In fact, in the Nordic countries, the incidence of dementia has begun to decline. Why? It is because in the past two or three decades, the life of the Nordic people has become healthier and healthier. So if you change your lifestyle a little bit from now on, such as eating more regularly, sleeping more regularly, exercising and eating more nutritious, it is likely that the incidence of dementia in our country will begin to decline when you get old.
How far is dementia from us?
Juan Li
Hello, my name is Li Juan, from the Institute of Psychology, Chinese Academy of Sciences. The topic of my speech today is how far is dementia from us.
Before answering this question, I want to ask, are there any post-50 s and post-60 s here? It seems rare, so dementia seems far away from all of us. I want to ask one more question: How old do you want to live? I heard that 100 years old is very good, and most people have very good expectations for health and longevity.
I estimate there are about 500 people here. Imagine if we can all live to be 60 years old-there should be no problem without accidents. By the age of 60, 20 of us may suffer from dementia. Do you know what our life expectancy is now? Seventy or eighty? Yes, 76.3 years old, to be more precise. Therefore, if all of us can live to an average life expectancy of 767 years, the number of people suffering from dementia among us will double to 40.
I think everyone here is in good health and mental state, so we are likely to live to 85 years old. By the time we are 85, one third of us may have dementia. If we are lucky enough to live to be 95 years old, then there will be one in two. So if everyone lives long enough, there may be only one final outcome, and we all go the same way.
Courths A.? Euro? J Neurol？ 1998; 5 (Supplement 4): S 1-8
Wilmoah et al. International geriatric psychiatry? 1997; 12: 84 1-56
Does this sound terrible? That's true. In particular, China has entered a period of rapid aging, and now the elderly population over 60 years old in China has exceeded 230 million, accounting for 16.7% of the total population. 22% of the world's elderly are in China. According to the prevalence rate of dementia reported by modern research, and the missed diagnosis rate of dementia in China is as high as 73%, it is estimated that the number of patients with Alzheimer's disease in China has exceeded100000, and there is a new case every 12 seconds.
The disease burden caused by dementia is nearly 400 billion yuan a year. What is this concept? It is Kenya's annual GDP, ranking 70th in the global GDP.
So let's go back and see what is Alzheimer's disease or Alzheimer's Harmo's disease. It was at a scientific meeting in June of 1906 1 1 that a German doctor named allers Altz Harmo Hamo reported a special case.
German doctor allers Altz Heimers Hamo
190 1, the old woman was taken to see a doctor by her family. At that time, her memory had deteriorated severely, it was very difficult to communicate with others, and she suspected her husband's infidelity for no reason. In the following years, her condition deteriorated sharply. 1906 In the spring, she died of serious infection caused by pneumonia and bedsore.
Dr. Al-Harmo Hamo had never seen such a strange case before, so he made an autopsy on the old woman with the consent of the patient's family. He found that the old woman's brain, especially the cerebral cortex, was severely atrophied-we know that the cerebral cortex is in charge of our memory, language and thinking.
And under the microscope, the doctor saw that there were a lot of necrotic nerve cells and many abnormal protein deposits in her brain. Later, in memory of this German doctor, people called this disease Alzheimer's Harmo's disease, which is what we call Alzheimer's Harmo's disease.
On the right of this photo is the dementia patient's. Outside the nerve cells of this dementia patient, we can see those black so-called plaques, which are senile plaques in the brain. Of course, they are different from senile plaques on the hands or faces of the elderly. There are also nerve fiber tangles in nerve cells, which lead to a large number of nerve cells dying and reduced synaptic connections between cells, which in turn leads to cortical atrophy.
On the right is the patient, and on the left is the brain of a normal old man.
All these will lead to the gradual decline of our cognitive functions such as memory, affect our mood and personality, and finally seriously affect the function of daily life. Now, dementia has become one of the four major killers affecting the health of the elderly.
In fact, dementia is not all degenerative Alzheimer's disease, and about 20% is vascular dementia. As the name implies, vascular dementia is dementia caused by vascular problems. The study also found that about 14% patients have neurodegenerative Alzheimer's disease, and at the same time there is dementia caused by this vascular problem, that is, * * * disease. In addition, there are about 10% of other types of dementia.
This is a self-portrait of American painter William Termohlen. After he was diagnosed with dementia, he kept painting his self-portrait for five years, from 1996 to 2000. The first one was 1967, when he was still healthy and young.
His self-portrait vividly depicts the gradual erosion of his brain by this disease. We can see that the details in the painting are getting less and less, and the painting style is getting more and more abstract. In the end, it may not be obvious that this is a person's face. And in this process, you may also feel the kind of fear and sadness of the painter, which is a very heartbreaking process.
These four people may be familiar to everyone, especially the first two. On the far left in the first row is Mr. Reagan, the 40th president of the United States. In our society that relies on strength and face, Mr. Reagan undoubtedly has both. The second is the British Prime Minister "Iron Lady" Margaret Thatcher. The third is China scientist, winner of the Nobel Prize in Physics, and Mr. Gao Kun, known as the father of optical fiber. The fourth is the author of One Hundred Years of Solitude, Mr. Marquez, who is also a Nobel Prize in Literature winner.
So someone asked me more than once: Why are these celebrities also demented? Is it because they work too hard and use their brains too much, resulting in a large number of death of their nerve cells and dementia?
Although I don't know why they are demented, I can be sure that they are not demented because of brain cell apoptosis caused by excessive brain use. Maybe, for example, they work too hard, have too much mental stress, can't sleep well and can't eat well, which leads to some cardiovascular and cerebrovascular diseases and then dementia. It is said that Mrs Thatcher induced vascular dementia after many strokes.
In fact, the study found that people with low education and some bad living habits are more likely to suffer from dementia, such as long-term sedentary and overeating. Then there is a history of severe brain trauma, or long-term exposure to harmful environment, or smoking, which are also more likely to suffer from dementia. In addition, dementia, like many diseases, is related to heredity.
When it comes to the relationship with heredity, we may have to distinguish between two kinds of dementia: one is early-onset dementia, and the other is what we call late-onset dementia, which is senile dementia.
Early onset dementia, as its name implies, is usually dementia before entering old age. At present, this kind of early-onset dementia has a pathogenic gene, that is, if you carry this gene, you will generally suffer from dementia before you enter old age. At present, there are three pathogenic genes: amyloid precursor protein gene (APP), presenilin 1( PS 1) and presenilin 2(PS2).
You may think, should I test and sequence to see if I have this disease-causing gene? Actually, it's not necessary If more people in your family suffer from dementia, and more importantly, they suffer from dementia before they enter old age, then it is very likely that this disease-causing gene is inherited in your family.
Late-onset dementia, that is, dementia that occurs after old age, has no pathogenic genes. It's not that you carry any genes. It must be dementia after entering old age or 60 years old, but there are risk genes. If you carry this risk gene, you are more likely to suffer from dementia in old age. At present, the most recognized risk gene may be apolipoprotein E gene (APOE).
Here, you may be interested in how to treat my dementia. How to treat it? I regret to tell you that there is no cure now. In other words, all drugs can't cure the current dementia, or can't reverse the course of the disease. Existing drugs can only partially alleviate some symptoms. Probably all pharmaceutical companies invested the most in the research and development of dementia drugs, but unfortunately, all drug research and development failed when they entered the third clinical phase.
You may think that the subjects in phase III clinical trials are all patients with severe dementia, and it is actually too late to give them drugs at this time. In fact, no one will suddenly get Alzheimer's disease, and the occurrence of this disease is a long process. Now some studies have found that this disease may occur slowly twenty or thirty years before the final clinical diagnosis. Therefore, from the 30 s to the 40 s, the disease may have begun to attack secretly.
We can look at this picture again. The abscissa is age, and the ordinate is score. Cool color is some cognitive functions, such as our plot memory, executive control function, processing speed and so on. These cognitive functions reach their peak in their twenties-probably the age of most people here-and then begin to decline.
Park & Bischof, 20 13?
In addition to these relatively advanced cognitive functions, some low-level cognitive functions such as senses will also change after entering middle-aged and elderly people. For example, like vision, after people reach the age of 50, the perceived color will become warmer and warmer; After the age of 60, the clarity of seeing moving objects will obviously decrease. Now research has found that a serious decline in early sense of smell may be an early sign of dementia.
Speaking of hearing, I actually want to ask if any elderly people in our family have hearing loss. It's not clear from here, but I guess it's quite common. In this case, I would like to ask again that the elderly may not be able to hear clearly or hear wrong when communicating with us because of hearing loss. Have we ever yelled at them? Everyone just needs to keep it in mind honestly. I'm sure there will be one.
In the long run, the elderly may become cautious when communicating with us, even afraid of interacting with people and young people. Over time, it may lead to social withdrawal and decreased interpersonal communication, which are also closely related to the high incidence of dementia.
Therefore, if there are elderly people with hearing loss at home, if hearing AIDS can be relieved at first, I suggest that they must be worn, although they may be a little uncomfortable at first. Of course, more importantly, we must be patient when communicating with the elderly with hearing loss.
You may remember that movie clip just now. The earliest symptom of dementia is memory loss like Alice. You may remember that when she was giving a lecture at the university, she couldn't remember those very familiar words. When she runs, she often gets lost on the road.
These are the early symptoms of dementia. ?
These cognitive decline, in addition to their own feelings, can also be measured by standardized neuropsychological tests. The following is a test of drawing a clock. As you can see, through these three different clocks, we can intuitively see the gradual evolution of the disease.
In addition to these behavioral changes that can be directly observed, there are some early signs that we can't directly observe. At this time, we need to use some other indicators, such as neurological indicators and biological indicators. Next, I want to share with you two related tasks of my team.
The first is the neurological index, which is the result of our cooperation with Professor Jiang Yang Clark of the University of Kentucky. As shown in the picture, after putting an electrode cap on the old man's head, we can measure the electrical activity in his brain. After wearing the electrode cap, the old man did a very simple task, which was actually a memory task, and the result was very interesting.
We have two kinds of old people, one is normal old people, and the other is mild cognitive impairment old people. When they do this memory task, there is no difference in accuracy and reaction time, but if we look at his EEG activity, we can see that there is an obvious negative wave in the left frontal lobe. This means that when he wants to achieve the same result as a normal old man, he may have to make more cognitive efforts.
Li et al. Research and research on Alzheimer's disease. Treatment? 20 17
The following example is a biomarker. This is a cooperative research between my team and researcher He from Institute of Biophysics, Chinese Academy of Sciences. Decorated formaldehyde, you may be familiar with it, but you may not know it. In fact, we also have formaldehyde in our bodies and formaldehyde metabolism. Formaldehyde in the body can be measured by collecting morning urine. Our research found that the higher the formaldehyde content of the elderly, the worse their cognitive function will be.
YuJ et al. Neuroscience bulletin? 20 14?
So I just said that these behavioral markers, neural markers, including these biochemical markers, can help us find those who may suffer from dementia in the future, which we call high-risk groups.
What can we do after finding those high-risk groups? Or what can we do for them? You can do physical exercise and cognitive activities. Physical exercise and social cognitive activities are the two most important protective factors. If you do such activities regularly, the risk of dementia will be reduced.
Older people who often engage in daily cognitive activities are 67% less likely to develop dementia than those who rarely engage in these cognitive activities. These daily cognitive activities include playing chess, playing cards, writing calligraphy, reading newspapers and even playing mahjong.
Proceedings of the National Academy of Sciences once reported a very interesting study. They scanned the brains of London taxi drivers and found that the hippocampus at the back of their brains was significantly larger than that of the control group of the same age. The hippocampus is closely related to our memory, so cognitive activities can change our brain.
Maguire et al. PNAS, 2000?
Besides doing some daily cognitive activities, you can also do some special cognitive training, such as memory training and executive control training in the laboratory. You may still remember these functions, that is, those functions that peaked in your twenties and then declined. The most important thing is actually memory and execution control, which is a bit like the CPU of our computer.
When we do memory strategy training, we will teach him some strategies, which is called mnemonic method. One of the most classic mnemonics may be "the palace of memory", or the temple of memory, which is actually the positional mnemonics.
According to legend, the positional memory method was invented by an ancient Greek poet. It is said that in 447 BC, he went to a grand banquet. Suddenly, two young people came to see him and he went out. As a result, after he went outside, the young man disappeared, the roof of the banquet hall collapsed, and everyone inside was killed, and there was no way to tell who was who. Then the Greek poet threw his head back and recalled the scene of the banquet and who was sitting in different positions.
After that, these philosophers and politicians in ancient Greece and Rome began to use this so-called memory palace to help them memorize their speeches. Why? First, because paper was particularly expensive at that time, it would be expensive to write on paper, so he always kept it in mind. Second, because it looks cool. Definitely not as good as you didn't take anything.
Of course, this is a joke. Later, someone studied the super brain, that is, the so-called people with super memory, and found that 90% people actually use this memory technology. Scanning the brains of these people with super memory, it is found that in the process of memory, the activation of those parts of the brain tube space perception, that is, our parietal lobe, the back of hippocampus and other parts will be stronger. This also proves that they did use this memory method.
Later, this mnemonic method was used more and more by people. For example, when we are in the laboratory, how will we teach the elderly to use it? Old people will pass a series of classic landmarks when they come to our laboratory. We will let the old people use these landmarks to build a so-called spatial brain map, or a memory palace. Then he linked what he wanted to remember with these classic landmarks.
In fact, this memory palace is not so mysterious. The picture also shows a memory palace, which should be designed by Emma Willard, an American educator in the19th century. She designed this memory palace to teach students history. The memory palace can actually be big or small, it can be real or you can imagine it. But as long as you are familiar with it and it is orderly, it can be used as a memory palace.
Just now I said that there is another function called executive control ability. We can play a little game to train our executive control ability. It's simple. Numbers will appear on the screen one by one later. Please remember the last four numbers. For example, 1 2 3 4, what are the last four numbers? 1 2 3 4。 If 6 appears again, what are the last four numbers? Two, three, four, six, right.
Then let's try. I will present it on the screen, and everyone's task is to remember the last four numbers. Let's start now.
-What are the last four numbers? ——9 7 2 9
Wow, I found a lot of super brains sitting among us. In fact, this is a very difficult task. When you start the test without daily training, more than half of the people can't remember it, so it doesn't matter if you can't remember it. It just means you might want to start training.
Just now we said that cognitive training can definitely improve or enhance our cognitive function. In addition to cognitive training, you can also use physical exercise. We know that exercise has many benefits. If we exercise regularly, you may look like the picture on the right when you are 70 years old, otherwise you may sit on the left.
But we may not know that exercise can also change our brains. You may remember the structure of the hippocampus. After entering old age, our hippocampus will shrink at the rate of 1%-2% every year. A study asked the elderly to do this aerobic walking. A year later, it was found that the hippocampus of the elderly who did aerobic brisk walking not only did not shrink, but also increased by 2%. So we say that exercise can not only strengthen our muscles, but also strengthen our brains.
Tai Ji Chuan is one of the treasures of oriental culture. My colleague, Dr. Wei Gaoxia from the Institute of Psychology, Chinese Academy of Sciences, found that the thickness of cortex in some areas of the brain will increase obviously in the elderly who have been beating Tai Ji Chuan for a long time.
What is more interesting is the picture below. As you may remember, I just said that there are risk genes for Alzheimer's disease. For example, this picture is related to BDNF (neurotrophic factor) gene.
Eriksson et al., 20 13
If he carries the risk allele of this gene, obviously, his memory is worse than those who carry the non-risk allele. However, we can see that these two lines overlap in the upper right corner. That is to say, even if a person carries the risk allele, through regular exercise, there is actually no difference in memory performance between him and those who do not carry it. In other words, exercise can offset the adverse effects of risk genes.
Maybe when I said it was good to play mahjong just now, all the young people here thought of playing games. Is playing games also helpful to the health of our brains? That's true. Now quite a few studies have found that playing games is helpful to our brain health and can prevent dementia. Although there are some inconsistent research reports.
Do these two pictures look very boyish and familiar? The game on the left is a 2D version of Crazy Birds, and the one on the right is a 3D version of Super Mary. You should all have played this game at your age. This study is very interesting. Actually, it is a recent project, so I want to share it here.
In fact, it trains two groups of college students, one is to shoot crazy birds, and the other is to shoot super Mary. For two weeks, I played games for 30 minutes every day. The results showed that in the Super Mary group, the spatial memory ability was significantly improved after two weeks.
Spatial memory ability is a very special memory ability. As you may know, in 20 14, the winner of the Nobel Prize in Physiology and Medicine found that there were positional cells responsible for spatial information in the hippocampus of mice.
This 3D Mario may be because it needs a lot of space navigation, and the scene of this game is more exciting. So from this perspective, it is necessary to constantly update the game.
But if we sit there and play games or mahjong for a long time to exercise our brains, it may have a bad influence on our cardiovascular and cerebrovascular circulation. However, it doesn't matter, because game makers are quite scientific. Everyone may have played sports games. We can play games while exercising, and the two can be combined.
Dance is actually a good form of exercise, because we can not only exercise, but also remember movements and rhythms and exercise our brains, especially square dance. There are 200 million elderly people in our country now. I suspect that there are about 1 100 million elderly people dancing in the square dance.
In fact, one of the studies we are doing now is to teach those sedentary old people to dance square dance. We are especially looking forward to seeing whether square dance can help improve the cognitive function of these elderly people, especially their memory, and whether it can reshape their brains, especially their hippocampus.
Just now I said that the 3D version of Super Mario will be good for brain health, because it is full of excitement. But for the elderly, such games may no longer be suitable. But we can also teach parents and grandparents to play some simple video games, or even just teach them to use smart phones.
For the elderly, especially those over 75 years old, if he learns to use smart phones, such as WeChat, he can establish a group with his old friends, colleagues and classmates, and he can share his life in a circle of friends, which is actually equivalent to opening a very interesting door to life.
The next few pages may not be clear. In fact, this is a guide manual made by a netizen to teach mom and dad to use WeChat. Illustrated with pictures and words, it's really touching.
In fact, in retrospect, many people present here may have a good start when teaching their parents to use smart phones, and then we may lose patience. But let's think about it. Did mom and dad teach us impatiently how to use spoons?
Some friends may inadvertently find that mom and dad are not the very tall and straight people who can bear everything for us. Sometimes we suddenly discover how they become cautious in front of us, and sometimes they are as timid as children. Because they are old, they actually need our care and love.
Many young parents say that they should participate in every step of their children's growth, but ask ourselves, have we actually missed many opportunities to participate in the growth or development of the elderly in the second half? In fact, teaching the elderly to use electronic devices is a good feedback opportunity. On the one hand, it can exercise their brains, on the other hand, it can broaden their social networks. This is actually very helpful to prevent the common negative emotions in old age-depression and loneliness.
So to sum up what we said just now, it is good to do sports, and it is also good to do more educational activities. We are curious to think, is it more beneficial to be together? There is an interesting animal study that answers this question.
This animal is actually a mouse. In this picture, there are four feeding conditions on the left. The top one is the ordinary feeding condition. The second one is that many toys are placed under the ordinary feeding condition, and mice can play in it. We call it a rich and exciting environment. The third condition is that there is a big wheel in which the mouse can move. The last one is to combine the first three items, including toys and big rollers.
What is the result? Let's have a look. On the right is actually a substructure in the hippocampus, called dentate gyrus, behind the hippocampus. In fact, the hippocampus is not big, and the unilateral hippocampus is about five or six cubic centimeters. The red dot in the dentate gyrus is a new nerve cell.
Corbyllo and others,? Learning & Memory? 20 1 1
We can see that there are many red spots in the dentate gyrus when there are wheels that can move, that is, there are new nerve cells. In our brain, there may be only two places where nerve cells can regenerate, one is dentate gyrus and the other is our olfactory bulb.
But the second condition is that if there is enough stimulation, actually no nerve cells can regenerate. Then look at the final comprehensive group conditions. In fact, it seems that there are more red spots, because rich stimulation can not lead to the regeneration of nerve cells, but it can make nerve cells better maintain their existing functions and apoptosis is slower. So it seems that there are the most nerve cells in the last case.
The study of this animal actually inspired my research group, and we did a study on human beings. We selected four communities in the Olympic Village Street, Chaoyang District, Beijing, next to the unit, and each community invited some elderly people to participate in our research, and randomly assigned the elderly in these four communities to four conditions.
One is the control group, doing nothing. One is to let him do cognitive training. There's another one who plays Tai Ji Chuan, besides cognitive training. The last one is the comprehensive intervention group. On the basis of the first three, we also do social psychological counseling.
We can see the results. The cognitive ability and social function of the comprehensive group improved the most. After three months, we continued to follow up and found that these effects still existed. We can't directly see the regeneration of human nerve cells, but we can use non-invasive neuroimaging technology, such as magnetic resonance imaging, to scan the brains of the elderly before and after intervention.
Results We found that the hippocampus and prefrontal lobe, which are the two regions most closely related to memory and executive control, are also the regions most affected by aging, and their functional relationship will be significantly improved after training.
More interesting is the histogram below. The ordinate of the histogram is the similarity between the old brain and the young brain. The pink column represents the old people who have been trained by us, and the blue column represents the untrained ones. We can see that after training, the brains of the elderly are more and more similar to those of young people in the following five brain networks. In other words, old people are more and more like young people.
I think all our friends over 30 have the same wish: I want to be young. Don't you all want to? So from here on, do you feel that your dream came true too suddenly? If you train, your brain will become younger and look more like a young man.
Besides cognitive training and more exercise, comprehensive intervention can also nourish diet. It is very important to control the risk factors of cardiovascular and cerebrovascular diseases.
At present, the frontier and hot spot in this field is to take these risk factors and protective factors into account for comprehensive intervention. At present, the research plan with the largest sample size and the most positive results in the world should be the finger research plan. In fact, it is the abbreviation of Finnish dementia prevention program, and F is actually the abbreviation of Finnish. Because the project originally started in Finland, although the leader of this research works in Karolinska, Sweden.
Now we can see that all over the world, a series of countries such as the United States, Britain, Australia, China and Singapore actually have research plans and projects that adopt similar research schemes. My research group is also a member of China Finger.
We are actually working on this road with scientists all over the world. Although we don't know exactly the pathogenesis of dementia, it doesn't affect our comprehensive intervention against known risk factors and protective factors. I especially hope that interested young people here will join our team.
We say that the aging population is a global challenge, and there is no way to reverse it, but this does not mean that the incidence of dementia will definitely increase with the aging population. In fact, in the Nordic countries, the incidence of dementia has begun to decline. Why? It is because in the past two or three decades, the life of the Nordic people has become healthier and healthier.
So if from now on, the lifestyle of all of you here changes a little, such as eating more regularly, sleeping more regularly, exercising more regularly and eating more nutritious, then it is very likely that the incidence of dementia in our country will begin to decline when you get old.
Finally, I want to share some interesting research results recently published. The first is the research team of Massachusetts Institute of Technology, who developed a functional drink that can nourish nerve synapses.
Why don't you go to heaven?