Q&A style onlyBe sure to identify the number of the question that you are answering 1. In our own words, how would you describe Mild Cognitive Impairment (MCI)? 2. A. What is the function of “Brain Networks”? B. How does the activity of these networks change when comparing a normal individual to a person suffering from dementia? 3. A U.S. study examined the relationship between walking and cognitive function. Describe 3 changes seen in walking with a MCI patient. a. b. c. 4. How can micro-bleeds in the brain be brain be detected with diagnostic imaging? 5. A study out of the University of Illinois looked at the relationship between moderate activities (example given brisk walking 1hr-3x’s /week) and the improvement cognitive function. A. The production of what 2 proteins were found to increase with these types of activity? B. Physiologically how do these proteins help with brain function?
Up until now, it’s been impossible to know who might develop dementia. Now, researchers have discovered
something surprising that can reveal early signs. It turns out that just measuring a person’s walking speed can
help doctors determine who might eventually develop the disease. There are special networks inside the brain,
and recent studies have shown that deterioration in these networks can lead to dementia. It has also become
clear that the way we walk can be a signal that those networks are slowing down. But experts say that early
detection of a decline in brain power and taking countermeasures could help prevent dementia.
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I would say that this is the strongest evidence we have now that we can at least postpone the onset of cognitive
impairment.
Furthermore, new drugs for keeping dementia at bay are in the pipeline. It may not be long before dementia is a
preventable disease. Advanced science is making the path clear. We’ll share the latest findings from the front lines
of dementia prevention.
Tomofumi Yamamoto is a writer at a magazine. He’s 63 years old. During an active 30-year career, he’s covered
everything from current events to literature. But soon after he turned 61, he noticed he had become more
forgetful. He started having difficulty recalling the names of close friends and remembering where he’d left things.
I can’t find my glasses. I guess I need to buy a third pair.
At first, he chalked it up to age and didn’t get too worried. But six months later, something happened that got his
attention. He’d forgotten about an important interview and double-booked another appointment. He had never
done that before in all his years as a writer.
I was really shocked, to say the least. The word “dementia” didn’t occur to me at first, or maybe I just didn’t want
to think about it. But all the things that were happening to me were real, and when I faced the facts, I had to admit
I wasn’t my normal self.
Yamamoto suspected he had dementia, so he consulted a doctor that specializes in the disease. He was tested
on cognitive skills, such as memory and judgment as well as spatial recognition. The doctor diagnosed Yamamoto
with something he had never heard of– mild cognitive impairment or MCI. Here’s what he learned. As people age,
cognitive functions, including memory and judgment, gradually weaken. But if the decline is fast and cognitive
functions fall below a certain level, the result is dementia.
People with dementia not only have impaired memory, but may also exhibit behavioral symptoms like wandering
and aggression. MCI is between dementia and what’s considered normal. Many people in this range are at risk of
dementia. Yamamoto was told he was one of them. He’s at a stage where he may forget things, but he can
manage normal daily activities. And he can keep working. But he was told that unless he took action, he might
eventually develop dementia. The news came as a shock. But later, his despair gave way to hope when he
learned something unexpected.
Different doctors told me that MCI, or mild cognitive impairment, can be cured if you take the appropriate steps.
That made me feel somewhat relieved. I think I’d come really close to the point of no return.
Studies are underway around the world on ways to prevent MCI patients from developing full-blown dementia.
Hi, Joseph.
Nice seeing you again. This is my wife, Ann.
Researchers in the United States tracked 600 elderly people with MCI to see how many would develop dementia.
Within five years about 50% of the subjects did, but 40% did not progress beyond MCI, and the remaining 10%
actually returned to the normal range. In other words, half of the subjects did not develop dementia.
Peter Jessup is an example of someone who had MCI but recovered normal functioning.
So how have you been since I last saw you?
Well, apparently quite good. Cheerful. Keeping busy and a working a lot-He had been diagnosed with MCI, but his doctor later confirmed that his cognitive functions had returned to
normal.
I have a very high level staff to remind me of things.
Like just about anything else, it seems like when I decide to use it, by gosh, it’s still there.
Whatever they’re testing if that’s normal, that’s fine, that’s great. And then we’ll just keep on.
As he said, you know I’m planning to live to at least 100, so you know.
Together.
Yes.
And that puts me at 105, so you do the math.
So we’ve got to plan a lot of things yet.
Patients like Peter might have been doing something good to their brains without realizing it, and that might
explain why they didn’t develop dementia. Peter and others offer hope that if MCI patients take appropriate
measures, dementia may be preventable.
If we can do more to reduce the risk or prevent their progression to frank dementia, that’s obviously our goal. MCI
is close to that threshold, and so that may be our last chance to prevent dementia.
There’s even more that can be done to prevent MCI from worsening to dementia. But first, let’s find out how to tell
if a person has mild cognitive impairment, or MCI.
This is Izumo city, in western Japan. A recent study here shed light on changes that occurred in the brains of MCI
patients. Researchers at Shimane University have joined hands with brain specialists. They used advanced
medical equipment to check brain activity in 300 people. Their project led to a new discovery on how the brain
works.
The brain is a hard working organ– different parts are constantly activated at lightning-speed. Cutting-edge
technology allows researchers to observe the process in slow motion. It turns out that no matter what people are
doing, their brains become active in multiple areas exactly at the same time. These remote connections are
known as “brain networks.” For instance, when people are doing simple calculations, the parts of the brain shown
in red work together as a single network. The brain has many other networks, including a visual network as well as
those related to the senses and motion. They work together allowing us to perform a wide range of functions.
Scientists have also found that brain networks change as people grow older. This is what the brain networks of an
average middle-aged adult look like. The thicker the line, the stronger the connection. In an elderly person’s brain,
parts of the networks become weaker, and their structures also change. As the connections grow looser, cognitive
function also suffers.
Even if the brain functions in different areas are still intact, they need to be connected and work well as a single
network. A deterioration in a network can have a significant impact on cognitive function.
Researchers have noticed abnormal changes in the brain networks of people with MCI. A study led by Washington
University in the US has focused on the strength of network connections. The researchers checked how the
connection strength changes as people move from normal functioning to MCI and then dementia. They found that
connections in people with MCI were weaker compared with people in the normal range. Aging alone could not
explain the difference. As MCI progresses to dementia, the connections started deteriorating much faster. So
spotting a weakening brain networks as early as possible holds the key to early detection of MCI.
A recent US study has identified a simple way to do this. It involves observing people do a certain everyday
activity– that activity is walking. It may seem amazing, but there’s a clear link between walking and cognitive
function. Researchers compared how a person with normal cognitive function walks with how a person suspected
of having MCI walks.
The one who may have MCI walks slowly, even though there is nothing wrong with his lower body. They also used
sensors to examine the way the participants move their feet. The one suspected of having MCI takes
comparatively shorter steps. And the person who may have MCI doesn’t distribute his body weight evenly on his
feet and is likely to wobble.
Researchers then pinpointed why weaker brain networks cause people to walk in a less stable manner. When we
walk, the brain networks related to vision and spatial recognition are operating at full capacity. They must process
the constantly changing information from our surroundings and make appropriate decisions in an instant. The job
of balancing the body is handled by brain networks responsible for the senses and movement. We are able to
walk with precision when these different networks function simultaneously– but they don’t in people with mild
cognitive impairment. They walk slowly or sometimes lose balance.
Now, once of all this information enters the brain, the brain has to process it and then send it to parts of the brain
that are involved in balance and the parts of the brain that make you take steps. And it does this in such an
instantaneous fashion and so smoothly that you’re not aware of it. And it’s a miracle that we are actually walking.
So by disrupting these networks, you’d start manifesting either problems walking or with balance.
The researchers studied walking related data on 27,000 people from 17 countries around the world. They looked
for a relationship between walking and the risk of developing dementia. The results showed that those who walk
slower than a certain speed are 1 and 1/2 times more likely to develop dementia, and if they’re also aware that
their memory has declined, the likelihood doubles. The study also examined how slowly a person must walk for
the risk of dementia to increase.
For different age groups and sexes, we have a set number. So approximately, it works out to– in our setting– if
you’re walking less than say, 0.8 meters per second, that’s probably slow. All we’re doing is identifying somebody
at high risk of having dementia. I think it’s a simple and easy way of assessing risk. In a clinical setting, all you
need is to measure a distance and have somebody time a patient walking across this distance using a stopwatch.
80 centimetres per second translates to 2.9 kilometers per hour. At that speed, a person would be overtaken by
other pedestrians or might have trouble crossing a street before the light turned red. This provides one measure
for risk. The researchers added another step so they could assess people’s risk of dementia even more
accurately. They had the subjects do this-B, D, F, H, J, L-They asked subjects to say every other letter of the alphabet while walking.
Q, S, U, W-People with normal cognitive skills can do this and still walk without slowing down too much. But people who show
signs of MCI can’t maintain speed once they start thinking about something. Walking and thinking at the same
time are difficult for them.
In a sense, his brain reached capacity– reached its maximal engagement or performance during the single task
and was unable to take it further when attention demands were increased. We certainly can say that those
individuals who walk more poorly– especially, in walking while talking– those individuals are at higher risk of
developing these negative outcomes. Yes.
People suspected of having MCI struggle to do two things at the same time and it’s because of the way their
brains work. The image on the right shows the brain of a person with possible MCI who’s trying to solve a simple
problem. Highly active areas appear in green, in fact, these areas play a role in increasing concentration. The
findings suggest that a brain that’s nearing MCI is unable to solve even simple problems unless it revs up
concentration.
So what it’s showing is that this is preceding the onset of cognitive decline. So even though on the outside these
individuals look perfectly fine– most of their cognitive testing they would look completely unimpaired– by using
fMRI we’re able to see that the underlying activity that is supporting cognition is actually altered. As we’ve seen,
there’s a close relationship between a slower walking speed and a deterioration in brain networks.
If you slow down suddenly when thinking about something as you walk, it may be a sign that your brain networks
are weakening. It might be a good idea to consult with a doctor specializing in cognitive diseases. Walking slowly
isn’t the only possible sign of MCI. There are several other signs– you don’t feel like going out, you no longer care
how you are dressed when you leave home, you are told that you say the same things again and again, you use
bills at stores more often so you don’t have to count coins, you cook only simple meals, people say your cooking
tastes different from before, you get scratches on your car more often. If three or more of these signs apply to
you, you might want to visit a medical specialist.
Research aimed at keeping brain networks from deteriorating is moving forward. Let’s take a closer look at how
brain networks function. Neurons convey information as electrical signals. They’re powered by nutrients and
oxygen from surrounding blood vessels. Damage to neurons and blood vessels causes brain networks to
deteriorate. Scientists have been paying closer attention to microbleeding– it happens when capillaries become
fragile and minor bleeding occurs. Microbleeding causes surrounding neurons to die, one after another, damaging
brain networks.
High-resolution brain scans can reveal tiny dark spots– they are areas of microbleeding. In fact, researchers know
microbleeding becomes more frequent as people progress from MCI to dementia. Finding a way to make
capillaries less prone to microbleeding might keep neurons from dying and that would benefit brain networks. Art
Kramer has discovered an effective way to strengthen brain networks that have weakened. He found that the
connections between circuits improved in people who followed a certain regimen for one year. It’s amazingly
simple– just walk, but how you walk is the key.
Kramer says people should take a one-hour long walk that’s brisk enough to speed up breathing and their heart
rate three times a week. That’s enough to cause a surprising change in the brain’s blood vessels and neurons.
So it’s a fairly modest investment of effort, in terms of the exercise, to walk a little faster– but not very fast– and to
walk a bit more than they normally walk.
Moderate exercise, such as brisk walking, stimulates the body to release greater amounts of a protein called
“vascular endothelial growth factor,” or VEGF. It promotes the formation of new blood vessels to replace damaged
ones. Walking faster also stimulates the secretion of brain derived neurotrophic factor or BDNF. This protein
promotes the generation of new neurons. Researchers believe this is why brisk walking boosts brain network
conectivity.
Connectivity certainly shifts to what it would look like in a younger person. In some ways, it looks like their brain is
becoming healthier– as it was when they were younger. Yes. People just walking three hours a week– that’s all
they did.
There are other ways to enhance the coordination between your brain networks. Researchers in Finland
conducted something called “the finger study.” This large-scale preventive research project looked at 1,260
elderly participants, including people with a higher risk of dementia. This study also found that brisk walking and
other exercises are helpful in preventing dementia when used in combination with other measures.
I would say that this is the strongest evidence we have now that we can at least postpone the onset of cognitive
impairment.
We visited one woman who took part in the finger study. Ulla Vahakangas lives in Helsinki by herself. She began a
program that gradually modified her lifestyle. Exercise plays a fundamental part. She walks at a fast pace for 30
minutes a day, three times a week. She also began mild strength training exercises.
And she improved her diet, cutting down on meat and salt and eating more fish and vegetables– they’re rich in
anti-oxidants and help prevent damage to neurons. In addition, she is careful not to consume too much butter.
Instead, Ulla maximizes her intake of olive and other vegetable oils. Tracking her blood pressure is another daily
task. Keeping hypertension at bay helps prevent microbleeding and protect brain networks. She also plays a 10minute memory game three times a week. It requires concentration and helps stimulate her brain.
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I’m fit both mentally and physically since I started improving my lifestyle. I’d feel something was missing if I didn’t
exercise. The dementia prevention program has now become part of my life. I can’t get by without it. I would grow
restless if I missed it even for one day.
For two years, Ulla and other participants with a higher risk of dementia made these lifestyle modifications to
safeguard their neurons and blood vessels. Their cognitive function improved by 25% on average compared to
people who didn’t participate. The study actually succeeded in improving something that typically declines with
age.
And we could still see that it’s possible to improve the memory and decrease the risk of cognitive impairment, so
that was a really positive surprise for us. So I normally say, it’s never too late to start to prevent dementia.
Let’s look again at the measures in the finger study. The researchers found they had a stronger preventive effect
when done in combination, rather than one-by-one. If walking briskly or doing other exercise isn’t possible, it’s OK.
Eating a better diet and controlling blood pressure are also beneficial.
Japan’s population is the fastest aging in the world. The number of people who develop dementia is expected to
rise even more in the future. Experts estimate that in 2015, some 5 million people in Japan had dementia. And
they say that by 2050 the number could top 10 million. Not only is the population of elderly with dementia
expected to grow, but it’s also likely to make up a larger proportion of the total population. At this rate, nursing and
health care systems could be overwhelmed. One of the researchers involved in the study says it’s crucial to find
ways to keep MCI from progressing to dementia.
This is the time for measures to prevent dementia. We can’t wait we need preventive action now.
Researchers in Japan are working on medications that can keep people with MCI from developing dementia.
We now have started a clinical trial to investigate whether cilostazol is effective for MCI patients to stop cognitive
decline or to suppress conversion of MCI to dementia. Cilostazol is a drug used to prevent strokes from recurring.
Researchers believe it may also be effective for safeguarding brain networks by preventing cerebral bleeding.
It give a lot of hope because the preclinical results seem very impressive.
I think that if the trial is successful in Japan it will have wide implications worldwide.
A clinical trial involving 200 people with MCI began in the summer of 2015. If all goes well, the drug is expected to
become available for use in treatment as early as 2021.
The drug should help ease worries among MCI patients that they might slip into dementia. I hope early
intervention will become standard practice.
In the US, the development of medications for MCI is proceeding at a rapid pace. Levetiracetam is used to treat
epilepsy. Researchers have found it also improves brain networks. People with MCI who take it have shown
improved memory. The final phase of the clinical trial is starting in early 2016. If it’s successful, the drug could be
used to treat MCI as early as 2019.
And ours would be the first targeting the overactivity and could be the first medication approved for this
population. This would be, first of all, a highly affordable medication.
Meanwhile, Japan is leading the way with a new community-wide initiative to detect MCI in the early stages. In
September 2015, the city of Takayama teamed up with the National Center for Geriatrics and Gerontology. They
began a dementia risk screening program for 10,000 residents aged 60 and older.
[SPEAKING JAPANESE]
The staff used the latest methods to measure participants’ walking speed and check for irregular walking rhythms.
Doctors then identify their risk for MCI and dementia as early as possible. There is another component that’s even
more innovative. The program offers incentives to encourage participants to take an active role in managing their
risk.
[SPEAKING JAPANESE]
This is an activity tracker. Participants each receive one to keep count of how many steps they take and their
walking speed. It’s meant to encourage brisk walking to help prevent dementia. The program also includes
enticements so people actually use the activity tracker and walk. The organizers identified 78 destinations around
the city that are appealing even to elderly people who are reluctant to go out. Each one features activities such as
dancing and board games to help strengthen brain network connections and prevent dementia.
And there is also a special terminal at each location. Users place their activity tracker on it and data, such as
average daily walking speed, are displayed. The terminals offer participants an enjoyable way to see if they’re
exercising enough to keep dementia at bay.
[SPEAKING JAPANESE]
Hiroyuki Shimada, of the National Center for Geriatrics and Gerontology, has played a central role in the program.
He’s confident it will improve early detection and management of dementia risks.
We can alert individuals about their dementia risks and advise them to act quickly. I hope to see about 80% of
people get checked. But in the first month after the program’s kickoff, turnout was much lower than expected. Just
23% of eligible residents signed up– far short of the target. City officials turned to social workers to find out why
more people hadn’t signed up.
[SPEAKING JAPANESE]
Fear had kept many residents from participating in the program.
I often hear people say how they hate the idea of developing dementia, but they aren’t proactive when it comes to
risk assessment and early intervention. I wonder if they’re hesitant because it’s about their health.
The organizers wanted to help people overcome their worries about getting checked. They discussed a possible
solutions.
How should we approach the skeptics?
They’re avoiding getting checked because they’re scared they’ll have a bad result. We might want to tone down
the dementia angle a little.
The team decided to drop dementia from the prevention program brochure. It now says, “Takahama City’s efforts
towards longevity and good health.”
We don’t intend to hide dementia. At the same time, we don’t want to stir up unnecessary fear. It’s important to
strike a balance.
People around the world are working to overcome the challenges posed by dementia. In 2012, Finland launched a
national strategy on dementia. The slogan is, “creating a memory-friendly Finland,” and the main focus is
prevention.
When someone has memory symptoms, he or she might be ashamed of them and the climate of attitude is very
negative– so there may be also fear. And when you don’t go to examine your brain early enough, it can affect in a
way that your disease will progress. We just have to give appropriate information on memory disorders to
everybody.
Today a variety of efforts are underway around the country to eliminate people’s fear of dementia. This event,
organized by the Alzheimer’s Society of Finland, drew people of all ages. They took part in a brain orienteering
activity. While walking in the woods they learned about brain health.
[NON-ENGLISH SPEECH]
They answered questions at each checkpoint. For example, how much could walking as a hobby reduce the risk
of progressive memory disease? 5%, 25%, or 50%? We’ll share the answer in just a moment. Participants enjoyed
walking through the woods to find all 10 checkpoints and learning tips on maintaining brain health.
Once they reach the goal, they checked their answers. The answer to that question about how much walking can
reduce the risk of dementia is 50%. Walking really is important to our health.
I must use and train my brain more.
The questions asked at the checkpoints taught me new things about the brain.
It starts from the brain health. It’s very important that, when you’re young, you know the things with effects to your
brain. In these little actions, we can change the world step-by-step.
Finland places particular importance on childhood education. As part of a compulsory health and physical
education program, students learn ways to maintain brain health.
[NON-ENGLISH SPEECH]
The objective is to eliminate undue fear about dementia by keeping people accurately informed, starting from
childhood.
I think it’s then easier for them to make a linkage to dementia and Alzheimer’s and maybe older relatives and stuff
like that.
Spreading information about dementia as a preventable disease, through this and other efforts, has become a
national priority in Finland.
The main target is this that all of us can leave our own house as long as possible. That’s the main point in
personally everybody. We are persons, all of us, we are persons. We try to make decisions earlier than too late. In
national level, we have too less money for that situation. We could be if we don’t do something for a national level.
So the state saves money and there is happy people.
Yes. Win-win.
We’re entering a new era in early detection and prevention of dementia. The deterioration of brain networks starts
in people with mild cognitive impairment and is often a precursor to dementia. But scientists are discovering ways
to spot the risks at an early stage, opening up new hope for preventing this debilitating disease.
The rejuvenating power of brisk walking combined with some lifestyle modifications could even reverse cognitive
declines that come with age. And if preventive medications are approved, people with MCI could soon have
access to another effective tool. The day when dementia is no longer unstoppable is getting closer. Around the
world this message is beginning to take hold.
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