE AT HHS.
IT IS MY PLEASURE TODAY TO BUILD
ON THE WONDERFUL BACKGROUND THAT
DR. MACGUIRE SHARED ABOUT 2021
NATIONAL PLAN TO ADDRESS
ALZHEIMER'S DISEASE AND OUR NEW
RISK REDUCTION GOAL.
SO SORRY I ADVANCED QUICKLY.
SO THE NATIONAL PLAN TO ADDRESS
ALZHEIMER'S DISEASE WAS
ESTABLISHED BY THE NATIONAL
ALZHEIMER'S PROJECT ACT OR NAPA,
PASSED IN 2011.
NATURAL PLAN DESCRIBES THE WORK
THAT IS UNDERTAKEN BY HHS
AGENCIES AND SELECT FEDERAL
PARTNERS INCLUDING THE
DEPARTMENT OF DEFENSE,
DEPARTMENT OF VETERANS AFFAIRS
AND NATIONAL SCIENCE FOUNDATION,
TO ADVANCE RESEARCH PUBLIC
UNDERSTANDING AND EFFECTIVE
CLINICAL INTERVENTIONS AND OTHER
SERVICES AND SUPPORTS TARGETING
ALZHEIMER'S DISEASE AND RELATED
DEMENTIAS.
NAPA ESTABLISHED AN ADVISORY
COUNCIL TO REVIEW AND COMMENT ON
THE NATIONAL PLAN AND ITS
IMPLEMENTATION AND TO MAKE
ANNUAL RECOMMENDATIONS TO THE
SECRETARY OF HEALTH AND HUMAN
SERVICES AND TO CONGRESS ON
PRIORITY ACTIONS.
IMPORTANTLY THE ADVISORY COUNCIL
INCLUDES BOTH FEDERAL AND PUBLIC
MEMBERS TO ENSURE THAT THE
NATIONAL PLAN IS INFORMED BY
BROAD STAKEHOLDER PERSPECTIVES.
WHEN IT WAS ESTABLISHED THE PLAN
HAD FIVE AMBITIOUS GOALS.
GOAL 1, STRATEGIES TO IDENTIFY
AND EXPAND RESEARCH ON ALZHEIMER
EAST DISEASE.
GOAL 2 INCLUDE STRATEGIES TO
IMPROVE CLINICAL CARE, 3,
STRENGTHEN LONG TERM CARE AND
CARE GIVING FOR PEOPLE WITH
ALZHEIMER'S DISEASE.
4 INCLUDES STRATEGIES TO EDUCATE
THE PUBLIC ABOUT ALZHEIMER'S
DISEASE AND GOAL 5 INCLUDES
STRATEGIES TO ENHANCE FEDERAL
GOVERNMENT ABILITY TO TRACK
PROGRESS ON NATIONAL PLAN.
A IN 2020 THE COUNCIL
BEGAN TO CONSIDER THE
POSSIBILITY OF SIX GOAL FOCUSED
ON DEMENTIA RISK REDUCTION.
ONE CONSIDER A RISK REDUCTION
GOAL.
WHILE NOT YET IDENTIFIED
EFFECTIVE INTERVENTIONS TO
PREVENT PEOPLE FROM GETTING
DEMENTIA ALTOGETHER WE HAVE BEEN
LEARN MORGUE ABOUT RISK FACTORS
FOR DEMENTIA AND WAYS TO REDUCE
THE CHANCES OF DEVELOPING THIS
DISEASE BY ADDRESSING RISK
FACTORS, IN PARTICULAR THERE'S
GROWING EVIDENCE THAT
EFFECTIVELY MANAGING
HYPERTENSION AND BEING MORE
PHYSICALLY AND COGNITIVELY
ACTIVE MAY REDUCE THE RISK OF
DEVELOPING DEMENTIA.
MORE STUDIES UNDERWAY TO
INVESTIGATE HOW RISK OF DEMENTIA
CHANGES WHEN WE ADDRESS OTHER
RISK FACTORS LIKE DIABETES
INADEQUATE SLEEP, POOR
NUTRITION, DEPRESSION, SUBSTANCE
USE DISORDERS, HEARING
DIFFICULTIES AND POOR DENTAL
HEALTH.
IN FALL 2021 AS DR. MACGUIRE
MENTIONED BASED ONLY GROWING
RESEARCH LITERATURE ON RISK
REDUCTION THE ADVISORY COUNCIL
AGREED ENOUGH POSITIVE EVIDENCE
TO WARRANT BROADER MORE
DELIBERATE EFFORTS BY HHS TO
ADDRESS RISK FACTORS FOR
DEMENTIA.
SO IN DECEMBER HHS ADDED A 6TH
GOAL TO THE NATIONAL PLAN.
TO ACCELERATE ACTION AND PROMET
HEALTHY AGING TO REDUCE RISK
FACTORS FOR ALZHEIMER'S DISEASE
AND RELATED DEMENTIAS.
AS THIS DIAGRAM FROM THE
NATIONAL PLAN SHOWS, COMPARE TO
PREVIOUS GOALS, THE NEW GOAL
PRIMARILY TARGETS INDIVIDUALS
WHO DO NOT YET HAVE ANY SYMPTOMS
OF DEMENTIA BUT MAYBE ELEVATED
RISK.
EVIDENCE ON RISK FACTORS FOR
ALZHEIMER'S DISEASE IS GROWING
AND STILL EVOLVING.
AS IS EVIDENCE ON THE IMPACTS OF
INTERVENTIONS THAT TARGET RISK
FACTORS.
STILL DEPARTMENT OF HEALTH AND
HUMAN SERVICES DECIDED TO ADD
THIS NEW GOAL FOR SEVERAL
REASONS.
FIRST HEALTHY AGING IS A KEY
PRIORITY FOR THE DEPARTMENT.
AND ADDRESSING THE RISK FACTORS
FOR DEMENTIA ALIGNS WITH
PROMOTING BRAIN HEALTH AND
HEALTHIER AGING OVERALL.
THERE ARE NO APPARENT DOWN SIDES
TO ADDRESSING RISK FACTORS BY
IDENTIFYING MANAGING CHRONIC
CONDITIONS OR PROMOTING IMPROVED
NUTRITION AND INCREASE PHYSICAL
ACTIVITY, THESE ARE THINGS WE
WANT TO DO ANYWAYS.
AS THE EVIDENCE BASE ON RISK
REDUCTION GROWS WE WANT TO BE
ABLE TO TRANSLATE OUR FINDINGS
INTO EFFECTIVE RISK REDUCTION
INTERVENTION AS QUICK AS
POSSIBLE.
THROUGH THIS NEW GOAL, WE WILL
BUILD INFRASTRUCTURE WE NEED TO
IDENTIFY AND RESEARCH RISK
REDUCTION INTERVENTION AND
TRANSLATE THOSE INTERVENTION TO
HEALTHCARE AND PUBLIC HEALTH
PRACTICES AS QUICKLY AS
POSSIBLE.
THE THIRD REASON RELATES TO
ACHIEVING HEALTH EQUITY WHICH IS
AMONG HHS HIGHEST PRIORITIES.
THE CHANCE OF DEVELOPING
ALZHEIMER'S DISEASE AN RELATED
DEMENTIA IS NOT EQUAL.
BLACK AND LATINO KNOW AMERICANS
ARE MORE LIKELY TO DEVELOP THE
CONDITION AS ARE WOMEN AND
PEOPLE WITH CHRONIC DISEASES.
AND THESE DISPARITIES ARE
PROJECTED TO WIDEN OVER TIME.
THERE IS ALSO EVIDENCE
COMMUNITIES OF COLOR EXPERIENCE
INEQUITIES AT EVERY STAGE OF
DEMENTIA CARE.
BLACK LATINO AND NATIVE AMERICAN
POPULATIONS LESS LIKELY TO
RECEIVE A TIMELY DIAGNOSIS OF
DEMENTIA, LESS LIKELY TO RECEIVE
EVIDENCE BASED TREATMENT AND
HAVE MORE DIFFICULTY ACCESSING
LONG TERM CARE AND SUPPORTS.
AS A RESULT EQUITY IN ADDRESSING
INTERRELATED SOCIAL DETERMINANTS
OF HEALTH ARE CORE PRINCIPLES OF
THE NATIONAL AND LONG BEEN
REFLECTED IN ACTIVITIES UNDER
ALL THE PLAN GOALS.
BUT KNOWING THE COMPREHENSIVELY
ADDRESS INEQUITIES IN DEMENTIA,
AND IN PARTICULAR, THE BURDEN
PLACED ON BLACK LATINO AND
NATIVE AMERICAN COMMUNITIES, WE
HAVE TO ALSO ADDRESS THE RISK
FACTORS THAT LEAD TO A HIGHER
PREVALENCE OF DEMENTIA IN THESE
COMMUNITIES IN THE FIRST PLACE.
THAT'S ANOTHER REASON HHS FELT
IT WAS IMPORTANT TO INCLUDE THIS
NEW GOAL ON RISK REDUCTION AND
TO EXPLICITLY EMPHASIZE
ELIMINATING DISPARITIES AND RISK
FACTORS.
BLACK LATINO AND NATIVE AMERICAN
POPULATIONS EXPERIENCE HIGHER
BURDEN OF RISK FACTORS FOR
DEMENTIA AND GREATER DIFFICULTY
ACCESSING HEALTHCARE TO ADDRESS
THESE RISK FACTORS. THESE
DIFFERENCES IN BURDEN OF RISK
FACTORS CONTRIBUTE TO
DIFFERENCES IN THE INCIDENCE OF
DEMENTIA IN THESE COMMUNITIES.
FOURTH AND FINALLY, HHS
RECOGNIZES THAT MANY OF THESE
RISK FACTORS ARE EITHER CAUSED
BY OR EXACERBATED BY SYSTEMIC
COMMUNITY AND STRUCTURAL
INEQUITIES.
SO THIS NEW 6TH GOAL PROVIDES AN
OPPORTUNITY TO ADDRESS NOT JUST
WHAT INDIVIDUALS CAN DO TO
PROTECT THEIR BRAIN HEALTH BUT
ALSO TO CREATE COMMUNITIES AND
INSTITUTIONS THAT SUPPORT
HEALTHY AGING FOR EVERYONE AND
THAT MAKE IT EASIER FOR PEOPLE
TO MAKE THESE CHANGES.
D THESE ARE REFLECTED IN
EACH STRATEGY UNDER THE GOAL.
6A WILL SUPPORT RESEARCH THAT
ENHANCE UNDERSTANDING OF
DEMENTIA RISK FACTORS AND THE
IMPACTS OF INTERVENTIONS THAT
ADDRESS RISK FACTORS.
STRATEGY 6B WILL RAPIDLY
TRANSLATE RESEARCH FINDINGS INTO
CLINICAL PRACTICE, STRATEGY 6C
INTO PUBLIC HEALTH ACTION AND
STRATEGY 6D INTO INTERVENTIONS
THROUGH AGING NETWORK.
STRATEGY 6E WILL ADDRESS
INEQUITIES IN RISK FACTORS AND
FINALLY THROUGH STRATEGY 6F WE
WILL WORK TO EDUCATE AND ENGAGE
THE PUBLIC AT LARGE ABOUT WAYS
TO REDUCE RISK FACTORS FOR
ALZHEIMER'S DISEASE AND RELATED
DYSTROPHIES.
DEMENTIA.
I WILL SHARE EXAMPLES TO GIVE
YOU CONCRETE ACTION STEPS WE ARE
PURSUING UNDER THE REDUCTION
GOAL.
IS 6A EXPAND RESEARCH ON RISK
FACTORS THE NATIONAL INSTITUTE
ON AGING AND NEUROLOGIC DISEASE
AND STROKE ARE SUPPORTING A
NUMBER OF STUDIES THAT EXAMINE
DIFFERENCES IN PREVALENCE OF
DEMENTIA RISK FACTORS ACROSS
DIFFERENT RACIAL AND ETHNIC
GROUPS, AND THE IMPACT THESE
DIFFERENTOR DIFFERENCE VERSUS ON
DISPARITIES IN ALZHEIMER'S
DISEASE AND RELATED DEMENTIA IN
THESE POPULATIONS. UNDER
STRATEGY 6B, TRANSLATE RESEARCH
FINDINGS TO CLINICAL PRACTICE,
HRSA IS USING GERIATRICS WORK
FORCE EDUCATION PROGRAM TO
DISSEMINATE CURRICULA TO TRAIN
HEALTHCARE WORK FORCE IN
ADDRESSING BRAIN HEALTH AND CDC
SUPPORTED THE AMERICAN COLLEGE
OF PREVENTIVE MEDICINE TO
DEVELOP A BRAIN HEALTH
CONTINUING EDUCATION AND
RESOURCE WEBSITE TO INCREASE
HEALTHCARE PROVIDERS AWARENESS
OF BRAIN HEALTH.
UNDER STRATEGY 6C TRANSLATE
RESEARCH FINDINGS TO PUBLIC
HEALTH PRACTICE, CDC IS
CONVENING A NATIONAL SUMMIT ON
RISK REDUCTION THIS YEAR.
UNDER STRATEGY 6D TRANSLATE
RESEARCH FINDINGS INTO
INTERVENTIONS THROUGH THE AGING
NETWORK, THE ADMINISTRATION ON
COMMUNITY LIVING IS DELIVERING
HEALTH AND WELLNESS PROGRAMS TO
OLDER ADULTS THROUGH THEIR
CAPACITY BUILDING AND
SUSTAINABLE SYSTEMS INITIATIVE
WITH SPECIAL FOCUS ON REACHING
HISTORICALLY UNDERSERVED
COMMUNITIES.
AND UNDER STRATEGY 6F ENGAGE
PUBLIC ON RISK REDUCTION IF
NATIONAL INSTITUTE NEUROLOGIC
DISEASE AND STROKE THROUGH MINE
YOUR RISKS CAMPAIGN AN CDC
THROUGH MILLION HEARTS KNISH
FIEF SUPPORT PUBLIC AWARENESS
CAMPAIGNS TO EDUCATE ABOUT THE
LINK BETWEEN HIGH BLOOD PRESSURE
AND DEMENTIA RISK.
OUR NEXT STEPS, FIRST, WE ARE
COMMITTED TO SUCCESSFULLY
IMPLEMENTING ALL OF THE RISK
REDUCTION ACTION STEPS
IDENTIFIED IN THE 2021 PLAN
UPDATE. AT THE SAME TIME WE
VIEW THESE AS THE BEGINNING OF
OUR EFFORTS ON RISK REDUCTION.
OUR WORK IS NOT DONE.
SO TO BUILD ON AND IMPROVE THE
WORK THROUGH THE RISK REDUCTION
SUBCOMMITTEE OF THE ADVISORY
COUNCIL ON ALZHEIMER'S RESEARCH
CARE AND SERVICES, WE WILL
IDENTIFY ADDITIONAL
OPPORTUNITIES TO ADVANCE THIS
IMPORTANT AGENDA.
THIS WILL INCLUDE CONNECTING
WITH BROADER HEALTH PROMOTION
AND DISEASE PREVENTION EFFORTS
WITH RELEVANCE TO BRAIN HEALTH
TO ENSURE WE ARE WORKING
COLLABORATIVELY AND
SYNERGISTICALLY TO SUPPORT
HEALTHY AGING.
AND AS DISCUSSED EARLIER, WE
WANT TO CONTINUE TO FOCUS ON
COMMUNITY RISK REDUCTION AND
SUPPORTING INTERVENTIONS THAT
HELP INDIVIDUALS TO MAKE HEALTHY
CHANGES RATHER THAN PLACING THE
ONUS ENTIRELY ON THEM
PARTICULARLY IN A HEALTH SOCIAL
SERVICES SYSTEM THAT CAN BE VERY
CHALLENGING TO NAVIGATE.
FINALLY, WE WANTS THIS TO BE A
TRULY NATIONAL PLAN, NOT JUST A
FEDERAL PLAN.
SO WE ARE EAGER TO ENGAGE WITH
STATE AND LOCAL GOVERNMENTS AND
NON-GOVERNMENTAL ORGANIZATIONS
TO UNDERSTAND HOW WE CAN WORK
TOGETHER TO IMPLEMENT AND
STRENGTHEN THE NATIONAL PLAN.
I WANT TO RECOGNIZE MY ASPE
COLLEAGUES WHO HAVE BEEN
COORDINATING ALL THIS WORK, IN
PARTICULAR LAUREN ANDERSON AND
GAAP KENNEDY AND BILL MARTIN AND
ESPECIALLY DR. HELEN LAMONT WHO
FOR HER LEADERSHIP.
I ALSO WANT TO THANK FEDERAL
PARTNERS FOR DOING ACTUAL WORK
OF IMPLEMENTING THIS REALLY
AMBITIOUS STRATEGY.
AND I WANT TO THANK SECRETARY
BECERRA FOR HIS SUPPORT OF THIS
INITIATIVE AS WELL AS REST OF
HHS LEADER EPISHIP.
FOR MORE INFORMATION I INCLUDED
A LINK TO THE NATIONAL PLAN
ITSELF IN THE 2021 UPDATE AS WE
AS REPORTING OF STAKEHOLDER
BRIEFING THAT WE DID WHICH
ENGAGED A NUMBER OF OUR PARTNERS
WHO ARE IMPLEMENTING THIS PLAN.
WE BELIEVE THIS NEW GOAL
REPRESENTS AN IMPORTANT STEP
TOWARD EPIIMPROVING HEALTH
OUTCOMES FOR OLDER AMERICAN AND
WE ARE VERY EXCITED TO WORK WITH
ALL OF YOU TO IMPLEMENT THIS
BOLD VISION FOR HEALTHY AGING
AND BRAIN HEALTH.
THANK YOU.
>> WE WILL TURN IT OVER TO DR.
BAKER.
>> THANK YOU EVERYONE FOR TAKING
YOUR TIME TODAY TO JOIN US.
MY JOB IS TO TAKE YOU THROUGH
WHAT IT MIGHT MEAN TO LOOK AT A
PARTICULAR RISK -- PARTICULAR
ELEMENT OF -- THAT WE CAN CHANGE
WHERE WE CAN MODIFY RISK AND
TALK TO YOU ABOUT WHAT ARE THE
STEPS FROM THE BEGINNING TO
IDENTIFYING A RISK MODIFIER TO
THE END OF PUSHING IT OUT AND
HOPEFULLY CHANGING POLICY DOWN
THE ROAD.
SO MY PARTICULAR AREA NOW THAT I
WILL FOCUS ON IS EXERCISE.
SO FIRST OF ALL I'M GOING TO
TALK TO YOU ABOUT HOW EXERCISE
PHYSICAL ACTIVITY IN PARTICULAR
IS GAINING MOMENTUM AS A
THERAPEUTIC STRATEGY TO PROTECT
BRAIN HEALTH AND REDUCE THE RISK
FOR COGNITIVE DECLINE AND
DEMENTIA.
I'M ALSO GOING TO SHARE RESEARCH
RESOURCES THAT ARE AVAILABLE TO
TEST WHETHER EXERCISE MIGHT BE A
POTENT RISK REDUCER FOR
DEMENTIA.
AND DESCRIBE SOME EVIDENCE
SHOWING THAT EXERCISE MIGHT
INDEED SERVE AS MEDICINE, COULD
BE MEDICINE.
WHAT ARE OUR OPTICALS SO FAR
MAKING PROGRESS AND LASTLY,
GOING FORWARD, WHAT ARE THE
ACTION ITEMS NEEDED TO DEVELOP A
SUSTAINABLE ACCESSIBLE
INTERVENTION PROGRAM.
AS TISA DESCRIBED A MOMENT AGO
NEW GOAL FOR THE NATIONAL PLAN
IS ACCELERATE ACTION TO PROMOTE
HEALTHY AGING AND REDUCE RISK
FACTORS FOR ALZHEIMER'S DISEASE
AN RELATED DEMENTIA.
AND THE GOAL IS TO REDUCE
PREVALENCE OF MODIFIABLE RISKS
BY 15%, BY 2030 WHICH WILL HAVE
TREMENDOUS IMACT ON DISEASE
ONSET AND PROGRESSION.
HERE ARE RISK FACTORS WE ARE
TARGETING HERE, THIS IS IN LINE
WITH GLOBAL INITIATIVES AS WELL,
FOR EXAMPLE, WORLD HEALTH
ORGANIZATION.
WE ARE ON THE SAME PAGE WHICH
RISK FACTORS TO TARGET.
NEXT SLIDE PLEASE.
RESOURCES AVAILABLE RIGHT NOW
THROUGH THE GOVERNMENT, THROUGH
NIH, YOU CAN SEE I WILL FOCUS MY
TALK RIGHT NOW ON
NON-PHARMACOLOGIC INTERVENTION,
THOSE INTERVENTIONS THAT ARE
FOCUSED ON REDUCING RISK.
MODIFIABLE RISK.
YOU CAN SEE THAT RIGHT NOW THE
NUMBER OF GRANTS NIH GRANTS
AVAILABLE TO STUDY
NON-PHARMACOLOGICAL
INTERVENTIONS IS GREATER THAN
THOSE GRANTS THAT ARE EARMARKED
FOR EARLY STAGE CLINICAL DRUG
DEVELOPMENT, LATE STAGE CLINICAL
DRUG DEVELOPMENT AND ONLINE IN
LINE WITH PRE-CLINICAL DRUG
DEVELOPMENT SO
NON-PHARMACOLOGICAL
INTERVENTIONS THAT WILL HELP
IDENTIFY THOSE RISKS THAT COULD
BE MODIFIED WE DO HAVE RESOURCES
TO DO THIS THROUGH NIH.
I WANT TO SHOW THAT OVER SINCE
2009, TO 2019, JUST WANT TO SHOW
YOU HOW THIS IS CHANGED.
THE NUMBER OF GRANTS FOCUSED ON
THESE MODIFIABLE RISK FACTORS
CHANGED OVER TIME.
WITHIN THE NON-PHARMACOLOGIC
INTERVENTION SHOWING A PIE CHART
HERE, DIVIDING DIFFERENT GRANTS
AVAILABLE SO WILL IS A LOT OF
BLUES LARGE SECTION DEVOTED TO
PHYSICAL ACTIVITY AND EXERCISE
AND THERE IS ANOTHER THAT GREEN,
I WILL BRING YOUR ATTENTION TO
THAT, COMBINATION THERAPY.
THAT IS WHERE THE FIELD IS MOVED
INTO COMBINING WHAT ARE THE
BENEFITS ON BRAIN IF ETIANE
PHYSICAL ACTIVITY, DIET, IF WE
CHANGE COGNITIVE ACTIVITY,
SOCIAL ENGAGEMENT.
THAT IS REALLY A HOT TOPIC RIGHT
NOW.
WHAT ACTION DESCRIBE WE WANT TO
ACCOMPLISH WITH GOAL 6 IS
EDUCATE PUBLIC AND HEALTHCARE
WORK FORCE ABOUT RISK REDUCTION.
SO WE CAN DO THIS, WE HAVE TO
THE MESSAGES HAS TO BE INTENSE,
HAS TO BE UBIQUITOUS.
SO IN 2019 THE "WALL STREET
JOURNAL" PUBLISHED THIS
PARTICULAR -- THIS IS A FRONT
PAGE FEATURE ARTICLE ALL ABOUT
WHAT IS TELLING US ABOUT
PREVENTING DEMENTIA WHERE THESE
PARTICULAR MODIFIABLE RISKS WERE
LISTED.
IT WAS A BEAUTIFUL ARTICLE, BUT
I -- IT WAS A MILESTONE BECAUSE
WE HAD NOT YET SEEN IN THE
PUBLIC DOPE MAIN AN ARTICLE WITH
THIS KIND OF A FOCUS ON
LIFESTYLE MODIFICATION AS A
MECHANISM TO PROTECT BRAIN
HEALTH.
COMMISSION, LANSETT COMMISSION
OF 2020, PUBLICKED THEIR
RECOMMENDATIONS, THEY --
ACCORDING TO LANSETT UP TO 35%
OF ALL DEMENTIA CASES COULD BE
PREVENTED BY TACKLING THESE RISK
FACTORS.
AND THAT WE REALLY NEED LONGER
TERM LIFESTYLE INTERVENTIONS.
THE CDC AND AMERICAN COLLEGE OF
MEDICINE HAD A PUBLICATION
CALLED PROMOTING HEALTHY
LIFESTYLES AND BLOOD PRESSURE
CONTROL AND DESCRIBES HOW
HEALTHY CHOICES CAN REDUCE RISK
OF COGNITIVE DECLINE.
THIS ARTICLE AND OTHER RESOURCE
HAVE BEEN WIDELY DECEMBER
SIMILARNATED SO THIS STARTS --
DISSEMINATED.
WE NEED TO GET OUT THE MESSAGE,
PHYSICAL ACTIVITY CAN HELP
REDUCE RISK OF COGNITIVE
DECLINE. I'M GOING TO ASK YOU
THE TAKE CONTROL AGAIN BECAUSE
IT IS NOT -- NEXT SLIDE.
THANK YOU.
SO EXERCISE IS MY FOCUS FOR A
MOMENT AS AN EXAMPLE.
WE KNOW THAT EXERCISE IS A
POTENT ANTI-AGING MECHANISM.
THAT EXERCISE REDUCES STRESS AND
IMPROVES MOOD, IMPROVES
CARDIOVASCULAR FUNCTION,
IMPROVES THE HEALTH OFS ARE
SELLS IN THE BODY AND THE BRAIN.
REDUCES YOUR RISK OF TYPE 2
DIABETES, IT REDUCES YOUR
OBESITY, IT TOUCHES ALL OF THESE
DISEASES THAT NATURALLY AT LEAST
IN OUR CULTURE, DO INCREASE IN
PREVALENCE WITH ADVANCING AGE.
IN THE LAST 15 YEARS WE ARE
LEARNING EXERCISE ALSO HAS
PROTECTION FOR BRAIN HEALTH AND
MAY IN FACT HEALTH PREVENT OR
SLOW OR PREVENT THAT COGNITIVE
DECLINE ASSOCIATED WITH
ALZHEIMER'S DISEASE AND RELATED
DEMENTIA.
THIS SLIDE IS A BUSY SLIDE, ONLY
TO SHOW YOU THIS IS WHAT WE HAVE
TO GO THROUGH, WHEN WE TRYING TO
IDENTIFY A RISK REDUCTION
STRATEGY, THE SCIENCE HAS TO BE
STRONG.
WE HAVE TO KNOW THIS IS A VIABLE
CANDIDATE IN ORDER FOR US TO
INVEST OUR RESOURCES BOTH IN
TERMS OF ROLLING THIS OUT NOT
ONLY IN SCIENCE BUT FOR CHANGING
HEALTH POLICY.
EXERCISE HAS MULTIPLE MECHANISMS
OF RESTORATION, BODY, BRAIN, IT
IMPROVES BRAIN CELL HEALTH;
REDUCES OXIDATIVE STRESS,
IMPROVES GLUCOSE METABOLISM, SO
FORTH.
THERE IS A LOT OF EVIDENCE TO
SUGGEST EXERCISE IS A PRIME
CANDIDATE FOR SLOPE REVERSING
AGING EFFECTS ON THE BODY BUT
ALSO SLOWING COGNITIVE DECLINE.
I WANT O SHOW YOU THREE
DIFFERENT EXAMPLES OF THREE
STUDIES TO MAKE MY POINT HERE.
THIS IS A STUDY, SHOWING BRAIN
IMAGES OF AN OLDER ADULT, THESE
ARE COGNITIVELY NORMAL OLDER
ADULTS.
THIS IS SIX MONTHS OF AEROBIC
EXERCISE INTERVENTION VERSUS
VETCHING AND BALANCE CONTROL.
WHAT YOU SEE IN THE COLORED
AREAS IN THE BLUE AREAS AND
ORANGE YELLOW, AREAS WITH BRAIN
VOLUME WAS INCREASED.
WITH SIX MONTHS OF EXERCISE.
NO MEDICATION ON BOARD.
SO THAT WAS IN COGNITIVELY
NORMAL FOLKS BUT SINCE THEN WE
HAVE SHOWN THERE ARE BENEFITS
WITH EXERCISE FOR PEOPLE WITH
MILD COGNITIVE IMPAIRMENT,
EARLIEST STAGES OF ALZHEIMER'S
DISEASE.
HERE IS ANOTHER EXAMPLE, ONE OF
OUR STUDIES.
WITH SIX MONTHS AEROBIC EXERCISE
IN PEOPLE WITH MILD COGNITIVE
IMPAIRMENT, THAT IS EARLY STAGE
OF ALZHEIMER'S DISEASE, WE SAW
CHANGES IN THEIR WHOLE BRAIN
BLOOD FLOW, THE BLOOD FLOW TO
THE WHOLE BRAIN.
AND WE ALSO SAW IMPORTANTLY
CHANGES IN SPECIFIC AREAS THAT
ARE ASSOCIATED WITH AGING.
THESE ARE RED AREAINGS, THE
AREAS THAT NATURALLY DECREASE
BLOOD FLOW WITH ADVANCING AGE
BUT OTHER AREAS THAT DECREASE
BLOOD FLOW WITH ALZHEIMER'S
DISEASE, IN THE BLUE AREA.
SO SIX MONTHS OF EXERCISE
CHANGED INCREASE BLOOD FLOW IN
THESE CRITICAL AREAS THAT HAVE
TO DO WITH AGING AND ALZHEIMER'S
DISEASE.
SO IS IT WORTH THE TROUBLE?
SO WHAT I'M SHOWING YOU HERE IS
A SUN ROOM OF MANY -- SEVERAL
DIFFERENT STUDIES CONDUCTED
SINCE 2010.
QUITE SOME FOR THE LAST 12
YEARS, THE LINE DOWN THE CENTER
KIND OF DIVIDES STUDIES THAT
INDICATE THAT IT IS NOT
EFFECTIVE, IT FAVORS CONTROL
VERSUS RESULTS FAVOR THAT
BENEFITS OF EXERCISE.
ALL OF SPOKES YOU SEE ON THE
RIGHT SIDE OF THE LINE FAVORED
EXERCISE, GIVES YOU THE OVERALL
IMPRESSION MAJORITY OF STUDIES
REVIEWED IN THE LAST 12 YEARS
ALL FAVOR THE BENEFITS OF
EXERCISE ON COGNITION WITH
PEOPLE WITH MILD COGNITIVE
IMPAIRMENT.
IN ORDER TO EVALUATE IS THIS A
VIABLE RISK REDUCTION STRATEGY,
WE HAVE TO REALLY PIECE APART,
DIVE IN AND TAKE A LOOK AT
EXERCISE WHAT ABOUT IT COULD BE
RISK REDUCING.
SO ONE PART WE HAVE LEARNED FROM
THAT IS EXERCISE IS ACTIVITY
MATTERS.
AS WITH ANY MEDICATION, IF THE
DOSE IS TOO LOW, YOU CANNOT
EXPECT THE SAME BENEFIT SO WHEN
I'M THINKING ABOUT ROLLING OUT A
PROGRAM FOR RISK REDUCTION, WE
HAVE TO PAY ATTENTION TO
INTENSITY.
WE ALSO KNOW THAT DURATION
MATTERS.
IF WE ARE -- IF ONE OF THE GOALS
OF RISK REDUCTION IS TO RESTORE
HEALTH TO THE BODY, IN ORDER TO
RESTORE HEALTH TO THE BRAIN, IT
CANNOT HAPPEN OVER NIGHT.
IT TAKES TIME TO RESTORE THIS
TYPE OF HEALTH.
SO SHORT, SHORT DURATIONS OF
EXERCISE, COUPLE OF MONTHS IS
NOT SUFFICIENT TO PROVIDE
PROTECTION AGAINST RISK.
THE LEVEL LEARNED FROM ALL
STUDIES THAT SUPPORT MATTERS.
YOU CAN'T JUST GO TO YOUR DOCTOR
AND SAY -- HAVE THE DOCTOR SAID
YOU NEED THE START EXERCISING.
-IS NOT HELPFUL.
THIS WILL NOT SUCCEED IN A
POPULATION WHO IS NOT USED TO
DOING EXERCISE.
SO IF WE ARE GOING TO SUCCESS IN
THIS PROGRAM WE HAVE TO PROVIDE
SUPPORT.
SOME OF OUR STUDIES WE HAVE
COMPLETED SO FAR HAVE SHOWN WITH
ADEQUATE SUPPORT WE CAN GET
PEOPLE TO STAY IN THE STUDY AND
KEEP EXERCISING AT THE
PRESCRIBED DOSE.
WE ALSO KNOW THAT RESOURCES
MATTER.
THE QUALITY OF THE NEIGHBORHOOD
FACILITIES.
THE PUBLIC MESSAGING.
HOW MUCH TIME DOES A PERSON HAVE
TO EXERCISE, ARE THEY BUSY DOING
CARETAKING SO THEY DON'T HAVE
SUFFICIENT TIME THE TAKE CARE OF
THEMSELVES.
ARE THERE TRANSPORTATION ISSUES.
COST ISSUES.
SO THE HEALTH EQUITY, HEALTH
DISPARITIES REALLY COME THE PLAY
WHEN TRYING TO ROLL OUT A
PROGRAM THAT IS EQUAL TO ALL
WHEN THERE ARE UNEQUAL BARRIERS.
SO I WANT TO SHOW YOU YOU CAN GO
AHEAD AN CLICK ON COUPLE.
ONE MORE.
SO I WANT TO GIVE AN EXAMPLE OF
A STUDY TRYING TO MEET THOSE
DIFFERENT QUESTIONS THAT I
PRESENTED IN A PREVIOUS PAGE.
THE EXCERPT TRIAL IS ONE WE JUST
FINISHED, IT IS A NATIONAL
TRIAL, WE HAVE ENGAGED WE HAVE
REALLY TRIED -- WORKING WITH A
COMMUNITY PARTNER WHICH IS KEY
FOR THE SUCCESS OF GOALS 6.
WE ARE WORKING WITH YMCA, THEY
HAVE BEEN AT TABLE SINCE DAY
ONE, WE KNOW IF WE ARE
SUCCESSFUL IT IS THE YMCA THAT
WILL ROLL OUT THIS PROGRAM OR
SOMEONE LIKE THE YMCA, NOT
ACADEMIC.
SO THIS PARTNERSHIP HAS BEEN
KEY.
WE ENGAGE THE COMMUNITIES, ALSO
PART OF OUR GOAL FOR PART OF THE
CHARGE FOR GOAL 6 TO WORK WITHIN
COMMUNITIES TO HEAL A COMMUNITY.
IN THIS STUDY WE HAVE GONE OUT
AND WORKED WITH THE COMMUNITY TO
GET PARTICIPANTS INTO THE STUDY
AND FIND COMMUNITY RESOURCES
THEY CAN USE TO COMPLETE THEIR
PHYSICAL ACTIVITY.
WE'LL REPORT TOP LINE RESULTS
THIS SUMMER.
AND NEXT.
FUTURE DIRECTIONS FOR
SUSTAINABILITY.
THIS IS OUR NEXT STEP.
WE GOT THE SCIENCE TO SAY IT
COULD BE A RISK REDUCTION.
SO HOW DO WE ROLL THIS OUT SO IT
COULD BE A VIABLE SUSTAINABLE
INTERVENTION TO REDUCE RISK FOR
ALL PEOPLE.
IF YOU CAN CLICK AROUND HERE,
THAT -- FOUR COLLISION.
SO WHAT YOU CAN SEE HERE IS WE
NEED -- WE HAVE NEEDS, IN ORDER
TO BUILD COMMUNITY PROGRAM, WE
HAVE TO HAVE READY ACCESS TO
FACILITIES, WE HAVE TO HAVE
UBIQUITOUS MESSAGING ENCOURAGING
PHYSICAL ACTIVITY, BASICALLY
CREATE A MOVEMENT WHERE THIS IS
THE STANDARD.
THIS HAS BEEN DONE AT OTHER
COUNTRIES NORWAY FOR EXAMPLE,
CHINA, WHERE EXERCISE FACILITIES
ARE WELL FUND AND AVAILABLE
WITHIN THE COMMUNITY.
IT CHANGES HOW PEOPLE BEHAVE.
WE HAVE TO HAVE LOW OR NO COST
ACCESS, WE NEED ADEQUATE
RESOURCES, SUPPORT FOR THESE
INDIVIDUALS YOU NEED COACHING
SUPPORT, THAT WHAT WE LEARNED
OVER AND OVER, LIFESTYLE
COACHING SUPPORT.
WE NEED PARTNERSHIP WITH
ORGANIZATIONS, WE NEED
HEALTHCARE TO WEIGH IN AND BE
PART OF THIS PROGRAM,
PRESCRIPTION IS PROVIDED WITH
REFERRALS TO A PROGRAM AND ALSO
OTHER LOGISTIC SUPPORT LIKE
TRANSPORTATION COMMUNITY FAMILY
SUPPORT AND ALSO IT HAS TO
CONTINUE TO BE EVIDENCE BASED.
SO HA IS THE IMPORTANCE OF
SCIENCE ALL THE NIH PROVIDED TO
PROVIDE THE RESOURCES FOR US TO
CONTINUE THESE INVESTIGATIONS.
MY LAST SLIDE PLEASE.
HOW DO WE TRANSITION FROM THIS
SCIENCE TO POLICY THIS IS WHAT
WE ARE WORKING ON, IT IS A WORK
IN PROGRESS BUT IT IS
IMPERATIVE, WE NEED ROBUST
RESULTS FROM SCIENCE, FROM
RIGOROUS TRIALS TO MOTIVATE
ACTION WE NEED A SENTENCE FOR
HEALTHCARE TO PROMOTE EXERCISE
AS MEDICINE PROGRAMS.
WE NEED PATIENCE INCENTIVES TO
PARTICIPATE.
WE NEED COMMUNITY BASED
INFRASTRUCTURE EQUAL, THERE'S
EQUITY FOR ALL COMMUNITIES, WHEN
WE ROLL THEM OUT ONE
NEIGHBORHOOD CANNOT BE -- EQUAL
ACCESS FOR ALL NEIGHBORHOODS
OTHERWISE THIS IS NOT GOING TO
ADDRESS OUR HEALTH EQUITY
PRIORITIES.
THANK YOU.
>> THANK YOU SO MUCH.
NEXT WE WILL HEAR FROM MATTHEW
BOMBART IN THE ALZHEIMER'S
ASSOCIATION.
>> THANK YOU VERY MUCH, LISA.
HELLO EVERYBODY.
GLAD TO BE WITH YOU TODAY.
AS THE SCIENCE ON DEMENTIA RISK
FACTORS INCREASES AND AS OUR
UNDERSTANDING GROWS, IT IS
REALLY RIPE FOR PUBLIC HEALTH TO
TAKE ACTION TO ADDRESS RISK
FACTORS FROM A COMMUNITY
PERSPECTIVE.
THAT IS PART OF WHAT THE NEW
GOAL SIX INCLUDES AND THAT IS
REALLY WHERE PUBLIC HEALTH
CENTER OF EXCELLENCE COMES IN
AND WHAT I WILL TALK TO YOU
ABOUT TODAY.
NEXT SLIDE.
BEFORE I GET TO THE CENTER OF
EXCELLENCE I WANT TO TALK TO YOU
ABOUT HOW BRIEFLY ABOUT HOW WE
GOT HERE.
AND MANY OF YOU ARE AWARE OF THE
BOLD ACT BUT JUST REVIEW IT FOR
THOSE NOT FAMILIAR, IN 2018
CONGRESS PASSED BUILDING LARGEST
DEMENTIA INFRASTRUCTURE FOR
ALZHEIMER'S ACT OR BOLD ACT TO
EXPAND THE NATION'S PUBLIC
HEALTH INFRASTRUCTURE TO ADDRESS
ALZHEIMER'S AND TO INCREASE THE
CAPACITY OF PUBLIC HEALTH TO
ADDRESS ALZHEIMER'S DISEASE
THERE ARE THREE MAIN COMPONENTS
OF THE LEGISLATION, THE FIRST IS
TO ESTABLISH CENTERS OF
EXCELLENCE, SECOND TO PROVIDE
GRANTS TO STATE LOCAL AND TRIBAL
PUBLIC HEALTH AGENCIES ACROSS
THE COUNTRY AND THE THIRD IS TO
INCREASE DATA ANALYSIS AND
TIMELY REPORTING.
IN 2020 AFTER CONGRESS PASSED
AND SUBS CAN'TLY FUNDED THE BOLD
ACT CDC FUNDED THREE CENTERS OF
EXCELLENCE INCLUDING THE
DEMENTIA RISK REDUCTION CENTER
AT THE ALZHEIMER'S ASSOCIATION,
THE OTHER TWO CENTERS FOCUS ON
CARE GIVING, OUT OF THE
UNIVERSITY OF MINNESOTA AND THE
THIRD IS EARLY DETECTION
DIAGNOSIS AFTER NEW YORK
UNIVERSITY.
NEXT SLIDE.
SO LET ME ILLUSTRATE WHY THE
RISK REDUCTION CENTER IS REALLY
IMPORTANT AND WHY ADDRESSING AT
THIS PARTICULAR TIME DEMENTIA
RISK FACTORS IS SO IMPORTANT
FROM A POPULATION LEVEL
PERSPECTIVE.
MANY OF YOU HAVE SEEN THESE
STATISTICS BEFORE BUT CURRENTLY
THERE ARE MORE THAN 6 MILLION
OLDER ADULTS IN THE UNITED
STATES LIVING WITH ALZHEIMER'S
DEMENTIA AND WITH THE AGING OF
POPULATION THAT IS PROJECTED TO
INCREASE TO NEARLY 14 MILLION IN
2060.
NEXT SLIDE.
IN LOOKING AT WHAT I CALL THE
FIVE -- THE BIG FIVE RISK
FACTORS.
THESE ARE RISK FACTORS THAT ARE
COMMONLY CITED AS RISK FACTORS
FOR COGNITIVE DECLINE AND
DEMENTIA, THEY ARE ALSO HAVE
SOME OF THE STRONGEST EVIDENCE
BEHIND THEM.
YOU CAN SEE THE PREVALENCE OF
THESE RISK FACTORS AMONG THE
U.S. POPULATION.
THE HYPERTENSION AMONG THOSE IN
MIDDLE AGE IS OVER 40%, OBESITY
IS NEARLY 40%, PHYSICAL
INACTIVITY YOU HEARD LAURA
TALKING ABOUT THAT, THAT'S WELL
OVER 40% CLOSING IN ON HALF OF
THE ADULT POPULATION WHO DO NOT
MEET PHYSICAL ACTIVITY
GUIDELINES.
WHEN YOU LOOK ACROSS ALL FIVE OF
THESE OVER 63% OF ADULTS IN THE
UNITED STATES HAVE ONE OR MORE
OF THESE RISK FACTORS FOR
DEMENTIA AND MORE THAN
TWO-THIRDS OF BLACKS AND
HISPANICS AND NATIVE AMERICANS
HAVE AT LEAST ONE OF THESE FIVE
RISK FACTORS.
SO ACCORDING TO THE LANSETT
COMMISSION AS MANY AS 40% OF
DEMENTIA CASES WORLDWIDE MIGHT
BE ATTRIBUTABLE TO 12 SUSPECTED
RISK FACTORS, MORE -- THEY
LOOKED AT MORE THAN THE FIVE I
SHOWED ON THE PREVIOUS SCREEN,
LOOKING AT THE 12 CITED BY THE
LANSETT COMMISSION, THEY
INDICATED THAT WORLD AS MANY AS
FOUR IN TEN DEMENTIA CASES COULD
BE ACONTRIBUTABLE TO THOSE 12
RISK FACTORS, GIVEN THAT AND
GIVEN THE HIGH PREVALENCE OF
RATES OF SOMEBODY'S RISK FACTORS
AS I SHOWED YOU ON THE PREVIOUS
SLIDE THERE A GREAT OPPORTUNITY
FOR PUBLIC HEALTH TO ACT.
AND THERE IS A POSSIBILITY FOR A
SIGNIFICANT IMPACT WITH AN
AGGRESSIVE ACTION.
I PUT ON THIS SCREEN THREE
POPULATION ATTRIBUTABLE RISK
ANALYSES, TWO OF THEM WERE
UNPUBLISHED BUT ONE WAS
PUBLISHED IN LANSETT NEUROLOGY
BACK IN 2014 THAT LOOKED AT WHAT
WOULD HAPPEN IF YOU COULD
AGGRESSIVELY ADDRESS RISK
FACTORS AND AGGRESSIVELY WAS A
10%, OR 15% PER DECADE
IMPROVEMENT IN THE BIG FIVE AS I
CALL THEM OR AS IN THE CASE OF
LANSETT NEUROLOGY ARTICLE THE
BIG 5 PLUS DEPRESSION AND
EDUCATION, YOU CAN SEE THERE
THAT WITH AN AGGRESSIVE EFFORT
TO IMPROVE THE PREVALENCE OF THE
RISK FACTORS IT COULD RESULT IN
AS MANY AS A MILLION OR MORE
FEWER CASES OF ALZHEIMER'S
DEMENTIA IN 2050.
SO THIS IS REALLY WHERE THE
CENTER OF EXCELLENCE COMES IN.
SO THE CENTERS OF EXCELLENCE AS
I MENTIONED THERE ARE THREE, ARE
REALLY DESIGNED TO GIVE PUBLIC
HEALTH AGENCIES AT THE STATE
LOCAL AND TRIBAL LEVEL TOOLS AND
RESOURCES AND NEEDED TO ACT IN
THEIR COMMUNITIES.
AND FOR CENTER OF EXCELLENCE ON
RISK REDUCTION I PUT ON THIS
SLIDE OUR GENERAL WORK FLOW.
WE -- PART OF OUR TASK IS
UNDERSTANDING THE SCIENCE AND
HELPING PUBLIC HEALTH AGENCIES
IN THE PUBLIC IN GENERAL
UNDERSTAND THE CURRENT STATE OF
THE SCIENCE.
THEN IDENTIFYING WHAT CAN BE
DONE ABOUT IT FROM A PUBLIC
HEALTH PERSPECTIVE, BUILDING
THOSE TOOLS AND RESOURCES FOR
PUBLIC HEALTH AND THEN REALLY
HELPING TO DRIVE ACTION BY
PUBLIC HEALTH AGENCIES.
I HAVE SHOWN THESE IN A LINEAR
FORMAT BECAUSE MY BRAIN WORKS
SEQUENTIALLY AND LITERALLY BUT
THERE ARE ACTIVITIES ON ALL OF
THESE STEPS OR MANY OF THESE
STEPS GOING ON AT THE SAME TIME.
THAT IS WHAT I WANT TO SHARE
WITH YOU NOW.
SOME OF THE THINGS BOLD CENTER
PUBLIC HEALTH CENTER ON RISK
REDUCTION HAS BEEN DOING.
NEXT SLIDE.
SO WE SPENT A GOOD CHUNK OF LAST
YEAR WORKING WITH OUR ACADEMIC
SCIENTIFIC PARTNER WAKE FOREST
SCHOOL OF MEDICINE JEFF
WILLIAMSON, LEADING THE EFFORT
THERE.
LAURA BAKER WHO YOU JUST HEARD
FROM WAS MEMBER OF THE RESEARCH
ROUND TABLE JEFF PUT TOGETHER
AND LED A REVIEW AND SAID THIS
IS THE STATE OF EVIDENCE ON
MODIFIABLE RISK FACTORS FOR
COGNITIVE DYCLONE AND DEMENTIA.
WE PUBLISHED ONE TO TWO PAGE
SUMMARIES ON 11 RISK FACTORS,
THEY TALK ABOUT THE CURRENT
STATE OF THE SCIENCE AS WELL AS
PUBLIC HEALTH IMPLICATIONS FOR
THOSE RISK FACTORS.
YOU CAN DOWNLOAD THOSE READ
THOSE ON WEBSITE AT ALZ.ORG/
ALZ.ORG/PUBLICHEALTH.
FOLLOWING REVIEW AN SYNTHESIS
LAST AUGUST WE HELD FIRST PUBLIC
HEALTH ROUND TABLE WITH PUBLIC
HEALTH ACADEMIC AND ON THE
GROUND PUBLIC HEALTH OFFICIALS
TO BEGIN IDENTIFYING AND
PRIORITIZING PUBLIC HEALTH
ACTIONS TO ADDRESS THESE RISK
FACTORS.
FOLLOWING THAT, WE HAVE BEGUN TO
PREPARE TOOL KITS AND OTHER
RESOURCES HOW PUBLIC HEALTH
ADDRESS RISK FACTORS COMMUNITY
LEVEL AND ANALYZING STATE AND
LOCAL LEVEL DATA ON VARY USE
RISK FACTORS AND THE LOCAL LEVEL
DATA IS PARTICULARLY INTRIGUING
AND HELPFUL BECAUSE IT WILL
IDENTIFY FOR STATE PUBLIC HEALTH
OFFICIALS AND LOCAL PUBLIC
HEALTH OFFICIALS WHERE THE
PARTICULAR HOT SPOTS MAYBE FOR
THE VARIOUS RISK FACTORS.
FOR MANY PUBLIC HEALTH AGENCIES,
EVEN IF COVID WERE NOT A FACTOR,
THE CAPACITY TO TAKE ON THIS
ISSUE IS VERY LIMITED.
A LOT OF PUBLIC HEALTH AGENCIES
ARE VERY SMALL AND DON'T HAVE A
LOT OF FUNDING.
SO IN RECOGNITION OF THIS, ONE
OF THE ACTIVITIES WE ARE DOING
AT THE BOLD CENTER IS WORKING
WITH PUBLIC HEALTH AGENCIES ON
COMMUNITY CONVENINGS.
IT IS TO USE THE PUBLIC HEALTH
CONVENER ROLE TO BRING COMMUNITY
STAKEHOLDERS AND COMMUNITY
ACTORS TOGETHER IN A STRUCTURED
THREE STEP PROCESS IN WHICH THEY
DECIDE HOW COLLECTIVELY AS A
COMMUNITY THEY CAN ADDRESS RISK
FACTORS.
THAT TAKES SOME OF THE LOAD OFF
PUBLIC HEALTH BUT HELPS TO DRIVE
ACTION TO IMPROVE THE PREVALENCE
OF THE RISK FACTORS.
NEXT SLIDE.
WE AT THE CENTER PUBLISHED
SUGGESTIONS ON RISK REDUCTION
RECOMMENDATIONS THAT CAN BE
INCLUDED IN STATE AND LOCAL
ALZHEIMER'S PLANS.
WE HAVE SEEN OVER THE LAST
DECADE AS ALL BUT ONE STATE
PUBLISHED A STATE ALZHEIMER'S
PLAN THAT THESE PLANS CAN REALLY
HELP DRIVE ACTION.
SO IF WE ARE GOING TO ADDRESS
RISK REDUCTION AND IF STATES ARE
GOING TO ADDRESS RISK REDUCTION
IT IS IMPORTANT THEY ARE
INCLUDED IN STATE'S PLANS AS
WRITTEN AND AS THEY ARE UPDATED
SO WE PUBLISHED A DOCUMENT ON
THINGS INCLUDED IN THAT -- IN
THOSE PLANS TO DRIVE ACTION.
AND WE ARE NOW CIRCLING BACK TO
THE BEGINNING OF LINEAR SPREAD
BACK TO RESEARCH ROUND TABLE, WE
ARE NOW GIN WORKING WITH
PARTNERS AT WAKE FOREST TO DO A
REVIEW AND SYNTHESIS OF THE
EVIDENCE ON SOCIAL DETERMINANTS
OF HEALTH RELATED TO DEMENTIA.
THAT IS FROM TWO PERSPECTIVES.
FIRST WHAT ARE THE SOCIAL
DETERMINANTS OF HEALTH THAT NAY
AND OF THEMSELVES BE RISK
FACTORS FOR DEMENTIA.
POVERTY, QUALITY OF EARLY
CHILDHOOD EDUCATION OR AIR
POLLUTION, AND TO LOOK AT SOCIAL
DETERMINANTS OF HEALTH THAT ARE
BARRIERS TO ADDRESSING SOME OF
THE MODIFIABLE RISK FACTORS FOR
DEMENTIA.
FOR EXAMPLE, CONTINUING ON THE
THEME OF PHYSICAL ACTIVITY,
ENCOURAGING PHYSICAL ACTIVITY TO
HELP REDUCE THE RISK IS A GREAT
GOAL BUT IT IS DIFFICULT IF
PEOPLE DON'T LIVE IN A SAFE
NEIGHBORHOOD.
IF THERE AREN'T PARTS IF PEOPLE
CAN'T AFFORD JIM MEMBERSHIPS SO
WHAT ARE SOCIAL DETERMINANTS OF
HEALTH THAT PLAY A ROLE IN
ADDRESSING DEMENTIA RISK.
SO NEXT SLIDE.
THAT IS BRINGING YOU UP TO DATE
ON WHERE WE HAVE BEEN IN THE
PAST ALMOST 18 MONTHS AS THE
RISK REDUCTION CENTER OF
EXCELLENCE.
BUT HERE ARE SOME OF THE OTHER
ACTIVITIES THAT WE HAVE IN THE
PIPELINE COMING UP.
BUILDING ON THE REVIEW AND
SYNTHESIS OF THE EVIDENCE ON
SOCIAL DETERMINANTS OF HEALTH WE
WILL BE HOLDING A WORKSHOP AT
THE ALZHEIMER'S ASSOCIATION
INTERNATIONAL CONFERENCE IN SAN
DIEGO THIS SUMMER.
TO REVIEW THE SCIENCE AND BEGIN
TRANSLATING THAT TO PUBLIC
HEALTH ACTION WILL BE BRINGING
TOGETHER BOTH DEMENTIA
RESEARCHERS AND PUBLIC HEALTH
COMMUNITY TO HAVE THIS
CONVERSATION THIS IS AN OPEN
MEETING.
YOU DON'T NEED TO ATTEND THE
AAIC ITSELF TO ATTEND THE
WORKSHOP SO MORE INFORMATION
WILL BE COMING BUT SAVE THE
DATE, IF YOU ARE INTERESTED IN
THAT.
FOLLOWING THAT WORKSHOP WE WILL
BE HAVING OUR SECOND ANNUAL
PUBLIC HEALTH ROUND TABLE TO
BEGIN IDENTIFYING AND
PRIORITIZING WHAT PUBLIC HEALTH
CAN DO ON SOCIAL DETERMINANTS OF
HEALTH.
WE ARE ALSO WORKING ON PUTTING
TOGETHER A DEMENTIA RISK
REDUCTION SUMMIT.
IN ATLANTA WORKING CLOSELY WITH
OUR PARTNERS AND FUNDERS AT CDC.
THIS IS BROADLY TO INCREASE
UNDERSTANDING OF DEMENTIA RISK
FACTORS AND REALLY TO PROMOTE
TRANSLATION OF SCIENCE IN TO
PUBLIC HEALTH ACTION.
THE OTHER THING WE HAVE BEGUN
WORKING ON IS DEVELOPMENT AND
TESTING OF RISK REDUCTION
MESSAGING THAT CAN BE USED FROM
A PUBLIC HEALTH PERSPECTIVE TO
REACH THE PUBLIC.
AND FINALLY, SOME HIGHLIGHTS OF
SOME OF OUR FUTURE ACTIVITIES
DOWN THE ROAD, THEY ARE NOT
QUITE YET IN THE PIPELINE.
BUT WE ARE PLANNING THEM DOWN
THE ROAD.
REGIONAL LEARNING
COLLABORATIVES. THIS IS
SOMETHING WE FOUND DOES NOT WORK
WELL OVER ZOOM.
SO WITH HOPEFULLY AS WE COME OUT
OF COVID WE WILL BE ABLE TO MOVE
FORWARD ON REGIONAL LEARNING
COLLABORATIVES TO BRING TOGETHER
STATE AND LOCAL AND TRIBAL
PUBLIC HEALTH OFFICIALS TO
INCREASE THEIR UNDERSTANDING
ABOUT DEMENTIA RISK FACTORS AND
WORK WITH THEM TO DEVELOP WORK
PLANS THANK YOU THEIR
COMMUNITIES.
WE ARE ALSO WORKING IN THE
FUTURE TO DEVELOP TOOLS FOR
PUBLIC HEALTH AGENCIES TO WORK
WITH LOCAL HEALTH SYSTEMS TO
ADDRESS DEMENTIA RISK FACTORS.
HEALTH SYSTEMS WHETHER HMO OR
HOSPITAL SYSTEM OR LARGE
POSITION PRACTICE THEY ARE
REALLY KEY IN THE LONG TERM TO
ADDRESSING DEMENTIA RISK
FACTORS, SO WE WILL BE
DEVELOPING TOOLS FOR HOW PUBLIC
HEALTH CAN WORK WITH THESE
HEALTH SYSTEMS TO COLLECTIVELY
PARTNER TO ADDRESS THE RISK
FACTORS AND WE WILL BE WORKING
TO EXPAND PARTNERSHIPS WITH
ORGANIZATIONS INVOLVED MANY THE
RISK FACTORS BOTH NATIONAL LEVEL
AND WORKING WITH LOCAL PUBLIC
HEALTH AGENCIES ON HOW THEY CAN
EXPAND PARTNERSHIPS IN THEIR
COMMUNITIES.
PLEASE FEEL FREE TO REACH OUT TO
US WITH ANY QUESTIONS THAT YOU
MIGHT HAVE, HAPPY TO TALK TO ANY
OF YOU WE CAN BE REACHED AT
CENTER OF EXCELLENCE AT ALZ.ORG,
OUR EMAIL ADDRESS AND FEEL FREE
TO GO TO ALZ.ORG PUBLICHEALTH.
THERE'S MATERIALS BROADLY ON THE
ALZHEIMER'S ISSUE, BUT THERE IS
ALSO SPECIFIC INFORMATION ON
RISK REDUCTION AND RISK FACTORS
INCLUDING MATERIALS I MENTIONED
TO YOU PREVIOUSLY.
LISA.
>> THANK YOU SO MUCH.
WE WILL TURN IT OVER TO DR.
NAVARRE.
>> THANK YOU SO MUCH.
I'M A PREVENTIVE CARDIOLOGIST AT
THE UNIVERSITY TEXAS SOUTH
WESTERN MEDICAL CENTER.
TODAY I WILL BE TALKING ABOUT
SOME WAYS THAT WE CAN BOTH LOWER
RISK OF DEMENTIA AND LOWER THE
RISK OF HEART DISEASE AND
STROKE.
THERE IS A LOT OF OVERLAP
BETWEEN WHAT I DO IN CLINIC AND
WHAT WE ARE ABLE TO DO FOR
PREVENTIVE INFECTION AS WELL.
THESE ARE MY DISCLOSURES.
JUST WANTED TO PAUSE A NOTE I
DID RECEIVE RESEARCH AND
CONSULTING FROM NUMBER OF
COMPANIES WHO MAKE THERAPIES IN
THESE AREAS, WANT TO BE
TRANSPARENT ABOUT THAT.
SO THIS SLIDE COMES FROM
SOMEBODY REFERENCED EARLIER 2020
LANSETT COMMISSION LOOKED AT
RISK FACTORS FOR DEMENTIA.
AND WE SEE A LOT OF THESE RISK
FACTORS ARE ALSO RISK FACTORS
FOR HEART DISEASE.
BEFORE WE GO INTO THAT, I JUST
HAVE TO PAUSE AND AS FORMAL
PHYSICIAN POINT OUT ONE OF THE
CHALLENGES FOR ONE O THESE RISK
FACTORS WHICH IS ACTUALLY QUITE
EASY TO TREAT FROM A MEDICAL
STANDPOINT BUT VERY HARD TO
TREAT FROM A POLICY STANDPOINT.
THAT'S HEARING IMPAIRMENT.
FROM A NUMBER OF PEOPLE WITH
HEARING -- WITHOUT ACCESS TO
HEARING RATES OR ASSISTIVE
DEVICE ARE AT INCREASE RISK OF
DEMENTIA.
CURRENT MEDICARE AND MEDICAID
INSURANCE POLICIES DON'T COVER
HEARING AIDS.
THERE IS ONGOING EFFORTS IN
CONGRESS TO MOVE FORWARD
LEGISLATION FROM THIS AREA.
SO IT IS FRUSTRATING AS A
CLINICIAN THAT SOME OF THESE
RISK FACTORS ARE ACTUALLY
POTENTIALLY MODIFIABLE BUT WE
FACE BARRIERS ON REIMBURSEMENT
AND COST RATHER THAN BARRIERS ON
THE ACTUAL SCIENCE.
THE OTHER SIDE I'M PREVENTIVE
CARDIOLOGIST AND I SPEND TIME
THINKING ABOUT WAYS TO PREVENT
CARDIOVASCULAR DISEASE INCLUDING
HEART FAILURE, CORONARY DISEASE,
HEART ATTACK AND STROKE.
AND THE NICE THING WHEN WE ARE
THINKING HOW TO PREVENT DEMENTIA
IS THAT OUT OF THESE 12 RISK
FACTORS, TEN OF THEM ARE
ACTUALLY STRONGLY ASSOCIATED
WITH HEART DISEASE AS WELL.
THOSE RISK FACTORS ARE LISTED
HERE OBJECT SLIDE.
SO WHILE WE STILL HAVE A NUMBER
OF RESEARCH NEEDS IN TERMS OF
UNDERSTANDING HOW TO MODIFY
THESE DIFFERENT RISK FACTORS IN
THE DEGREE TO WHICH MODIFYING
RISK FACTORS CAN IMPROVE
COGNITION AND COGNITIVE FUNCTION
OVER TIME.
WE HAVE REALLY STRONG EVIDENCE
WHILE WAITING FOR THAT, THAT
THERE IS SIGNIFICANT BENEFIT IN
TERMS OF CARDIOVASCULAR DISEASE
PROTECTION TO MODIFY THOSE RISK
FACTORS EARLY AND SUSTAINED OVER
THE LIFE COURSE.
TODAY WE WILL TALK ABOUT FIVE OF
THESE.
AND THESE ARE RISK FACTORS THAT
I THINK ARE ONES THAT WE
COMMONLY ADDRESS IN CLINIC AND
THERE ARE RISK FACTORS THAT
PEOPLE WHO ARE INTERESTED IN
LOWERING RISK OF HEART DISEASE
AND DEMENTIA CAN WORK WITH THEIR
HEALTHCARE PROVIDER TO RECEIVE
MEDICATION AND OTHER BEHAVIORAL
SUPPORT TO HELP ADDRESS THESE
RISK FACTORS.
WE WILL START WITH TWO, SMOKING
AND OBESITY.
I THINK IT IS IMPORTANT FOR US
TO POINT OUT FROM A PHYSICIAN
STANDPOINT THESE ARE RISK
FACTORS TO TO BE CONSIDERING MED
CAP CONDITIONS AND ARE MEDICALLY
TREATABLE.
WE OFTEN USE -- THERE IS STIGMA
AROUND OBESITY AND SMOKING AS
LIFESTYLE PROBLEM AND WHILE
LIFESTYLE MODIFICATIONS ARE
CRITICAL COMBATING BOTH OBESITY
AND SMOKING, THERE ARE NUMBER OF
WAYS THAT PATIENTS WITH WORK
WITH THEIR HEALTHCARE PROVIDERS
FOR MEDICAL SUPPORT IN THESE
INTERVENTIONS.
FOR OBESITY WE KNOW THAT HEALTHY
DIET IRRESPECTIVE OF WEIGHT LOSS
CAN LOWER THE RISK OF
CARDIOVASCULAR DISEASE.
AND REFERRALS TO
NUTRITIONALLISTS AND REGISTERED
DIETITIANS ARE WAYS TO ENGAGE
COLLEAGUES WHO CAN HELP GUIDE
PATIENTS TO CHANGES IN THEIR
DIET, TO BOTH HELP WEIGHT LOSS
BUT MORE IMPORTANTLY HEART
HEALTHY FOODS TO PROMOTE
CARDIOVASCULAR HEALTH OVER THE
LIFE SPAN.
FOR PEOPLE WITH SEVERE OBESITY,
BARIATRIC SURGERY, HAS NOT ONLY
SHOWN TO LEAD THE WEIGH LOSS BUT
IN FACT LOWERS THE COMPLICATIONS
OF OBESITY LIKE HYPERTENSION AND
DIABETES AND LOWERS THE RISK OF
LONG TERM CARDIOVASCULAR
DISEASE.
FINALLY IT IS AN EXCITING AREA
FOR MEDICAL TREATMENT OF OBESITY
AS A NUMBER OF FDA APPROVED
MEDICATIONS NOW TO TREAT
DIABETES THAT (INAUDIBLE) WEIGHT
LOSS.
ONE OF THESE CLASSES OF
MEDICATION THE GOP 1 RECEPTOR
AGONIST CLASS AND ONE OF THOSE
AT HIGHER DOSES IS NOW APPROVED
FOR WEIGHT LOSS.
SO WE HAVE NOW MEDICATION TO
HELP LOWER CARDIOVASCULAR
DISEASE RISK AND TREAT OBESITY
AT SAME TIME.
OBVIOUSLY WE HAVE CHALLENGES IN
BOTH UTILIZATION OF MEDICATIONS,
THEY OFTEN ARE EXPENSIVE AND WE
ARE GOING TO NEED TO PAY
ATTENTION TO OUT OF POCKET COST
FOR PATIENTS FOR THESE THERAPIES
AN WORK TO PROMOTE PRICING FOR
EQUAL ACCESS FOR ALL.
SMOKING IS ANOTHER MEDICAL
PROBLEM WE CAN TREAT OR HELP
SUPPORT PATIENTS WITH.
WITH BOTH FDA APPROVED
MEDICATION AS WELL AS PROVEN
EFFECT OF BEHAVIORAL COUNSELING.
NUMEROUS STUDIES HAVE SHOWN
MEDICATION PHARMACO THERAPIES
WORKS BETTER WHEN PAIRED WITH
REFERRAL THE BEHAVIORAL
COUNSELING.
EVERYBODY IN THE UNITED STATES
HAS ACCESS TO EITHER PHONE BASED
OR WEB-BASED BEHAVIORAL HEALTH
SUPPORT FOR SMOKING CESSATION
LIEU THE QUIT LINE OR SMOKE
FREE.GOV.
ALSO HAVE REFERENCES FOR OTHER
LANGUAGES SO IT IS NOT FOR THOSE
WHO SPEAK ENGLISH.
WE ALSO KNOW MEDICATION THERAPY
AND NICOTINE REPLACEMENT THERAPY
CHAN TAX AND WELLBUTRIN, HAVE
BEEN SHOWN TO HELP PEOPLE ABOUT
SANE FROM SMOKING.
THE CHALLENGES THAT PROVIDERS
DON'T ALWAYS RECOMMEND FOR
PATIENTS WHO SEEK TO QUIT
SMOKING SO WE NEED TO DO A
BETTER JOB ON OUR END AS
HEALTHCARE PROVIDERS AND LEARN
UTILIZATION OF THESE THERAPIES,
IDENTIFYING PATIENTS WHO MAY
BENEFIT FROM THEM AND HELPING
PROVIDE ACCESS TO THERAPY FOR
PATIENTS AS THEY SEEK TO PUT
CIGARETTE SMOKING AND USE OF
OTHER TOBACCO PRODUCTS.
BEHEARD FROM DR. BAKER ABOUT
PHYSICAL ACTIVITY TELLING US THE
IMPORTANT LENGTH BETWEEN
MOVEMENT EXERCISE AND PROMOTING
LONG (INAUDIBLE).
I WANT TO POINT OUT ONE THING
FROM A PHYSICIAN STANDPOINT THAT
IS HELPFUL FOR PATIENTS AS THEY
THINK ABOUT HOW THEY CAN
INCREASE PHYSICAL ACTIVITY.
IT CAN BE DAUNTING TO GO FROM NO
PHYSICAL ACTIVITY TO HAVING TO
RUN A MARATHON BUT THAT IS NOT
WHAT WE ARE ASKING PEOPLE TO DO.
IN FACT THOUGH DR. BAKER
EMPHASIZES THE IMPORTANCE OF
SUSTAINED CARD -- FITNESS OVER
THE LIFE SPAN, IN FACT EVEN
SMALL INCREASES IN THE AMOUNT OF
REGULAR PHYSICAL ACTIVITY HAVE
BEEN SHOWN TO LOWER THE RISK OF
ALZHEIMER'S DISEASE AS WELL AS
COGNITIVE IMPAIRMENT COMPARED TO
NO ACTIVITY.
IN FACT EVEN MODERATE ACTIVITY
DEFINED AS WALKING ACTIVITY
THREE OR MARITIMES A WEEK IN
WOMEN WAS SHOWN OVER THE AGE OF
65 AS SHOWN TO LOWER THE RISK OF
COGNITIVE IMPAIRMENT BY ALMOST
58%.
SO FOR THOSE OF YOU WHO MAY BE
OVERWHELMED OR FEEL LIKE YOU
CAN'T REACH THE MINIMUM
RECOMMENDED PHYSICAL ACTIVITY
TARGET, HOWEVER CLOSE YOU CAN
GET THERE EVEN INCREMENTAL
INCREASES IN SUSTAINED PHYSICAL
ACTIVITY OVER YEARS IS LIKELY TO
DECREASE LONG TERM RISK OF
DEMENTIA AND COGNITIVE
IMPAIRMENT.
WE ALSO KNOW THAT PHYSICAL
ACTIVITY IS A KEY WAY TO HELP
PREVENT CARDIOVASCULAR DISEASE
INCLUDING HEART ATTACK AND
STROKE.
THESE ARE THE RECOMMENDATIONS
FROM THE AMERICAN HEART
ASSOCIATION FOR PHYSICAL
ACTIVITY IN ADULTS.
THE RECOMMENDATIONS ARE 150
MINUTE AS WEEK OF MODERATE
ACTIVITY OR 75 MINUTE AS WEEK OF
HIGH INTENSITY ACTIVITY.
AND THE EASIEST WAY I TALK TO MY
PATIENTS HOW TO KNOW IF WHAT YOU
KNOW IS MISDEMEANOR RAT OR
RIGOROUS.
WITH MODERATE I CAN E YOU SHOULD
BE, WHOING HARD ENOUGH TO SPEAK
IN COMPLETE SENTENCES BUT
COULDN'T SING A SONG.
HIGH INTENSITY ACTIVITY IS
SOMETHING LIKE RUNNING OR
SINGLES TENNIS WHERE YOU CAN
SPEAK BUT ONLY IN VERY SHORT
SENTENCES BECAUSE YOU ARE TRYING
TO CATCH YOUR BREATH.
WE ALSO RECOMMEND THE HEART
ASSOCIATION AT LEAST TWO DAYS A
WEEK OF STRENGTH FROM MUSCLE
BUILDING BECAUSE THAT CAN
PROMOTE ADDITIONAL METABOLIC
STABILITY AND DECREASE FURTHER
RISK OF HEART DISEASE IN HEART
DISEASE RISK FACTORS LIKE
DIABETES.
BLOOD PRESSURE IS A KEY
MODIFIABLE RISK FACTOR DEMENTIA
AND CARDIOVASCULAR DISEASE.
ONE STUDY SHOWING THE IMPORTANCE
OF SUSTAINED CONTROL AND BLOOD
PRESSURE OVER TIME, COMING FROM
FRAMINGHAM COHORT STUDY.
THIS TOOK PEOPLE IN THE 70s AN
FOLLOWED THYMICAE KIDS HOW RISK
FACTORS IN MIDDLE OF YOUR LIFE
IMPACT YOUR LONG TERM RISK OF
THINGS LIKE DEMENTIA AND
CARDIOVASCULAR DISEASE.
THIS PARTICULAR STUDY PEOPLE
WERE FOLLOWED FOR SEVERAL
DECADES AND WERE FOUND -- THEY
FOUND FOR EVERY TEN POINT
INCREASE IN BLOOD PRESSURE IN
MID LIFE, YOUR LONG TERM RISK OF
DEMENTIA WAS INCREASED BY 20%.
EMPHASIZING THE IMPORTANCE OF
THINKING EARLY ABOUT MODIFYING
RISK FACTORS TO HELP PROMOTE
LONG TERM BRAIN HEALTH.
WHAT DO WE KNOW ABOUT BLOOD
PRESSURE AND DEMENTIA FROM
CLINICAL TRIALS?
THIS META ANALYSIS PUBLISHED IN
JAMA TOOK 14 RANDOMIZED TRIALS
PEOPLE WHO RANDOMIZE DIFFERENT
BLOOD PRESSURE THERAPY AND
POOLED THE DATA TOGETHER FOR
100,000.
THE FOLLOW-UP TIME WAS ABOUT
FOUR YEARS.
AND POOLED TOGETHER THE AUTHORS
FOUND A SMALL BUT REAL DECREASE
MANY THE RISK OF DEMENTIA AS
WELL AS COGNITIVE DECLINE AND
THE GROUPS OF PEOPLE WHO WERE
RANDOMIZED TO BLOOD PRESSURE
LOWERING COMPARED TO PEOPLE WHO
WERE NOT.
YOU MIGHT ASK THIS LOOKS REALLY
SMALL COMPARED TO DATA YOU
SHOWED ON THE LAST SLIDE.
I WILL POINT OUT THAT MOST OF
THESE TRIALS DON'T FOLLOW PEOPLE
A LONG TIME.
WE ARE LOOKING AT THE BENEFIT OF
BLOOD PRESSURE LOWERING ABOUT
FOUR YEARS ON AVERAGE WITH THESE
STUDIES.
WE KNOW THAT THE BIOLOGY OF
DEMENTIA IS SOMETHING THAT TAKES
A LONG TIME TO ACCUMULATE RISK
AND A LONG TIME TO START TO
ACCUMULATE RISK WHICH MEANS WE
HAVE A LONG TIME TO ACCUMULATE
BENEFIT.
SO WHEN I LOOK AT THESE DATA IN
CONTEXT WITH OBSERVATIONAL DATA
FOR FRAMINGHAM, IT EMPHASIZES
THE IMPORTANT OF NOT WAITING
LATER IN LIFE FOR BLOOD PRESSURE
CONTROL TO MAXIMIZE POTENTIAL
BENEFIT OF BLOOD PRESSURE
LOWERING ON OVERALL RISK OF
DEMENTIA AND COGNITIVE DECLINE.
THIS RANDOMIZED TRIAL GAVE
ADDITIONAL INFORMATION FOR US.
ABOUT WHAT THE OPTIMAL BLOOD
PRESSURE SHOULD BE TO HELP
PREVENT DEMENTIA AND PROMOTE
LONG TERM BRAIN HEALTH.
THIS IS DEFINED TO SHOW WHETHER
OR NOT A LOWER TARGET BLOOD
PRESSURE IN THIS CASE SOLID
BLOOD PRESSURE LESS THAN 120 WAS
BETTER THAN TARGET SYSTOLIC
BLOOD PRESSURE LESS THAN 140.
THE OVERALL STUDY WE SAW
DRAMATICALLY (INAUDIBLE) STROKE
AND HEART ATTACK AND RANDOMIZED
LOWER VERSUS HIGHER BLOOD
PRESSURE.
FOLLOW-UP SUBSET OF PEE P L HAD
COGNITIVE ASSESSMENT AND WHAT WE
FOUND IS 17% DECREASE IN RISK OF
DEMENTIA AS WELL AS 19% DECREASE
IN MILD CONTROLOR COGNITIVE
IMPAIRMENT IN RANDOMIZED
(INAUDIBLE) IT IS IMPORTANT TO
ASK THAT PROBABLY DUE TO SAMPLE
SIZE IS RELATIVE RISK REDUCTION
WAS NOT STATISTICALLY
SIGNIFICANT.
COMBINED WITH WHAT WE KNOW ABOUT
-- FROM OBSERVATIONAL STUDIES
ABOUT RISK OF HYPERTENSION AND
DEMENTIA RISK IT IS BIOLOGICALLY
PLAUSIBLE LOWERING BLOOD
PRESSURE WILL HELP PROMOTE --
PREVENT DIABETES COGNITIVE
IMPAIRMENT OVER TIME.
DIABETES IS ANOTHER RISK FACTOR
THAT WE CAN TREAT MEDICALLY TO
HELP PREVENT RISK OF DEMENTIA.
THIS GRAPH COMES FROM A NICE
REVIEW ARTICLE OF THE --
DIABETES AND HOW IT INTERPLAYS
WITH RISK OF DEMENTIA, BOTH
THROUGH PROMOTING
ATHEROSCLEROSIS, MICROVASCULAR
DISEASE DIRECT TOXICITY IN THE
BRAIN AND INSULIN.
WE KNOW THAT DURATION OF
DIABETES HAVING UNCONTROLLED
DIABETES HYPOGLYCEMIC CREASE
RISK OF DEMENTIA.
ALL THESE THINGS INCREASE THE
RISK OF MYOCARDIAL INFARCTION
AND STROKE OVER TIME.
THE LAST WE HAVE HAD TWO CLASSES
OF THERAPIES THAT ARE ABSOLUTELY
BREAK THROUGH TREATMENT TO HELP
US LOWER THE RISK OF
CARDIOVASCULAR DISEASE IN
PERSONS WITH DEUTSCHE.
THESE INCLUDE CLASS OF
MEDICATIONS CALLED STLT 2
INHIBITORS AND GLP, 1 RECEPTOR
AGONISTS WHICH NOT ONLY LOWER
BLOOD GLUCOSE CONTROL IN PEOPLE
WITH DIABETES THEY HAVE BEEN
SHOWN TO DECREASE RISK OF HEART
ATTACK, STROKE, HEART FAILURE
AND CARDIOVASCULAR DEATH.
AS SUCH THE AMERICAN DIABETES
ASSOCIATION NOW RECOMMENDS THAT
ALL PERSONS WITH DIABETES TYPE 2
DIABETES WHO ARE AT RISK FOR
CARDIOVASCULAR DISEASE OR
ESTABLISHED CARDIOVASCULAR
DISEASE USE AGENTS AS FIRST
VOLUME AFTER PERFORMING TO HELP
FURTHER PROMOTE CARDIOVASCULAR
HEALTH.
WE DON'T KNOW IF THESE WILL
DECREASE RISK OF DEMENTIA, BUT
WE DO KNOW THAT BY PREVENTING
STROKES WE CAN PROMOTE LONG TERM
BRAIN HEALTH.
I WOULD BE REMISS TO NOT TALK
ABOUT STROKE AND STROKE
PREVENTION AS PARTS OF THE
BROADER CONVERSATION ABOUT
PRESERVING FUNCTIONAL STATUS IN
BRAIN HEALTH OVER TIME.
I WILL POINT OUT TWO IMPORTANT
RISK FACTORS THAT ARE KEY TO
HELP PREVENTING STROKE OVER LIFE
COURSE.
FIRST TREATMENT OF LDL
CHOLESTEROL.
WE KNOW FROM CLINICAL TRIALS
TENS OF THOUSANDS OF PEOPLE,
LOWERING LDL CHOLESTEROL WITH
STATIN THERAPY DECREASE NOT ONLY
RISK OF HEART ATTACK AND HEART
DISEASE, BUT ALSO RISK OF
STROKE.
IN FACT STATINS HAVE BEEN SHOWN
TO LOWER THE RISK OF STROKE BY
17% WHEN COMPARED TO A PLACEBO.
THE OTHER TYPE OF STROKE THAT WE
CAN PREVENT ARE STROKES THAT ARE
FROM THE HEART RHYTHM PROBLEM
ATRIAL FIBRILLATION.
ATRIAL FIBRILLATION LEADS THE
BLOOD CLOTS IN THE HEART THAT
WHEN THEY BREAK THREE CAN GO TO
THE BRAIN.
THOUGH WE HAVE NUMBER OF SHEER
THERAPIES TO PREVENT STROKE IN
PEOPLE WITH ATRIAL FIBRILLATION,
ANTI-COAGULANTS, GOING GENERIC
SOON, WE STILL FIND ONE IN THREE
PEOPLE WITH ATRIAL FIBRILLATION
HIGH RISK FOR STROKE ARE NOT ON
A BLOOD THINNER.
THIS IS A MASSIVELY IMPORTANT
OPPORTUNITY FOR US TO DECREASE
THE RISK OF STROKE BUT INCRESSET
THROUGHIZATION OF
ANTI-COAGULATION THERAPY IN
PEOPLE WITH ATRIAL FIBRILLATION.
ALSO WE HAVE NEW TECHNOLOGIES
THAT ARE HELPING US BETTER
IDENTIFY PEOPLE WITH ATRIAL
FIBRILLATION FOR -- BEFORE THEY
PRESENT STROKE IN THE FIRST
PLACE.
THIS INCLUDES DETECTION
TECHNOLOGIES SHOWN TO BE
ACCURATE IN BOTH THE APPLE
IWATCH AS WELL AS THE FIT BIT.
THE NEXT ERA OF AFIB IS GOING TO
MOVE TO INCREASE ATRIAL
FIBRILLATION AN IMPROVE
POPULATION HEALTH WORK TOWARDS
INCREASING ANTI-COAGULATION TO
HELP PREVENT IN THIS POPULATION.
CLINIC WORRIED ABOUT DEMENTIA
RISK I TALK TO THEM ABOUT
MODIFIABLE RISK FACTOR BUS ALSO
MAKE SURE THAT'S BROADER
CONVERSATION AROUND PREVENTING
STROKE AND IMPLEMENTING OVERALL
BRAIN HEALTH.
WITH THAT HUE FOR YOUR TIME.
>> THANK YOU VERY MUCH DR.
HOBART.
NEXT WE'LL HAVE OUR FINAL
SPEAKER OF THE DAY.
>> THANKS.
LET ME BEGIN BY SAYING I'M
EXTREMELY GRATEFUL TO THE STAFF
AT THE AREA COUNTY HERE IN
FOURTH WORTH AND OTHER PARTNERS
WHO MADE MY WORK I WILL BE
TALKING ABOUT POSSIBLE OVER THE
PAST 15 YEARS.
NEXT SLIDE.
AREA AGENCIES WERE CREATED BY
THE OLDER AMERICANS ACT IN 1973.
FOR MOST OF THE 49 YEAR HISTORY,
TRIPLE A IS REQUIRED TO TARGET
SERVICES TO HIGH RISK
POPULATIONS.
I'M GOING TO BE SHARING THOSE
PROVISIONS WITH YOU FROM THE
ACT, TALK ABOUT SOME OF THE
TARGETED PROGRAMMING WE HAVE
DONE HERE IN TEAR RANT COUNTY, A
COUPLE OF OUR ACL FUNDED
DEMENTIA CAPABLE PROJECTS AND
ALSO SERVICES TO ADDRESS SOCIAL
DETERMINANTS OF HEALTH.
AND SOME OF THE BARRIERS THAT WE
HAVE FACED AND PROVIDING
COMMUNITY BASED SERVICES AND
SUPPORTS.
NEXT SLIDE.
THESE ARE THE TARGETING
PROVISIONS INCLUDED MISDEMEANOR
THE OLDER AMERICANS ACT.
THEY HAVE REMAINED RELATIVELY
THE SAME FOR ABOUT 40 YEARS.
IN THE '90s THERE WAS MORE
EMPHASIS AT IT ON LOW INCOME
MINORITY INDIVIDUALS AND ALSO IN
THE 2000 AMENDMENTS TARGETING TO
PEOPLE RESIDING IN RURAL AREAS
IN TEXAS WE ARE PARTICULARLY
CONCERNED ABOUT NUMBER 6 BECAUSE
ACCORDING TO CMS WE HAVE MORE
LOW PERFORMING ONE STAR NURSING
HOMES THAN ANY OTHER STATE IN
THE COUNTRY.
ONE OF MY FAVORITE WAYS THE
APPROACH ANY CONVERSATION ABOUT
HEALTH DISPARITIES IS BY LOOKING
AT ZIP CODE DATA.
FOR EXAMPLE WE HAVE A ZIP CODE
HERE IN TERRANT COUNTY WITH A
LIFE EXPECTANCY OF 66.7 YEARS.
WHAT YOU WILL FIND MANY THAT ZIP
CODE AND SIMILAR ZIP CODES ARE
HIGH RATES OF HEART DISEASE,
HYPERTENSION, DIABETES,
DEMENTIA, ALSO HIGH CRIME
NEIGHBORHOODS, BIG FOOD DESERTS
WITHOUT A LOT OF ACCESS TO
HEALTHY FOOD.
ALSO ONE RISK FACTOR I HAVEN'T
HEARD MENTIONED TODAY AND THAT'S
AVERAGE NUMBER OF REVERSE
CHILDHOOD -- ADVERSE CHILDHOOD
EXPERIENCES WHICH ARE ASSOCIATED
WITH A LOT OF OTHER RISK FACTORS
THAT WE DISCUSSED.
MY FAVORITE OUT OF ALL THE
OUTREACH STRATEGIES AS FAR AS
BEING MOST EFFECTIVE IS DOOR TO
DOOR STRATEGIES, THESE ARE VERY
LOW COST STRATEGIES FOR REACHING
PEOPLE.
REACHING UNSERVED AND
UNDERSERVED POPULATIONS.
NEXT SLIDE.
WE STARTED USING GEOGRAPHIC
INFORMATION SYSTEMS TO TARGET
SERVICES IN LOW INCOME AREAS
WITH HIGH CONCENTRATIONS OF
PEOPLE LIVING ALONE.
TO ADDRESS LONELINESS IN 2006.
IN 2008 WE REPLICATED DEMENTIA
CARE TRANSITIONS PROGRAM, THAT
WAS DEVELOPED BY BAILOR SCOTT
WHITE IN CENTRAL TEXAS THEN
UNITED WAY FUNDED A NINE YEAR
HEALTHY AGING INDEPENDENT LIVING
INITIATIVE THAT INCLUDED BOTH
PROGRAMS FOR CAREGIVERS AS WELL
AS WELLNESS PROGRAMS WE SERVED
OVER 63,000 PEOPLE.
THERE IS OUTCOME DATA ON 30,000,
ALMOST 30,000 OF THOSE PEOPLE.
WHAT WE HAVE LEARNED FROM ALL
THESE INITIATIVES IS THAT WE CAN
MAKE MUCH BIGGER DIFFERENCE IF
WE FOCUS ON POPULATIONS WITH LOW
TO MODERATE COGNITIVE
IMPAIRMENT.
AS A FAILED FUTURE FARMER OF
AMERICA FROM EAST TEXAS, I
ALWAYS TRIED TO SURROUND MYSELF
WITH MUCH SMARTER PEOPLE SO I
BRIEFLY WANT TO ACKNOWLEDGE A
FEW PARTNERS, ALLEN STEVENS AND
JIM YUNG CHO JIM BAILOR SCOTT,
THEY PROVIDED THE BULK OF THE DI
PROJECTS AND MATTHEW SMITH AT
TEXAS A AND M.
JANICE AND JENNIFER ARE PARTNERS
FOR EIGHT YEARS ON HRSA PROJECT.
MAR SERKSLLA AND KATHERINE
DANIEL AT UTA AND LAST BUT NOT
LEAST, MY TRUSTED ADVISOR FOR
OVER 30 YEARS ON ALL MATTERS
DEMENTIA AND CARE GIVING, NANCY
WILSON.
NEXT SLIDE.
SO IN 2016 WE DECIDED TO GO ALL
IN ON DEMENTIA HEALTH
DISPARITIES.
AND APPLY FOR FUNDING FROM
ADMINISTRATION FOR COMMUNITY
LIVING AND RECEIVE THAT FUNDING.
WHAT WE DISCOVERED OVER THE
FIRST THREE YEARS OF THE PROJECT
WAS THERE IS A LOT MORE PEOPLE
LIVING ALONE WITH DEMENTIA THAN
WE ANTICIPATED.
SO WE RECEIVED AN EXPANSION
GRANT TO SERVE THAT POPULATION
IN 2019.
ALL STATE UNITS ON AGING THAT
OVERSEE AREA DENSITIES ON AGING
NATIONWIDE OR MOST OF THEM,
REQUIRE THE USE OF SOME KIND OF
FUNCTIONAL ASSESSMENT TO
DETERMINE ELIGIBILITY FOR
UNDELIVERED MEALS AND OTHER
SERVICES WE USED THAT AS A
BASELINE, AND DOING SCREENING
FOR DEMENTIA AND USE THAT IN A
FEW QUESTIONS I WILL MENTION IN
A MOMENT TRIGGER ADMINISTRATION
OF THE ADA, WE USE THE QLAD IN
THIS BURDEN, AS OUTCOME MEASURES
AND ALSO THE (INAUDIBLE) FOR
PERSON CENTERED PLANNING.
NEXT SLIDE.
SO WE FOUND A FEW QUESTIONS ON
THE TEXAS CONSUMER NEEDS
EVALUATION FORM THAT WE THOUGHT
IF THEY ANSWER YES TO ANY ONE OF
THESE QUESTIONS MAYBE GO AHEAD
AND DO THE ADA.
WHICH WE DID.
I LIKE TO SAY THIS WOULD NOT
HAVE BEEN POSSIBLE WITHOUT THE
HELP OF MEALS ON WHEELS OF
TERRAN COUNTY, ONE OF THE BEST
IN THE UNITED STATES.
WE VIRTUALLY SCREEN ALL OF THE
PEOPLE GETTING MEALS ON WHEELS
IN TERRANT COUNTY, ACCORDING TO
THE ADA, 41% OF THOSE SCREENED
HAD AT LEAST SOME POSSIBLE
SYMPTOMS OF DEMENTIA.
ABOUT HALF OF THOSE, ABOUT 19%
OF THE TOTAL OVER 3,000 PEOPLE,
WERE PEOPLE LIVING ALONE WITH
DEMENTIA.
WE WERE REALLY PLEASED WITH THE
OUTCOMES AFTER WE PROVIDED
SERVICES PRIMARILY TO ADDRESS
SOCIAL DETERMINANTS OF HEALTH.
NEXT SLIDE.
I NEVER HEARD OF CULTURALLY
LINGUISTICALLY APPROPRIATE
SERVICES UNTIL 2015 WHEN WE WERE
PUTTING TOGETHER GRANT
APPLICATION AND I WAS TOLD ABOUT
STANDARDS BY MARSELLA NAVA AND I
THOUGHT BOY, THIS REALLY FITS
NICELY WITH WHAT WE ARE TRYING
TO ACCOMPLISH WITH THE
(INAUDIBLE) SO MARSELLA
CONDUCTED TWO HALF DAY TRAININGS
FOR ALL OF OUR PARTNERS.
AND WE RATED OURSELVES THE
LOWEST ON STANDARD 11.
SO WE DECIDED THAT AS A GROUP AS
A COMMUNITY THAT WE WOULD FOCUS
ON THAT ONE STANDARD WHICH IS TO
COLLECT AND MAINTAIN ACCURATE
RELIABLE DEMOGRAPHIC DATA BY
DOING SO WE WERE ABLE TO
INCREASE SERVICES TO AFRICAN
AMERICAN HISPANIC CAREGIVERS BY
17%.
SERVICES TO PEOPLE WITH
DEMENTIA, BY 21%.
WE PUT THIS LIST TOGETHER WITH
THE HELP OF ONE OF OUR DEMENTIA
CAPABLE PARTNERS IN HOUSTON.
BAKER RIPLY.
WE THINK THESE ARE THE MOST
NEEDED SERVICES FOR PEOPLE WITH
DEMENTIA.
IN MY OPINION I THINK ASSISTIVE
AND TRANSPORTATION AND IN HOME
VISITS BY PHYSICIANS IS
CRITICAL, IT IS A LITTLE
UNREALISTIC TO EXPECT A PERSON
LIVING ALONE WITHOUT FAMILY
CAREGIVER SUPPORT WHICH IS ABOUT
HALF THE PEOPLE WE SERVE, TO
SOMEHOW FIND THEIR WAY INTO A
DOCTOR'S OFFICE FOR A FORMAL
DIAGNOSIS WHICH IS NEEDED FOR
ACCESS TO SERVICES.
SO ONLY ABOUT 30% OF THE PEOPLE
WE IDENTIFIED WITH THE ADA AS
HAVING A POSSIBLE SYMPTOMS OF
DEMENTIA HAD A FORMAL DIAGNOSIS.
SO FIGURING OUT A WAY TO GET TO
THOSE PEOPLE, SINCE IT IS VERY
DIFFICULT FOR THEM TO ACCESS
MEDICAL SERVICES IS CRITICAL.
I HEARD JANICE KANABLE ONCE SAY
ONE AT ONE OF OUR HRSA MEETINGS
THAT THE FUTURE OF HEALTHCARE IS
IN THE COMMUNITY.
I COULDN'T AGREE MORE.
AND I THINK SOME FINANCIAL
INCENTIVES NEED TO BE PUT IN
PLACE TO ENSURE WE GET MORE
HEALTHCARE OUT TO PEOPLE,
PARTICULARLY THOSE LIVING WITH
DEMENTIA.
A COUPLE OF MACRO TRENDS THAT
KEEP ME AWAKE AT NIGHT THESE
DAYS.
ONE IS THERE ARE MORE OLDER
AMERICANS LIVING ALONE THAN ANY
OTHER COUNTRY.
THE OTHER TREND IS WITH EACH
UPCOMING COHORT, WE ARE SEEING
MORE JOBLESS AMERICANS.
WE REFER TO THEM AS ELDER
ORPHANS.
IN FACT IN A RECENT SURVEY, OF
AMERICANS AGES 18 TO 49, 44%
SAID HAY WOULD NOT LIKELY OR
DEFINITELY NOT HAVE CHILDREN.
SO SO THOSE DAYS OF US BEING
ABLE TO RELY ON FAMILY CARE
GIVERS TO PROVIDE THE BULK OF
CARE, FOR PEOPLE WITH DEMENTIA
ARE COMING TO AN END.
SO THANK YOU VERY MUCH.
IF YOU HAVE ANY QUESTIONS FEEL
FREE TO EMAIL ME.
>> GREAT.
THANK YOU TO ALL THE SPEAKERS
TODAY.
WE WILL WAIT A SECOND FOR THEM
TO ALL GET ON VIDEO AGAIN.
IT TAKES A COUPLE OF MINUTES TO
FIND NOSE BUTTONS.
SO SINCE YOU ARE AVAILABLE,
FIRST QUESTION I HAVE IS IS THE
DEIDENTIFY DATA COLLECTED ON THE
AD 8, IS THAT AVAILABLE TO
PEOPLE FOR RESEARCH PURPOSES?
>> I WOULD NEED TO CHECK WITH
ALLEN STEVENS AND JIM CHO AT
BAILOR SCOTT WHITE.
BUT JUST SHOOT ME AN EMAIL AND
THEN WE WILL SEE IF THAT IS
POSSIBLE.
>> THANK YOU VERY MUCH.
DR. NAVARRE, SO WHEN YOU SEE
PATIENTS IN CLINIC, AND YOU
TRYING TO HELP THEM REDUCE THE
RISK OF ALL THESE BAD THINGS
THAT COULD HAPPEN, WHAT DO YOU
WISH THEY WOULD TELL YOU, OR
WHAT THINGS WOULD BE HONEST WITH
YOU ABOUT?
THAT CAN HELP YOU HELP THEM?
>> I LIKE MY PATIENTS TO BE
HONEST WITH ME ABOUT EVERYTHING.
AND I THINK THAT PEOPLE OFTEN
FEEL LIKE RELUCTANT TO TELL ME
ALL THE THINGS THAT YOU THINK
YOU CAN DO BETTER WITH.
AND OUR JOB AS DOCTORS ISN'T TO
JUDGE OR GIVE YOU A REPORT CARD.
AND I THINK PEOPLE OFTEN FEEL
AFRAID TO BE FULLY TRANSPARENT
BECAUSE THEY DON'T WANT TO GET A
BAD GRADE FROM THEIR DOCTOR OR
HEAR ALL THE THINGS THEY ARE
DOING WRONG.
THE REALITY IS YES, I IN AN
IDEAL WORLD YOU DO EVERYTHING
RIGHT.
THE GOOD NEWS IS YOU CAN GET A
BENEFIT FROM EACH OF THESE
THINGS INDEPENDENT WITHOUT DOING
THEM ALL.
SO SAY YOU HAVE A PHYSICAL
IMPAIRMENT AND YOU CAN'T
EXERCISE OR YOU HAVE CHRONIC
ARTHRITIS AND JUST CAN'T
INCREASE PHYSICAL ACTIVITY
WITHOUT SUBSTANTIAL PAIN.
THAT IS OKAY.
WE CAN GIVE YOU SOME WAYS TO EAT
HEALTHIER, WE CAN HELP YOU QUIT
SMOKING AND CONTROL YOUR BLOOD
PRESSURE.
SO BOTH SHARING EVERYTHING THAT
YOU ARE DOING HONESTLY, BUT
MOSTLY BEING HONEST WITH YOUR
DOCTOR WHERE YOUR CHALLENGES
ARE, IT IS GREAT WHEN SOMEBODY
SAYS LOOK I WON'T QUIT SMOKING.
YOU CAN TALK ALL DAY AIN'T
HAPPENING.
I WILL STAKE A STATIN.
HELP ME FIGURE OUT WAYS TO WORK
TOGETHER AND FIND MODIFIABLE
RISK FACTORS RATHER THAN HAVE ME
SHOOTING IN THE DARK.
>> RIGHT.
THANK YOU, VERY MUCH.
DR. SHERRY, THE NEW GOAL FOR --
FROM THE NATIONAL PLAN IS
TALKING ABOUT RISK REDUCTION.
CAN YOU GIVE A BRIEF -- WHAT IS
RISK REDUCTION VERSUS
PREVENTION?
ARE THEY THE SAME THING?
>> THANK YOU SO MUCH, DR.
MACGUIRE.
WHAT AN EXCELLENT QUESTION.
I CAN TELL YOU HOW WE ARE
CONCEPTUALIZING THE DIFFERENCE
BETWEEN RISK REDUCTION AND
PREVENTION IN THE CONTEXT OF
THIS NEW GOAL.
WE THINK OF RISK REDUCTION ON A
POPULATION LEVEL.
WHAT ARE THE THINGS WE CAN DO
THAT WOULD REDUCE THE LIKELIHOOD
OF THE GROUP OF PEOPLE OVERALL
DEVELOPING DEMENTIA?
WHEREAS WHEN WE THINK OF
PREVENTION IN THIS SPECIFIC
CONTEXT RECOGNIZING A LOT OF
PEOPLE USE THESE TERMS
INTERCHANGEABLY, WE THINK OF THE
DISTINCTION AS WHAT CAN WE DO TO
STOP A PERSON FROM GETTING
DEMENTIA ALL TOGETHER.
SO THAT IS THE DISTINCTION WE
DRAW AND WE DO IT IN PART
BECAUSE WE RECOGNIZE AS OUR
PRESENTERS HAVE SO ELOQUENTLY
DESCRIBED TODAY THE SCIENCE AND
UNDERSTANDING OF WHAT FACTORS
CONTRIBUTE TO DEVELOPING
ALZHEIMER'S DISEASE IS EVOLVING
AND IS COMPLEX, IT APPEARS A
MULTI-FACTORAL ILLNESS AND
CONDITION.
SO IT I CAN BE ADDRESSING ONE
RISK FACTOR SUCH AS HYPERTENSION
CAN REDUCE THE RISK BUT MAY NOT
PREVENT IT ALL TOGETHER BECAUSE
THERE ARE OTHER FACTORS THAT
CONTRIBUTE TO THIS.
SO IN OUR APPROACH WE HAVE TRIED
IN USING THE TERM RISK REDUCTION
TO ACKNOWLEDGE THE LIMITATIONS
OF WHAT THE RESEARCH TELLS US
RIGHT NOW.
AND WE HAVE UNFORTUNATELY NOT
DESPITE THROUGH GOAL ONE
NATIONAL PLAN REALLY DRIVING
TOWARDS AND WE HAVEN'T GIVEN UP
BUT WE HAVE NOT IDENTIFIED THAT
ONE SILVER BULLET INTERVENTION
JUST YET.
THAT CAN PREVENT A PERSON FROM
GETTING ALZHEIMER'S DISEASE.
IMPORTANTLY WE HAVE IDENTIFIED
ALL OF THESE OTHER RISK FACTORS
THAT WE CAN INTERVENE TO REDUCE
CHANCES.
WE WANT TO BE CLEAR WHEN WE
COMMUNICATE TO THE PUBLIC DOING
THINGS LIKE KEEPING BLOOD
PRESSURE UNDER CONTROL,
EXERCISING MORE, BEING MORE
COGNITIVELY ACTIVE, THESE ARE SO
IMPORTANT BECAUSE THEY CAN
REDUCE YOUR RISK BUT WE ALSO
WANT TO BE CLEAR WE DON'T GET --
HAVE EVIDENCE THAT THEY WILL
STOP YOU AS AN INDIVIDUAL FOR
DEVELOPING ALZHEIMER'S DEMENTIA
ALL TOGETHER.
I HOPE THAT ADDRESSES YOUR
QUESTION.
>> IT DID.
THANK YOU, VERY MUCH.
>> MATTHEW, IS THERE ANY RISK
REDUCTION DATA RELATING TO
AMERICAN INDIAN ALASKA NATIVE
PEOPLE AND TRIBAL COMMUNITIES
WITH DEMENTIA?
>> DATA IN THAT POPULATION IS
VERY HARD TO COME BY.
THERE ARE COUPLE OF THINGS WE DO
KNOW.
AS I MENTIONED ON ONE OF MY
SLIDES MORE THAN TWO-THIRDS OF
NATIVE AMERICANS HAVE AT LEAST
ONE OF THOSE BIG FIVE RISK
FACTORS HYPERTENSION DIABETES
OBESITY SMOKING OR PHYSICAL
INACTIVITY.
WE ALSO KNOW THAT IN GENERAL THE
PREVALENCE OF A LOT OF RISK
KNACK TORRS IS MUCH HIGHER AMONG
NATIVE AMERICANS, A LOT OF THESE
-- A LOT OF THESE CONDITIONS ARE
MUCH HIGHER IN GENERAL AMONG
NATIVE AMERICANS WHEN COMPARED
WITH WHITES.
THE OTHER THING WE KNOW AND I
THINK YOU ARE INVOLVED IN THE
STUDY THAT LOOKED AT THIS --
PUBLISHED A COUPLE OF YEARS AGO,
THAT BETWEEN 2014 AND 2060, SO
OVER THAT TIME SPAN, THE NUMBER
OF NATIVE AMERICANS WITH
DEMENTIA IS EXPECTED TO INCREASE
FIVE FOLD.
AND SO THAT IS A HUGE INCREASE
IN THE POPULATION AND PART OF
THAT IS IMPROVED HEALTHCARE IN
GENERAL SO PEOPLE ARE LIVING
LONGER.
BUT IT IS ALSO PROBABLY A FACTOR
OF THE HIGHER PREVALENCE OF SOME
OF THESE RISK FACTORS.
>> THANK YOU VERY MUCH.
DR. BAKER.
CAN YOU COMMENT ON THE EFFECT OF
CHRONIC SLEEP DEPRIVATION AND
POTENTIAL IMPACT ON DEMENTIA?
>> THIS IS A NEW AREA THAT IS
GETTING A LOT OF ATTENTION NOW,
SLEEP, QUALITY, AND COGNITIVE
HEALTH AND DECLINE.
THE LATEST SCIENCE THAT WE ARE
LEARNING ABOUT SUGGESTS THAT
DURING SLEEP A VERY IMPORTANT
PROCESS TAKES PLACE.
I ALWAYS LIKE TO THINK OF IT AS
BRAIN TAKES OUT TRASH.
AT NIGHT.
IF WE DO NOT GET GOOD QUALITY
SLEEP, WELL, WE MOW WHAT HAPPENS
IN OUR HOUSES WHEN THAT DOESN'T
HAPPEN, RIGHT?
SO WHY WOULD WE EXPECT ANYTHING
DIFFERENT.
IF WE CAN'T TAKE OUT THE TRASH,
AND -- JUST EVERY DAY WHEN WE
ARE THINKING -- EVERYTHING WE
DO, THERE ARE BY-PRODUCTS THAT
WE HAVE TO -- THERE'S EXTRA --
THERE'S TRASH THAT NEEDS TO BE
DISPOSED OF AT THE END OF THE
DAY.
WHAT WE ARE LEARNING IS PEOPLE
WHO ARE NOT GETTING GOOD QUALITY
SLEEP HAVE HIGHER BUILD UP OF
THIS TRASH.
SO WHAT WE HAVE SEEN IN SCIENCE
IS THERE IS A HIGHER BUILD UP OF
AMYLOID PROTEIN MANY THE BRAIN
FOR PEOPLE WHO HAVE CHRONIC
PROBLEMS WITH SLEEP.
SLEEP COMES IN ALL SHAPES POOR
SLEEP IN ALL SHAPES AND SIZES SO
POOR QUALITY CAN RELATE TO NOT
HAVING ENOUGH SLEEP, IT COULD BE
RELATED TO SLEEP APNEA WHERE YOU
HAVE INSUFFICIENT OXYGEN
SUPPLIED TO THE BRAIN AT NIGHT.
IT COULD BE RELATED TO
DISTURBANCES THAT OCCUR OR
EXPOSURES, OTHER EXPOSURES
HAPPENED THAT DISTURB QUALITY OF
SLEEP.
SO ONE OF OUR RISK REDUCTION
MANTRAS THAT WE HAVE IS REALLY
PAY ATTENTION TO YOUR SLEEP.
THERE'S OHIO TRICKS WELL
ESTABLISHED WHO CAN FIND THEM IN
MANY DIFFERENT SITES, NIH HAS
STRATEGIES TO HELP BEHAVIORS
THAT YOU CAN DRAW THAT ARE
IMPORTANT TO TRY TO PROTECT
SLEEP.
I WANT TO SAY IF YOU HAVE OR
SUSPECT SLEEP APNEA, I STRONGLY
ENCOURAGE THAT YOU ENCOURAGE
YOUR PEOPLE THAT YOU WORK WITH
TO GET THAT CHECKED OUT.
WE ARE LEARNING THAT TREATMENT
OF SLEEP APNEA CAN HAVE
SIGNIFICANT IMPACT ON COGNITIVE
TRAJECTORY.
>> I HAVE TO JUMP IN AND MAKE A
PLUG HERE FOR THE HEART TOO ON
SLEEP.
WE HAVE A LOT OF DATA THAT SHOWS
THAT NOT JUST -- NOT ENOUGH
SLEEP POOR QUALITY SLEEP BUT
EVEN IRREGULAR SLEEP CAN
INCREASE RISK OF CARDIOVASCULAR
DISEASE.
SLEEP APNEA UNTREATED CAUSES
HYPERTENSION AND OTHER HEART
PROBLEMS.
THERE ARE THINGS YOU CAN DO
MEDICALLY TO HELP YOU SLEEP
BETTER INCLUDING REFERRING TO
SLEEP STUDY BUT ALSO SOME SIMPLE
THINGS MAYBE MEDICATIONS YOU ARE
TAKING, OR OTHER THINGS YOU ARE
DOING THAT MAYBE AFFECTING YOUR
SLEEP THAT WE CAN HELP WITH.
>> THANK YOU ALL VERY MUCH.
THIS WAS A VERY INFORMATIVE
SESSION.
I WANT TO LET YOU KNOW THAT THIS
IS A WEBINAR SERIES THAT HAPPENS
ABOUT QUARTERLY SO PLEASE CHECK
OUT THE WEBSITE, THAT IS SHOWN
HERE ON THIS SLIDE AND YOU WILL
SEE THE NEXT WEBINAR AND ALSO IF
YOU MISS THIS WEBINAR, IF YOU
MISSED WATCHING AND WANT TO MAKE
SURE YOUR FRIEND SEE IT AND
COLLEAGUES SEE IT YOU CAN SEND
THEM THE RECORDING WILL BE
POSTED AS WELL.
SO ONCE AGAIN, THANK YOU ALL,
EXCELLENT PRESENTATIONS.
AND THANK YOU FOR PARTICIPATING.