Rachel Whitmer, PhD, delivers an insightful lecture on maintaining brain health across different stages of life. She emphasizes early intervention, the complexities of cognitive decline and dementia, and the impact of risk factors such as lifestyle and socio-economic conditions. The lecture highlights preventive measures and research advancements in cognitive aging, aiming to equip viewers with actionable insights.
Quick insights
- Early intervention for brain health: brain health starts early, not just in later years. Dr. Whitmer explains why it’s crucial to focus on maintaining cognitive function from childhood through adulthood.
- Understanding dementia and its different forms: learn about the different types of dementia, including Alzheimer’s and vascular dementia, and how mixed pathologies often complicate the condition.
- Research insights on disparities in dementia risks: Dr. Whitmer shares key findings from large-scale studies that highlight how racial, ethnic, and socio-economic disparities affect brain health.
- Preventive measures for dementia: discover actionable steps for reducing dementia risk, including modifiable lifestyle factors like diet, physical activity, and mental health management.
Featured expert: Rachel Whitmer, PhD
Rachel Whitmer, PhD, is a tenured Professor of Public Health Sciences and Neurology, Chief of then Division of Epidemiology at the University of California Davis (UC Davis) School of Medicine and Co-Director of the UC Davis Alzheimer’s Disease Research Center. Professor Whitmer was the first female ‘Target of Excellence’ hire at UC Davis School of Medicine, a special hiring mechanism to recruit high impact scientists who are internationally renown experts in their fields and will bridge needed gaps in the research mission of the university. Dr. Whitmer was recruited to meld population science and epidemiology with the UC Davis Alzheimer’s disease research center and help the center expand into community-based sciences with a focus on groups historically underrepresented in research.
Video highlights
00:09 – Introduction
Dr. Rachel Whitmer introduces herself as a professor and vice chair of research in Public Health Sciences and Neurology at UC Davis, as well as the director of the UC Davis Alzheimer’s Disease Research Center. She outlines the lecture’s focus on brain health and wellness, emphasizing the importance of a proactive, lifelong approach to brain care, rather than waiting until later in life to address cognitive issues.
00:40 – The vision of the UC Davis Alzheimer’s Disease Research Center
Dr. Whitmer discusses the center’s vision of promoting a lifetime of brain health for everyone. The center aims to advance the science of healthy brain aging, especially in diverse populations, and to provide care for those affected by cognitive decline and dementia.
01:17 – What influences cognitive decline and dementia?
Dr. Whitmer explains that cognitive decline and dementia are influenced by multiple disease-related pathways but can be mitigated by protective factors that promote cognitive resilience. The lecture will explore strategies to lower the risk of cognitive decline and dementia while promoting brain health.
00:02:23 – The global dementia crisis
With projections indicating over 131 million dementia cases by 2050, Dr. Whitmer stresses the urgent need for early and sustained focus on brain health from childhood through adulthood. The talk highlights why it’s critical to start thinking about brain health long before symptoms typically appear.
03:38 – What is dementia?
Dr. Whitmer defines dementia as a syndrome, describing it as an umbrella term for various types of cognitive impairment, including Alzheimer’s disease (the most common subtype) and vascular dementia (caused by vascular brain injury, such as stroke). She notes that most people diagnosed with dementia exhibit mixed pathology, meaning they have both neurodegenerative and vascular changes in the brain.
04:24 – Health disparities and dementia
Dr. Whitmer discusses the disparities in dementia risk among different racial, ethnic, socioeconomic, and geographic groups. She emphasizes the importance of considering environmental, sociocultural, behavioral, and biological factors over the life course in understanding these disparities.
05:06 – Understanding health disparities in cognitive decline
She continues to explore how socio-economic disadvantages, low levels of formal education, and other social determinants of health contribute to an increased risk of dementia. These factors create significant health disparities that affect cognitive outcomes across different populations.
06:06 – What are health disparities?
Dr. Whitmer defines health disparities as the unequal distribution of health and wellness due to unfair economic arrangements, poor social policies, and bad politics. She clarifies that differences in dementia rates among various groups are not due to intrinsic biological factors but rather to these disparities.
07:10 – Dementia rates among different ethnic groups
Dr. Whitmer shares insights from a 2016 study examining dementia rates among different racial and ethnic groups within Kaiser Permanente Northern California. The study revealed significant disparities, with African Americans showing higher incidence rates and Asian Americans the lowest.
09:18 – Linking social determinants to cognitive decline
Dr. Whitmer explains how disparities in dementia rates reflect broader socio-cultural factors rather than intrinsic genetic differences, highlighting the need for research and policy interventions that address these underlying issues.
10:00 – When does cognitive decline begin & what influences dementia risk?
Dr. Whitmer emphasizes that changes in the brain leading to dementia accumulate decades before symptoms appear. This highlights the need for early prevention strategies focusing on maintaining brain health throughout life. One study she reviewed found that midlife obesity increases the risk of dementia by 74%, underscoring the importance of avoiding obesity and maintaining healthy behaviors during early and midlife stages.
She also discusses the challenge of studying smoking’s impact on dementia due to smokers’ shorter life expectancy. However, the data clearly shows that heavy smoking (e.g., two or more packs per day) nearly doubles the risk of dementia, making smoking cessation a vital part of brain health maintenance.
Next, Dr. Whitmer introduces the CAIDE Risk Score, a tool that assesses midlife dementia risks based on factors like age, education, cholesterol levels, and blood pressure. She notes that this score has been validated across diverse populations, including those in Northern California.
Dr. Whitmer then discusses a study linking birthplace in the “stroke belt” (a region in the southern United States) with an increased risk of dementia, even among those who move away later in life. This suggests that early-life environmental factors and education quality are critical for long-term brain health.
She shifts her focus to diabetes and its relationship to dementia, stressing the importance of glycemic control in reducing neurodegenerative and vascular brain damage risks. Dr. Whitmer outlines strategies for maintaining stable blood glucose levels to avoid severe hypo- or hyperglycemic episodes that could lead to complications, including dementia.
Finally, Dr. Whitmer discusses the impact of early cardiovascular risk factors, including those from adolescence, on cognitive function later in life. This emphasizes the need for early intervention and a healthy lifestyle to protect brain health well into old age.
19:18 – Exceptional cognitive aging in nonagenarians
Highlights findings from studies on individuals in their 90s who exhibit exceptional cognitive aging. These individuals maintain cognitive function comparable to those in their 50s and 60s, offering insights into the lifestyle and protective factors that contribute to such outcomes.
20:25 – The Lancet Commission’s 2024 report on dementia prevention
Dr. Whitmer introduces the Lancet Commission’s 2024 report, which identifies 14 modifiable risk factors that could prevent or delay 45% of dementia cases globally. These factors range from early-life education to midlife behaviors like smoking and obesity, and late-life issues like social isolation.
21:46 – Breaking down dementia risk factors across life stages
She explains the breakdown of these 14 risk factors by life stage, urging the audience to consider how they can mitigate these risks at different points in their lives to protect their brain health.
23:15 – The role of diet in dementia prevention
Although not fully covered in the Lancet report, Dr. Whitmer notes that diet is a significant factor in dementia prevention. She briefly touches on how diet is being studied in current multi-domain lifestyle trials focused on cognitive health.
25:26 – Health policy recommendations for brain health
Dr. Whitmer concludes with recommendations from the Lancet report, emphasizing the need for policies that ensure high-quality education, encourage physical activity, treat depression, and reduce smoking and hypertension to improve brain health across populations.
27:08 – Preventing cognitive decline: The Finger Study
Dr. Whitmer discusses the Finger Study, a landmark research project from Finland that demonstrated how a multi-domain lifestyle intervention could significantly reduce cognitive decline in older adults. This study integrated dietary improvements, regular physical activity, cognitive training, and management of vascular risk factors, establishing a strong foundation for ongoing research in dementia prevention.
Dr. Whitmer highlights how the success of the Finger Study has inspired global replication efforts, including the US POINTER study, in which UC Davis is involved. The US POINTER study aims to adapt the Finger Study’s multi-domain approach to develop a sustainable brain health program suited for the U.S. population.
She concludes by emphasizing the vast public health implications of delaying dementia onset. Dr. Whitmer notes that even a five-year delay in dementia onset could prevent millions of cases, highlighting the critical importance of early, sustained brain health interventions across the lifespan.
34:10 – Conclusion
Dr. Whitmer wraps up her lecture by reiterating that brain health should be a lifelong focus. She encourages the audience to take proactive steps to protect their cognitive function and reduce the risk of dementia, starting from early life and continuing through old age. She emphasizes that by understanding and managing risk factors at various stages of life, individuals can significantly influence their brain health outcomes.
Dr. Whitmer ends with a hopeful note, urging everyone to adopt a multi-faceted approach to brain wellness that includes dietary changes, regular physical activity, cognitive challenges, and social engagement. By doing so, individuals can aspire not only to prevent cognitive decline but also to achieve exceptional cognitive aging, maintaining vibrant mental faculties well into their later years.
Resources
- UC Davis Alzheimer’s Disease Research Center
- The Lancet Commission on Dementia Prevention, Intervention, and Care (2024)
- National Institutes of Health (NIH)
- US POINTER Study
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References
- Whitmer, R. A., Sidney, S., Selby, J., Johnston, S. C., & Yaffe, K. (2005). Midlife cardiovascular risk factors and risk of dementia in late life. Journal of the American Medical Association, 293(3), 2234–2240. https://doi.org/10.1001/jama.293.3.2234
- Whitmer, R. A., Gunderson, E. P., Quesenberry, C. P., Zhou, J., & Yaffe, K. (2005). Obesity in middle age and future risk of dementia: A 27 year longitudinal population based study. BMJ, 330(7504), 1360. https://doi.org/10.1136/bmj.38446.466238.E0
- Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., … & Kivipelto, M. (2015). A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet, 385(9984), 2255-2263. https://doi.org/10.1016/S0140-6736(15)60461-5
- Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., … & Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet Commission. The Lancet, 388(10061), 2811-2822. https://doi.org/10.1016/S0140-6736(24)00366-5
- Kivipelto, M., Ngandu, T., Laatikainen, T., Winblad, B., Soininen, H., & Tuomilehto, J. (2006). Risk score for the prediction of dementia risk in 20 years among middle-aged people: a longitudinal, population-based study. The Lancet Neurology, 5(9), 735-741. https://doi.org/10.1016/S1474-4422(06)70537-3