1 00:00:06,520 --> 00:00:12,520 THIS IS KELVIN CHOI SENIOR 2 00:00:12,520 --> 00:00:14,760 INVESTIGATOR WITH INTRAMURAL 3 00:00:14,760 --> 00:00:15,080 RESEARCH. 4 00:00:15,080 --> 00:00:16,040 HAPPY SPRING. 5 00:00:16,040 --> 00:00:18,120 THE WEATHER'S GETTING NICE. 6 00:00:18,120 --> 00:00:19,640 IT'S PROBABLY HOT TO STAY INSIDE 7 00:00:19,640 --> 00:00:21,040 AND WATCH THE SEMINAR. 8 00:00:21,040 --> 00:00:23,000 IF YOU WANT TO TAKE IT OUTSIDE 9 00:00:23,000 --> 00:00:24,160 AND ENJOY THE NICE WEATHER AND 10 00:00:24,160 --> 00:00:25,800 SIT UNDER A TREE, THAT WOULD BE 11 00:00:25,800 --> 00:00:28,440 A NICE THING TO DO. 12 00:00:28,440 --> 00:00:31,840 TODAY WE ARE FORTUNATE TO HAVE 13 00:00:31,840 --> 00:00:32,880 REBECCA GOTTESMAN TO BE OUR 14 00:00:32,880 --> 00:00:37,080 GUEST SPEAKER. 15 00:00:37,080 --> 00:00:42,120 THE BRANCH CHIEF OF THE STROKE 16 00:00:42,120 --> 00:00:46,840 BRANCH AND NEUROEPIDEMIOLOGY AT 17 00:00:46,840 --> 00:00:48,000 THE NATIONAL INSTITUTE OF 18 00:00:48,000 --> 00:00:50,080 NEUROLOGICAL DISORDERS AND 19 00:00:50,080 --> 00:00:51,760 STROKE IN BETHESDA, MARYLAND. 20 00:00:51,760 --> 00:00:54,000 SHE COMPLETED HER MEDICAL 21 00:00:54,000 --> 00:00:55,720 TRAINING AT COLUMBIA UNIVERSITY 22 00:00:55,720 --> 00:01:00,480 AND HER INTERNSHIP IN NEUROLOGY 23 00:01:00,480 --> 00:01:02,080 RESIDENCY AS WELL AS VASCULAR 24 00:01:02,080 --> 00:01:04,640 NEUROLOGY AT JOHNS HOPKINS 25 00:01:04,640 --> 00:01:09,560 UNIVERSITY AND COMPLETED A Ph.D. 26 00:01:09,560 --> 00:01:11,200 AT THE BLOOMBERG SCHOOL OF 27 00:01:11,200 --> 00:01:13,760 PUBLIC HEATH AND IN THE 28 00:01:13,760 --> 00:01:18,120 DEPARTMENT OF NEUROLOGY AT JOHNS 29 00:01:18,120 --> 00:01:22,040 HOPKINS IN 2021 AND SHE JOINED 30 00:01:22,040 --> 00:01:22,200 NIH. 31 00:01:22,200 --> 00:01:24,920 HER RESEARCH S ON THE VASCULAR 32 00:01:24,920 --> 00:01:29,440 CONTRIBUTIONS TO COGNITIVE 33 00:01:29,440 --> 00:01:30,120 IMPAIRMENT, DEMENTIA AND 34 00:01:30,120 --> 00:01:32,280 ALZHEIMER'S DISEASE AS WELL AS 35 00:01:32,280 --> 00:01:34,120 THE CEREBRAL SMALL VESSEL 36 00:01:34,120 --> 00:01:37,680 DISEASE AND POST-STROKE DEMENTIA 37 00:01:37,680 --> 00:01:40,600 AND STUDIES LARGE EPIDEMIOLOGY 38 00:01:40,600 --> 00:01:42,080 COHORTS WITH LEADERSHIP ROLES IN 39 00:01:42,080 --> 00:01:46,600 THE ARIC STUDY AND DISCOVERY 40 00:01:46,600 --> 00:01:50,840 COHORT AND USES NEURO IMAGING 41 00:01:50,840 --> 00:01:56,320 RELATED TO THESE QUESTIONS. 42 00:01:56,320 --> 00:02:02,080 SHE'S A FORMER SOCIETY EDITOR 43 00:02:02,080 --> 00:02:03,760 FOR THE JOURNAL OF NEUROLOGY AND 44 00:02:03,760 --> 00:02:07,040 WON AN AWARD FROM THE AMERICAN 45 00:02:07,040 --> 00:02:07,560 HEART ASSOCIATION. 46 00:02:07,560 --> 00:02:08,920 WITHOUT FURTHER ADO, 47 00:02:08,920 --> 00:02:09,760 DR. GOTTESMAN, THE PODIUM IS 48 00:02:09,760 --> 00:02:10,640 YOURS. 49 00:02:10,640 --> 00:02:13,000 >>THANK YOU SO MUCH. 50 00:02:13,000 --> 00:02:14,840 IT'S GREAT TO HAVE A CHANCE TO 51 00:02:14,840 --> 00:02:16,840 MEET OTHER PEOPLE INTERESTED IN 52 00:02:16,840 --> 00:02:18,200 DISPARITIES AND SOME OF THE 53 00:02:18,200 --> 00:02:20,400 ISSUES IN POPULATION-BASED 54 00:02:20,400 --> 00:02:20,640 STUDIES. 55 00:02:20,640 --> 00:02:23,000 I'LL TALK ABOUT REDUCING 56 00:02:23,000 --> 00:02:24,760 DEMENTIA IN POPULATIONS AND WHY 57 00:02:24,760 --> 00:02:27,200 IT COULD BE A WAY TO FOCUS ON 58 00:02:27,200 --> 00:02:27,480 PREVENTION. 59 00:02:27,480 --> 00:02:29,840 I DON'T HAVE DISCLOSURES. 60 00:02:29,840 --> 00:02:33,600 THIS WAS ADDED IN THE LAST 61 00:02:33,600 --> 00:02:35,680 SECONDS BEFORE THE TALK KELVIN 62 00:02:35,680 --> 00:02:38,160 ASKED TO E-MAIL HIM IF YOU HAVE 63 00:02:38,160 --> 00:02:39,360 QUESTIONS SINCE THERE'S NOT 64 00:02:39,360 --> 00:02:40,520 ANOTHER WAY TO RAISE HANDS AND 65 00:02:40,520 --> 00:02:41,840 IF YOU THINK OF SOMETHING AFTER 66 00:02:41,840 --> 00:02:43,160 THE TALK YOU CAN SEND IT 67 00:02:43,160 --> 00:02:43,920 DIRECTLY TO ME. 68 00:02:43,920 --> 00:02:45,680 HERE'S A BRIEF OUTLINE OF WHAT 69 00:02:45,680 --> 00:02:47,600 I'LL TALK TO YOU TODAY ABOUT. 70 00:02:47,600 --> 00:02:49,280 FIRST A BIT ABOUT THE 71 00:02:49,280 --> 00:02:51,400 EPIDEMIOLOGY OF DEMENTIA OVER 72 00:02:51,400 --> 00:02:53,320 ALL AND IN DISPARITY POPULATIONS 73 00:02:53,320 --> 00:02:54,840 AND THEN WE'LL TALK ABOUT 74 00:02:54,840 --> 00:02:56,640 VASCULAR RISK FACTORS OF 75 00:02:56,640 --> 00:02:58,840 DEMENTIA AND WHY THIS IS SO 76 00:02:58,840 --> 00:03:01,040 IMPORTANT NOT JUST IN 77 00:03:01,040 --> 00:03:03,360 UNDERSTANDING PREVENTION AND 78 00:03:03,360 --> 00:03:08,640 ETIOLOGY OF DEMENTIA AND 79 00:03:08,640 --> 00:03:10,840 CONTRIBUTIONS FOR DEMENTIA AND 80 00:03:10,840 --> 00:03:12,800 MECHANISMS FOR DISPARITIES WITH 81 00:03:12,800 --> 00:03:14,840 SOME DISCUSSION OF DIFFERENCES 82 00:03:14,840 --> 00:03:19,160 IN BIOMARKERS FOR DEMENTIA BY 83 00:03:19,160 --> 00:03:20,320 RACE AND EXPLORING SOCIAL 84 00:03:20,320 --> 00:03:21,360 DETERMINATES OF HEALTH AND TO 85 00:03:21,360 --> 00:03:23,240 FOCUS ON THE POSSIBILITY OF 86 00:03:23,240 --> 00:03:25,240 PREVENTION AND WHAT WE KNOW THUS 87 00:03:25,240 --> 00:03:27,440 FAR IN POTENTIAL TARGETS OF 88 00:03:27,440 --> 00:03:27,760 PREVENTION. 89 00:03:27,760 --> 00:03:29,480 CERTAINLY WELL KNOWN TO MANY OF 90 00:03:29,480 --> 00:03:35,800 US THAT DEMENTIA IS A GROWING 91 00:03:35,800 --> 00:03:37,000 PUBLIC HEALTH EPIDEMIC AND WHAT 92 00:03:37,000 --> 00:03:41,000 THE RATES OF DEMENTIA BROADLY 93 00:03:41,000 --> 00:03:44,360 ARE EXPECTED TO LOOK LIKE. 94 00:03:44,360 --> 00:03:45,360 IT'S AN UMBRELLA TERM AND 95 00:03:45,360 --> 00:03:46,880 ALZHEIMER'S DISEASE IS THE 96 00:03:46,880 --> 00:03:47,440 PRIMARY CAUSE. 97 00:03:47,440 --> 00:03:48,640 IN GENERAL THERE'S FEW 98 00:03:48,640 --> 00:03:49,560 SUCCESSFUL TREATMENTS. 99 00:03:49,560 --> 00:03:51,400 WE NOW HAVE A COUPLE DRUGS 100 00:03:51,400 --> 00:03:53,080 APPROVED FOR ALZHEIMER'S 101 00:03:53,080 --> 00:03:53,520 DISEASE. 102 00:03:53,520 --> 00:03:55,240 THERE'S MANY CLINICAL TRIALS 103 00:03:55,240 --> 00:03:56,200 ACTIVELY EVALUATING 104 00:03:56,200 --> 00:03:56,800 INTERVENTIONS. 105 00:03:56,800 --> 00:03:58,040 UNTIL RECENTLY NO INTERVENTIONS 106 00:03:58,040 --> 00:04:00,080 HAD BEEN SUCCESSFUL AND I DO 107 00:04:00,080 --> 00:04:02,800 WANT TO POINT OUT THAT RECENT 108 00:04:02,800 --> 00:04:05,320 STUDIES THOUGH WE HAVE A COUPLE 109 00:04:05,320 --> 00:04:09,000 DRUGS WERE TESTED IN NON-DIVERSE 110 00:04:09,000 --> 00:04:10,320 POPULATIONS WE'LL TALK BRIEFLY 111 00:04:10,320 --> 00:04:11,600 AT THEN IF THERE'S TIME. 112 00:04:11,600 --> 00:04:14,040 NOT ONLY ARE DEMENTIA RATES 113 00:04:14,040 --> 00:04:14,880 GROWING IN GENERAL AND EXPECTED 114 00:04:14,880 --> 00:04:18,160 TO GROW OVER THE WORLD BUT WE 115 00:04:18,160 --> 00:04:20,360 KNOW THEY'RE HIGHER IN 116 00:04:20,360 --> 00:04:20,880 MINORITIZED POPULATIONS. 117 00:04:20,880 --> 00:04:24,000 HERE'S DATA FROM THE KAISER 118 00:04:24,000 --> 00:04:25,360 SYSTEM SHOWING HIGH RATES WITH 119 00:04:25,360 --> 00:04:29,600 AGE CROSS ETHNIC AND BLACK AND 120 00:04:29,600 --> 00:04:31,360 LATINO RATES HIGHER RATES AND 121 00:04:31,360 --> 00:04:33,400 THESE ARE PREVALENCE NOT 122 00:04:33,400 --> 00:04:35,840 NECESSARILY INCIDENTS. 123 00:04:35,840 --> 00:04:38,800 SIMILAR USING MEDICARE WE SEE 124 00:04:38,800 --> 00:04:41,880 HIGHER RATES IN BLACK 125 00:04:41,880 --> 00:04:46,040 PARTICIPANTS AND BLACK MEDICARE 126 00:04:46,040 --> 00:04:48,680 RECIPIENTS AND HISPANIC 127 00:04:48,680 --> 00:04:49,440 INDIVIDUALS AS WELL. 128 00:04:49,440 --> 00:04:51,360 THE PROBLEM IS THAT DEMENTIA 129 00:04:51,360 --> 00:04:54,080 RATES ARE EXPECTED TO INCREASE 130 00:04:54,080 --> 00:04:55,160 OVER TIME IN MINORITIZED 131 00:04:55,160 --> 00:04:55,680 POPULATIONS. 132 00:04:55,680 --> 00:04:57,400 WE KNOW AND I'LL SHOW YOU DATA 133 00:04:57,400 --> 00:04:58,640 IN A MOMENT SHOWING THERE'S SOME 134 00:04:58,640 --> 00:05:00,640 EVIDENCE THAT DEMENTIA RATES ARE 135 00:05:00,640 --> 00:05:02,000 GOING DOWN IN THE GENERAL 136 00:05:02,000 --> 00:05:03,400 POPULATION BUT WE THINK THEY'RE 137 00:05:03,400 --> 00:05:06,080 GOING TO CONTINUE TO GO UP. 138 00:05:06,080 --> 00:05:07,840 HERE'S THE RATES LOOKING AT 139 00:05:07,840 --> 00:05:09,000 WHITES AND WE THINK OVER TIME 140 00:05:09,000 --> 00:05:10,960 THESE ARE GOING TO REDUCE OVER 141 00:05:10,960 --> 00:05:12,160 TIME BUT IN BLACK AND HISPANIC 142 00:05:12,160 --> 00:05:13,080 INDIVIDUALS THE RATES ARE 143 00:05:13,080 --> 00:05:15,920 EXPECTED TO GO UP OVER TIME. 144 00:05:15,920 --> 00:05:17,720 AND THERE'S SEVERAL OTHER 145 00:05:17,720 --> 00:05:20,160 FACTORS THAT WE'LL CONSIDER AND 146 00:05:20,160 --> 00:05:22,800 WE'LL TALK ABOUT VASCULAR RISK 147 00:05:22,800 --> 00:05:23,800 FACTORS AND POSSIBLY MODIFY RISK 148 00:05:23,800 --> 00:05:26,040 OF DEMENTIA AND IN OTHER STUDIES 149 00:05:26,040 --> 00:05:30,240 SUCH AS THE CHICAGO HEALTH AND 150 00:05:30,240 --> 00:05:32,040 AGING PROJECT BLACK VERSUS WHITE 151 00:05:32,040 --> 00:05:32,800 HAVE LOWER COGNITIVE PERFORMANCE 152 00:05:32,800 --> 00:05:34,920 BUT DECLINE IS SIMILAR. 153 00:05:34,920 --> 00:05:37,000 SO RATE OF CHANGE IS NOT 154 00:05:37,000 --> 00:05:39,440 NECESSARILY IMPACTED BY RACE BUT 155 00:05:39,440 --> 00:05:42,240 MORE PREVALENT DEMENTIA IN 156 00:05:42,240 --> 00:05:43,480 BLACKS VERSUS WHITES WHY WE SEE 157 00:05:43,480 --> 00:05:45,000 THE INCREASE OVER TIME AND 158 00:05:45,000 --> 00:05:47,240 EXPECT THEY'LL GO UP FURTHER. 159 00:05:47,240 --> 00:05:48,760 A FAIR AMOUNT OF THAT DIFFERENCE 160 00:05:48,760 --> 00:05:51,320 BY RACE IS EXPLAINED BY 161 00:05:51,320 --> 00:05:52,560 EDUCATION DEPENDING ON THE 162 00:05:52,560 --> 00:05:52,760 STUDY. 163 00:05:52,760 --> 00:05:55,080 IT DEPENDS ON WHAT PROPORTION WE 164 00:05:55,080 --> 00:05:57,640 THINK IS EXPLAINED BY EDUCATION 165 00:05:57,640 --> 00:05:58,560 BUT CERTAINLY NOT EVERYTHING. 166 00:05:58,560 --> 00:06:04,640 THIS IS SHOWING DATA FROM THE 167 00:06:04,640 --> 00:06:07,240 FRAMINGHAM STUDY AND ALL CAUSE 168 00:06:07,240 --> 00:06:07,840 NOT SPECIFICALLY ALZHEIMER'S 169 00:06:07,840 --> 00:06:08,960 DISEASE HAVE BEEN DECREASING 170 00:06:08,960 --> 00:06:09,840 OVER TIME. 171 00:06:09,840 --> 00:06:10,640 THAT'S PROMISING. 172 00:06:10,640 --> 00:06:15,320 THE PROBLEM IS WE DON'T 173 00:06:15,320 --> 00:06:16,640 NECESSARILY SEE PARTICULAR 174 00:06:16,640 --> 00:06:18,920 REDUCTION IN DEMENTIA RATES IN 175 00:06:18,920 --> 00:06:20,280 DISPARITY POPULATIONS AND 176 00:06:20,280 --> 00:06:23,760 FRAMINGHAM IS NOT A NON-DIVERSE 177 00:06:23,760 --> 00:06:26,600 COHORT STUDY AND THINK OF WHY WE 178 00:06:26,600 --> 00:06:29,840 MAY BE UNDER INFLUENCING RATES 179 00:06:29,840 --> 00:06:31,720 IN DISPARATE POPULATIONS AND WHY 180 00:06:31,720 --> 00:06:32,960 THEY'RE NOT GOING DOWN. 181 00:06:32,960 --> 00:06:34,880 LOOKING AT THE HEALTH AND 182 00:06:34,880 --> 00:06:41,000 RETIREMENT STUDY LED BY A FORMER 183 00:06:41,000 --> 00:06:43,040 POSTDOC OF MINE NOW AT GEORGE 184 00:06:43,040 --> 00:06:45,320 WASHINGTON AND NOW LOOKING AT 185 00:06:45,320 --> 00:06:50,400 PREVALENCE OF DEMENTIA BLACK 186 00:06:50,400 --> 00:06:52,920 VERSUS WHITE IS BETWEEN 1.5 AND 187 00:06:52,920 --> 00:06:54,920 2 AND IF ADJUST FOR FACTORS THE 188 00:06:54,920 --> 00:06:57,320 RATES ARE PRETTY FLAT OVER TIME 189 00:06:57,320 --> 00:07:03,760 MEANING REGARDLESS OF WHAT'S 190 00:07:03,760 --> 00:07:04,920 HAPPENING WITH WHITES THE RATES 191 00:07:04,920 --> 00:07:06,360 ARE CONSISTENT OVER TIME. 192 00:07:06,360 --> 00:07:07,760 WE CONTINUE TO SEE DISPARITY. 193 00:07:07,760 --> 00:07:09,360 THERE'S A NUMBER OF DIFFERENT 194 00:07:09,360 --> 00:07:11,240 REASONS THIS MAY HAPPEN I 195 00:07:11,240 --> 00:07:11,760 MENTIONED BEFORE. 196 00:07:11,760 --> 00:07:14,480 WE KNOW MOST STUDIES THAT LOOK 197 00:07:14,480 --> 00:07:16,920 AT CLINICAL POPULATIONS FOR 198 00:07:16,920 --> 00:07:17,920 INSTANCE IN ALZHEIMER'S DISEASE 199 00:07:17,920 --> 00:07:19,400 CENTERS TEND TO UNDER RECRUIT 200 00:07:19,400 --> 00:07:22,880 FROM DISPARITY POPULATIONS. 201 00:07:22,880 --> 00:07:24,520 WE KNOW MOST DIAGNOSTIC CRITERIA 202 00:07:24,520 --> 00:07:27,360 WERE NOT DEVELOPED IN DIVERSE 203 00:07:27,360 --> 00:07:29,000 POPULATIONS AND THE DATA IS NOT 204 00:07:29,000 --> 00:07:31,920 DEVELOPED IN THESE POPULATIONS 205 00:07:31,920 --> 00:07:35,080 AND THERE'S REDUCED ODDS OF 206 00:07:35,080 --> 00:07:36,880 BEING DIAGNOSED WITH DEMENTIA AS 207 00:07:36,880 --> 00:07:39,360 A BLACK ADULT AND WE MAY BE 208 00:07:39,360 --> 00:07:42,160 FURTHER UNDERESTIMATING THE 209 00:07:42,160 --> 00:07:42,440 DISPARITY. 210 00:07:42,440 --> 00:07:45,520 LESS IS KNOWN IN HISPANIC LATINX 211 00:07:45,520 --> 00:07:46,640 POPULATIONS. 212 00:07:46,640 --> 00:07:47,560 THE PRESENTATION MAY LOOK 213 00:07:47,560 --> 00:07:49,600 DIFFERENT IN LATINX OLDER 214 00:07:49,600 --> 00:07:50,080 ADULTS. 215 00:07:50,080 --> 00:07:56,560 THERE'S MORE LIKELY TO BE MOOD 216 00:07:56,560 --> 00:07:57,880 SYMPTOMS IN ADDITION AND FEWER 217 00:07:57,880 --> 00:08:02,960 DATA ARE AVAILABLE BUT RATES 218 00:08:02,960 --> 00:08:13,520 TEND TO BE HIGHER IN LESS LIKELY 219 00:08:15,840 --> 00:08:16,160 TO BE DIAGNOSED. 220 00:08:16,160 --> 00:08:18,480 WHAT ABOUT THE DEMENTIA 221 00:08:18,480 --> 00:08:18,760 ETIOLOGY. 222 00:08:18,760 --> 00:08:21,160 THIS LEADS TO THE BULK OF WHAT 223 00:08:21,160 --> 00:08:24,080 TO TALK ABOUT PREVENTION. 224 00:08:24,080 --> 00:08:27,400 IF WE KNOW DEMENTIA IS A PROBLEM 225 00:08:27,400 --> 00:08:29,360 AND THERE'S NOT A REDUCTION OF 226 00:08:29,360 --> 00:08:32,000 DISPARITIES IN BLACK AND LATINX 227 00:08:32,000 --> 00:08:34,280 INDIVIDUALS, WHY DOES ETIOLOGY 228 00:08:34,280 --> 00:08:34,480 MATTER? 229 00:08:34,480 --> 00:08:36,840 IF THERE'S ETIOLOGIES MODIFIABLE 230 00:08:36,840 --> 00:08:38,600 OR PREVENTIBLE THAT'S AN 231 00:08:38,600 --> 00:08:41,000 APPEALING TARGET ESPECIALLY IF 232 00:08:41,000 --> 00:08:44,240 THOSE MODIFIABLE AND PREVENTIBLE 233 00:08:44,240 --> 00:08:45,520 FACTORS ARE DISPROPORTIONATELY 234 00:08:45,520 --> 00:08:47,400 RESPONSIBLE FOR THOSE RISKS IN 235 00:08:47,400 --> 00:08:47,920 THOSE POPULATIONS. 236 00:08:47,920 --> 00:08:58,280 THAT'S WHAT WE MORE OR LESS SEE. 237 00:08:58,280 --> 00:09:01,760 HERE'S DATA FROM THE STUDY THEY 238 00:09:01,760 --> 00:09:05,760 LOOKED AT INDIVIDUALS DIAGNOSED 239 00:09:05,760 --> 00:09:13,560 WITH DEMENTIA POSTMOREM AND 240 00:09:13,560 --> 00:09:16,200 THESE DATA ARE FROM 2015 AND 241 00:09:16,200 --> 00:09:18,960 THERE'S NEWER ENTITIES ANOTHER 242 00:09:18,960 --> 00:09:19,640 NEUROPATHOLOGY THIS GROUP 243 00:09:19,640 --> 00:09:21,800 DESCRIBED THAT WAS NOT NOTICED 244 00:09:21,800 --> 00:09:25,000 OR RECOGNIZED AS A SEPARATE 245 00:09:25,000 --> 00:09:27,240 ENTITY AT THIS TIME. 246 00:09:27,240 --> 00:09:28,800 THE PIES LOOK A LITTLE DIFFERENT 247 00:09:28,800 --> 00:09:31,200 BUT PURE A.D. MORE COMMON IN THE 248 00:09:31,200 --> 00:09:34,520 PATHOLOGY OF WHITE INDIVIDUALS 249 00:09:34,520 --> 00:09:35,320 VERSUS BLACK AND MIXED 250 00:09:35,320 --> 00:09:37,680 PATHOLOGY, THIS IS A MIX OF 251 00:09:37,680 --> 00:09:39,000 ALZHEIMER'S AND STROKE LIKE 252 00:09:39,000 --> 00:09:40,280 CHANGES WHICH IS WHAT I'LL FOCUS 253 00:09:40,280 --> 00:09:42,480 ON FOR MOST MY TALK. 254 00:09:42,480 --> 00:09:46,600 THIS IS LEWY BODY AND ALL THE 255 00:09:46,600 --> 00:09:46,800 ABOVE. 256 00:09:46,800 --> 00:09:49,760 THESE ARE INFARCTS ACCOUNT FOR A 257 00:09:49,760 --> 00:09:51,960 LARGER PROPORTION OF DEMENTIA 258 00:09:51,960 --> 00:09:53,520 CASES THAN IN WHITE INDIVIDUALS. 259 00:09:53,520 --> 00:09:56,240 MIXED PATHOLOGY IS IMPORTANT 260 00:09:56,240 --> 00:10:01,160 ESPECIALLY IN BLACKS. 261 00:10:01,160 --> 00:10:07,760 YOU CAN SEE HERE AND IN GENERAL 262 00:10:07,760 --> 00:10:08,960 IF YOU HAVE VASCULAR CHANGES IN 263 00:10:08,960 --> 00:10:13,120 THE BRAIN YOU CAN GET AWAY WITH 264 00:10:13,120 --> 00:10:14,920 LESS ALZHEIMER'S NEUROPATHOLOGY 265 00:10:14,920 --> 00:10:16,920 TO GET TO EQUIVALENT LEVEL OF 266 00:10:16,920 --> 00:10:17,160 DECLINE. 267 00:10:17,160 --> 00:10:19,400 MANY PEOPLE WITH DEMENTIA HAVE 268 00:10:19,400 --> 00:10:21,160 VASCULAR RISK FACTORS. 269 00:10:21,160 --> 00:10:23,320 IT'S NOT ENTIRELY CLEAR IS THIS 270 00:10:23,320 --> 00:10:24,960 BECAUSE ONE MAY CONTRIBUTE TO 271 00:10:24,960 --> 00:10:27,680 THE OTHER OR COMMON. 272 00:10:27,680 --> 00:10:28,800 NEURODEGENERATION IS COMMON 273 00:10:28,800 --> 00:10:30,560 LEADING TO ALZHEIMER'S AND 274 00:10:30,560 --> 00:10:33,000 VASCULAR RISK FACTORS SUCH AS 275 00:10:33,000 --> 00:10:37,840 HIGH CHOLESTEROL WERE ALSO 276 00:10:37,840 --> 00:10:38,080 COMMON. 277 00:10:38,080 --> 00:10:40,360 SOME EVIDENCE SUGGESTED THEY'RE 278 00:10:40,360 --> 00:10:41,000 LINKED. 279 00:10:41,000 --> 00:10:44,280 THE MIXED PATHOLOGY WE SEE IN 280 00:10:44,280 --> 00:10:45,320 BLACK INDIVIDUALS AND THE FACT 281 00:10:45,320 --> 00:10:47,760 THERE'S ASSOCIATION WITH 282 00:10:47,760 --> 00:10:51,320 DEMENTIA AND MAYBE ALZHEIMER'S 283 00:10:51,320 --> 00:10:52,120 DISEASE SPECIFICALLY POINTS TO 284 00:10:52,120 --> 00:10:53,160 POTENTIAL OPPORTUNITIES FOR 285 00:10:53,160 --> 00:10:53,720 PREVENTION. 286 00:10:53,720 --> 00:10:56,320 IF WE THINK OF MIXED DEMENTIA IN 287 00:10:56,320 --> 00:10:57,480 WHITE POPULATIONS IN THIS WAY 288 00:10:57,480 --> 00:10:58,800 MAYBE IN DISPARITY POPULATIONS 289 00:10:58,800 --> 00:11:01,040 THERE'S A LARGER PROPORTION OF 290 00:11:01,040 --> 00:11:03,920 CASES THAT ARE VASCULAR ETIOLOGY 291 00:11:03,920 --> 00:11:05,280 AND MIXED WHICH MEANS THIS IS AN 292 00:11:05,280 --> 00:11:08,680 AREA WE CAN TARGET OR MODIFY. 293 00:11:08,680 --> 00:11:11,040 IT'S A LARGER PROPORTION OF 294 00:11:11,040 --> 00:11:19,520 DEMENTIA CASES POTENTIAL LY 295 00:11:19,520 --> 00:11:21,520 MODIFIABLE IN THESE POPULATIONS. 296 00:11:21,520 --> 00:11:24,520 MUCH OF THE REASON MOST 297 00:11:24,520 --> 00:11:25,480 TREATMENTS HAVE BEEN 298 00:11:25,480 --> 00:11:26,280 UNSUCCESSFUL IS BECAUSE OF THE 299 00:11:26,280 --> 00:11:26,960 LONG PERIOD. 300 00:11:26,960 --> 00:11:28,720 IF YOU TREAT PEOPLE ONCE THEY 301 00:11:28,720 --> 00:11:30,720 HAVE SYMPTOMS IF YOU LOOK AT 302 00:11:30,720 --> 00:11:32,560 THIS VARIATION ON THE CURVE YOU 303 00:11:32,560 --> 00:11:35,400 CAN SEE ONCE SOMEBODY HAS 304 00:11:35,400 --> 00:11:39,160 SYMPTOMS THEIR DISEASE IS FAIRLY 305 00:11:39,160 --> 00:11:39,400 ADVANCED. 306 00:11:39,400 --> 00:11:40,800 THESE ARE SHOWING BIOMARKERS 307 00:11:40,800 --> 00:11:43,120 THAT CHANGE IN THE DECADES 308 00:11:43,120 --> 00:11:44,360 PRECEDING COGNITIVE CHANGE. 309 00:11:44,360 --> 00:11:47,080 IF YOU WAIT UNTIL COGNITIVE 310 00:11:47,080 --> 00:11:48,400 CHANGE STARTS WHICH IS WHEN 311 00:11:48,400 --> 00:11:49,520 SOMEONE IS ENROLLED IN THE TRIAL 312 00:11:49,520 --> 00:11:50,520 IT'S LATE IN THE PROCESS. 313 00:11:50,520 --> 00:11:51,720 IN GENERAL THINKING OF 314 00:11:51,720 --> 00:11:55,080 IDENTIFYING PEOPLE AT A 315 00:11:55,080 --> 00:11:56,360 PRE-CLINICAL STAGE WHEN THEY'RE 316 00:11:56,360 --> 00:11:58,120 AT RISK BUT NOTHING HAS CHANGED 317 00:11:58,120 --> 00:11:59,760 IN TERMS OF BIOMARKERS WILL BE 318 00:11:59,760 --> 00:12:00,040 IMPORTANT. 319 00:12:00,040 --> 00:12:02,120 IT'S BEEN SPECULATED THE 320 00:12:02,120 --> 00:12:03,000 VASCULAR FACTORS I MENTIONED 321 00:12:03,000 --> 00:12:05,400 THERE'S OVERLAP IN PATHOLOGIES, 322 00:12:05,400 --> 00:12:08,400 LOTS OF MIXED PATHOLOGY AND MANY 323 00:12:08,400 --> 00:12:08,960 PEOPLE HAVE A COMBINATION 324 00:12:08,960 --> 00:12:10,760 VASCULAR RISK FACTORS IN 325 00:12:10,760 --> 00:12:15,400 DEMENTIA AND I'LL SHARE SOME OF 326 00:12:15,400 --> 00:12:17,000 THE EPIDEMIOLOGIC DATA BUT 327 00:12:17,000 --> 00:12:20,320 EVIDENCE IT MAY PROCEED THE A.D. 328 00:12:20,320 --> 00:12:22,320 SPECIFIC CHANGES, THIS CURVE 329 00:12:22,320 --> 00:12:24,320 SHOWS YOU CAN'T SEE THE DETAIL 330 00:12:24,320 --> 00:12:29,040 BUT THE FIRST LINE IS VASCULAR 331 00:12:29,040 --> 00:12:31,320 DYSREGULATION WHICH MAY PRECEDE 332 00:12:31,320 --> 00:12:34,520 CHANGES IN AMYLOID AND TAU AND 333 00:12:34,520 --> 00:12:36,080 COGNITION AND THE OTHER SUPPORT 334 00:12:36,080 --> 00:12:39,160 FOR THE CHANGES HAPPEN EARLY IS 335 00:12:39,160 --> 00:12:40,680 MOST DATA SHOW NOT ONLY ARE 336 00:12:40,680 --> 00:12:43,600 VASCULAR RISK FACTORS ED WITH 337 00:12:43,600 --> 00:12:45,000 COGNITIVE DECLINE BUT ASSOCIATED 338 00:12:45,000 --> 00:12:47,200 FROM MIDDLE AGE AND PROBABLY 339 00:12:47,200 --> 00:12:49,880 EARLIER IF WE HAD DATA SETS THAT 340 00:12:49,880 --> 00:12:51,760 EXTEND FROM THAT ENTIRE TIME 341 00:12:51,760 --> 00:12:52,120 PERIOD. 342 00:12:52,120 --> 00:12:54,480 MIDLIFE APPEARS TO BE AN 343 00:12:54,480 --> 00:12:57,000 IMPORTANT WINDOW FOR PREVENTION 344 00:12:57,000 --> 00:12:59,000 AND IF WE SEE DISPROPORTIONATE 345 00:12:59,000 --> 00:13:01,080 RATES OF VASCULAR ETIOLOGY IN 346 00:13:01,080 --> 00:13:03,360 BLACK VERSUS WHITE INDIVIDUALS 347 00:13:03,360 --> 00:13:06,120 MAY EXPLAIN DISPARITIES IN RATES 348 00:13:06,120 --> 00:13:08,040 AND MAYBE AN OPPORTUNITY FOR 349 00:13:08,040 --> 00:13:08,320 PREVENTION. 350 00:13:08,320 --> 00:13:10,200 TO PROVIDE MORE EVIDENCE THAT 351 00:13:10,200 --> 00:13:12,840 VASCULAR RISK FACTORS ARE ED 352 00:13:12,840 --> 00:13:15,360 WITH COGNITIVE DECLINE AND 353 00:13:15,360 --> 00:13:15,680 DEMENTIA. 354 00:13:15,680 --> 00:13:19,400 THIS IS A GUIDELINE FOR THE 355 00:13:19,400 --> 00:13:21,000 PREVENTION OF STROKE AND THE 356 00:13:21,000 --> 00:13:21,880 RISK FACTORS WE'RE THINKING 357 00:13:21,880 --> 00:13:23,040 ABOUT WHEN WE THINK OF 358 00:13:23,040 --> 00:13:25,000 PREVENTING STROKE IN ADULTS AND 359 00:13:25,000 --> 00:13:26,280 THE RISK FACTORS WE KNOW THAT 360 00:13:26,280 --> 00:13:28,000 APPEAR TO HAVE ASSOCIATIONS WITH 361 00:13:28,000 --> 00:13:30,000 COGNITIVE DECLINE IN DEMENTIA. 362 00:13:30,000 --> 00:13:31,320 IN GENERAL THE SOUTHEASTERN PART 363 00:13:31,320 --> 00:13:33,680 OF THE COUNTRY AS ALL OF YOU 364 00:13:33,680 --> 00:13:34,960 KNOW IS CALLED THE STROKE BELT. 365 00:13:34,960 --> 00:13:37,000 THIS IS AN AREA WHERE STROKE 366 00:13:37,000 --> 00:13:39,160 RATES AND STROKE DEATH RATES ARE 367 00:13:39,160 --> 00:13:40,560 EXCEPTIONALLY HIGH. 368 00:13:40,560 --> 00:13:43,320 THIS IS THE TARGET OF STUDIES 369 00:13:43,320 --> 00:13:46,800 LIKE THE REGARD STUDY TRYING TO 370 00:13:46,800 --> 00:13:49,200 UNDERSTAND REASONS FOR THIS 371 00:13:49,200 --> 00:13:52,800 DISPROPORTIONATE RATE OF STROKE 372 00:13:52,800 --> 00:13:55,720 AND WE LOOKED AT PEOPLE IN THE 373 00:13:55,720 --> 00:13:58,480 HIGH RATE MORTALITY STATE 374 00:13:58,480 --> 00:14:00,720 OPPOSED TO ELSEWHERE HAD HIGHER 375 00:14:00,720 --> 00:14:09,960 RATES OF DEMENTIA SO ECOLOGIC 376 00:14:09,960 --> 00:14:12,080 REASONS AND THE STROKE BELT IS 377 00:14:12,080 --> 00:14:14,480 WHERE WE HAVE THE HIGHEST 378 00:14:14,480 --> 00:14:15,360 PROPORTION OF BLACK INDIVIDUALS 379 00:14:15,360 --> 00:14:21,240 AND RESIDENTS RESIDING. 380 00:14:21,240 --> 00:14:23,480 TO TELL YOU WHAT WE KNOW ABOUT 381 00:14:23,480 --> 00:14:27,840 VASCULAR RISK FACTORS AND 382 00:14:27,840 --> 00:14:28,640 DEMENTIA. 383 00:14:28,640 --> 00:14:31,920 I HAVE AN ASSOCIATION WITH THE 384 00:14:31,920 --> 00:14:36,840 ARIC STUDY AND IT'S THE 385 00:14:36,840 --> 00:14:38,160 ATHEROSCLEROSIS RISK IN 386 00:14:38,160 --> 00:14:39,360 COMMUNITY STUDY STARTED IN THE 387 00:14:39,360 --> 00:14:42,600 LATE 1980s, NEARLY 16,000 ADULTS 388 00:14:42,600 --> 00:14:44,760 45 TO 64 AT STUDY ONSET. 389 00:14:44,760 --> 00:14:46,920 THIS SAYS VISIT SEVEN. 390 00:14:46,920 --> 00:14:49,440 WE'RE CURRENTLY ON VISIT 10. 391 00:14:49,440 --> 00:14:52,000 I'M SHOWING YOU THROUGH VISIT 7 392 00:14:52,000 --> 00:14:53,480 BECAUSE THAT'S THE DATA I'LL 393 00:14:53,480 --> 00:14:55,080 SHARE UP THROUGH AND THE HOPE IS 394 00:14:55,080 --> 00:14:59,000 TO CONTINUE TO SEE THESE ADULTS 395 00:14:59,000 --> 00:15:01,840 WHO ARE NOW IN THEIR 85 PLUS AGE 396 00:15:01,840 --> 00:15:03,760 RANGE BUT IMPORTANTLY THEY'VE 397 00:15:03,760 --> 00:15:05,040 BEEN FOLLOWED CONTINUOUSLY AND 398 00:15:05,040 --> 00:15:08,280 HAD A NUMBER OF IN-PERSON VISITS 399 00:15:08,280 --> 00:15:11,600 AND HAD ANNUAL AND NOW SEMI 400 00:15:11,600 --> 00:15:14,360 ANNUAL PHONE CALLS TO LEARN 401 00:15:14,360 --> 00:15:16,960 ABOUT HOSPITALIZATION AND OTHER 402 00:15:16,960 --> 00:15:23,200 EVENTS AND HAD COGNITION EVENTS 403 00:15:23,200 --> 00:15:24,960 AND AT VISIT 5 THAT THE AN 404 00:15:24,960 --> 00:15:28,960 INF 405 00:15:28,960 --> 00:15:32,480 INFORMANTIN INTER -- 406 00:15:36,800 --> 00:15:39,000 AND WE HAVE STROKE SCREENING AND 407 00:15:39,000 --> 00:15:40,480 WE HAVE CS VISITS CONTINUING TO 408 00:15:40,480 --> 00:15:42,480 GO ON WHERE THERE'S MORE 409 00:15:42,480 --> 00:15:43,200 DETAILED COGNITIVE ASSESSMENT. 410 00:15:43,200 --> 00:15:47,200 A SUBSET OF PARTICIPANTS HAVE 411 00:15:47,200 --> 00:15:48,080 HAD BRAIN MRI WHICH WILL BE 412 00:15:48,080 --> 00:15:49,680 IMPORTANT WHEN I TALK ABOUT 413 00:15:49,680 --> 00:15:50,880 MECHANISM AND CONTINUE TO GET 414 00:15:50,880 --> 00:15:56,480 MRI AT CURRENT VISITS AND 415 00:15:56,480 --> 00:15:59,800 FURTHER SUBSET AT THIS PET THAT 416 00:15:59,800 --> 00:16:09,920 BINDS TO AMYLOID FLORBETAPIR AND 417 00:16:09,920 --> 00:16:12,840 SCANNED PARTICIPANTS AT THE ARIC 418 00:16:12,840 --> 00:16:15,080 PET STUDY VISIT AND REPEAT IN 419 00:16:15,080 --> 00:16:16,240 THE SUBSET AND NOW WE'RE GETTING 420 00:16:16,240 --> 00:16:18,640 MORE SCANS NOW IN OUR CURRENT 421 00:16:18,640 --> 00:16:19,720 VISITS. 422 00:16:19,720 --> 00:16:26,960 AND TO POINT OUT ARIC IS THESE 423 00:16:26,960 --> 00:16:29,680 AREAS AND ALL FOUR SITES 424 00:16:29,680 --> 00:16:31,600 REPRESENT A COMBINATION OF 425 00:16:31,600 --> 00:16:33,920 RURAL, URBAN, BLACK, WHITE 426 00:16:33,920 --> 00:16:35,560 PARTICIPANTS PRIMARILY. 427 00:16:35,560 --> 00:16:37,640 WHEN I TALK ABOUT COGNITIVE 428 00:16:37,640 --> 00:16:38,760 CHANGE WHICH I'LL MENTION 429 00:16:38,760 --> 00:16:40,320 SHORTLY I'LL TALK ABOUT CHANGE 430 00:16:40,320 --> 00:16:43,240 IN COGNITION OVER TIME AS WELL 431 00:16:43,240 --> 00:16:45,280 AS INCIDENT DEMENTIA EVENTS. 432 00:16:45,280 --> 00:16:47,280 AND I WON'T HAVE TIME TO GO INTO 433 00:16:47,280 --> 00:16:52,480 DETAIL BUT WE CONSIDER ATTRITION 434 00:16:52,480 --> 00:16:54,400 AND WE USE BOTH INVERSE RATING 435 00:16:54,400 --> 00:16:56,280 AND SOME STUDIES AS WELL AS 436 00:16:56,280 --> 00:16:57,880 MULTIPLE CHANGE EQUATIONS TO TRY 437 00:16:57,880 --> 00:17:00,120 TO ACCOUNT FOR THE ATTRITION 438 00:17:00,120 --> 00:17:02,560 HIGHLY ASSOCIATED WITH OUR RISK 439 00:17:02,560 --> 00:17:04,960 FACTORS OF INTEREST AND WITH 440 00:17:04,960 --> 00:17:06,800 LIKELIHOOD OF DROP OUT RELATED 441 00:17:06,800 --> 00:17:08,240 TO COGNITIVE CHANGE OVER TIME. 442 00:17:08,240 --> 00:17:10,400 FIRST, WHAT ABOUT STROKE? 443 00:17:10,400 --> 00:17:12,640 I TOLD YOU THE STROKE BELT 444 00:17:12,640 --> 00:17:13,960 PEOPLE BORN IN THE STROKE BELT 445 00:17:13,960 --> 00:17:15,400 HAT HIGHER RATES OF DEMENTIA. 446 00:17:15,400 --> 00:17:17,760 I MENTIONED I'M FOCUSSING ON 447 00:17:17,760 --> 00:17:19,440 STROKE RISK FACTORS AS POSSIBLE 448 00:17:19,440 --> 00:17:21,640 WAYS TO MODIFY RISK OF DEMENTIA. 449 00:17:21,640 --> 00:17:24,560 FIRST IS STROKE ITSELF RELATED 450 00:17:24,560 --> 00:17:27,640 TO DEMENTIA? 451 00:17:27,640 --> 00:17:28,960 YES, IT IS. 452 00:17:28,960 --> 00:17:32,200 WE LOOKED AT STROKE AS WELL AS 453 00:17:32,200 --> 00:17:36,120 STROKE SEVERITY AT PEOPLE IN THE 454 00:17:36,120 --> 00:17:39,800 A K 455 00:17:39,800 --> 00:17:42,080 ARIC SCALE AND THEY SHOWED 456 00:17:42,080 --> 00:17:43,520 HIGHER NUMBERS MORE SEVERE 457 00:17:43,520 --> 00:17:44,720 STROKES AND PEOPLE WITH MORE 458 00:17:44,720 --> 00:17:46,360 SEVERE STROKES HAD A GREATER 459 00:17:46,360 --> 00:17:49,000 RISK OF DEMENTIA. 460 00:17:49,000 --> 00:17:50,840 ADDITIONALLY IF YOU HAD 461 00:17:50,840 --> 00:17:53,000 RECURRENT STROKE AND ONE WAS A 462 00:17:53,000 --> 00:17:54,240 SEVERE STROKE THE RISK WENT UP 463 00:17:54,240 --> 00:17:56,200 FURTHER. 464 00:17:56,200 --> 00:17:57,520 THIS IS ADJUSTED FOR RISK 465 00:17:57,520 --> 00:17:59,160 FACTORS, MEDICATION USE, 466 00:17:59,160 --> 00:18:01,080 ETCETERA AND YOU CAN SEE WE SEE 467 00:18:01,080 --> 00:18:02,880 A DOSE RESPONSE TYPE OF 468 00:18:02,880 --> 00:18:04,480 RELATIONSHIP IF YOU HAVE ONE 469 00:18:04,480 --> 00:18:06,280 MINOR STROKE, RISK GOES UP 470 00:18:06,280 --> 00:18:08,480 NEARLY DOUBLING OVER TRIPLED IF 471 00:18:08,480 --> 00:18:09,920 YOU HAVE ONE SEVERE STROKE 472 00:18:09,920 --> 00:18:11,320 COMPARED TO PEOPLE WITH NO 473 00:18:11,320 --> 00:18:12,480 STROKE AND MULTIPLE STROKES THE 474 00:18:12,480 --> 00:18:15,360 RISK CONTINUES TO GO UP IF ONE 475 00:18:15,360 --> 00:18:19,400 WAS SEVERE. 476 00:18:19,400 --> 00:18:21,400 WHAT HAD WHAT ABOUT DISPARITIES? 477 00:18:21,400 --> 00:18:25,000 WE FOUND IN BLACK VERSUS WHITE 478 00:18:25,000 --> 00:18:26,280 PARTICIPANTS HAVING AT LEAST ONE 479 00:18:26,280 --> 00:18:27,400 MODERATE TO SEVERE STROKE 480 00:18:27,400 --> 00:18:31,880 INCREASED RISK OF DEMENTIA MORE 481 00:18:31,880 --> 00:18:35,160 SO THAN IN WHITE PARTICIPANTS. 482 00:18:35,160 --> 00:18:36,760 MILD STROKE WAS SIMILARLY 483 00:18:36,760 --> 00:18:39,360 INCREASED FOR BLACK AND WHITE 484 00:18:39,360 --> 00:18:41,360 INDIVIDUALS. 485 00:18:41,360 --> 00:18:46,080 THE HAZARD RATIOS AND SIMILAR 486 00:18:46,080 --> 00:18:47,120 RELATIVE TO THOSE WHO DIDN'T 487 00:18:47,120 --> 00:18:48,400 HAVE BUT IF ONE STROKE WAS 488 00:18:48,400 --> 00:18:49,840 MODERATE TO SEVERE AND COULD 489 00:18:49,840 --> 00:18:51,400 HAVE BEEN YOU ONLY HAD ONE 490 00:18:51,400 --> 00:18:53,840 STROKE THE RISK WENT UP HERE 491 00:18:53,840 --> 00:18:55,400 FOURFOLD INCREASE RISK IF YOU 492 00:18:55,400 --> 00:18:57,200 WERE BLACK PARTICIPANT WHO HAD A 493 00:18:57,200 --> 00:18:58,160 MODERATE TO SEVERE STROKE 494 00:18:58,160 --> 00:18:59,320 COMPARED TO NOT HAVING A STROKE 495 00:18:59,320 --> 00:19:07,320 AT ALL VERSUS IF YOU ARE WHITE 496 00:19:07,320 --> 00:19:09,000 AND THE INCREASE BUT NOT 497 00:19:09,000 --> 00:19:10,640 COMPARED TO WHITE INDIVIDUALS 498 00:19:10,640 --> 00:19:12,920 AND DON'T SEE RACE DIFFERENCES 499 00:19:12,920 --> 00:19:15,360 IN THE MILD TO MODERATE STROKES 500 00:19:15,360 --> 00:19:16,960 MORE IN THE NUMBER OF STROKES 501 00:19:16,960 --> 00:19:17,160 ALONE. 502 00:19:17,160 --> 00:19:20,360 THE NUMBER OF STROKES HAS A 503 00:19:20,360 --> 00:19:25,400 SIMILAR AFFECT BY RACE FOR 504 00:19:25,400 --> 00:19:25,800 DEMENTIA. 505 00:19:25,800 --> 00:19:27,400 WHAT ABOUT VASCULAR RISK FACTORS 506 00:19:27,400 --> 00:19:29,000 AND STROKE IS A FACTOR BUT NOT 507 00:19:29,000 --> 00:19:32,560 THE ONLY TARGET FOR PREVENTION. 508 00:19:32,560 --> 00:19:37,000 WE WANT TO PREVENT DEMENTIA BY 509 00:19:37,000 --> 00:19:38,960 PREVENTING STROKE. 510 00:19:38,960 --> 00:19:42,160 STROKE ITSELF CONTRIBUTES TO 511 00:19:42,160 --> 00:19:47,280 DEMENTIA BUT THE RISK FACTORS TO 512 00:19:47,280 --> 00:19:48,960 DEMENTIA RISK. 513 00:19:48,960 --> 00:19:56,240 ANDREA SCHNEIDER DID THIS ATT 514 00:19:56,240 --> 00:19:57,960 JOHNS HOPKINS IN HYPERTENSION 515 00:19:57,960 --> 00:20:00,320 AND FOUND PEOPLE WITH HIGH BLOOD 516 00:20:00,320 --> 00:20:02,440 PRESSURE IN MIDDLE AGE HAD 517 00:20:02,440 --> 00:20:04,760 STEEPER COGNITIVE DECLINE OVER 518 00:20:04,760 --> 00:20:07,160 THE DECADES COMPARED TO PEOPLE 519 00:20:07,160 --> 00:20:08,760 WHO HAD NORMAL BLOOD PRESSURE 520 00:20:08,760 --> 00:20:12,280 AND THOSE ON MEDICATIONS WERE IN 521 00:20:12,280 --> 00:20:12,520 BETWEEN. 522 00:20:12,520 --> 00:20:15,200 THESE ARE MODELS LOOKING AT 523 00:20:15,200 --> 00:20:17,240 CONTINUOUS BLOOD PRESSURE WE 524 00:20:17,240 --> 00:20:19,080 LOOKED AT BLOOD PRESSURE AND SEE 525 00:20:19,080 --> 00:20:21,880 THE SAME BASIC BUT WHEN YOU LOOK 526 00:20:21,880 --> 00:20:25,360 AT LATE LIFE BLOOD PRESSURE IS 527 00:20:25,360 --> 00:20:27,120 NOT AS IMPORTANT FOR SUBSEQUENT 528 00:20:27,120 --> 00:20:28,080 COGNITIVE OUTCOMES. 529 00:20:28,080 --> 00:20:33,000 AND THEY LOOKED AT DIABETES AND 530 00:20:33,000 --> 00:20:38,760 HEMOGLOBIN A1C AND IN DIABETICS 531 00:20:38,760 --> 00:20:41,000 THE HIGHER THE GREATER THE 532 00:20:41,000 --> 00:20:42,640 COGNITIVE DECLINE WHEN SHE 533 00:20:42,640 --> 00:20:44,640 LOOKED AT GLYCEMIC CONTROL IN 534 00:20:44,640 --> 00:20:47,080 MIDLIFE WAS ASSOCIATED WITH 535 00:20:47,080 --> 00:20:48,800 WORSE COGNITIVE CHANGE, STEEPER 536 00:20:48,800 --> 00:20:50,720 DECLINE OVER THE DECADES. 537 00:20:50,720 --> 00:20:53,680 THESE ARE PAIRS OF ESTIMATES ARE 538 00:20:53,680 --> 00:20:54,880 TO SHOW YOU THE EFFECT OF 539 00:20:54,880 --> 00:20:56,920 ACCOUNTING FOR ATTRITION. 540 00:20:56,920 --> 00:20:58,840 WE DID THINGS -- THINGS LOOK 541 00:20:58,840 --> 00:21:00,520 WEAKER IF YOU DON'T CONSIDER THE 542 00:21:00,520 --> 00:21:01,560 ATTRITION PEOPLE WITH DIABETES 543 00:21:01,560 --> 00:21:03,680 AT MIDLIFE ARE LIKELY NOT TO 544 00:21:03,680 --> 00:21:05,840 MAKE IT TO A LATER VISIT AND 545 00:21:05,840 --> 00:21:06,640 PEOPLE WITH COGNITIVE CHANGE ARE 546 00:21:06,640 --> 00:21:09,000 MOST LIKELY NOT TO MAKE IT TO A 547 00:21:09,000 --> 00:21:09,800 LATER VISIT. 548 00:21:09,800 --> 00:21:11,520 MAY LOSE THAT POTENTIAL IF YOU 549 00:21:11,520 --> 00:21:13,840 DON'T ACCOUNT FOR THAT 550 00:21:13,840 --> 00:21:14,800 ATTRITION. 551 00:21:14,800 --> 00:21:17,640 WHAT ABOUT DEMENTIA THEMSELVES 552 00:21:17,640 --> 00:21:20,960 ARE THESE VASCULAR RISK FACTORS 553 00:21:20,960 --> 00:21:21,320 ED? 554 00:21:21,320 --> 00:21:21,800 YES. 555 00:21:21,800 --> 00:21:22,960 WE LOOKED AT DEMENTIA SEVERAL 556 00:21:22,960 --> 00:21:24,520 WAYS I WON'T GET IN TREMENDOUS 557 00:21:24,520 --> 00:21:28,960 DETAIL WE HAVE THE PEOPLE WE SAW 558 00:21:28,960 --> 00:21:32,960 IN PERSON AND HAVE DETAILED 559 00:21:32,960 --> 00:21:35,920 INFORMANT INTERVIEW AND PEOPLE 560 00:21:35,920 --> 00:21:37,720 IDENTIFIED THROUGH PHONE 561 00:21:37,720 --> 00:21:38,680 INTERVIEWS AND HOSPITALIZATION 562 00:21:38,680 --> 00:21:38,880 CODES. 563 00:21:38,880 --> 00:21:41,400 WE HAVE A MODEL I'LL SHOW THE 564 00:21:41,400 --> 00:21:42,640 RESULTS OF HERE. 565 00:21:42,640 --> 00:21:44,520 A NUMBER OF VASCULAR RISK 566 00:21:44,520 --> 00:21:46,720 FACTORS ARE ASSOCIATED WITH 567 00:21:46,720 --> 00:21:48,880 DEMENTIA WHEN WE ADJUST FOR 568 00:21:48,880 --> 00:21:49,360 THEM. 569 00:21:49,360 --> 00:21:51,160 CURRENT SMOKERS HAVE HIGHER RISK 570 00:21:51,160 --> 00:21:53,480 OF DEMENTIA, INDIVIDUALS WITH 571 00:21:53,480 --> 00:21:56,280 DIABETES, HAZARD OF 1.77 ARE 572 00:21:56,280 --> 00:21:58,200 RISK OF DEMENTIA. 573 00:21:58,200 --> 00:22:00,720 THESE ARE MIDLIFE VASCULAR RISK 574 00:22:00,720 --> 00:22:02,320 FACTORS LOOKING AT DEMENTIA RISK 575 00:22:02,320 --> 00:22:04,000 OVER THE 25 YEARS. 576 00:22:04,000 --> 00:22:08,160 HYPERTENSION AND THESE ARE OLDER 577 00:22:08,160 --> 00:22:10,560 DEFINITIONS WHAT'S CALLED 578 00:22:10,560 --> 00:22:12,200 HYPERTENSION IS CALLED STAGE 1 579 00:22:12,200 --> 00:22:13,840 AND WHAT IS HYPERTENSION THERE 580 00:22:13,840 --> 00:22:15,480 IS NOW STAGE 2 AND INCREASED 581 00:22:15,480 --> 00:22:18,320 RISK WITH EITHER ENTITIES AND 582 00:22:18,320 --> 00:22:20,640 BMI AND CHOLESTEROL FOR THIS 583 00:22:20,640 --> 00:22:22,600 PARTICULAR STUDY WE DID NOT FIND 584 00:22:22,600 --> 00:22:24,880 ASSOCIATIONS FOR MIDLIFE BMI OR 585 00:22:24,880 --> 00:22:27,160 RISK OF DEMENTIA INDEPENDENT OF 586 00:22:27,160 --> 00:22:31,240 THE OTHER RISK FACTORS AND 587 00:22:31,240 --> 00:22:32,800 DEMOGRAPHICS. 588 00:22:32,800 --> 00:22:35,000 AND APOE THE STRONGEST RISK 589 00:22:35,000 --> 00:22:37,000 FACTOR FOR GENETIC DISEASE WAS 590 00:22:37,000 --> 00:22:39,320 ASSOCIATED WITH DEMENTIA AND THE 591 00:22:39,320 --> 00:22:44,920 AFFECT SIZE FOR HAVING AT LEAST 592 00:22:44,920 --> 00:22:49,000 ONE APOE ALLELE IS NOT THAT FAR 593 00:22:49,000 --> 00:22:50,280 OFF WITH WHAT WE SEE WITH 594 00:22:50,280 --> 00:22:50,800 DIABETES. 595 00:22:50,800 --> 00:22:52,320 THIS IS PREVENTIBLE AND 596 00:22:52,320 --> 00:22:53,120 COMPELLING IN TERMS OF THE 597 00:22:53,120 --> 00:22:54,640 EFFECT SIZE WE SEE FOR DIABETES. 598 00:22:54,640 --> 00:22:56,160 AND THEN IMPORTANTLY WHAT ABOUT 599 00:22:56,160 --> 00:22:57,320 THE DIFFERENCES BY RACE. 600 00:22:57,320 --> 00:23:00,800 AS I MENTIONED, WE KNOW RATES OF 601 00:23:00,800 --> 00:23:03,840 DEMENTIA ARE HIGHER IN BLACKS. 602 00:23:03,840 --> 00:23:08,960 WE KNOW MIXED DEMENTIA IS MORE 603 00:23:08,960 --> 00:23:11,400 PREVALENT THAN BLACKS AND WHITES 604 00:23:11,400 --> 00:23:14,040 SO THESE RISK FACTORS AFFECT 605 00:23:14,040 --> 00:23:15,920 BLACK AND WHITES DIFFERENTLY AND 606 00:23:15,920 --> 00:23:17,600 FOR SMOKING IN PARTICULAR WE SEE 607 00:23:17,600 --> 00:23:20,000 SMOKE IS NOT A RISK FACTOR IN 608 00:23:20,000 --> 00:23:21,880 BLACK PARTICIPANTS BUT IT IS IN 609 00:23:21,880 --> 00:23:25,240 WHITES AND IN GENERAL MANY VERY 610 00:23:25,240 --> 00:23:29,440 FEW BLACK PARTICIPANTS IN ARIC 611 00:23:29,440 --> 00:23:30,000 SMOKE. 612 00:23:30,000 --> 00:23:31,680 FOR DIABETES AND HYPERTENSION 613 00:23:31,680 --> 00:23:33,920 THE RISK IS SIMILAR, MEANING, IF 614 00:23:33,920 --> 00:23:36,240 YOU'RE DIABETIC AND MIDDLE ABLE 615 00:23:36,240 --> 00:23:39,320 AND BLACK VERSUS WHITE YOUR 616 00:23:39,320 --> 00:23:40,960 INCREMENTAL RISK OF DEMENTIA 617 00:23:40,960 --> 00:23:43,200 WILL BE SIMILAR IN EITHER 618 00:23:43,200 --> 00:23:43,440 GROUPS. 619 00:23:43,440 --> 00:23:44,960 SAME FOR HYPERTENSION BUT IT 620 00:23:44,960 --> 00:23:47,280 DOESN'T ACCOUNT FOR DIFFERENCES 621 00:23:47,280 --> 00:23:50,360 AND PREVALENCES OF THE RISK 622 00:23:50,360 --> 00:23:51,440 FACTORS WHICH CAN ACCOUNT FOR 623 00:23:51,440 --> 00:23:53,480 LARGER PROPORTION AND HAVING THE 624 00:23:53,480 --> 00:23:54,840 RISK FACTOR DOESN'T INCREASE THE 625 00:23:54,840 --> 00:23:57,680 RISK IT'S INCREASED IN BOTH 626 00:23:57,680 --> 00:23:59,360 GROUPS. 627 00:23:59,360 --> 00:24:03,360 THE APOE E4 ALLELE IS A STRONGER 628 00:24:03,360 --> 00:24:04,720 KNOWN GENETIC RISK FACTORS IN 629 00:24:04,720 --> 00:24:05,880 WHITES THAN BLACKS. 630 00:24:05,880 --> 00:24:08,160 WE FOUND SUPPORT FOR THAT AND 631 00:24:08,160 --> 00:24:09,840 IMPORTANT IN BLACKS BUT NOT AS 632 00:24:09,840 --> 00:24:12,920 STRONG FOR WHITES. 633 00:24:12,920 --> 00:24:16,840 THIS MAY ACCOUNT FOR THE MIXED 634 00:24:16,840 --> 00:24:18,960 DEMENTIA LOOKING AT ALL-CAUSE 635 00:24:18,960 --> 00:24:19,600 DEMENTIA. 636 00:24:19,600 --> 00:24:24,680 SO KEEN ON WALKER DID THIS WORK 637 00:24:24,680 --> 00:24:27,200 FOR ME AND WHEN HE LOOKED AT 638 00:24:27,200 --> 00:24:30,520 CHANGE OVER THE LIFE COURSE AND 639 00:24:30,520 --> 00:24:32,040 BLOOD PRESSURE IN PARTICULAR. 640 00:24:32,040 --> 00:24:34,240 I TOLD YOU MIDLIFE WAS IMPORTANT 641 00:24:34,240 --> 00:24:36,440 AND WAS IMPORTANT IN PREVENTION 642 00:24:36,440 --> 00:24:40,680 AND EARLY CLINICAL CHANGES IN 643 00:24:40,680 --> 00:24:41,320 ALZHEIMER'S DISEASE AND 644 00:24:41,320 --> 00:24:42,680 EPIDEMIOLOGIC DATA SHOWS 645 00:24:42,680 --> 00:24:43,960 STRONGER ASSOCIATIONS FOR MID 646 00:24:43,960 --> 00:24:45,360 LIFE AND ASKED WHAT IF PEOPLE 647 00:24:45,360 --> 00:24:47,320 HAVE CHANGES OVER THEIR LIFE 648 00:24:47,320 --> 00:24:50,720 COURSE DOES THAT AFFECT THEIR 649 00:24:50,720 --> 00:24:52,440 LIKELIHOOD OF DEVELOPING 650 00:24:52,440 --> 00:24:55,360 DEMENTIA AND FOUND PEOPLE WITH 651 00:24:55,360 --> 00:24:56,960 HYPERPENSION FOLLOWED BY LATE 652 00:24:56,960 --> 00:25:01,000 LIFE HYPOTENSION AND LOW BLOOD 653 00:25:01,000 --> 00:25:05,000 PRESSURE AND MEANING DIASTOLIC 654 00:25:05,000 --> 00:25:07,400 BELOW 60 AND HYPERTENSION 655 00:25:07,400 --> 00:25:09,840 FOLLOWED BY HYPOTENSION WAS 656 00:25:09,840 --> 00:25:11,200 ASSOCIATED WITH THE GREATEST 657 00:25:11,200 --> 00:25:12,960 RISK OF DEMENTIA AND 658 00:25:12,960 --> 00:25:16,880 HYPERTENSION FOLLOWED BY LATE 659 00:25:16,880 --> 00:25:19,560 LIFE HYPOTENSION AND THIS 660 00:25:19,560 --> 00:25:22,560 PATTERN WAS PROBLEMATIC AND MOST 661 00:25:22,560 --> 00:25:24,520 INDIVIDUALS WERE ON 662 00:25:24,520 --> 00:25:27,360 BLOOD-PRESSURE LOWERING 663 00:25:27,360 --> 00:25:29,600 MEDICATIONS AND EXCLUDED PEOPLE 664 00:25:29,600 --> 00:25:32,400 WITH EARLY COGNITIVE CHANGES AND 665 00:25:32,400 --> 00:25:34,760 WE SEE THE SAME RELATIONSHIP. 666 00:25:34,760 --> 00:25:37,680 IN RACE STRATIFIED MODELS WE 667 00:25:37,680 --> 00:25:39,440 DIDN'T SEE PARTICULAR 668 00:25:39,440 --> 00:25:42,040 DIFFERENCES IN THE EFFECTIVE 669 00:25:42,040 --> 00:25:43,040 BLOOD PRESSURE OVER TIME. 670 00:25:43,040 --> 00:25:44,960 BUT WE DON'T SEE THE 671 00:25:44,960 --> 00:25:47,680 HYPERTENSION FOLLOWED BY 672 00:25:47,680 --> 00:25:48,480 HYPOTENSION PARTICULARLY 673 00:25:48,480 --> 00:25:49,920 PROBLEMATIC IN BLACKS VERSUS 674 00:25:49,920 --> 00:25:50,280 WHITES. 675 00:25:50,280 --> 00:25:52,480 WHAT ABOUT POTENTIAL MECHANISMS 676 00:25:52,480 --> 00:25:55,120 OF VASCULAR IMPACT OF DEMENTIA? 677 00:25:55,120 --> 00:25:58,760 I HOPE I CONVINCED YOU SOMEWHAT 678 00:25:58,760 --> 00:26:01,560 VASCULAR RISK FACTORS ASSOCIATED 679 00:26:01,560 --> 00:26:03,520 WITH COGNITIVE CHANGE AND 680 00:26:03,520 --> 00:26:03,760 DEMENTIA. 681 00:26:03,760 --> 00:26:06,280 WHAT ARE THE POTENTIAL REASONS 682 00:26:06,280 --> 00:26:06,760 THAT MAY BE? 683 00:26:06,760 --> 00:26:08,960 IN EPIDEMIOLOGY WE TEND TO USE 684 00:26:08,960 --> 00:26:10,640 BIOMARKERS WHETHER IMAGING OR 685 00:26:10,640 --> 00:26:13,000 BLOOD BASED TO HELP US 686 00:26:13,000 --> 00:26:14,280 UNDERSTAND MECHANISMS. 687 00:26:14,280 --> 00:26:16,280 CERTAINLY ONE POTENTIAL 688 00:26:16,280 --> 00:26:17,840 MECHANISM IS IF YOU HAVE 689 00:26:17,840 --> 00:26:19,280 VASCULAR RISK FACTORS AND 690 00:26:19,280 --> 00:26:20,960 DEVELOPED STROKE THAT CAN 691 00:26:20,960 --> 00:26:22,960 CONTRIBUTE TO COGNITIVE DECLINE 692 00:26:22,960 --> 00:26:23,720 AND DEMENTIA. 693 00:26:23,720 --> 00:26:29,320 HERE'S AN EXAMPLE OF AN MRI AND 694 00:26:29,320 --> 00:26:30,720 ACUTE STROKE AND SEE THESE 695 00:26:30,720 --> 00:26:32,600 INDEPENDENT OF CLINICAL STROKE. 696 00:26:32,600 --> 00:26:34,720 WHAT ABOUT SUBCLINICAL CHANGES? 697 00:26:34,720 --> 00:26:36,960 PEOPLE WITH VASCULAR RISK 698 00:26:36,960 --> 00:26:40,520 FACTORS ACCUMULATE A FAIR NUMBER 699 00:26:40,520 --> 00:26:48,680 OF THE IS KEEMIC -- ISCHEMIC 700 00:26:48,680 --> 00:26:50,240 INFARCT AND MICROBLEED AND 701 00:26:50,240 --> 00:26:51,600 PEOPLE CAN HAVE VASCULAR RISK 702 00:26:51,600 --> 00:26:53,280 FACTORS AND HAVE LOSS IN THE 703 00:26:53,280 --> 00:26:54,880 BRAIN OVER TIME WHICH MAY 704 00:26:54,880 --> 00:26:57,360 ATTRIBUTE TO COGNITION AND IT'S 705 00:26:57,360 --> 00:27:02,800 TRUE VASCULAR RISK FACTORS MORE 706 00:27:02,800 --> 00:27:04,120 DIRECTLY TO CONTRIBUTE TO 707 00:27:04,120 --> 00:27:05,640 ALZHEIMER'S NEUROPATHIC CHANGES 708 00:27:05,640 --> 00:27:10,200 AND WE LOOK AT THE ALZHEIMER'S 709 00:27:10,200 --> 00:27:12,200 CHANGE AND THE PET IS A WAY TO 710 00:27:12,200 --> 00:27:16,000 LOOK AT AMYLOID BURDEN BRAINS OF 711 00:27:16,000 --> 00:27:18,280 INDIVIDUALS WHO DID NOT HAVE 712 00:27:18,280 --> 00:27:20,040 DEMENTIA AND UNDERSTAND HOW 713 00:27:20,040 --> 00:27:21,000 VASCULAR RISK FACTORS RELATE TO 714 00:27:21,000 --> 00:27:25,000 THE FINDING THIS IS A POSITIVE 715 00:27:25,000 --> 00:27:27,400 AMYLOID PET SCAN. 716 00:27:27,400 --> 00:27:29,120 WHAT'S THE POTENTIAL FOR THESE 717 00:27:29,120 --> 00:27:30,520 BEING LINK BETWEEN VASCULAR RISK 718 00:27:30,520 --> 00:27:35,080 FACTORS AND COGNITIVE DECLINE 719 00:27:35,080 --> 00:27:37,200 >>MISSISSIPPI UNIVERSITY 720 00:27:37,200 --> 00:27:40,960 MEDICAL CENTER LOOKED AT THE 721 00:27:40,960 --> 00:27:42,960 CHANGES I SHOWED HERE AND SILENT 722 00:27:42,960 --> 00:27:44,600 INFARCTS AND THE COMBINATION OF 723 00:27:44,600 --> 00:27:46,200 THEM AND PARTICULARLY THE 724 00:27:46,200 --> 00:27:47,760 COMBINATION WAS ASSOCIATED WITH 725 00:27:47,760 --> 00:27:48,800 STEEPER COGNITIVE DECLINE OVER 726 00:27:48,800 --> 00:27:49,840 TWO DECADES. 727 00:27:49,840 --> 00:27:55,520 IN ADDITION, MELINDA POWER AT 728 00:27:55,520 --> 00:28:02,960 G.W. FOUND THE HAVE MORE LOSS OF 729 00:28:02,960 --> 00:28:05,080 WHITE MATTER INTEGRITY USING 730 00:28:05,080 --> 00:28:07,760 DIFFUSER TENSION IMAGING AND THE 731 00:28:07,760 --> 00:28:09,480 PATTERN OF HIGH BLOOD PRESSURE 732 00:28:09,480 --> 00:28:14,400 FOLLOWED BY LOW PRESSURE MAY 733 00:28:14,400 --> 00:28:16,760 CONTRIBUTE TO BRAIN VOLUME LOSS 734 00:28:16,760 --> 00:28:18,040 AND THEY TEND TO HAVE LESS 735 00:28:18,040 --> 00:28:20,800 COGNITION OVER TIME AND PEOPLE 736 00:28:20,800 --> 00:28:26,080 WITH MORE PROGRESSION OF THESE 737 00:28:26,080 --> 00:28:28,760 CONDITIONS HAVE ASSOCIATIONS AND 738 00:28:28,760 --> 00:28:32,600 PHYSICAL ACTIVITY SHOWS 739 00:28:32,600 --> 00:28:33,880 DIFFERENCES AFFECTING REGIONS WE 740 00:28:33,880 --> 00:28:37,080 KNOW ARE IMPORTANT IN 741 00:28:37,080 --> 00:28:37,440 ALZHEIMER'S. 742 00:28:37,440 --> 00:28:39,160 SOME EVIDENCE LINKING VASCULAR 743 00:28:39,160 --> 00:28:41,120 RISK FACTORS TO THESE IMAGING 744 00:28:41,120 --> 00:28:44,280 MARKERS AND LINKING THEM TO 745 00:28:44,280 --> 00:28:44,960 COGNITION. 746 00:28:44,960 --> 00:28:47,520 WHAT ABOUT THE AMYLOID 747 00:28:47,520 --> 00:28:48,160 HYPOTHESIS? 748 00:28:48,160 --> 00:28:53,000 I EXPLAINED THAT AMYLOID IS A 749 00:28:53,000 --> 00:28:58,480 LEADING HYPOTHESIS IS FELT TO 750 00:28:58,480 --> 00:29:00,040 CAUSE ALZHEIMER'S DISEASE AND 751 00:29:00,040 --> 00:29:02,520 WHAT MECHANISTICALLY LINK TO 752 00:29:02,520 --> 00:29:04,960 DEMENTIA ONE IS DO THEY DIRECTLY 753 00:29:04,960 --> 00:29:07,840 CONTRIBUTE TO AMYLOID DEPOSITION 754 00:29:07,840 --> 00:29:10,280 IN THE BRAIN AND WE LOOKED AT 755 00:29:10,280 --> 00:29:11,720 VASCULAR RISK FACTORS IN MIDDLE 756 00:29:11,720 --> 00:29:13,520 AND LATER AGE AND FOCUSSED ON 757 00:29:13,520 --> 00:29:16,360 MIDDLE AGE WITH THE HYPOTHESIS 758 00:29:16,360 --> 00:29:18,840 VASCULAR RISK FACTORS IN MIDDLE 759 00:29:18,840 --> 00:29:20,480 MAY BE ASSOCIATED WITH AMYLOID 760 00:29:20,480 --> 00:29:23,400 DEPOSITION LATER IN LIFE 761 00:29:23,400 --> 00:29:25,000 INDEPENDENT OF FACTORS AND IN 762 00:29:25,000 --> 00:29:26,640 PARTICULAR WE LOOKED AT NUMBER 763 00:29:26,640 --> 00:29:29,000 OF VASCULAR RISK FACTORS HERE. 764 00:29:29,000 --> 00:29:32,280 WE TALLIED HOW MANY OF HIGH 765 00:29:32,280 --> 00:29:33,760 BLOOD PRESSURE AND CHOLESTEROL, 766 00:29:33,760 --> 00:29:36,560 OBESITY, SMOKING AND DIABETES 767 00:29:36,560 --> 00:29:39,680 AND HOW MANY RISK FACTORS YOU 768 00:29:39,680 --> 00:29:41,960 HAD AND PEOPLE WITH MORE OF THE 769 00:29:41,960 --> 00:29:44,120 RISK FACTORS COMPARED TO PEOPLE 770 00:29:44,120 --> 00:29:45,520 WHO HAD NONE THAT PEOPLE WHO HAD 771 00:29:45,520 --> 00:29:48,960 MORE OF THE RISK FACTORS HAD A 772 00:29:48,960 --> 00:29:50,840 GREATER AMYLOID IN THEIR BRAIN 773 00:29:50,840 --> 00:29:52,200 IF YOU HAD ONE RISK FACTOR YOU 774 00:29:52,200 --> 00:29:53,760 HAD IN BETWEEN. 775 00:29:53,760 --> 00:29:55,560 A DOSE RESPONSE AND THE ACTUAL 776 00:29:55,560 --> 00:29:56,720 NUMBERS ARE SHOWN IN THE TABLE 777 00:29:56,720 --> 00:29:59,480 HERE AND AS WE GET TO LATER 778 00:29:59,480 --> 00:30:01,360 VISITS, MEANING LESS MIDLIFE AND 779 00:30:01,360 --> 00:30:04,200 LATER IN LIFE AND MORE 780 00:30:04,200 --> 00:30:06,960 CONCURRENT WITH AMYLOID SCAN WE 781 00:30:06,960 --> 00:30:09,240 DON'T SEE THE SAME RELATIONSHIP 782 00:30:09,240 --> 00:30:11,520 SHOWING THE IMPORTANCE OF LIFE 783 00:30:11,520 --> 00:30:12,880 COURSE IN VASCULAR RISK FACTORS 784 00:30:12,880 --> 00:30:16,160 AND A LINK TO AMYLOID DEPOSITION 785 00:30:16,160 --> 00:30:16,960 THAT CAN LEAD TO ALZHEIMER'S 786 00:30:16,960 --> 00:30:27,400 DISEASE OR AT LEAST IS A MARKER 787 00:30:27,400 --> 00:30:30,000 OF ALZHEIMER'S DISEASE. 788 00:30:30,000 --> 00:30:37,600 AND KEENON WALKER LOOKS AT THESE 789 00:30:37,600 --> 00:30:40,360 CARDIOVASCULAR RISK FACTORS AND 790 00:30:40,360 --> 00:30:43,200 PEOPLE WITH THESE HAD MORE MORE 791 00:30:43,200 --> 00:30:44,640 AMYLOID DEPOSITION AND SAW 792 00:30:44,640 --> 00:30:46,640 STRONGER RELATIONSHIPS IN BLACK 793 00:30:46,640 --> 00:30:50,240 PARTICIPANTS COMPARED TO WHITE. 794 00:30:50,240 --> 00:30:53,000 THE AMOUNT OF QUARTILES OF RACE 795 00:30:53,000 --> 00:30:59,520 AND FOUND HIGHER AMYLOID 796 00:30:59,520 --> 00:31:04,360 DEPOSITION IN BLACK INDIVIDUALS 797 00:31:04,360 --> 00:31:06,440 WITH THESE AND I HOPE YOU 798 00:31:06,440 --> 00:31:07,280 PROVIDED VASCULAR RISK FACTORS 799 00:31:07,280 --> 00:31:11,640 ARE ASSOCIATED DEMENTIA AND MAY 800 00:31:11,640 --> 00:31:14,560 BE AN APPEALING TARGET FOR 801 00:31:14,560 --> 00:31:15,400 PREVENTION BECAUSE OF THE MIXED 802 00:31:15,400 --> 00:31:20,480 CASES WE SEE IN DEMENTIA IN 803 00:31:20,480 --> 00:31:22,640 BLACK VERSUS WHITE INDIVIDUALS 804 00:31:22,640 --> 00:31:24,400 AND WHAT EVIDENCE IS THERE IN 805 00:31:24,400 --> 00:31:27,320 THE LITERATURE AND FOCUSSING ON 806 00:31:27,320 --> 00:31:27,960 THE EPIDEMIOLOGIC LITERATURE 807 00:31:27,960 --> 00:31:29,400 THAT SHOWS DIFFERENCES IN RACE 808 00:31:29,400 --> 00:31:31,360 AND WHAT MIGHT THE MECHANISMS 809 00:31:31,360 --> 00:31:31,520 BE? 810 00:31:31,520 --> 00:31:34,360 ONE THING TO LOOK AT IS HOW THE 811 00:31:34,360 --> 00:31:36,960 BIOMARKERS FOR ALZHEIMER'S 812 00:31:36,960 --> 00:31:38,440 DISEASE DIFFER BY RACE. 813 00:31:38,440 --> 00:31:39,360 IS THERE A DIFFERENCE IN THE 814 00:31:39,360 --> 00:31:41,000 DISEASE PROCESS AND IN THE 815 00:31:41,000 --> 00:31:43,200 INDIVIDUALS WE ENROLL FOR 816 00:31:43,200 --> 00:31:43,440 STUDIES? 817 00:31:43,440 --> 00:31:47,280 THE ANSWER IS PROBABLY YES TO 818 00:31:47,280 --> 00:31:51,400 BOTH AND TO THE LATTER. 819 00:31:51,400 --> 00:31:55,280 THE ARIC STUDY WAS FROM THREE 820 00:31:55,280 --> 00:31:55,960 COMMUNITIES. 821 00:31:55,960 --> 00:31:58,920 WE FOUND INDEPENDENT OF AGE, 822 00:31:58,920 --> 00:32:02,400 SEX, EDUCATION, APOE, WHITE 823 00:32:02,400 --> 00:32:03,400 MATTER HYPERINTENTION TI AND 824 00:32:03,400 --> 00:32:07,520 BRAIN VOLUME IF PEOPLE HAD MILD 825 00:32:07,520 --> 00:32:13,000 IMPAIRMENT OR NOT WE SEE HIGHER 826 00:32:13,000 --> 00:32:15,080 AMYLOID IN BLACK VERSUS WHITE 827 00:32:15,080 --> 00:32:17,000 AND NO STUDIES THAT WERE 828 00:32:17,000 --> 00:32:19,480 RECRUITING PEOPLE FOR AMYLOID 829 00:32:19,480 --> 00:32:21,400 IMAGING HAD DIVERSE POPULATIONS 830 00:32:21,400 --> 00:32:22,240 AT ALL. 831 00:32:22,240 --> 00:32:23,840 NO ONE HAD SHOWN ANYTHING LIKE 832 00:32:23,840 --> 00:32:24,960 THIS AND WE WERE SURPRISED BY 833 00:32:24,960 --> 00:32:28,880 THE FINDING AND NOT SURE WHAT TO 834 00:32:28,880 --> 00:32:30,080 MAKE OF IT. 835 00:32:30,080 --> 00:32:32,040 IT WAS NOTHING WE HYPOTHESIZED 836 00:32:32,040 --> 00:32:34,520 AT THE POINT BUT WE THINK OF 837 00:32:34,520 --> 00:32:36,520 DEFINING DISEASE BY THESE 838 00:32:36,520 --> 00:32:38,360 IMAGING BIOMARKERS WE NEED TO 839 00:32:38,360 --> 00:32:39,600 UNDERSTAND HOW THEY MIGHT DIFFER 840 00:32:39,600 --> 00:32:40,960 ACROSS RACE ETHNIC GROUPS AND 841 00:32:40,960 --> 00:32:42,280 WHAT THE REASONS FOR THE 842 00:32:42,280 --> 00:32:43,160 DIFFERENCE MIGHT BE. 843 00:32:43,160 --> 00:32:44,560 INTERESTINGLY, SINCE THAT STUDY 844 00:32:44,560 --> 00:32:49,800 CAME OUT, THESE ARE OUR DATA 845 00:32:49,800 --> 00:32:51,200 AGAIN 2016 SHOWING HIGHER RATES 846 00:32:51,200 --> 00:32:54,200 OF AMYLOID IN BLACKS VERSUS 847 00:32:54,200 --> 00:32:56,840 WHITES REGARDLESS OF WHAT APOE 848 00:32:56,840 --> 00:32:58,640 LEVEL YOU'RE LOOKING AT. 849 00:32:58,640 --> 00:33:00,600 HERE'S HIGHER AMYLOID IN BLACKS 850 00:33:00,600 --> 00:33:00,960 VERSUS WHITES. 851 00:33:00,960 --> 00:33:04,200 AS THE NOT EXPLAINED BY THE APOE 852 00:33:04,200 --> 00:33:06,440 DIFFERENCE WE SEE WITH DEMENTIA 853 00:33:06,440 --> 00:33:08,960 IN THE CLINICAL DEMENTIA EVENTS. 854 00:33:08,960 --> 00:33:11,800 THIS IS A STUDY WHERE YOU SEE 855 00:33:11,800 --> 00:33:13,960 ALMOST THE SAME TABLE PUBLISHED 856 00:33:13,960 --> 00:33:15,360 YEARS AGO LOOKING AT A CLINICAL 857 00:33:15,360 --> 00:33:18,760 TRIAL RECRUITING PEOPLE CALLED 858 00:33:18,760 --> 00:33:23,520 THE A4 STUDY AND THEY FOUND THE 859 00:33:23,520 --> 00:33:26,640 OPPOSITE THE NON-HISPANIC BLACK 860 00:33:26,640 --> 00:33:28,640 PARTICIPANTS THE ORANGE BAR WERE 861 00:33:28,640 --> 00:33:30,200 CONSISTENTLY AT LOWER AMYLOID 862 00:33:30,200 --> 00:33:31,640 LEVELS COMPARED TO OTHER GROUPS 863 00:33:31,640 --> 00:33:32,320 ON PET SCAN. 864 00:33:32,320 --> 00:33:34,600 ON A SIMILAR SCAN DEFINING 865 00:33:34,600 --> 00:33:36,560 THINGS IN A SIMILAR WAY THEY SEE 866 00:33:36,560 --> 00:33:38,640 A VERY DIFFERENT FINDING. 867 00:33:38,640 --> 00:33:40,960 THIS IS THE CLINICAL TRIAL 868 00:33:40,960 --> 00:33:41,320 POPULATION. 869 00:33:41,320 --> 00:33:43,160 THEY TRIED HARD AND BEEN 870 00:33:43,160 --> 00:33:44,320 SUCCESSFUL AND HAD A DIVERSE 871 00:33:44,320 --> 00:33:46,920 POPULATION BUT IT'S NOT A 872 00:33:46,920 --> 00:33:48,600 COMMUNITY-BASED COHORT AND WE 873 00:33:48,600 --> 00:33:49,720 NEED TO CONSIDER THAT. 874 00:33:49,720 --> 00:33:55,160 IN THE WORK IN THE ALZHEIMER'S 875 00:33:55,160 --> 00:33:57,000 DISEASE CENTER THEY FOUND 876 00:33:57,000 --> 00:34:00,200 SIMILAR AMYLOID ON BLACK AND 877 00:34:00,200 --> 00:34:02,840 WHITE AND LOWER LEVELS OF CSF 878 00:34:02,840 --> 00:34:04,040 TAU WHICH WE DON'T HAVE THAT 879 00:34:04,040 --> 00:34:06,160 WORK IN OUR DATA YET. 880 00:34:06,160 --> 00:34:08,000 WE HAD INCONSISTENT RESULTS AND 881 00:34:08,000 --> 00:34:09,480 LEADS TO CONFUSION IN THE FIELD 882 00:34:09,480 --> 00:34:11,840 BUT AN EMPHASIS WE NEED TO THINK 883 00:34:11,840 --> 00:34:13,720 ABOUT BIOMARKER LEVELS AND HOW 884 00:34:13,720 --> 00:34:15,400 THEY MAY DIFFERENT BY RACE 885 00:34:15,400 --> 00:34:16,640 ETHNIC GROUPS AND WHY THEY MAY 886 00:34:16,640 --> 00:34:18,840 DIFFER AND WHAT THAT SAYS ABOUT 887 00:34:18,840 --> 00:34:20,240 OUR RECRUITMENT AND POTENTIAL 888 00:34:20,240 --> 00:34:20,800 SELECTION BIAS. 889 00:34:20,800 --> 00:34:22,360 HERE'S SOME POSSIBLE 890 00:34:22,360 --> 00:34:25,080 EXPLANATIONS FOR WHAT WE SAW AND 891 00:34:25,080 --> 00:34:33,200 REASONS FOR THESE INCONSISTENT 892 00:34:33,200 --> 00:34:35,640 -- INCONSISTENCIES AND THERE'S 893 00:34:35,640 --> 00:34:37,200 MORE MIXED PATHOLOGY IN PEOPLE 894 00:34:37,200 --> 00:34:38,640 THAT PRESENT. 895 00:34:38,640 --> 00:34:42,680 IF YOU LOOK AT A COGNITIVELY 896 00:34:42,680 --> 00:34:44,960 IMPAIRED POPULATION YOU MAY SEE 897 00:34:44,960 --> 00:34:46,640 THIS AND WE RECRUIT FROM PEOPLE 898 00:34:46,640 --> 00:34:49,120 WHO DIDN'T HAVE DEMENTIA AND MAY 899 00:34:49,120 --> 00:34:51,920 EXPLAIN THE FINDING AND I SHOWED 900 00:34:51,920 --> 00:34:53,000 VASCULAR RISK FACTORS ARE 901 00:34:53,000 --> 00:34:56,200 ASSOCIATED WITH AMYLOID. 902 00:34:56,200 --> 00:34:58,760 IS IT POSSIBLE THE RELATIONSHIP 903 00:34:58,760 --> 00:35:00,800 COULD REFLECT IN HIGHER LEVELS 904 00:35:00,800 --> 00:35:02,400 OF AMYLOID BECAUSE THERE'S MORE 905 00:35:02,400 --> 00:35:05,000 VASCULAR RISK IN BLACK VERSUS 906 00:35:05,000 --> 00:35:06,400 WHITE INDIVIDUALS AND THE 907 00:35:06,400 --> 00:35:07,120 EMPHASIS. 908 00:35:07,120 --> 00:35:09,840 IT DEPENDS HOW YOU CONSIDER THE 909 00:35:09,840 --> 00:35:11,120 POPULATION, A CLINICAL TRIAL 910 00:35:11,120 --> 00:35:12,960 POPULATION, PEOPLE MOTIVATED 911 00:35:12,960 --> 00:35:15,680 COME IN TO BE PART OF A CLINICAL 912 00:35:15,680 --> 00:35:18,320 TRIAL OR ALZHEIMER'S DISEASE 913 00:35:18,320 --> 00:35:21,520 CENTER WHICH IS A 914 00:35:21,520 --> 00:35:24,400 DISPROPORTIONATELY HIGHER 915 00:35:24,400 --> 00:35:27,400 EDUCATED POPULATION AND MAY BE 916 00:35:27,400 --> 00:35:30,920 LESS RISK AND WE HAVE TO LOOK AT 917 00:35:30,920 --> 00:35:32,720 DIVERSE POPULATIONS AND BUT IT'S 918 00:35:32,720 --> 00:35:34,440 IMPORTANT TO UNDERSTAND IT IF 919 00:35:34,440 --> 00:35:36,080 POTENTIAL THERAPEUTICS ARE GOING 920 00:35:36,080 --> 00:35:38,760 TO BE IMPACTFUL IN DIVERSE 921 00:35:38,760 --> 00:35:39,400 POPULATIONS BECAUSE IF WE'RE 922 00:35:39,400 --> 00:35:41,880 SCREENING PEOPLE BASED ON 923 00:35:41,880 --> 00:35:43,520 IMAGING, BIOMARKER LEVELS, 924 00:35:43,520 --> 00:35:44,960 ETCETERA, WE MAY GET A DIFFERENT 925 00:35:44,960 --> 00:35:46,200 STORY DEPENDING ON WHO WE 926 00:35:46,200 --> 00:35:48,880 RECRUITED FOR THE STUDY AND HOW 927 00:35:48,880 --> 00:35:52,120 WE DEFINE POSITIVITY, ETCETERA. 928 00:35:52,120 --> 00:35:54,640 TO WRAP UP IN THINKING OF 929 00:35:54,640 --> 00:35:56,320 MECHANISM AND WRAP UP THE TALK 930 00:35:56,320 --> 00:35:57,000 IN GENERAL BEFORE WE TALK 931 00:35:57,000 --> 00:36:01,960 BRIEFLY ABOUT WHAT WE KNOW ABOUT 932 00:36:01,960 --> 00:36:03,760 PREVENTION, WHAT ABOUT SOCIAL 933 00:36:03,760 --> 00:36:04,600 DETERMINATES OF HEALTH. 934 00:36:04,600 --> 00:36:06,720 WE TALKED ABOUT RACE AND NEED TO 935 00:36:06,720 --> 00:36:08,960 THINK OF UPSTREAM FACTORS AND 936 00:36:08,960 --> 00:36:15,400 WHAT MAY HAVE CONTRIBUTED. 937 00:36:15,400 --> 00:36:19,840 CHRISTEN GEORGE LED THE STUDY 938 00:36:19,840 --> 00:36:21,480 AND WE LOOKED AT LIFE COURSE AND 939 00:36:21,480 --> 00:36:23,280 EDUCATION FACTORS AND THERE'S A 940 00:36:23,280 --> 00:36:26,000 NUMBER OF WAYS WE DEFINE LIFE 941 00:36:26,000 --> 00:36:28,960 COURSE SES IN CHILDHOOD AND 942 00:36:28,960 --> 00:36:33,160 YOUNG ADULTHOOD AND ONLY STARTED 943 00:36:33,160 --> 00:36:35,280 SAYING PARTICIPANTS 45 AND UP SO 944 00:36:35,280 --> 00:36:36,520 A LOT OF THIS IS BY INFORMATION 945 00:36:36,520 --> 00:36:39,400 WHERE THEY LIVED AND WE HAVE 946 00:36:39,400 --> 00:36:41,040 INFORMATION ABOUT PARENTAL 947 00:36:41,040 --> 00:36:42,760 EDUCATION BY INTERVIEW AND WHAT 948 00:36:42,760 --> 00:36:47,320 SHE FOUND IS PEOPLE WHO HAD A 949 00:36:47,320 --> 00:36:52,960 HIGHER LIFE COURSE SOCIO 950 00:36:52,960 --> 00:36:56,960 ECONOMIC STATUS AND INDIVIDUAL 951 00:36:56,960 --> 00:36:59,840 SOCIO ECONOMIC STATUS AND SOME 952 00:36:59,840 --> 00:37:01,000 NEIGHBORHOOD LEVEL ECONOMIC 953 00:37:01,000 --> 00:37:03,000 STATUS HAD A LOWER RISK OF 954 00:37:03,000 --> 00:37:04,960 DEMENTIA BUT THERE'S EXCITING 955 00:37:04,960 --> 00:37:12,040 WORK BEING DONE WITH THE AREA 956 00:37:12,040 --> 00:37:19,840 DEPRIVATION INDEX AND A SUMMER 957 00:37:19,840 --> 00:37:21,520 STUDENT LED WORK LOOKING AT 958 00:37:21,520 --> 00:37:23,480 WHETHER THE RACE DIFFERENCE WE 959 00:37:23,480 --> 00:37:27,080 SAW IN THE ARIC PET STUDY COULD 960 00:37:27,080 --> 00:37:29,520 BE EXPLAINED BY OTHER SOCIO 961 00:37:29,520 --> 00:37:31,360 ECONOMIC FACTORS, OTHER SOCIAL 962 00:37:31,360 --> 00:37:32,320 FACTORS. 963 00:37:32,320 --> 00:37:35,160 WE ADJUSTED FOR EDUCATION AND 964 00:37:35,160 --> 00:37:38,520 VASCULAR RISK FACTORS AND WHITE 965 00:37:38,520 --> 00:37:40,920 MATTER, AND DIDN'T SEE THE 966 00:37:40,920 --> 00:37:43,520 DIFFERENCE AMYLOID EFFECTS WERE 967 00:37:43,520 --> 00:37:45,400 GREATER IN BLACKS THAN WHITES 968 00:37:45,400 --> 00:37:47,800 AND THIS IS SHOWING WHAT THE 969 00:37:47,800 --> 00:37:48,920 ESTIMATES ARE IF WE ADJUST FOR 970 00:37:48,920 --> 00:37:51,280 THE OTHER FACTORS. 971 00:37:51,280 --> 00:37:54,880 AGE, SEX, APOE, HYPERTENSION, 972 00:37:54,880 --> 00:37:56,960 DIABETES, SMOKING, BODY MASS, 973 00:37:56,960 --> 00:37:57,400 EDUCATION. 974 00:37:57,400 --> 00:38:02,800 THIS IS SHOWING A CONSISTENTLY 975 00:38:02,800 --> 00:38:04,520 HIGH ODDS OF AMYLOID FOR BLACKS 976 00:38:04,520 --> 00:38:08,200 VERSUS WHITES AND WHEN WE ADDED 977 00:38:08,200 --> 00:38:09,400 ANNUAL INCOME FACTORS AND 978 00:38:09,400 --> 00:38:10,720 PRIVATE INSURANCE STATUS YOU CAN 979 00:38:10,720 --> 00:38:12,880 SEE WE'RE STARTING TO CHIP AWAY 980 00:38:12,880 --> 00:38:14,040 AT THE AFFECT OF THE RACE 981 00:38:14,040 --> 00:38:16,840 DIFFERENCE ON AMYLOID. 982 00:38:16,840 --> 00:38:18,600 IT'S HIGHLY LIKELY THERE ARE 983 00:38:18,600 --> 00:38:20,440 SUFFICIENT SOCIAL FACTORS THAT 984 00:38:20,440 --> 00:38:22,040 COULD EXPLAIN THE RACE 985 00:38:22,040 --> 00:38:23,440 DIFFERENCE WE SEE CLEARLY IN 986 00:38:23,440 --> 00:38:25,800 GENERAL FOR THESE STUDIES WE'RE 987 00:38:25,800 --> 00:38:27,000 NOT DOING A GOOD ENOUGH JOB OF 988 00:38:27,000 --> 00:38:28,600 CAPTURING WHAT THE FACTORS ARE 989 00:38:28,600 --> 00:38:29,840 AND THAT'S TRUE ACROSS THE 990 00:38:29,840 --> 00:38:30,040 BOARD. 991 00:38:30,040 --> 00:38:32,960 WHAT WE FOUND IS 8% OF THE RACE 992 00:38:32,960 --> 00:38:38,960 EFFECT ON AMYLOID POSITIVITY IS 993 00:38:38,960 --> 00:38:39,280 M 994 00:38:39,280 --> 00:38:42,040 MEDIATED BY INCOME AND 10% BY 995 00:38:42,040 --> 00:38:43,000 INSURANCE STATUS. 996 00:38:43,000 --> 00:38:44,800 THERE'S STILL A GREAT DEAL WE 997 00:38:44,800 --> 00:38:47,360 DON'T KNOW WHY IS THERE BUT 998 00:38:47,360 --> 00:38:48,480 STILL NEED TO THINK OF OTHER 999 00:38:48,480 --> 00:38:50,200 SOCIAL FACTORS. 1000 00:38:50,200 --> 00:38:52,880 THERE'S OTHER SOCIAL FACTORS. 1001 00:38:52,880 --> 00:38:59,440 OLIVIA MANUAL A POST-BAC WITHME 1002 00:38:59,440 --> 00:39:00,640 IS LOOKING AT LOW BIRTH WEIGHT 1003 00:39:00,640 --> 00:39:07,400 AND FOUND PEOPLE WITH A 1004 00:39:07,400 --> 00:39:11,920 SELF-REPORTED LOWER BIRTH WEIGHT 1005 00:39:11,920 --> 00:39:15,720 ARE A LOWER RISK BUT NOT BIG. 1006 00:39:15,720 --> 00:39:17,520 HIGH BIRTH WEIGHT IS ASSOCIATED 1007 00:39:17,520 --> 00:39:20,680 WITH A HIGHER RISK OF DEMENTIA 1008 00:39:20,680 --> 00:39:24,240 ONLY IN BLACK BUT NOT WHITE 1009 00:39:24,240 --> 00:39:24,520 PATIENTS. 1010 00:39:24,520 --> 00:39:28,280 THIS IS ABOVE 9 POUNDS. 1011 00:39:28,280 --> 00:39:30,000 INDEPENDENT OF OTHER BASIC 1012 00:39:30,000 --> 00:39:31,160 DEMOGRAPHIC AND EDUCATION RISK 1013 00:39:31,160 --> 00:39:32,960 FACTORS BUT WE'RE STILL IN THE 1014 00:39:32,960 --> 00:39:34,320 PROCESS OF DELVING INTO OTHER 1015 00:39:34,320 --> 00:39:35,640 SOCIO ECONOMIC FACTORS TO TRY TO 1016 00:39:35,640 --> 00:39:37,200 EXPLAIN THE DIFFERENCES. 1017 00:39:37,200 --> 00:39:40,000 SO TIMELY WHAT ABOUT 1018 00:39:40,000 --> 00:39:40,960 OPPORTUNITIES FOR PREVENTION? 1019 00:39:40,960 --> 00:39:43,880 IN GENERAL, I TOLD YOU THAT 1020 00:39:43,880 --> 00:39:45,280 THESE RISK FACTORS ARE IMPORTANT 1021 00:39:45,280 --> 00:39:46,200 SO POTENTIALLY COULD BE 1022 00:39:46,200 --> 00:39:48,680 SOMETHING THAT IS A TARGET FOR 1023 00:39:48,680 --> 00:39:48,960 PREVENTION. 1024 00:39:48,960 --> 00:39:52,440 I WANT TO EMPHASIZE THESE ARE 1025 00:39:52,440 --> 00:39:54,800 ESTIMATES OF OPTIMAL 1026 00:39:54,800 --> 00:39:56,160 CARDIOVASCULAR HEALTH ACROSS THE 1027 00:39:56,160 --> 00:39:58,840 DIFFERENT MEASURES AND SHOWING 1028 00:39:58,840 --> 00:40:02,400 YOU IN NON-HISPANIC BLACKS AND 1029 00:40:02,400 --> 00:40:04,960 WHITES AND MEXICAN-AMERICAN 1030 00:40:04,960 --> 00:40:06,280 INDIVIDUALS AND THESE ARE 1031 00:40:06,280 --> 00:40:08,960 STATISTICS IF YOU LOOK AT BMI, 1032 00:40:08,960 --> 00:40:11,960 THIS BLUE IS IDEAL, RED IS 1033 00:40:11,960 --> 00:40:12,280 INTERMEDIATE. 1034 00:40:12,280 --> 00:40:14,840 LOWER RATES OF IDEAL AND 1035 00:40:14,840 --> 00:40:16,960 INTERMEDIATE IN BLACK AND 1036 00:40:16,960 --> 00:40:20,960 HISPANIC INDIVIDUALS AND SIMILAR 1037 00:40:20,960 --> 00:40:22,720 NUMBERS IN DIET AND BLOOD 1038 00:40:22,720 --> 00:40:26,200 PRESSURE AND LOWER RATES OF 1039 00:40:26,200 --> 00:40:27,400 CARDIOVASCULAR HEALTH IN 1040 00:40:27,400 --> 00:40:28,360 MINORITIZED POPULATIONS. 1041 00:40:28,360 --> 00:40:28,960 THERE'S A TREMENDOUS 1042 00:40:28,960 --> 00:40:30,320 OPPORTUNITIES FOR PREVENTION 1043 00:40:30,320 --> 00:40:31,560 BECAUSE WE'RE NOT DOING A GOOD 1044 00:40:31,560 --> 00:40:33,240 JOB AT ACHIEVING THE TARGETS. 1045 00:40:33,240 --> 00:40:35,600 AND I'M NOT GOING TO GO INTO 1046 00:40:35,600 --> 00:40:38,640 THIS IN DETAIL AND I SUSPECT 1047 00:40:38,640 --> 00:40:39,720 EVERYONE ON THE MEETING COULD 1048 00:40:39,720 --> 00:40:41,160 TEACH ME ABOUT THIS BETTER THAN 1049 00:40:41,160 --> 00:40:43,560 I UNDERSTAND IT MYSELF BUT I 1050 00:40:43,560 --> 00:40:45,120 WANT TO MAKE THE POINT THAT ALL 1051 00:40:45,120 --> 00:40:47,440 OF THESE IMPORTANT SOCIAL 1052 00:40:47,440 --> 00:40:48,600 FACTORS WE THINK ABOUT 1053 00:40:48,600 --> 00:40:50,480 INDIVIDUAL LEVEL, NEIGHBORHOOD 1054 00:40:50,480 --> 00:40:52,920 LEVEL, SOCIETY LEVEL, COMMUNITY 1055 00:40:52,920 --> 00:40:55,000 LEVEL CAN INFLUENCE HEALTH TO 1056 00:40:55,000 --> 00:40:57,120 THE POINT THEY INFLUENCE BIOLOGY 1057 00:40:57,120 --> 00:40:59,160 AND CAN INFLUENCE THE RISK 1058 00:40:59,160 --> 00:41:00,280 FACTORS. 1059 00:41:00,280 --> 00:41:01,640 SEEING DIFFERENCES IN RISK 1060 00:41:01,640 --> 00:41:03,200 FACTOR PREVALENCE DOESN'T MEAN 1061 00:41:03,200 --> 00:41:04,680 THEY'RE NOT INFLUENCED BY SOCIAL 1062 00:41:04,680 --> 00:41:07,400 FACTORS BUT THERE'S MANY WAYS IN 1063 00:41:07,400 --> 00:41:08,960 WHICH SOCIAL FACTORS CAN 1064 00:41:08,960 --> 00:41:12,160 INFLUENCE RISK OF DEMENTIA AND 1065 00:41:12,160 --> 00:41:13,840 THEREFORE POTENTIALLY BE TARGETS 1066 00:41:13,840 --> 00:41:14,240 FOR PREVENTION. 1067 00:41:14,240 --> 00:41:16,240 SO JUST TO WRAP UP IN WHAT WE 1068 00:41:16,240 --> 00:41:20,520 KNOW ABOUT PREVENTION SO FAR. 1069 00:41:20,520 --> 00:41:23,400 SO MARK LEED USED ARIC DATA 1070 00:41:23,400 --> 00:41:26,720 TRYING TO UNDERSTAND THE 1071 00:41:26,720 --> 00:41:30,440 PROPORTION OF PREVENTIBLE CASES 1072 00:41:30,440 --> 00:41:32,200 FOCUSSING ON THE MODIFIABLE RISK 1073 00:41:32,200 --> 00:41:33,200 FACTORS IDENTIFIED. 1074 00:41:33,200 --> 00:41:34,640 BASED ON THE DATA SOME I SHARED 1075 00:41:34,640 --> 00:41:36,960 AND SOME FROM OTHER COHORTS, 1076 00:41:36,960 --> 00:41:39,400 THEY TARGETED THESE PRIMARY 1077 00:41:39,400 --> 00:41:40,600 FACTORS THEY FELT WERE 1078 00:41:40,600 --> 00:41:42,360 MODIFIABLE RISK FACTORS FOR 1079 00:41:42,360 --> 00:41:43,440 DEMENTIA. 1080 00:41:43,440 --> 00:41:45,400 THIS IS OVER THE LIFE COURSE AND 1081 00:41:45,400 --> 00:41:48,440 WHY THE LIFE COURSE IS IMPORTANT 1082 00:41:48,440 --> 00:41:49,640 AND HIGH BLOOD PRESSURE, 1083 00:41:49,640 --> 00:41:51,000 OBESITY, THEY PUT DIABETES IN 1084 00:41:51,000 --> 00:41:52,760 LATER LIFE BUT WE THINK IT'S 1085 00:41:52,760 --> 00:41:54,000 PARTICULARLY IMPORTANT IN 1086 00:41:54,000 --> 00:41:55,200 MIDLIFE AS WELL. 1087 00:41:55,200 --> 00:41:56,600 THESE RISK FACTORS, WE LOOKED AT 1088 00:41:56,600 --> 00:41:58,680 THEM TO SEE WHAT PROPORTION OF 1089 00:41:58,680 --> 00:42:00,240 DEMENTIA CASES THEY ACCOUNTED 1090 00:42:00,240 --> 00:42:00,480 FOR. 1091 00:42:00,480 --> 00:42:03,840 WE FOUND 41% OF DEMENTIA CASES 1092 00:42:03,840 --> 00:42:05,760 IN THE U.S. WERE ATTRIBUTABLE TO 1093 00:42:05,760 --> 00:42:10,360 THE 12 RISK FACTORS PARTICULARLY 1094 00:42:10,360 --> 00:42:17,800 HYPERTENSION AND PHYSICAL 1095 00:42:17,800 --> 00:42:27,360 INACTIVITY IF EACH RISK FACTORS 1096 00:42:27,360 --> 00:42:30,040 WAS REDUCED IT REDUCED THE RISK 1097 00:42:30,040 --> 00:42:37,480 BY 7% AND HIS -- THIS WAS 1098 00:42:37,480 --> 00:42:39,280 HIGHER IN OTHER POPULATION AND 1099 00:42:39,280 --> 00:42:40,960 WE AT ALZHEIMER'S TREATMENTS. 1100 00:42:40,960 --> 00:42:43,000 RECENT THERAPIES HAVE BEEN IN 1101 00:42:43,000 --> 00:42:48,000 RELATIVE NON-DIVERSE 1102 00:42:48,000 --> 00:42:48,360 POPULATIONS. 1103 00:42:48,360 --> 00:42:57,840 HERE'S AN EDITORIAL TALKING 1104 00:42:57,840 --> 00:43:01,040 ABOUT THE STUDY AND THEY WERE 1105 00:43:01,040 --> 00:43:03,400 SELF-REPORTED FOR LECANEMAB AND 1106 00:43:03,400 --> 00:43:08,960 BECAUSE IT WAS A RANDOMIZED 1107 00:43:08,960 --> 00:43:12,280 TRIAL ONLY 6 WERE BLACK AND 1108 00:43:12,280 --> 00:43:15,160 THERE'S A NEW NEWER THERAPEUTIC 1109 00:43:15,160 --> 00:43:17,920 WITH HIGHER RATES OF HISPANIC 1110 00:43:17,920 --> 00:43:20,960 INDIVIDUALS BUT STILL LOWER 1111 00:43:20,960 --> 00:43:24,840 RATES OF BLACK PARTICIPANTS AND 1112 00:43:24,840 --> 00:43:28,480 THIS ALLOWED RISK FACTORS AND 1113 00:43:28,480 --> 00:43:30,040 OTHER TRIALS HAVE A PURE 1114 00:43:30,040 --> 00:43:32,440 ALZHEIMER'S POPULATION SO THEY 1115 00:43:32,440 --> 00:43:35,440 OFTEN EXCLUDE VASCULAR RISK 1116 00:43:35,440 --> 00:43:37,000 FACTORS WHICH IS WHY THEY'RE 1117 00:43:37,000 --> 00:43:40,960 SHOOTING THEMSELVES IN THE FOOT 1118 00:43:40,960 --> 00:43:44,760 WITH LESS DIVERSE POPULATIONS. 1119 00:43:44,760 --> 00:43:47,320 OTHER RISK TRIALS, PRINT MIND 1120 00:43:47,320 --> 00:43:48,960 WHICH LOOKED AT AGGRESSIVE BLOOD 1121 00:43:48,960 --> 00:43:50,000 PRESSURE CONTROL DID A BETTER 1122 00:43:50,000 --> 00:43:52,920 JOB AT RECRUITING MORE DIVERSE 1123 00:43:52,920 --> 00:43:55,360 POPULATIONS AND FOUND EVIDENCE 1124 00:43:55,360 --> 00:43:56,720 MORE AGGRESSIVE VERSUS LESS 1125 00:43:56,720 --> 00:43:57,400 AGGRESSIVE BLOOD PRESSURE 1126 00:43:57,400 --> 00:43:59,080 CONTROL WAS ASSOCIATED WITH LESS 1127 00:43:59,080 --> 00:44:01,040 MCI BUT NOT DEMENTIA 1128 00:44:01,040 --> 00:44:02,440 SPECIFICALLY WHICH WAS THE 1129 00:44:02,440 --> 00:44:07,480 PRIMARY HYPOTHESIS. 1130 00:44:07,480 --> 00:44:11,080 THE STUDY OF ASPIRIN AND WAS 1131 00:44:11,080 --> 00:44:14,040 NEGATIVE FOR DEMENTIA ONLY HAD 1132 00:44:14,040 --> 00:44:16,080 5% BLACK PARTICIPANTS. 1133 00:44:16,080 --> 00:44:19,320 MULTI-MODAL INTERVENTIONS ARE 1134 00:44:19,320 --> 00:44:20,960 NOW A NEW DIRECTION. 1135 00:44:20,960 --> 00:44:24,920 THE FINGER TRIAL SHOWED EVIDENCE 1136 00:44:24,920 --> 00:44:28,960 IN FINLAND THAT A MULTIMODAL 1137 00:44:28,960 --> 00:44:30,040 INCLUDING COGNITIVE STIMULATION 1138 00:44:30,040 --> 00:44:34,000 AND PHYSICAL ACTIVITY AND 1139 00:44:34,000 --> 00:44:41,480 HEALTHY DIET WHICH WAS A HEALTHY 1140 00:44:41,480 --> 00:44:47,720 NORDIC DIET CONTRIBUTED TO A 1141 00:44:47,720 --> 00:44:50,840 HEALTHIER LIFESTYLE AND THEY'RE 1142 00:44:50,840 --> 00:44:52,320 LOOKING TO RECRUIT DIVERSE 1143 00:44:52,320 --> 00:44:54,880 POPULATIONS AND PLANNING TO 1144 00:44:54,880 --> 00:44:56,640 STUDY A SIMILAR MULTIMODAL 1145 00:44:56,640 --> 00:44:56,960 INTERVENTION. 1146 00:44:56,960 --> 00:45:02,640 IN CONCLUSION WE SEE HIGHER 1147 00:45:02,640 --> 00:45:04,360 RATES IN BLACK AND HISPANIC 1148 00:45:04,360 --> 00:45:05,600 INDIVIDUALS IN THE U.S. 1149 00:45:05,600 --> 00:45:08,600 VASCULAR RISK FACTOR A GREAT 1150 00:45:08,600 --> 00:45:09,480 OPPORTUNITY FOR PREVENTION WE 1151 00:45:09,480 --> 00:45:10,760 HAVE A CLEAR ASSOCIATION FOR 1152 00:45:10,760 --> 00:45:11,440 OUTCOME. 1153 00:45:11,440 --> 00:45:12,960 THEY MAY BE IMPORTANT AT AN 1154 00:45:12,960 --> 00:45:15,680 EARLY STAGE OF DISEASE AND VERY 1155 00:45:15,680 --> 00:45:17,680 COMMON IN DISPARITY POPULATIONS. 1156 00:45:17,680 --> 00:45:18,880 THERE MAY BE SOME DIFFERENCES IN 1157 00:45:18,880 --> 00:45:20,520 THE RISK FACTORS IN BLACKS 1158 00:45:20,520 --> 00:45:22,160 VERSUS WHITES AND STILL NEED TO 1159 00:45:22,160 --> 00:45:23,360 UNDERSTAND MORE WHY THAT'S THE 1160 00:45:23,360 --> 00:45:25,520 CASE AND WE NEED TO THINK 1161 00:45:25,520 --> 00:45:26,960 CAREFULLY ABOUT BIOMARKERS WHEN 1162 00:45:26,960 --> 00:45:28,280 WE DESIGN TRIALS AND INTERPRET 1163 00:45:28,280 --> 00:45:31,080 TRIAL RESULTS AND MAKE SURE THE 1164 00:45:31,080 --> 00:45:32,720 STUDIES HAVE DIVERSE STUDY 1165 00:45:32,720 --> 00:45:33,040 POPULATIONS. 1166 00:45:33,040 --> 00:45:36,000 THE MORE WE TRY TO TRACE BACK 1167 00:45:36,000 --> 00:45:38,200 THE MECHANISMS WE NEED TO THINK 1168 00:45:38,200 --> 00:45:39,040 OF SOCIAL DETERMINATES AND NEED 1169 00:45:39,040 --> 00:45:43,000 TO DO A BETTER JOB OF STUDYING 1170 00:45:43,000 --> 00:45:45,040 THEM IN LARGE COHORT CLINICAL 1171 00:45:45,040 --> 00:45:48,280 TRIAL STUDIES BUT MAY NOT 1172 00:45:48,280 --> 00:45:49,720 ELIMINATE WHAT IMPACTS HEALTH 1173 00:45:49,720 --> 00:45:50,000 OUTCOMES. 1174 00:45:50,000 --> 00:45:51,120 WE'RE CONTINUING TO DO A LOT OF 1175 00:45:51,120 --> 00:45:53,920 THE WORK LOOKING AT ARIC AND 1176 00:45:53,920 --> 00:45:55,960 MODIFIABLE RISK FACTORS AND 1177 00:45:55,960 --> 00:46:00,280 INTERACTIONS BETWEEN VARIOUS 1178 00:46:00,280 --> 00:46:01,680 OMICS AND SOCIAL DETERMINATES OF 1179 00:46:01,680 --> 00:46:08,960 HEALTH AND THOSE WHO CAN ACHIEVE 1180 00:46:08,960 --> 00:46:11,320 RELATIVE NORMAL HEALTH THAT HAVE 1181 00:46:11,320 --> 00:46:12,440 PATHOLOGY AND LOOKING AT THE 1182 00:46:12,440 --> 00:46:13,960 LIFE COURSE AND THE DISCOVERY 1183 00:46:13,960 --> 00:46:16,320 COHORT WHICH IS AN ONGOING 1184 00:46:16,320 --> 00:46:17,840 DETAILED STUDY LOOKING AT 1185 00:46:17,840 --> 00:46:20,560 POST-STROKE DEMENTIA IN 1186 00:46:20,560 --> 00:46:22,680 DISPARITY POPULATIONS FOCUSSING 1187 00:46:22,680 --> 00:46:24,640 ON THE YOU HAVE A VULNERABLE 1188 00:46:24,640 --> 00:46:27,400 BRAIN WITH A STROKE AND THAT 1189 00:46:27,400 --> 00:46:29,720 IMPACTS THE RISK AND WE HAVE 1190 00:46:29,720 --> 00:46:32,280 P.I.s AT MASS GENERAL AND A LEAD 1191 00:46:32,280 --> 00:46:33,520 THE STATISTIC CORPS. 1192 00:46:33,520 --> 00:46:36,960 WE'RE RECRUITING 8,000 PEOPLE 1193 00:46:36,960 --> 00:46:40,080 WITH ISCHEMIC STROKE AT 30 SITES 1194 00:46:40,080 --> 00:46:42,480 FOCUSSING ON DIVERSE POPULATIONS 1195 00:46:42,480 --> 00:46:44,360 AND FOCUSSING ON COGNITIVE 1196 00:46:44,360 --> 00:46:45,560 IMPAIRMENT AND DEMENTIA AFTER 1197 00:46:45,560 --> 00:46:45,800 STROKE. 1198 00:46:45,800 --> 00:46:50,640 WITH THAT I'D LIKE TO 1199 00:46:50,640 --> 00:46:51,960 ACKNOWLEDGE ALL OF MY MANY 1200 00:46:51,960 --> 00:46:52,680 INCREDIBLE COLLABORATORS AND OUR 1201 00:46:52,680 --> 00:46:55,160 FUNDING SOURCES AND MY FUNDING 1202 00:46:55,160 --> 00:46:56,120 SOURCE IN THE INTRAMURAL 1203 00:46:56,120 --> 00:46:58,240 RESEARCH PROGRAM AND WITH THAT I 1204 00:46:58,240 --> 00:47:01,000 WILL STOP AND IF THERE'S 1205 00:47:01,000 --> 00:47:02,720 QUESTIONS THROUGH KELVIN OR IF 1206 00:47:02,720 --> 00:47:04,400 HE CAN ASK THEM OR FEEL FREE TO 1207 00:47:04,400 --> 00:47:04,960 REACH OUT BY E-MAIL. 1208 00:47:04,960 --> 00:47:12,640 THANKS SO MUCH. 1209 00:47:12,640 --> 00:47:15,320 >>THANK YOU, DR. GOTTESMAN. 1210 00:47:15,320 --> 00:47:19,400 VERY INTENSIVE BODY OF WORK THAT 1211 00:47:19,400 --> 00:47:22,640 REALLY SHOWCASES THE 1212 00:47:22,640 --> 00:47:24,960 RELATIONSHIP BETWEEN RACE AND 1213 00:47:24,960 --> 00:47:26,440 ETHNICITY AND SOCIAL 1214 00:47:26,440 --> 00:47:31,120 DETERMINATES AND THE BIOLOGICAL 1215 00:47:31,120 --> 00:47:33,520 MECHANISM WITH IMPAIRMENT OF 1216 00:47:33,520 --> 00:47:33,880 DEMENTIA. 1217 00:47:33,880 --> 00:47:36,560 IT'S BLIND BLOWING THE WORK 1218 00:47:36,560 --> 00:47:37,120 BEING DONE. 1219 00:47:37,120 --> 00:47:38,000 IT'S VERY IMPRESSIVE. 1220 00:47:38,000 --> 00:47:43,040 I HAVE A FEW QUESTIONS AND YOU 1221 00:47:43,040 --> 00:47:44,720 CAN SEND AN E-MAIL AND ASK THE 1222 00:47:44,720 --> 00:47:47,280 QUESTIONS OF YOU. 1223 00:47:47,280 --> 00:47:50,560 ONE OF WHICH IS THAT I FOUND 1224 00:47:50,560 --> 00:47:53,320 SOME OF THESE STUDIES THAT HAVE 1225 00:47:53,320 --> 00:47:59,800 CONDUCTED IN THE PAST STARTING 1226 00:47:59,800 --> 00:48:02,120 MORE WITH LATE LIFE AND LATER ON 1227 00:48:02,120 --> 00:48:03,400 AND KNOWING THE PREMATURE 1228 00:48:03,400 --> 00:48:06,200 MORTALITY IN CERTAIN POPULATIONS 1229 00:48:06,200 --> 00:48:07,880 IT POSES A CHALLENGE OF 1230 00:48:07,880 --> 00:48:09,480 UNDERSTANDING SOME FACTORS MAY 1231 00:48:09,480 --> 00:48:14,560 HAVE LED TO PREMATURE MORTALITY 1232 00:48:14,560 --> 00:48:18,360 AND COMPARED TO CAUSE OF DEATH 1233 00:48:18,360 --> 00:48:19,480 AND HAVING THE OUTCOME. 1234 00:48:19,480 --> 00:48:22,320 I UNDERSTAND YOU TRIED TO DO 1235 00:48:22,320 --> 00:48:24,800 SOME OF THE PROJECTS TO ACCOUNT 1236 00:48:24,800 --> 00:48:26,320 FOR THOSE BUT IT STILL SEEMS TO 1237 00:48:26,320 --> 00:48:30,200 BE A BIG CHALLENGE THERE. 1238 00:48:30,200 --> 00:48:31,280 IS THAT CORRECT? 1239 00:48:31,280 --> 00:48:33,920 >>YOU'RE RIGHT. 1240 00:48:33,920 --> 00:48:35,600 WE CLEARLY SEE DISPROPORTIONATE 1241 00:48:35,600 --> 00:48:37,800 ATTRITION IN MORTALITY IN BLACK 1242 00:48:37,800 --> 00:48:40,720 INDIVIDUALS IN ARIC. 1243 00:48:40,720 --> 00:48:41,560 NO QUESTION. 1244 00:48:41,560 --> 00:48:43,880 JACKSON IN PARTICULAR THERE'S 1245 00:48:43,880 --> 00:48:45,000 ONGOING THERE WAS A WHOLE WATER 1246 00:48:45,000 --> 00:48:48,040 DISASTER THE PAST YEAR. 1247 00:48:48,040 --> 00:48:48,960 THERE'S CURRENT THREATS TO 1248 00:48:48,960 --> 00:48:50,200 HEALTH OF INDIVIDUALS IN JACKSON 1249 00:48:50,200 --> 00:48:52,960 AND WE KNOW WHEN WE LOOK AT THE 1250 00:48:52,960 --> 00:48:55,440 ATTRITION OF OUR COHORT OVERTIME 1251 00:48:55,440 --> 00:48:57,520 IT'S DISPROPORTIONATE IN JACKSON 1252 00:48:57,520 --> 00:49:00,120 IN PARTICULAR WE HAVE BLACK 1253 00:49:00,120 --> 00:49:04,160 PARTICIPANTS FROM JACKSON AND 1254 00:49:04,160 --> 00:49:05,680 WINSTON AND SALEM. 1255 00:49:05,680 --> 00:49:07,280 WE TRY TO ACCOUNT FOR THAT 1256 00:49:07,280 --> 00:49:08,240 ATTRITION KNOWING THE 1257 00:49:08,240 --> 00:49:09,600 INDIVIDUALS MOST AT RISK FOR THE 1258 00:49:09,600 --> 00:49:11,120 OUTCOME ARE LEAST LIKELY TO MAKE 1259 00:49:11,120 --> 00:49:11,840 IT IN. 1260 00:49:11,840 --> 00:49:14,760 THE IDEA IS YOU UPWEIGHT THOSE 1261 00:49:14,760 --> 00:49:16,960 LESS LIKELY TO MAKE IT TO A 1262 00:49:16,960 --> 00:49:21,880 LATER VISIT TO COME UP TO A 1263 00:49:21,880 --> 00:49:22,560 PSEUDO POPULATION IF THEY HADN'T 1264 00:49:22,560 --> 00:49:24,960 HAD THE ATTRITION BUT YOU CAN'T 1265 00:49:24,960 --> 00:49:26,680 UPWEIGHT PEOPLE THAT DON'T 1266 00:49:26,680 --> 00:49:26,880 EXIST. 1267 00:49:26,880 --> 00:49:27,560 THERE'S THAT CONSIDERATION. 1268 00:49:27,560 --> 00:49:30,120 WE LOOK AT COMPETING RISK OF 1269 00:49:30,120 --> 00:49:32,000 DEATH IN OUR ANALYSES AS A 1270 00:49:32,000 --> 00:49:32,960 SECONDARY ANALYSIS TO HELP US 1271 00:49:32,960 --> 00:49:34,960 UNDERSTAND HOW THAT AFFECTS OUR 1272 00:49:34,960 --> 00:49:36,840 ASSOCIATIONS AND MOST OF WHAT I 1273 00:49:36,840 --> 00:49:38,040 SHOWED YOU HAS SIMILAR 1274 00:49:38,040 --> 00:49:39,440 ASSOCIATIONS WHEN WE LOOKED AT 1275 00:49:39,440 --> 00:49:41,160 COMPETING RISK OF DEATH AS WELL. 1276 00:49:41,160 --> 00:49:43,360 THE PROBLEM IS THAT EVERY STUDY 1277 00:49:43,360 --> 00:49:44,960 OF AN AGING POPULATION, EVEN IF 1278 00:49:44,960 --> 00:49:48,640 YOU RECRUIT PEOPLE AT AGE 70 IS 1279 00:49:48,640 --> 00:49:50,760 GOING TO BE A SURVIVAL 1280 00:49:50,760 --> 00:49:51,080 POPULATION. 1281 00:49:51,080 --> 00:49:52,160 THAT'S THE DEFINITION OF 1282 00:49:52,160 --> 00:49:53,960 RECRUITING PEOPLE IN OLDER AGE 1283 00:49:53,960 --> 00:49:56,960 OR WE FOLLOW THEM TO OLDER AGE. 1284 00:49:56,960 --> 00:49:59,160 THE ADVANTAGE WE KNOW WHO WE 1285 00:49:59,160 --> 00:50:00,400 HAVE AND DON'T HAVE BUT ANY 1286 00:50:00,400 --> 00:50:02,560 STUDY THAT STUDIES AGING IS 1287 00:50:02,560 --> 00:50:04,800 GOING TO HAVE A SURVIVORSHIP 1288 00:50:04,800 --> 00:50:07,760 ISSUE AND WE THINK OF THIS A LOT 1289 00:50:07,760 --> 00:50:10,320 ESPECIALLY FOR OUR ARIC PET 1290 00:50:10,320 --> 00:50:12,760 STUDY IN PARTICULAR WAS ONLY 1291 00:50:12,760 --> 00:50:15,400 PEOPLE WITHOUT DEMENTIA. 1292 00:50:15,400 --> 00:50:15,680 . 1293 00:50:15,680 --> 00:50:17,920 WE SOMETIMES HAVE FOUND 1294 00:50:17,920 --> 00:50:20,120 UNEXPECTED ASSOCIATIONS WHERE WE 1295 00:50:20,120 --> 00:50:22,880 SAW A RISK FACTOR WE THOUGHT 1296 00:50:22,880 --> 00:50:25,000 WOULD INCREASE AMYLOID BUT IS 1297 00:50:25,000 --> 00:50:26,000 PROTECTIVE BECAUSE WE THINK THE 1298 00:50:26,000 --> 00:50:28,680 PEOPLE THAT MADE IT THIS FAR IF 1299 00:50:28,680 --> 00:50:30,920 YOU HAD THAT RISK FACTOR AND HAD 1300 00:50:30,920 --> 00:50:34,400 AMYLOID INTO OUR BRAIN YOU WOULD 1301 00:50:34,400 --> 00:50:37,480 PROBABLY NOT MAKE IT IN OUR 1302 00:50:37,480 --> 00:50:40,120 STUDY BECAUSE WE EXCLUDE PEOPLE 1303 00:50:40,120 --> 00:50:42,760 SO IT'S TRICKY TO THINK OF 1304 00:50:42,760 --> 00:50:43,640 SURVIVORSHIP AND WE ACKNOWLEDGE 1305 00:50:43,640 --> 00:50:45,000 IT'S A LIMITATION BUT I THINK 1306 00:50:45,000 --> 00:50:47,880 ANY STUDY OF OLDER PEOPLE YOU'LL 1307 00:50:47,880 --> 00:50:50,280 ENCOUNTER THAT ISSUE. 1308 00:50:50,280 --> 00:50:52,760 >>AND ALSO THINK BACK TO SOME 1309 00:50:52,760 --> 00:50:55,520 OF THE WHEN YOU SHOW THE SLIDE 1310 00:50:55,520 --> 00:50:59,280 FOR THE LANCET REPORT SOME 1311 00:50:59,280 --> 00:51:03,440 THINGS MENTIONED LIKE ONLY ONE 1312 00:51:03,440 --> 00:51:04,560 BEING MENTIONED IS EDUCATION AND 1313 00:51:04,560 --> 00:51:05,680 EIGHT OF THINGS ARE MIDLIFE AND 1314 00:51:05,680 --> 00:51:06,560 LATER IN LIFE. 1315 00:51:06,560 --> 00:51:08,720 IS THAT BECAUSE OF THE 1316 00:51:08,720 --> 00:51:12,400 AVAILABILITY OF THE DATA AND NOT 1317 00:51:12,400 --> 00:51:13,440 BECAUSE THEY'RE NOT INFORMED OF 1318 00:51:13,440 --> 00:51:15,920 EARLIER STAGE OF LIFE BUT NOT 1319 00:51:15,920 --> 00:51:18,440 ENOUGH DATA AND WE SHOWCASE THE 1320 00:51:18,440 --> 00:51:18,800 IMPACT. 1321 00:51:18,800 --> 00:51:22,280 >>YES, 300%, YES. 1322 00:51:22,280 --> 00:51:24,040 IF ANYONE HAS A PEDIATRIC COHORT 1323 00:51:24,040 --> 00:51:27,440 THAT WANTS TO EXTEND -- THIS IS 1324 00:51:27,440 --> 00:51:32,520 MY FANCY TO FOLLOW PEOPLE FROM 1325 00:51:32,520 --> 00:51:33,000 EARLIER AGE. 1326 00:51:33,000 --> 00:51:38,120 I DON'T THINK MIDLIFE IS 1327 00:51:38,120 --> 00:51:39,440 IMPORTANT BUT IF YOU ARE NOT 1328 00:51:39,440 --> 00:51:41,880 EXPOSED BY SOMETHING YOU'RE SAFE 1329 00:51:41,880 --> 00:51:44,000 AND PROBABLY HYPERTENSION IN 1330 00:51:44,000 --> 00:51:45,000 MIDDLE AGE YOU'RE BEING EXPOSED 1331 00:51:45,000 --> 00:51:47,240 AT A CRITICAL PERIOD AND 1332 00:51:47,240 --> 00:51:48,040 PROBABLY REFLECTED OF DURATION 1333 00:51:48,040 --> 00:51:48,960 OF EXPOSURE. 1334 00:51:48,960 --> 00:51:50,440 IF YOU HAVE IT IN MIDLIFE YOU 1335 00:51:50,440 --> 00:51:52,480 HAVE IT FOR LONGER. 1336 00:51:52,480 --> 00:51:57,600 I THINK CARDIA IS LOOKING AT 1337 00:51:57,600 --> 00:52:01,520 EARLIER ADULTHOOD BUT THEY'RE 1338 00:52:01,520 --> 00:52:03,440 NOT OLD ENOUGH YET AND SEE 1339 00:52:03,440 --> 00:52:05,440 ASSOCIATIONS WITH COGNITION. 1340 00:52:05,440 --> 00:52:07,360 SOME PEDIATRIC COHORTS IN THE 1341 00:52:07,360 --> 00:52:10,160 YOUNG FIN STUDY IN FINLAND 1342 00:52:10,160 --> 00:52:11,640 SHOWING ASSOCIATION BETWEEN 1343 00:52:11,640 --> 00:52:13,000 OPTIMAL CARDIOVASCULAR HEALTH 1344 00:52:13,000 --> 00:52:15,000 AND COGNITION IN THE 20s BUT WE 1345 00:52:15,000 --> 00:52:17,000 DON'T KNOW WHAT THAT MEANS FOR 1346 00:52:17,000 --> 00:52:18,840 LONGER TERM OUTCOMES AND 1347 00:52:18,840 --> 00:52:20,280 CERTAINLY NOT FOR ANY OF THE 1348 00:52:20,280 --> 00:52:23,000 BIOMARKERS THAT TAKE DECADES TO 1349 00:52:23,000 --> 00:52:23,240 DEVELOP. 1350 00:52:23,240 --> 00:52:26,320 SO YOU'RE ABSOLUTELY RIGHT 1351 00:52:26,320 --> 00:52:27,960 THERE'S CLEARLY OTHER IMPORTANT 1352 00:52:27,960 --> 00:52:29,400 FACTORS THAT OCCUR EARLIER IN 1353 00:52:29,400 --> 00:52:31,080 THE LIFE COURSE. 1354 00:52:31,080 --> 00:52:35,560 MANY ARE CO-LINEAR WITH 1355 00:52:35,560 --> 00:52:37,000 EDUCATION AND BIRTH WEIGHT WE 1356 00:52:37,000 --> 00:52:39,480 SEE INDEPENDENT ASSOCIATIONS 1357 00:52:39,480 --> 00:52:41,960 WITH EDUCATION AND EDUCATION 1358 00:52:41,960 --> 00:52:43,200 ACCOUNTS FOR MUCH OF THESE BUT 1359 00:52:43,200 --> 00:52:43,800 NOT EVERYTHING. 1360 00:52:43,800 --> 00:52:46,040 SO MUCH IS NEEDED TO BE DONE TO 1361 00:52:46,040 --> 00:52:47,680 LOOK EARLIER IN THE LIFE COURSE 1362 00:52:47,680 --> 00:52:49,000 BECAUSE IF WE'RE REALLY 1363 00:52:49,000 --> 00:52:51,440 FOCUSSING ON PREVENTION AND 1364 00:52:51,440 --> 00:52:53,560 REDUCING IF THE POINT IS SOCIAL 1365 00:52:53,560 --> 00:52:55,280 FACTORS CONTRIBUTE TO CHANGES IN 1366 00:52:55,280 --> 00:52:56,840 BIOLOGY BUT CONTRIBUTE TO 1367 00:52:56,840 --> 00:52:58,960 CHANGES IN DEMENTIA RATES THEN 1368 00:52:58,960 --> 00:53:01,200 OBVIOUSLY THE EARLIER YOU TARGET 1369 00:53:01,200 --> 00:53:08,160 THOSE PREVENTSIVE OF PREVENTIVE 1370 00:53:08,160 --> 00:53:11,520 STUDIES THE MORE THEY'LL IMPACT 1371 00:53:11,520 --> 00:53:14,360 THE BIOLOGICAL CHANGES. 1372 00:53:14,360 --> 00:53:15,440 >>PARTICULARLY WHEN YOU RAISE 1373 00:53:15,440 --> 00:53:21,000 THE FINDING ABOUT BIRTH WEIGHT 1374 00:53:21,000 --> 00:53:23,880 AND BLACK INDIVIDUALS AND HIGH 1375 00:53:23,880 --> 00:53:26,000 BIRTH WEIGHT ASSOCIATED WITH THE 1376 00:53:26,000 --> 00:53:28,400 MORE SIGNIFICANT DECLINE I'M 1377 00:53:28,400 --> 00:53:30,400 WONDERING DOES IT HAVE ANYTHING 1378 00:53:30,400 --> 00:53:35,960 TO DO WITH GESTATIONAL DIABETES 1379 00:53:35,960 --> 00:53:37,520 HIGHER AMONG BLACK WOMEN 1380 00:53:37,520 --> 00:53:39,480 ACCORDING TO SOME DATA. 1381 00:53:39,480 --> 00:53:45,000 >>YOU'RE ABSOLUTELY -- I AGREE 1382 00:53:45,000 --> 00:53:48,960 IT'S HIGHLY LIKELY IT REFLECTS 1383 00:53:48,960 --> 00:53:50,640 HEALTH OF THE MOTHER BUT ANY 1384 00:53:50,640 --> 00:53:52,080 BIRTH WEIGHT MEASUREMENT WILL 1385 00:53:52,080 --> 00:53:53,560 REFLECT HEALTH OF MOTHER BUT 1386 00:53:53,560 --> 00:53:57,760 PARTICULARLY IN THAT CASE IT'S A 1387 00:53:57,760 --> 00:53:59,840 REFLECTION OF A DIABETIC MOTHER. 1388 00:53:59,840 --> 00:54:02,160 WE HAVE SOME PARENTAL 1389 00:54:02,160 --> 00:54:05,080 INFORMATION AND PARENTAL 1390 00:54:05,080 --> 00:54:06,320 EDUCATION AND OCCUPATION AND BUT 1391 00:54:06,320 --> 00:54:11,840 NOT MUCH OTHER IN TERMS OF THEIR 1392 00:54:11,840 --> 00:54:12,680 HEALTH MEASURES. 1393 00:54:12,680 --> 00:54:14,120 BUT THAT'S THE POINT OF A LOT OF 1394 00:54:14,120 --> 00:54:16,320 THESE FINDINGS IS EVEN IF WE CAN 1395 00:54:16,320 --> 00:54:18,120 LOOK WITHIN ONE GENERATION FOR 1396 00:54:18,120 --> 00:54:19,320 EXAMPLE AND TRY TO EDUCATE FOR 1397 00:54:19,320 --> 00:54:21,280 EVERY FACTOR WE THINK IS 1398 00:54:21,280 --> 00:54:27,160 PRESENT, IF YOU HAVE DECADES OF 1399 00:54:27,160 --> 00:54:29,600 SYSTEMIC RACISM ALTERING THE WAY 1400 00:54:29,600 --> 00:54:31,400 HEALTH IS DEALT WITH AND HEALTH 1401 00:54:31,400 --> 00:54:33,000 MAY AFFECT OTHER OUTCOMES YOU'RE 1402 00:54:33,000 --> 00:54:34,560 NOT REALLY GOING TO BE ABLE TO 1403 00:54:34,560 --> 00:54:36,160 ACCOUNT FOR THOSE UNLESS YOU 1404 00:54:36,160 --> 00:54:37,880 HAVE MULTI-GENERATIONAL STUDIES. 1405 00:54:37,880 --> 00:54:40,400 YOU'RE RIGHT, THAT'S PROBABLY A 1406 00:54:40,400 --> 00:54:42,560 KEY DRIVER OF SOME OF THE 1407 00:54:42,560 --> 00:54:43,760 FINDING IN BLACK INDIVIDUALS IN 1408 00:54:43,760 --> 00:54:44,080 PARTICULAR. 1409 00:54:44,080 --> 00:54:44,800 >>YEAH. 1410 00:54:44,800 --> 00:54:48,120 AND I THINK ONE OF THE -- YOUR 1411 00:54:48,120 --> 00:54:51,560 CALL FOR MORE DIVERSE POPULATION 1412 00:54:51,560 --> 00:54:54,120 IN THE STUDIES AND ONE POINT I 1413 00:54:54,120 --> 00:54:58,720 WANTED TO RAISE WITH YOU IS THE 1414 00:54:58,720 --> 00:54:59,720 HETEROGENEITY WITH THE ETHNIC 1415 00:54:59,720 --> 00:55:01,800 RACIAL GROUPS AND PARTICULARLY 1416 00:55:01,800 --> 00:55:05,880 WHEN WE THINK ABOUT BLACK 1417 00:55:05,880 --> 00:55:11,600 INDIVIDUALS AND WE HAVE A 1418 00:55:11,600 --> 00:55:14,920 SIGNIFICANT PROPORTION OF THEM 1419 00:55:14,920 --> 00:55:19,520 WE SEE AN INCREASING NUMBER OF 1420 00:55:19,520 --> 00:55:21,120 AFRICAN IMMIGRANT OR AFRO 1421 00:55:21,120 --> 00:55:22,720 CARIBBEANS AND WHEN WE EXTEND 1422 00:55:22,720 --> 00:55:24,160 THAT TO THE ASIAN POPULATIONS 1423 00:55:24,160 --> 00:55:30,760 YOU SEE A MIXED GROUP OF PEOPLE 1424 00:55:30,760 --> 00:55:33,440 SO I THINK IS THERE ENOUGH DATA 1425 00:55:33,440 --> 00:55:35,160 TO EVEN LOOK AT THAT 1426 00:55:35,160 --> 00:55:37,000 HETEROGENEITY WITHIN THE RACIAL 1427 00:55:37,000 --> 00:55:37,720 GROUPS? 1428 00:55:37,720 --> 00:55:42,480 >>DEFINITELY NOT IN OUR STUDY. 1429 00:55:42,480 --> 00:55:44,720 SO ONE FREQUENT CRITICISM WHICH 1430 00:55:44,720 --> 00:55:47,560 WE FULLY ADMIT WE CAN'T TOTALLY 1431 00:55:47,560 --> 00:55:50,440 OVERCOME IS HOW MUCH OF WHAT WE 1432 00:55:50,440 --> 00:55:52,480 SEE IS BECAUSE OF JACKSON, 1433 00:55:52,480 --> 00:55:52,760 MISSISSIPPI. 1434 00:55:52,760 --> 00:55:54,880 HOW MUCH IS COMMUNITY-SPECIFIC. 1435 00:55:54,880 --> 00:55:56,840 THE DISCOVERY COHORT WHICH IS 1436 00:55:56,840 --> 00:55:57,760 RECRUITING PEOPLE THAT HAVE 1437 00:55:57,760 --> 00:55:59,840 STROKE AND LOOKING AT 1438 00:55:59,840 --> 00:56:01,840 POST-STROKE DEMENTIA IS 1439 00:56:01,840 --> 00:56:03,480 RECRUITING FROM 30 DIFFERENT 1440 00:56:03,480 --> 00:56:05,960 SITES ACROSS THE U.S. WHICH 1441 00:56:05,960 --> 00:56:07,560 DOESN'T ADDRESS MORE GLOBAL 1442 00:56:07,560 --> 00:56:08,760 DIVERSITY AND WE'VE BEEN VERY 1443 00:56:08,760 --> 00:56:10,880 CAREFUL TO MAKE SURE NOT ONLY DO 1444 00:56:10,880 --> 00:56:12,440 WE HAVE SITES WITH DIVERSE 1445 00:56:12,440 --> 00:56:14,280 POPULATIONS AND NOT ONLY 1446 00:56:14,280 --> 00:56:15,480 RECRUITING MEXICAN AMERICANS BUT 1447 00:56:15,480 --> 00:56:19,160 IN TERMS OF DIVERSITY OF OUR 1448 00:56:19,160 --> 00:56:20,360 DISPARITIES POPULATIONS. 1449 00:56:20,360 --> 00:56:22,480 AND AS WE THINK ABOUT THE DATA 1450 00:56:22,480 --> 00:56:24,600 MAKING SURE WE HAVE DATA FROM 1451 00:56:24,600 --> 00:56:25,920 PEOPLE THAT ARE GEOGRAPHICALLY 1452 00:56:25,920 --> 00:56:31,520 DIVERSE SO NOT JUST REPRESENTING 1453 00:56:31,520 --> 00:56:32,920 ONE COMMUNITY FOR EXAMPLE. 1454 00:56:32,920 --> 00:56:39,520 SO MESA IS ANOTHER COHORT STUDY 1455 00:56:39,520 --> 00:56:41,000 INCLUDING BLACK POPULATION, 1456 00:56:41,000 --> 00:56:45,000 LATINX AND ASIAN POPULATION AND 1457 00:56:45,000 --> 00:56:46,600 WHITE POPULATION. 1458 00:56:46,600 --> 00:56:49,920 I'M PRETTY SURE THEY'RE ALL 1459 00:56:49,920 --> 00:56:52,400 CHINESE INDIVIDUALS FROM SAN 1460 00:56:52,400 --> 00:56:57,000 FRANCISCO BECAUSE THERE'S LINKS 1461 00:56:57,000 --> 00:56:59,240 CERTAIN COMMUNITIES TO CERTAIN 1462 00:56:59,240 --> 00:57:07,040 GROUPS OF POPULATIONS AND 1463 00:57:07,040 --> 00:57:08,680 INEVITABLY YOU'LL LIKELY TO 1464 00:57:08,680 --> 00:57:10,080 CONSIDER THAT ISSUE AND 1465 00:57:10,080 --> 00:57:12,360 SOMETHING TO CONSIDER IF WE 1466 00:57:12,360 --> 00:57:14,800 OBSERVE X IT DOESN'T HAVE MUCH 1467 00:57:14,800 --> 00:57:18,960 MEANING IS X ISN'T WELL DEFINED 1468 00:57:18,960 --> 00:57:21,640 AND THE POPULATION THAT HAS THAT 1469 00:57:21,640 --> 00:57:23,720 OBSERVATION ISN'T WELL DEFINED. 1470 00:57:23,720 --> 00:57:25,640 >>I'M LOOKING TO THE DATA WHERE 1471 00:57:25,640 --> 00:57:27,240 WE HAVE A DIVERSE POPULATION TO 1472 00:57:27,240 --> 00:57:28,920 LOOK AT THE HETEROGENEITY WITHIN 1473 00:57:28,920 --> 00:57:30,880 EACH GROUP AND WHEN YOU TALK 1474 00:57:30,880 --> 00:57:33,000 ABOUT THE RISK FACTORS RELATED 1475 00:57:33,000 --> 00:57:36,960 TO STROKE AND DEMENTIA FOR A 1476 00:57:36,960 --> 00:57:39,480 PARTICULAR RACIAL GROUP THEY'RE 1477 00:57:39,480 --> 00:57:40,960 VARY GREATLY WITH BEING A 1478 00:57:40,960 --> 00:57:44,160 SPECIFIC RACIAL GROUP AND I CAN 1479 00:57:44,160 --> 00:57:47,040 SAY I STUDY SMOKING WHEN YOU 1480 00:57:47,040 --> 00:57:52,000 LOOK AT ASIAN, THERE'S A 1481 00:57:52,000 --> 00:57:53,000 PREFERENCE BUT DIFFERENT WHEN 1482 00:57:53,000 --> 00:57:56,560 YOU LOOK AT CHINESE AMERICAN AND 1483 00:57:56,560 --> 00:58:00,000 JAPANESE AMERICAN VERSUS 1484 00:58:00,000 --> 00:58:02,040 JAPANESE IMMIGRANT VERSUS OTHERS 1485 00:58:02,040 --> 00:58:04,600 AND YOU LOOK AT FILIPINOS AND 1486 00:58:04,600 --> 00:58:09,640 THERE'S A HIGHER RATE OF SO THE 1487 00:58:09,640 --> 00:58:12,040 RATE OF CONTRIBUTION OF THE RISK 1488 00:58:12,040 --> 00:58:14,040 FACTOR IN THE SUBPOPULATION 1489 00:58:14,040 --> 00:58:16,960 COULD BE QUITE DIFFERENT AND 1490 00:58:16,960 --> 00:58:19,600 BRING BACK TO THE POINT OF 1491 00:58:19,600 --> 00:58:22,080 TAILORING THE PREVENTION 1492 00:58:22,080 --> 00:58:23,720 STRATEGY KNOWING THE 1493 00:58:23,720 --> 00:58:24,560 HETEROGENEITY WILL BE QUITE 1494 00:58:24,560 --> 00:58:25,000 IMPORTANT. 1495 00:58:25,000 --> 00:58:26,280 >>THAT'S A GREAT POINT. 1496 00:58:26,280 --> 00:58:30,720 THANK YOU FOR BRINGING THAT UP. 1497 00:58:30,720 --> 00:58:33,960 >>SO UNFORTUNATELY WE'RE RIGHT 1498 00:58:33,960 --> 00:58:36,280 UP TO OUR WONDERFUL CONVERSATION 1499 00:58:36,280 --> 00:58:40,560 ABOUT THE TOPIC OF DISPARITY IN 1500 00:58:40,560 --> 00:58:42,120 STROKE AND COGNITIVE IMPAIRMENT. 1501 00:58:42,120 --> 00:58:44,560 AS DR. GOTTESMAN PUT THERE'S 1502 00:58:44,560 --> 00:58:46,080 MORE WORK THAT NEEDS TO BE DONE 1503 00:58:46,080 --> 00:58:49,000 AND THAT'S WHY WE'RE HERE TO DO 1504 00:58:49,000 --> 00:58:50,520 THE RESEARCH AND HOPEFULLY MAKE 1505 00:58:50,520 --> 00:58:53,920 AN IMPACT IN REDUCING THE BURDEN 1506 00:58:53,920 --> 00:58:56,880 OF STROKE AND DISABILITY WITHIN 1507 00:58:56,880 --> 00:58:59,400 THE POPULATION ALSO DISPARITY OF 1508 00:58:59,400 --> 00:59:01,240 IT. 1509 00:59:01,240 --> 00:59:03,160 LOOKING FOR MORE OF THE WORK 1510 00:59:03,160 --> 00:59:04,480 YOU'RE GOING TO DO, 1511 00:59:04,480 --> 00:59:05,960 DR. GOTTESMAN AND WHEN YOU DO 1512 00:59:05,960 --> 00:59:07,480 WE'LL INVITE YOU BACK. 1513 00:59:07,480 --> 00:59:08,280 >>THANK YOU SO MUCH. 1514 00:59:08,280 --> 00:59:09,960 THANKS FOR HAVING ME. 1515 00:59:09,960 --> 00:59:10,120 BYE. 1516 00:59:10,120 --> 00:00:00,000 >>TAKE CARE, EVERYONE.