Future treatments for brain ageing:

1
Future treatments for brain ageing

• medical, social and political implications

2
70 60 50 40 30 20 10 0
US population aged 65 and 85 years
65 years
85 years
1950 1960 1970 1980 1990 2000 2010 2020
2030
Source www.cdc.gov/nchs/products/pubs/hus/charts
3
Sources of brain ageing
intrinsic
extrinsic
Failure of compensatory re-modeling of brain
connections
Corruption of brain cell membranes, degradation
of regulatory molecules
4
Interventions to slow or prevent brain ageing

• remodeling - psychological therapies
• prevent reactivation of brain development
  programmes
• oxidative stress - enhancement or mimicry of
  natural antioxidants
• fats - use of statins - reduction of stroke risk

5
Heart disease in US men
Disease prevalence
30
20
10
0
1980
1986
change
-10
disease
-20
55-74
-30
65-74
75
6
Experimental increases of lifespan

• Successful antioxidant strategies
• caloric restriction in mammals
• some genetic mutations modify life span
• suggestion that a small number of fundamental
  processes are involved and these are common to
  ageing in many species.

7
Age-specific incidence of age-related disorders
Age specific incidence rates
age
8
Age-specific incidence of age-related disorders
Life expectancy
women
Age specific incidence rates
9
Disabled people in UK who are likely to require
personal help
6 5 4 3 2 1
millions
1991 2002 2011 2021 2031 2041 2051 2061
10
Years of life remaining and years dependent
Katz et al (1983)
11
Incidence of Alzheimers disease
?
3.0 2.0 1.0 0
annual incidence
65 70 75 80 85
90
age
12
delay of onset Alzheimers disease
3.0 2.0 1.0 0
annual incidence
65 70 75 80 85
90
age
13
Impact of dementia delay on US population
projections

• Intervention (1998)
• none
• delay of 6 months
• delay of 1 year
• delay of 2 years
• delay of 5 years

• Effect (by 2007)
• 2.73 million cases
• 100,000
• 210,000
• 410,000
• 1.15 million

Brookmeyer et al, Am J Pub Health 1998. 88
1337-42
14
Medical implications

• New diseases may appear - survivors differ
• increased demand to repair degeneration
• good reasons to maintain quality of life in
  extreme old age - alternatives are more costly
• health inequalities will increase

15
Social implications

• Age structure of families has changed
• increased social exclusion for some
• elite old will make social and political
  demands
• health inequalities will increase
• unknown consequences of lifespan extension beyond
  10 years

16
Political implications

• Grey vote will increase 30-40
• new economic roles for old people
• developing countries will be disadvantaged in
  making this adjustment
• pensionable ages will be renegotiated
• 15 year Healthy Available Life Expectancy option

17
The burden of age-related diseases

• derives from increasing survival
• survival differs between individuals
• survivors may differ from non-survivors in
  susceptibility to diseases

18
The burden of age-related diseases brain cancer
Age-specific mortality
3
6
9
Age group population size (105)
19
Population pyramids 1901 - 1971
1971
1971
Women
Men
1901
1901
20
Is dementia part of normal ageing?

• No clear boundaries between normal ageing and
  dementia
• individual differences in capacity to withstand
  damage of dementia
• most is known about when dementia will develop
  not whether