it's a a wonderful opportunity to talk to you a little bit about a fairly complex uh topic that we're going to try to do our best to uh cover some of the basics tonight so let's Dive Right In with a couple of potential scenarios so uh uh Linda who's 35 has always been interested in her uh background and her family she uh sends a DNA kit uh to a popular genetic company uh in in order to learn more about her background and a few weeks later sitting at her computer looking at her email she gets her
results back and is a bit surprised and shocked to find out uh in the section on the APO e Gene uh that she carries an APO E4 uh Gene variant and it says in the report that this is uh potentially going to be increasing her risk of Alzheimer disease so now she's not sure what to do on the right hand side is uh David who's a 48-year-old architect he is very close with his family he uh he Prides himself and his family Prides themselves on their longevity he has many relatives who have lived well i
nto their 90s and um unfortunately there's one common thread that he's also aware of is that many of his uh relatives in their 90s have developed dementia and so he's wondering as well about whether he is um at increased risk given his family history so I think these are some of the common scenarios that we see people sometimes reflecting on with respect to genetics So today we're going to talk a little bit about a broad overview and some of the other non-modifiable risk factors things you can't
change uh Trisha is going to give an overview of some of the genetic factors and then we'll talk about some of the things that you can do with respect to modifiable risk factors that may actually help to reduce your risk of Dementia or slow progression uh no matter what the genetics say then we'll briefly touch on some additional resources so I think many of you are probably familiar with it but it's good that we start on Common Ground so uh when when we say somebody has a dementia it implies t
hat there are uh cognitive or brain issues often memory impairment but also other ones as we'll see it's typically something that can be assessed by a physician in an office setting and some form of objective cognitive testing will typically show the memory deficit and in order to be called dementia it has to be severe enough that it interferes with day-to-day function and uh some of the various brain function or cognitive domains that may be affected include learning and memory so forgetting na
mes or appointments repeating oneself uh language issues like problems word finding uh visual spatial challenges so possibly getting lost or uh no longer being able to drive safely executive functioning refers to more complex tasks like planning um decision making sequencing things like cooking a a complex meal and then there may also be changes to the brain that impact uh social aspects or personality when we think about the different causes of dementia broadly speaking for most of the types of
dementia that occur in older adults that are what we call Progressive or uh neurod degenerative or degenerative that affect the brain and progress they can sort of be be simplified into two main families of uh diseases that involve some form of a toxic protein and then um blood vessel health so vascular dementia and dementia it's important to remember is an umbrella term from that standpoint there are uh many many causes over 50 types of dementia uh but some of them are quite rare so normally w
e talk about the most common ones like Alzheimer disease which probably accounts for about 50 or 60% of all dementias vascular dementia which is thought to be the second most common there are sometimes a a mix of different types of dementias so often somebody might have some Alzheimer's and some vascular dementia and then other ones that U many of you may have heard of include fronto temporal dementia Louis body dementia um and other more rare causes like Huntington disease but I mention these d
ifferent types because it adds complexity when we talk about genetic factors because um these different disorders may have different genetic factors which we'll talk about uh the scope here even uh even since the time I made this Slide the uh some of the data is already uh out of date so um if you were here for the the pre-webinar slideshow there's now thought to be over 600 50,000 people living with dementia about 25,000 new cases per year um probably almost a million uh by 2032 and um of cours
e this impacts um many of you because I saw from the poll many of you are uh Care Care Partners of people living with dementia so uh this is a very important disorder the the more we can understand uh about the different factors related to dementia uh hopefully the more we can do to lessen the impact in terms of thinking about all dementias including Alzheimer's and others when we look at one of the most important factors that we can't modify it's age and so why why is the prevalence increasing
in Canada in part it has to do with our aging population if you look at the uh age on the left when somebody's 65 to 69 the prevalence of demen is not that high it's maybe around 1% but essentially the prevalence doubles every five years after that now not everybody is going to get dementia as they age and as we'll talk about it's a constellation or combination of different factors that contributes to the risk of developing dementia including genetics but age is a major non-modifiable risk facto
r and you can see in people's 90s probably about 30% uh of people in their 90s will uh develop dementia so again when we're talking about risk factors we want to situate genetics within the category of non-modifiable things that you really can't change so age is very important gender family history and genetics are considered the non-modifiable risk factors and it is also really important to remember that most cases of most dementias are not thought to be strongly caused by genetics or inherited
it isn't to say that there aren't uh susceptibility or risks related to the genetic factors but they're not strongly causal so often if we think about what types of dementias are really strongly familial or related to genetics it's thought to be really only about 1% that are strongly determined by genetic so those modifiable risk factors which we'll come back to later turn out to be very important so genetics and dementia what's the connection well in order to get there we need to start at the
basics we need to start at understanding the principles or the simplistic ideas behind genetics and uh inheritability if you remember back in your biology 101 days the body is made up of millions and millions of cells brain cells liver cells heart cells all with its own job and its mandate but how does it know how does it know what kind of cell it should be and what its job should be well it's written in the DNA in each cell there are 23 pairs of chromosomes half the genetic material from your m
om half from your dad on each chromosome there are uh strands of DNA that double helix that you remember learning about in in Middle School in the DNA are sequences AG GTC are the basic building blocks and they build into genes which are signals signals to the cell as to what kind of cell it should be and what its job should be genes are what cause your eye color to be a certain color genes can also be variants there be variations of them genes sometimes can mutate and sometimes genes can also c
ause suscepti ilities or trouble with disease a few statements about genetics and dementias that are true across all types of dementia first as you've already heard most of the cases of dementia are not strongly caused by genetics I.E having Gene X does not give you dementia y most cases the vast majority of cases are what we call sporadic sporadic can mean unpredictable but really what it means is its combination think of it like a stew a stew of age some genetic susceptibility environment medi
cal and lifestyle factors as you've already heard age is a number one non-modifiable risk factor now as I said within this stew there are genes genes do have a role to play and many of the genes that have been found in the dementias are what we call susceptibility genes so what that means is it changes your risk doesn't cause it but it changes your risk and because Alzheimer's disease or Alzheimer's dementia is the most common form it is the most popular it is also very very well studied so we'r
e really going to focus in on Alzheimer's disease and its genetics so the vast vast majority of cases over 95% of the cases are what we call sporadic Alzheimer's disease classic presentation is age over age 65 so older presentation what we we call late life presentation and as I said it is a combination of some susceptibility genes but also lifestyle and environment to create the perfect store as I mentioned before susceptibility genes do not cause Alzheimer's disease multiple genes have been id
entified and only some of them have been fully studied the most popular one or the most famous one if you will is the APO e the APO e Gene has a day job its day job is to make a protein to help cholesterol carry your cholesterol into the bloodstream and scientists when looking at a population level have noticed that apoe has a number of alals or variations there's E2 E3 and E4 all slightly different but all doing the same similar job at the population level what they noticed is persons that had
E2 seem to have a slightly low lower risk of developing Alzheimer's disease those with E3 had the usual or standard amount of risk and those with E4 seem to have a higher risk now this is at a population level and so one of the things you need to think about is well what's the natural prevalence of all these different variations within that particular population and in the population that was studied initially which is primarily European background 5 to 10% of that population had E2 uh maybe 15
to 25% had E4 but really most people had three and so what this brings up is that the population that's being studied will also have an impact on how many or your risk at an individual level and this is known as genetic ancestry so as I mentioned the initial study was done on a European background population if this was at a different population that was studied for example a population that came from Africa or from Asia or from the Middle East or from Latin America would have a different preval
ence or different makeup or um occurrence of these different uh variants or alals but what does this mean at a personal level so as I mentioned before you get half your genetic material from Mom and half from Dad so on the right hand side you can see a table of different combinations of genes that you can inherit from your parents of course of course the ones that you're most interested in are with the one that is slightly unhelpful that APO E4 and you can see there are a few combos two combos w
here there is a single Al of APO E4 and one combination that has two copies of APO E4 what does this mean for your lifetime risk of Alzheimer's well again studied in large populations the estimate is the average lifetime risk of Alzheimer's disease is about 15% most of that risk does come later in life as you've already heard persons that have no APO E4 alal may have a slight reduction maybe %. those with one apoe alil may have a slight increase in Risk at 29% two copies even higher risk but wha
t does this mean if I have no copies of apoe4 am I off the hook no not really because there are other lifestyle modifications and environmental factors that may come into play if for example I'm also a professional boxer and I refuse to wear headgear well that's going to increase my risk and all of that good that came with that probably would kind of get negated on the other hand if I happen to have two copies of April E4 is it written in the stars or written in the genes that I will get Alzheim
er's no not necessarily there are a number of other factors that will come into play that could reduce your risk such as becoming bilingual such as having a vigorous exercise program Etc so simply have APO E4 does not confer a causality of getting Alzheimer's disease but it does change the risk a little bit and is a susceptibility gene what about other forms well there are a few forms of Alzheimer's disease dementia that might be more strongly genetically linked and there's a few listed here for
persons with triom 21 or down syndrome persons with Huntington's disease which is a neurological condition or some rare forms of familial Alzheimer's disease which are often young onset let's talk about this familiar Alzheimer's disease first it's pretty rare as you've heard most of the cases are sporadic these cases less than 5% some as low as 1% or even less than 1% depending on the region and the patient population in question these persons present very early so unlike the classic you know o
lder adult these people present in their 30s or 40s or 50s and if you look at the chart on the right that's a family tree everybody with gray is an affected person so you can see it is very strongly expressed it's what we call an autosomal dominant pattern um and the genetics for this have been studied there are three genes prolin one and two and AP and mutations in any one of these can be a uh a factor in having this type of familial Alzheimer's disease but as I said this is very rare another s
pecial population are persons with Down Syndrome these people have three copies of chromosome 21 and as luck would have it they have an extra copy of the AP Gene which I just talked about in the previous slide and that increases the risk of Alzheimer's disease in looking at large populations of persons with Down Syndrome up to half of them will develop Alzheimer's disease in relatively early age in the 50s and 60s huntingtons similarly can also be very genetically heavily linked now this diagram
is a very nice uh schema to kind of show you how the genetic factors and environmental factors intermingle and change if you look at the bottom line green means more genetic blue to Red means more environment so you can see the relative proportion of mix in different types of disease so let's start at the top the first is chronic traumatic en copath or CTE this primarily occurs in young people with repeated head trauma most notably in professional athletes that are boxers play American football
or are professional wrestlers so for these people repeated head trauma or environmental problems are the main cause as opposed to genetics so you can see it's mostly blue and red mostly red actually and a tiny bit of green then moving down to the second line we have Alzheimer's disease and you can see on the left there is a little bit of green there is a little bit of genetic input um that would account for some of the young familial cases as well as possibly some susceptibility but the vast bu
lk of it really is environmental a lot of blue a lot of red even more so if you look down below is vascular dementia also known as stroke rated dementia again genetics does play a small part primarily in susceptibility but again lifestyle choices environmental factors weigh heavily in the creation of this particular disease condition then looking down at the last example we have Huntington's disease and this is a very genetic very strongly genetic neurological condition that affects your movemen
t but also your thinking and for this one it is mostly genetic as an impact with very very little environmental input so the big question should you get a genetic test what does it mean well before we answer that question you have to think well why are you getting this test um you want to think about whether you're using it for research purposes versus clinical care or personal care as the case may be if you are participating in research studies as I've alluded to there are many many research st
udies on different populations of people looking at their susceptibility and following them over time so there will be some people that are doing it as part of a research project and we're not going to um delve into that too deeply most of the people that are thinking about genetic testing are thinking about it in clinical care context in the two cases that you heard at the beginning and just to kind of give you some context for clinical care genetic testing is formally ordered by a physician it
's a referral process usually there's a genetic counselor involved at the local place where I work it is a specialty clinic a specialty genetics clinic and it involves multiple visits you meet with a genetic counselor to go through your family tree go through your symptoms go through any Imaging you might have then you get the testing and then finally you have another session with the Gen counselor to actually explain what it all means to you personally as you can imagine this is a very emotiona
lly stressful um process and you want to make sure that you have the proper support for the vast bulk of cases as I've mentioned they are mostly sporadic Alzheimer's disease cases 95% and plus and for that patient population and that family population genetic testing is generally not recommended genetic testing may be indicated in very select cases so if you find yourself with a family history of very young onset of 30 year olds and 40 year olds getting Alzheimer's that may be a discussion for y
ou to have with your own professional healthare team or if you're worried or have Huntington's disease or any other strongly neurological condition that may be a condition for having a test done so we've talked a little bit about some of the important non-modifiable risk factors including age and then uh some of the genetic factors including the susceptibility genes but what can you do if you have some of these genetic factors and so uh increasingly over the last decade or more people have begun
to appreciate that there's quite a bit that in individuals can do to reduce their risk of dementia so I'm going to talk to you now about what is known in the in the research field now about things that can promote brain health so when we're talking about risk reduction with respect to dementia there are a few different things that we're talking about one is decreasing the lifetime risk of developing dementia uh in some cases it might be delaying the on said and then um finally some of the risk
factors that I'm going to talk about have also got evidence for slowing the progression and to some degree it's around a balance of um trying to find things that may reduce damage to the brain but also some things that might increase capacity and what I'm going to be talking to you largely derived from uh what are called systematic reviews or metaanalyses so not just sort of one new study that uh just popped up in in the newspaper uh but actually multiple studies that have reinforced that these
are sort of the best evidence uh risk factors and things that you can do to reduce your risk so I'm going to talk about six ways to promote brain health and many of these uh can benefit your brain whether you already have a diagnos of mild cognitive impairment or dementia whether you have susceptibility genes or not so let's start in first physical activity and weight management so we would recommend something like the 24-hour movement guidelines that Canada has where you are exercising and gett
ing 150 minutes per week of moderate to vigorous physical activity you're also doing some balance classes or balance exercises and strength training a couple of days a week and uh getting a good night's sleep and reducing your sedentary activity these things uh healthy and increased physical activity and exercise have also been shown to benefit people if they have the higher risk susceptibility genes like the apoe4 uh variant in terms of uh vascular uh causes or contributors um treating medical
conditions and promoting blood vessel Health can reduce your risk um one of the only medications that has been shown to reduce the risk of dementia is actually anti-hypertensives or blood pressure medications there are non-medication ways of trying to reduce high blood pressure as well and the same goes for managing diabetes and elevated blood cholesterol these are all good things to do to help to promote blood vessel health and reduce the vascular damage that might happen to the brain many peop
le are aware that smoking is uh bad for your lungs and is associated with heart disease it's also associated with um damage to blood vessels in the brain and possibly direct damage to the brain as well so if you do smoke try to stop smoking um and that can help to reduce your risk similarly as we understand more about some of the other health risks of alcohol we know that people who um use a lot of alcohol or are heavy drinkers are at increased risk of um various health problems they're also at
increased risk of cognitive problems so less alcohol or no alcohol is better in terms of diet there's been increasing evidence to support a sort of brain healthy diet that looks quite a lot like the Mediterranean diet that would be the best studied one and what that is is a diet with um uh fresh fruits vegetables um no real like Ultra processed foods so um healthier Whole Foods legumes as far as protein there's less um red meat and more uh fish for example in the Mediterranean diet uh less salt
and more flavoring with herbs for example uh unfortunately there's really no compelling evidence to support any sort of magic vitamins or supplements so uh the best supporting evidence for promoting brain health would be around uh healthy diet cognitive and social activity is also emerged as an important sort of protective factor that can help help to build capacity and reduce risk um Patricia was just saying that you know if you learn a new language or can speak uh in uh more than one language
that kind of cognitive activity kind of keeps your brain fresh and active uh so there isn't that much detail on what specific activities but it's probably things that push you in a bit of a gray Zone and uh keep your brain learning new things so learning a musical instrument or a language um pushing yourself doing harder sokos than you might normally do uh social activities as well it's more like social isolation has been shown to uh be a bit of a risk factor so the more you can get involved in
social activities uh the healthier for your brain as well it's probably a bit of a multifactorial thing right because when you're more social you're probably also getting more cognitive stimulation and you may also be more physically active if you have to go somewhere walk somewhere to meet up with friends finally I wanted to talk about a few other uh specific kind of risk factors or conditions um on on the one hand there are certain medications that may interfere with your thinking and memory a
nd processing so they're not really causing dementia per se but they may be causing symptoms that can look like dementia because they may interfere with memory or processing speed so these are generally sedating types of medications but we see people who have been on these medicines for years and sometimes you know somebody gets started on uh a benzodiazapine type of drug for anxiety and it can accumulate over time they're older they may be more vulnerable to side effects um sleeping pills same
thing somebody started a sleeping pill years ago with good intentions but they haven't stopped them and they may run into problems with side effects uh certain pain medications like opioids or narcotics may also uh cause side effects that can look like um like dementia some other important conditions that are really important to be aware of uh hearing loss so if you have one try to prevent your hearing from getting damaged in the first place so protect your hearing but it's a good idea to have y
our hearing checked um and if you do have hearing loss you are at increased risk of dementia however if you use hearing aids you can mitigate that risk so a really important model modifiable risk factor people with hearing loss are about 90% increased risk of developing dementia versus those that don't have hearing loss um and as I said it it is a good news story that with hearing aids you can reduce that risk again people who have had traumatic brain injury where they have lost Consciousness fr
om the force of the blow or as uh Trisha was mentioning if they engage in sort of uh sports or certainly things like boxing where they're getting hits to the Head um that can increase your risk of dementia so what can you do um wear a helmet if you are cycling um be focused on your balance to try to reduce your risk of Falls so that's where balance exercises and strength training uh and reducing hazards in your home that might be tripping hazards so all of those things uh can help to reduce your
risk of uh having a head injury major depression is also a risk factor for dementia so if your mood is low get it checked out and if you need treatment for depression there are good non-medication and medication treatments available an emerging risk factor as well as air pollution and secondhand smoke now there may not be that much you can do about air pollution if you're forced to live in the same place but secondhand smoke is probably um something that you can take action on to reduce your ex
posure so all of those things um can help to reduce your risk and the other thing that has been studied is that the more of these healthy lifestyle behaviors that you can do the better in terms of reducing your risk of Dementia in um a an article from 2020 where they studied people over many many years and looked at their healthy lifestyle behaviors five different behaviors um physical activity light to moderate drinking so not heavy drinking uh being cognitively active not smoking and having a
high quality diet like the Mediterranean diet if you engaged in just two to three of those behaviors you had a 37% lower risk of developing alzheimer's than um somebody who was only doing zero or one those healthy lifestyle behaviors if you could do four or five you had a 60% lower risk of uh developing Alzheimers versus those who only did zero or one of those behaviors so the more the better so a significant amount of dementia can be delayed or prevented it's never too early or too late to star
t what is good for the brain is good for the body and vice versa so the things that I've talked about in terms of reducing your risk of dementia um also turn out to reduce your risk of uh cancer and heart disease as well and the more factors you can address the better and again even if you have susceptibility genes many of these interventions that you do these healthy lifestyle changes can still lower that risk I just want to mention a couple of other resources um a great resource that was if yo
u joined early uh the Alzheimer's Society has great information on their website and your local Alzheimer's Society also has great programs and uh opportunities and education sessions like these uh webinars as well so this is a great place to stay up todate uh they often post you know um research uh on genetics or research studies uh in real time um I wanted to talk to you briefly about our McMaster optimal aging portal and a dementia risk initiative as well so the portal is a a free website wit
h uh evidence-based content on uh various topics related to health and social aspects of Aging well so beyond just cognitive health and brain health there's uh all kinds of topics covered our division of e-learning Team also develops kind of multimedia e-learning lessons on various topics many of them related to uh brain health and mental health including our um uh program on dementia risk reduction so that um includes an e-learning lesson about 30 minutes going in more depth on some of the thin
gs that I just spoke to you about uh there's also a 12-week uh free email thing you can get an email a week about risk factor uh there's the uh the voiceover Avatar uh that I've become known for uh there's also text content if you prefer to read about the different risk factors and learn a bit more about them um I saw that many of you joining tonight are um identifying as Care Partners of people living with dementia uh some of you may be familiar with our other site icare.com e-learning lessons
on various topics other resources and we also have recorded videos on various topics such as what is dementia how to promote brain health mild cognitive impairment so um with that let's uh just summarize a little bit some of the uh the key points sure so rounding out the key messages number one most Dimensions don't run in families or have a very very strong genetic cause routine genetic testing is therefore not recommended most dementias are due to a complex combination of age genes environment
and other factors there are several genes like April E4 that may increase a chance of developing dementia but even with genetics as a risk factor you can still benefit from a healthy lifestyle and if we were to go back to Linda who remember she had uh was interested in learning about her ancestry so sent away her DNA sample to um one of those genetic testing companies and got back that she had uh one of the apoe4 alals in her case she uh went to the Alzheimer's Society website she learned a lit
tle bit more about the risks associated with apoe4 she spoke with her doctor and um she also went to the dementia risk.com control to reduce her risk and engaged in a number of those uh healthy factors uh for David when he was worried about his family history he he did go to talk to his family doctor who did recommend uh given the number of people in his family recommend that he see a genetic counselor when the genetic counselor went over his family history in more detail though there weren't ac
tually that many relatives that had developed dementia and those that did were all in their 90s at the time and it didn't seem to follow a pattern where there was everybody or anybody getting dementia at a much younger age so it seemed to fit in line with a sporadic um pattern of uh dementia with um only the oldest adults getting in so after going over that with the genetic counselor it was decided that um genetic testing was not warranted in his case but he was also interested in doing what he
could to live to a ripe old age like many of his ancestors and also engaged in uh several of the healthy lifestyle behaviors as well so with that um why don't we go to uh the Q&A wonderful thank you both for an absolutely excellent presentation great to have uh all of that information uh formalized and thank you so much for sharing the resour ver including the Alzheimer's Society of Canada uh many of our viewers May um not yet know that Landmark study part two was released just last week so if a
nyone is interested in that Alzheimer's Society of Canada has that uh that's part two of a three-part study um so thank you so much for that and I know I've already shared this with Dr levenson before but I look forward to getting up on Thursday morning and having my optimal aging newsletter sitting there in my email box so I really do encourage uh people that are are are thinking about how to age optimally to sign up for that newsletter so we do have a Q&A uh there is a little box at the bottom
of your screen and I see we are getting a couple questions there you will also see that in our chat my co-worker uh Jake has just put in a short survey so we always really appreciate people taking a moment to go through and answer a survey uh and before we finish tonight we will share a screen with a QR code we won't do that quite yet because we do want to get to um some questions so um I'm really excited about this one question so thank you to our Anonymous attendee is there a link to ADHD the
re is some similarity in the cognitive symptoms especially in executive functioning I've actually been asked that a lot lately so I look forward to hearing your your thoughts on that one I I can start and then maybe Trisha can can join in uh I know it's it's kind of an active area of research at the moment and there there is a group out west that does um I think they're in Alberta that uh has been looking more and more into uh sort of either people who might be diagnosed with both ADHD and Mild
cognitive impairment um or perhaps they've been diagnosed with mild cognitive impairment or dementia but it's actually felt that they've been misdiagnosed and they may actually have um have ADHD that has not yet been accurately diagnosed so uh I I will say that I think this is an emerging area still there's not a very strong Association uh I think you know up until a few years ago people were tended to be a bit more focused on the diagnosis of ADHD in children and it's really only in the last de
cade or so that people have become more attentive to people who may have you know ADHD that's perhaps gone undiagnosed into their adult life and maybe even into older age so you're right that um some of the executive function issues and attention issues and working memory issues uh can be seen in ADHD and in dementia as well but you can also find executive dysfunction in in other conditions as well so Trisha I don't know if you have anything yeah no absolutely this is a very very hot topic and s
till emerging and evolving uh so as Dr lenson said that the evidence is changing day by day and adult adult diagnosis of ADHD there are some smaller studies that do show even with you know adjusting for compounding factors there may be a small increased risk of getting dementia uh but that is you know still to be confirmed and and elaborated on but very promising interesting research that's happening right now on this topic perfect thank you so much for that um I apologize because I might butche
r uh how to pronounce a few of these things but I'm going to try um is it also the apoe4 gene in people with triem 21 or uh was that a so so yeah that that one is um AP which stands for amalo precursor protein so it's different from the apoe4 Gene and um as Trisha said the AP Gene the ameloid precursor protein uh sits on chromosome 21 so with the extra copy of it it's thought that the predisposition for um Dementia in people with Down Syndrome in most cases is that extra copy uh of the AP or the
amalo precursor protein that is generating more ameloid that um sort of becomes some of the plaques that are sometimes uh seen in in Alzheimer disease so yeah it's the AP Gene in the case of triom 21 agreed I did I did see another question around that which is is there any evidence-based research indicating that the life style factors also minimize the risk for people with triom 21 and again this is kind of an interesting area there's there's there's been a bit of a Renaissance lately in um stu
dying people with triom 21 and trying to uh both learn more about Alzheimer's disease from that population but also give something more back to that Community because I think um the the age that people with uh Down syndrome are living is also longer so um people with triom 21 tend to have other medical issues as well so uh they wouldn't always have lived into their 50s and 60s before but the longevity now of people with Down Syndrome because of good improved Medical Care and other factors is lon
ger so more people with Down Syndrome are developing dementia and as far as I understand while there's part of that roundabout was saying like there hasn't been a ton of research done my understanding is that these lifestyle factors do also um provide benefit but I again it seems like this is uh there's been more interest in um more studies involving uh people with triom 21 um the next question is asking around you mentioned the uh boxing American football wrestling uh what are your thoughts on
soccer um in terms of a sport being where you might head the ball um I think the area of chronic traumatic and copy is also evolving there's actually an entire Institute in Boston just looking at this and its impact particularly on not only professional athletes but even at the amateur and Junior levels and they have found that um if you're using a lot of uh headers uh in in soccer that can be a smaller risk factor certainly it's not as common as as cont Sports where you're actually butting head
s literally but there is some thought and this is uh primarily looking at people that were um you know uh young athletes that died for other reasons and then looking at the brain and looking at the amount of uh trauma and stress that was on their brain and and the number of concussive injuries they had in their in their youth again this is a very hot topic um and one of of increasing research yeah and I think there there have been some um efforts to have heading introduced later in the sport jus
t because of concerns that there may be an increased vulnerability to concussion in uh if people start with heading younger the the sporting associations have been very good and very proactive if if players particularly young players are are having concussive injuries there are timeouts there are uh particularly in American football the American Football Association the NL have looked at trying to reduce uh tackling and and things to minimize that risk or mtig that risk as much as they can yes w
onderful I know with my own children's sports that was definitely something that was uh being paid attention to so it's good to see that um I have a question here is there any research on ttis being associated with increase risk I'm gonna let Trisha take that one I'm not an expert on that particular field of literature but as far as I know uh not really um because it it is it is very bothersome it's a very bothersome symptom but um it depends on how troubling it is the reason why hearing impairm
ent is a problem is because that tends to reduce your social interactions and when you are listening to people uh you tend to use all of your brain power just to focus on just trying to figure out the words let alone the content um so if you do have ringing in your ears and chronic ttis um my understand my limited understanding is that um the the impact on on later life cognition is not is not an obvious link I think it it's it's a very common symptom in some cases it can be you know associated
with hearing loss and so the hearing loss aspect does function as a risk factor but it's unclear whether tinitus or ttis is an independent risk factor but if it is associated with hearing loss then hearing loss turns out to be a really complex and important risk factor it's probably as Trisha is just saying both things we don't understand that may be more primary but also the cascading aspect of more social isolation it also increases your risk for Falls quite dramatically so you may also predis
pose yourself to Falls and then a traumatic brain injury which would also increase your risk so there could be a few fact s but uh I'm not I'm not aware that tinitus is sort of an independent one yes no that's that's great thank you for those those answers uh we have someone saying that their maternal grandmother mother and Uncle have had uh dementia and now uncle who is mother's brother was confirmed diagnosed with uh young onset Alzheimer's would I be able to get genetic testing is the questio
n I I would suggest a referral uh for to a genetic counselor I think you know given a strong family history that seems to follow that that pattern and again we're providing education not sort of medical advice so uh it's always a good disclaimer around that so I think if we were to look at it from an educational standpoint in terms of the example that Trisha showed uh previously this is the that is the type of family history especially if there's a known relative uh who has been diagnosed with k
ind of a young onset or a familial Alzheimer disease so it would be worthwhile talking to your family doctor and getting a referral for genetic counseling and and then following their advice is what I would say so our next question uh someone says their husband is 55 and diagnosed with young onset Alzheimer's Dementia or frontal lobe dementia they're uh supposed to be getting the testing back back this week will there be something on that that may give a a hint to what type he actually has this
is actually something I get asked a lot people will say to me the doctor said Alzheimer's or they said dementia then they changed it up very often it lands on Lou body or something uh completely different than the person was thinking so I'd love to hear uh both your thoughts on that you want to start and then I'll I'll add in uh sure I think you know there there are um a couple of genes that are more strongly associated with particular types of dementia so if the genetic testing in this case cam
e back with a few of the well-described genes um Trisha mentioned you know the preyan one and preyan 2 and the that AP the ameloid precursor protein if it came back with one of those then it's more likely to be an Alzheimer uh familial Alzheimer dementia and then um there are a few other uh genes that are more likely to be associated with fronto temporal uh so I would say it's it's most likely going to be helpful but there there is some overlap in in in some of the other uh risk genes but what w
ould you say absolutely so oftentimes when they do do genetic testing they may do um a panel so that maybe more than one in this case it certainly sounds that more than one type of genes or genetic profile has been looked at and you know it is one piece of information often very strong strongly useful piece of inform but it's also taken in context of what the person is like in person if they've had neuroimaging or fancy neuroimaging spec scanning and pet scanning that may be um you know another
piece of evidence so you put all the different pieces together and sort of like looking at um you know a jigsaw puzzle and putting all the pieces together to arrive at a diagnosis and sometimes it can be a little bit tricky um initially because you know the the symptoms they may not be reading the textbook and their symptoms might be slightly different than the classical presentation of one type of Dementia or another or they may have early symptoms of one out of sequence um so there's there's H
some variability in that but I think if you get all the different pieces of the puzzle you sit down with your team your healthare team you should be able to piece it together and see what type of dementia um they actually do have I I think it's um this is a a very challenging thing sometimes for families and also for clinicians though because you know most people don't have a confirmed diagnosis it is still clinically what are the symptoms and uh as I explained at the beginning yes it's an umbr
ella term but sometimes people have a mix so I think uh it it is appreciated now with sort of slightly better neuroimaging that that people may well have a mix of different dementias so the pattern um May May resemble both or you have people who have Alzheimer but just because it's relatively common it may Target say the frontal loes in one person so they may have more prominent frontal lobe features so it looks like a frontal temporal dementia but um it it may still be a Alzheimer's or a mix so
we're just coming up to the end of our time and I I really like this question and if we could just take a moment to address this have there been any studies around different populations such as Asians black indigenous in relation to genetics and risks and if so what are the findings I know the landmark study part two did address some of these issues but uh definitely to see uh your understanding want to go first no I'm G yes there are differences there are differences at at many different level
s and this is this is the wonderful thing about research and diversifying the research and looking at different um populations of people um and there's differences at every stage so we mentioned um earlier on in the talk about difference in genetics difference in prevalence of different variance of this apoe Gene and there have been a number of studies looking at different um populations from around the world and they have different prevalences some some have more of one type of alal versus anot
her and others do not lifestyle certainly is different eating habits are different exercising habits are very different um and so it's it's a wonderful tapestry of of different cultures um education level is also something and and level of literacy has also been studied across different cultures uh whether or not you're bilingual that has also been shown to be very very protective Ive so lots of different factors have been looked at uh across cultures um also you know even just looking at um peo
ple's relationship to the word dementia how they manage how they perceive their symptoms how the caregivers uh interact with the family members is also very different
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