公开课-关爱惟士
公开课
(24)模快3---社会参与-Social Engagement

课程视频http://player.youku.com/embed/XMjY3ODM3MjMyNA



Associate Professor Michael Valenzuela

Michael Valenzuela副教授


When researchers talk about social engagement, they’re really talking about getting out of the house, and trying to measure that, getting out of the house to meet either your friends, family or new people. There are different ways technically to measure that. Sometimes it’s literally, “How often are you meeting or getting together with a friend or a family member?” You can get a little bit more complicated and actually try and map out people’s social networks, but the general idea is meeting people that you either know or new people, and outside of the house.

当研究人员谈论社会参与时,他们的确在谈论走出家门,并试图衡量它,离开房子,去见你的亲朋好友或结交新朋友。在技术上有不同的方法来衡量这个。有时它的字面意思是,“你多久出门会见朋友或家人或与之聚会?”你可以得到一个更复杂,实际上尝试和勾画出人们的社交网络,但一般是指出去会见你认识的人或结交新朋友。


There’s now quite a lot, dozens, of population-based studies or public health studies, which really means you’ve got a large group of people who’ve been followed for a number of years, and that kind of research shows, time and again, that those who are more socially active have a lower risk of dementia. Or the inverse, if you’re socially isolated, then you have a higher risk for dementia. So, from that population-based research, I think there’s quite a lot of evidence for that. It becomes a little bit more difficult when we try and translate that to the clinical trials or interventions context, but I think the main message there is that social activity, social engagement, is a risk or a protective factor for dementia. I think that evidence is pretty strong. Moving from there, it gets quite complicated.

现在有相当多的,几十个基于人群的研究或公共卫生研究,这真的意味着你有一大群已经随访了很多年的人,而且这类研究表明那些更积极社会活动的人具有较低的痴呆风险。或者反之,如果你是孤立于社会的,那么你有更高的痴呆风险。所以,我想有相当多的证据基于那些人群的研究。当我们尝试并将其转化为临床试验或干预情况时,这会更加困难,但我认为最主要的信息是社交活动或社会参与是痴呆的风险或保护因素,相关的这些证据相当有力。离开这些证据就会变得相当复杂。


Why social engagement should be related to dementia risk is a really tricky question to answer. We’ve got lots of theories. If you just think about it in first principles, socialising with other people demands a lot of your brain. You need to work memory; a nice social interaction means, if you’ve met the person before, you remember something about them that you can incorporate in your conversation. You’ve got to plan ahead. You have to follow the niceties of social conventions, sometimes called EQ or emotional intelligence. It requires quite a lot of mental work. So the connection could be through cognitive exercise or cognitive demands. The other side of the equation is social activity, for most people, there’s an inherent reward feedback system there. It’s a pleasurable act, to go out and socialise, so that leads to more sustainable behaviour. So, once you start socialising, you get in the habit, you enjoy it and you do it more and more in your life. So there could be an emotional or emotive side to that link. Whether there is an inherent value to social activity and dementia risk, independent of either cognitive activity or the reward feedback, we don’t really know.

为什么社交参与应该与痴呆风险相关是一个非常棘手的需要回答问题。我们已获得很多的理论。如果你只是考虑第一原则:与其他人社交需要大量使用你的大脑。你需要使用记忆力;一个良好的社交互动意味着,如果你曾经遇到过这些人,你会记住他们一些相关信息以便融入你的谈话。你必须提前做好计划。你必须遵循社会惯例的微妙,有时称为EQ或情商。它需要相当多的脑力劳动。因此,人际关系可以通过认知锻炼或认知需求。方程的另一边是社会活动,对于大多数人来说,这里有一个固有的奖励反馈系统。出去和社交是愉快的行为,以至于会导致更多的此类可持续的行为。所以,一旦你开始社交,你会养成习惯,你享受它,你会在你的生活中做得越来越多。所以,可能存在一个情感或情绪方面的链接。我们真的不知道是否存在社会活动和痴呆风险的内在价值,独立于认知活动或奖励反馈,


I guess on the negative side of social activity, if you’re withdrawn, you’re stuck in your house most of the time, not meeting your friends or family or not meeting new people, this is related to increased risk of dementia. And there are various sides to that observation. On the one hand, we do know that, in the years leading up to a dementia diagnosis, people start to withdraw somewhat from their social contacts, so it could actually be an early warning sign that maybe dementia is in the future for an individual. Or that person may be suffering from mental health problems, like depression, which means that you withdraw from your normal day-to-day activities and this leads to social withdrawal as well. So they could be two explanations for that observation, but I think there’s enough evidence from the public health literature, which tries to statistically adjust for those possible scenarios, and there is still a link between greater social activity being linked to reduced dementia risk. So I think there is some truth on both ends of the spectrum, that low social engagement is a risk factor for dementia, and high social engagement is a protective factor.

我猜想在社交活动的负面与痴呆的风险增加有关,如果你从社交活动中撤回,你大部分时间被困在家里,不去见你的朋友或家人或认识新的人。这一观察有各个方面。一方面,我们知道,在导致诊断出认知症的几年中,人们开始从他们的社交联系中退出,因此这实际上可能是个人会痴呆的一个预警信号。此人也可能患有精神健康问题,如抑郁症,这也导致退出社会,即意味着你退出正常的日常活动。因此它们可能是这个观察的两种解释,但我认为有足够的公共卫生文献证据,其试图用统计学方法调整这些可能的情况,并且更大的社会活动与减少的痴呆风险之间仍然有一个链接。因此,我认为在其两端都有一些事实,那就是社会参与度低是痴呆的一个风险因素,社会参与度高是一个保护因素。


Unfortunately, I don’t think we can quantify what is the perfect amount of social activity. Putting a lot of different streams of research together in my book, which is called “Maintain Your Brain,” I really recommend a common sense approach to it, which is that, particularly after retirement, because a lot of things change in retirement - one of the more stark things is that people go from a social network at work to often having a much more restricted social network, so I think it’s really important after retirement that people try and replace that social engagement. And what that means, I think, in terms of recommendations, is that people should try and start some new pastime or hobby, or join some kind of interest group out there, which means they’ve got to leave the home, they’re meeting new people. Ideally it’s ticking off what I call the three keys: that it entails or has cognitive activity, social activity and some physical activity. If you can try and start a new pastime that has those three key ingredients, I think you’re doing a good thing to lower your risk for dementia.

不幸的是,我不认为我们可以量化什么是完美的社会活动量。在我这本名为“保持你的大脑”的书里,我把大量不同的研究结果放在一起,从而推荐一种特别是在退休后使用的一种常识性的方法。因为在退休后许多事情发生改变 – 其中更严峻的事情是人们在工作中的社交网络经常有一个更受限制的社交网络,所以我认为在退休后,人们试着换一种社交参与方式是非常重要的。我认为应该建议人们开始尝试一些新的消遣或爱好,或加入在那里的某种兴趣小组,这意味着他们必须离开家,去认识新朋友。理想情况下,它敲出了我所说的三个键:它需要或具有认知活动,社交活动和一些体育活动。如果你可以尝试和开始一个有这三个关键因素的新的消遣活动,我认为你在做一件降低你患认知症的风险的好事情。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-31
(25)什么是抑郁症?What is Depression??

课程视频:http://player.youku.com/embed/XMjY4NjQzMDQzMg




Text Overview of Video

Professor Nicola Lautenschlager

Nicola Lautenschlager教授


It is important to discriminate, when we use the term “depression,” between the term how we use it often in everyday life, “Oh I feel depressed today,” and depression as a medical condition. In the latter scenario, depression is a mental health problem, and is an illness and, obviously, is a very important illness to treat, because if not recognised and treated, it can come along with very severe health outcomes. It is one of the most common mental health conditions, and it is actually also one of the most common health conditions, full stop. Current estimations of how common depression is globally, estimate that roughly, at any given time, 350 million people suffer from depression globally. When it comes to using depression as a term in our everyday language, we often describe with that [word] just having a bad day, and sometimes it can also mean feeling stressed. We all can have symptoms of depression. Let’s say we go through a very difficult phase in our life. We have adverse life circumstances, without actually fulfilling the criteria to experience full-blown depression as a medical condition. What are the essential criteria or essential symptoms of depression as an illness? Obviously, most important is the symptom of feeling down or having a low mood. That’s usually considered central in a depressive episode, for example, but it has to be more than that. Usually it has to be around for a certain duration of weeks. It has to be severe enough that it impacts on the person’s daily life. For example, it impacts on their work or impacts on their family life. There are other important symptoms like having poor sleep, or having changed appetite, having changed energy levels, and the interesting thing about depression is that it can go either way. You have people who are more fatigued and sleep more, and have no energy, and find it very difficult to get out of bed and do things. But then you can also have people who have more an agitated depression, meaning they’re restless, they can’t sleep, they are overactive, they’re reactive, but all the activities they might do might not be very meaningful, because they can’t concentrate.

当我们使用“抑郁症”一词时,把我们日常用词“哦,我今天感到郁闷”和抑郁症作为一种医学名词区分清楚,是很重要的。在后一种情况下,抑郁症是一个精神健康问题,是一种疾病。这显然是一种非常重要的疾病,因为如果不承认和治疗这种疾病,它可以产生非常严重的结果。它绝对是最常见的精神健康问题之一。目前对全球抑郁症普遍性的估计是,在任何特定时间,全球大致估计有3.5亿抑郁症患者。当谈到我们在日常用语中使用抑郁这个词时,我们经常用这个词来描述糟糕的一天,有时它也可以指感到有压力。我们都会有抑郁症状。让我们说,在我们的生活中我们经历了一个非常困难的阶段。我们有不利的生活环境,实际上没有满足作为医疗条件全面体验抑郁症的标准。抑郁症作为疾病的基本标准或基本症状是什么?显然,大多数重要的的症状是情绪低落或情绪低潮。例如,这通常被认为是抑郁发作的中心,但它不仅仅如此。通常它必须有数周的持续,必须足够严重到影响人的日常生活。例如,它影响他们的工作或他们的家庭生活。另外它还有如睡眠不足,食欲改变,能量水平变化等其他重要的症状。关于抑郁症的有趣的事情是,它可以采取任何一种方式。有些抑郁症患者感到疲劳,并且睡眠更多,无精打采,并发现很难起床去做事。但是,有更多的激动性忧郁症患者,他们坐立不安,无法入睡,他们过度活跃,他们有反应能力,但因为他们不能集中精力导致他们可能做的所有活动没有什么意义。


The challenge with depression is that it can come with various forms of presentation, and therefore can be missed, for example, in general practice, especially if it presents in an unusual form. One interesting question is, “Does depression look different in a younger person versus an older person?” What’s important to understand is that the core symptoms of depression are the same in young and old. But research tells us that in old age there are certain symptoms which are more prominent, when it comes to depression, than in younger people. I’ll give you an example. Older people with depression tend to feel more somatic symptoms and these are usually the complaints or the concerns they communicate to their general practitioner. So they have headaches or they have problems with their stomach or their bowels. They might have pain in their chest or they feel they have weak muscles. So we have to be mindful, working in the health field, or also just as family members, that when an older person has many changing and various health complaints, somatic health complaints, that what could be behind it is a depression, especially if the general practitioner investigating can’t find any causes for these complaints. That’s different to younger people. Since younger people tend to experience more the mental health side of depression, with having a low mood and feeling irritable, for example.

抑郁症的挑战是,它可以带有各种形式的表现,因此,例如在一般实践中,特别是如果它以不寻常的形式出现,可能会被错过。一个有趣的问题是,“年轻人和老年人抑郁症看起来不同吗?”重要的是要明白,抑郁症的核心症状在年轻人和老年人中是相同的。但研究告诉我们,人年老时,有些在抑郁症方面症状比年轻人中更突出。我给你举一个例子。抑郁症老年患者往往感觉更多的躯体症状,他们往往向他们的全科医生的倾诉和抱怨他们有头痛或胃肠的问题。他们或许感觉他们的胸痛或肌肉无力。所以作为在健康领域的工作者,或者只是作为家庭成员,我们必须注意,当一个老年人有许多健康方面的投诉,身体健康的抱怨,它的背后可能是一种抑郁症,特别是如果全科医生检查后无法找到这些投诉的任何原因。这点与年轻人不同。因为年轻人倾向于经历更多的心理健康方面的抑郁症,例如情绪低落和感觉易怒。



Another important fact to be aware of, is that older generations of people tend to associate a bigger stigma with having a mental health condition such as depression, and therefore are much more reluctant to talk about it, because they often interpret that as a failure of who they are, and it might be a sign of weakness, or weakness of character. It is rarer in older people for them to talk about their mental health, even to their loved ones, than on average it is in younger people. There is also an interesting gender bias. So, not surprisingly, looking at western societies, men find it harder to talk about their mental health than women, and there is also a geographical difference, that people living in rural communities find it harder to talk about their mental health compared to people living in cities.

另一个需要注意的重要事实是,老一代人倾向于将更大的耻辱感与精神健康出问题(如抑郁症)联系起来,因此更加不愿意谈论它,因为他们经常将其解释为他们很失败,或者认为它可能是一个弱点或性格上的弱点的迹象。平均来说和年轻人相比,老年人很少谈论他们的心理健康,特别是和他们的亲人。另外还有一个有趣的性别偏见。所以,毫不奇怪,在西方社会,男人发现比女人更难以谈论他们的心理健康,还有一个地理差异,和生活在城市的人相比,生活在农村社区的人更难以谈论他们的心理健康。


One important point when it comes to depression in older people is, to try to investigate “Why is the person experiencing depression in the first place?” This is particularly important if it is an older person who never had a depressive episode before in their life. We call that having late onset depression for the first time in their life. The reason why this is important is, that there are different health or medical conditions which might be causing the symptoms of depression. It could be just a depressive episode for various reasons, and these reasons could be changing of the body, physiologically, due to ageing, additionally with chronic health issues, additionally through changes to their life circumstances, but it also could be a symptom of emerging biological changes to the brain, due to cognitive decline or emerging dementia. We do know that there is a certain percentage of people who develop, later on, dementia, such as Alzheimer's disease, where the first symptom was actually change to their mood with developing depression, and research has shown that can be several years before there is any onset of clear cognitive changes.

对于老年人的抑郁症,一个要点是试图调查“为什么这个人首先经历抑郁症?”这对于从前从未有过抑郁发作的一个老年抑郁症患者是特别重要的。在他们的老年生活中发生了第一次抑郁症发作,这种抑郁症我们称其为晚发性抑郁症。这很重要的原因是,有不同的健康或医疗条件可能会导致抑郁症的症状。它可能只是由于各种原因的一种抑郁发作,这些原因可能是由于老化导致的生理上的身体的改变,还有慢性健康问题,另外还有他们的生活环境的改变,但它也可能是一种由于认知衰退或新出现的痴呆引起脑的生物变化的症状。我们知道,有一定百分比的人后来会发展成认知症,如阿尔茨海默病,其中第一个症状是抑郁症的发展导致他们的情绪改变。并且研究表明,在出现任何明显的认知变化之前可能是几年的时间。


It is important not to scare people who have late onset depression, because that might not be the case for them. What the recommendation is for clinicians is, if a person develops late onset depression, to assess their memory, and even after they have recovered from the depression, to see them on a regular basis and to continue to assess their memory, just to have an eye on it. Because usually, if it would be due to underlying dementia processes, eventually you would be able to measure the cognitive decline. To give you an idea, most studies statistically estimate that a person with late onset depression has roughly a twofold risk of developing cognitive decline, compared to an older person who doesn’t experience late onset depression.

重要的是不要恐吓有晚发性抑郁症的人,因为他们可能不会发展成认知症。如果一个人患了迟发性抑郁症,对临床医生的建议是,去评估他们的记忆力,甚至在他们从抑郁症恢复之后,定期随访他们并继续评估他们的记忆力,只要留意他们就可以了。因为通常,如果它是由于潜在的痴呆过程,最终你将能够衡量的认知衰退。为了给你一个想法,大多数研究统计学估计,与没有经历迟发性抑郁症的老年人相比,具有迟发性抑郁症的人具有发展认知衰退的两倍风险。


How common is that, that an older person with depression also has problems with their cognition? Studies estimate between 40% to 60% of older people who experience depression have, at the same time, problems with their cognition. Very often it is around being able to concentrate and pay attention, which is typical for depression, but this is a much higher percentage than in younger people. Sometimes one comes across a term called “pseudo dementia” especially in the older literature which tries to describe these changes to cognition, while depression is present, and it’s called “pseudo” because very often when the person has recovered from their depressive symptoms, also their cognition returns to normal again.

老年人有抑郁症也有他们的认知问题,这是多么常见呢?研究估计40%至60%的老年人经历过抑郁症,同时,他们有认知问题,很多时候它是指无法集中精力和注意力,这是典型的抑郁症,但这是一个比年轻人高得多的百分比。有时候,特别是在老的文献中,一个称为“假性痴呆” 的术语,试图描述这些认知的变化,而当抑郁症存在,它被称为“伪”,因为很多时候,当人们从抑郁症状恢复后,他们的认知又恢复正常。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任


塔斯马尼亚大学预防认知症MOOC
2018-05-31
(26)抑郁和认知症风险-Depression and Dementia Risk

课程视频:http://player.youku.com/embed/XMjY3ODM3ODMyMA



Text Overview of Video

Professor Nicola Lautenschlager

Nicola Lautenschlager教授


When we look at common risk factors for cognitive decline and dementia, depression is one of the most prominent ones. One interesting question is, “Why is that the case?” and, “What do we know about this?” One observation is that, especially if people have had several significant episodes of clinical depression throughout their lifetime, that it looks like there is an accumulative risk of depression, in terms of their cognitive health, when they get older. There are some underlying strong hypotheses, which one comes across in the literature, about why increasing numbers of depressive episodes throughout life might increase the risk of dementia later on. One of these hypotheses is that it has to do with the impact of having increased stress hormones in your body, while you go through a depressive episode. For example, one of these stress hormones is cortisol, and we do know that if you have, for a prolonged period, high levels of cortisol in your body, as is the case when you have a depression, it specifically damages the neurons in the hippocampus, which we know we need to lay down new memory, and which is the area which is damaged early in Alzheimer's disease. Therefore, the message for consumers and clinicians is, if depression is present at any time in life, it’s important to diagnose it as early as possible, and to treat it effectively, as early as possible, to reduce the time with having high hormonal stress burden on the brain. It is more the untreated, unrecognised depression which is harmful for future dementia risk, and not so much the well treated depression, if that makes sense.

当我们研究认知衰退和痴呆的常见风险因素时,抑郁症是最突出的一个。一个有趣的问题是,“为什么是这种情况?”和“我们知道什么?”一个观察是,如果人们在他们的一生中有几个重大的临床抑郁症的发作,看起来特别像是抑郁症在认知健康方面的风险累积。在文献中有一些潜在的强有力的假设,其中有一个是关于为什么越来越多的抑郁发作在整个生活中可能会增加后来患认知症的风险的假设,你经历一个抑郁发作,它与你的身体里的压力激素增加的影响有关。例如,其中一种压力激素是皮质醇,据我们所知如果当你抑郁症发作后,你在你的身体中会长期有高水平的皮质醇,,它会专门损害在海马区的神经元。我们知道我们需要把新的记忆储存在海马区,这是在阿尔茨海默病早期损坏的区域。因此,消费者和临床医生的信息是,如果抑郁症存在于生命中的任何时间,重要的是尽早诊断它,并且尽可能早地进行有效的治疗,以减少大脑的高激素压力负担的时间。未治疗的,未被识别的抑郁症,对未来的认知症风险更有害,而不是治疗好的抑郁症,如果这是有道理话的。


Another interesting fact is that depression and dementia share many risk factors, and they’re both common. Obviously, an interesting research question is, “How much are they connected, and how much is just the fact that they share common risk factors?” I’ll give you an example. It has been shown that early experience of trauma in childhood, which might be physical, sexual or psychological, is harmful for having a higher risk later on of developing depression. But more recently, it has also been shown that it is a risk factor independently for having a high risk of dementia. That’s just one example. If you look at chronic health conditions, we know that especially cerebrovascular disease or vascular risk factors, like chronic heart disease, chronic hypertension, anything which basically damages the blood vessels and subsequently also the blood vessels in the brain, increases the risk of having depression, but also increases the risk of having cognitive decline. There is actually a specific term for older people, when they experience depression in the presence of many vascular risk factors, which we call “vascular depression.”

另一个有趣的事实是抑郁症和认知症共同有许多危险因素,而且这些因素都很常见。显然一个有趣的研究问题是,“他们有多少联系,他们有多少共同的风险因素?”我给你举一个例子。已有研究表明儿童期创伤的早期经验,这可能是身体,性或心理上的,是有害的,这对后来发展成抑郁症具有更高的风险。但是最近的研究已表明,它是独立地具有高痴呆风险的风险因素。这只是一个例子。如果你看看慢性健康状况,我们知道特别是脑血管疾病或血管危险因素,如慢性心脏病,慢性高血压,基本上任何损害血管以及随后伤害脑血管的东西,都会增加抑郁的风险,但也增加了认知衰退的风险。实际上,对于老年人,当他们在有许多血管风险因素时经历抑郁症时, 我们称之为“血管性抑郁症”这一特定的术语。


When it comes to treatment of depression in older people, the take-home message is, it should be treated as aggressively in older people as it is treated in younger people. There is no room for therapeutic nihilism just because a person is older. The good news is that older people very often respond very well to appropriate treatment which, for most people, would be a combination of social support and psychological support, plus use of anti-depressants, and usually general practice is the area where this treatment takes place. Basically, depression is one of the best treatable mental health conditions we have. There are some differences between young and older people. Because of the presence of chronic health problems, there is a percentage of older people with depression who have a poorer outcome in terms of recovery. Meaning they might have more, what we call, treatment resistant depression, or might not be able to be completely free of symptoms. They also can have a higher risk of relapse. So the recommendation is, if they benefited well from an anti-depressant, they should stay on that medication and not stop again, to avoid the higher relapse risk.

当谈到老年抑郁症的治疗时,我们应该像治疗年轻人一样去积极地治疗老年人。没有只因为一个人年纪大了而存在治疗虚无主义的空间。好消息是,老年人往往对恰当的治疗反应很好,对于大多数人来说,恰当的治疗将是社会支持和心理支持的组合,加上使用抗抑郁药, GP通常是这种治疗的地点。抑郁症基本上是我们拥有最好治疗效果的精神卫生疾病之一。年轻人和老年人的情况有些不同。由于存在慢性健康问题,有一定比例的抑郁症老年患者,在恢复方面有较差的结果。这意味着他们可能有更多的我们所说的治疗耐药性抑郁症,或者可能无法完全没有症状。他们也可能有更高的复发风险。因此,我们的建议是,如果他们从抗抑郁剂中获益良好,他们应该坚持服用那种药物,不再停药,以避免更高的复发风险。


A common myth is that older people are less able to benefit from psychotherapy. This goes all the way back to Sigmund Freud, who stated that himself, that if a person is older than 50 years they are too old and rigid to benefit from psychotherapy. It’s quite amusing because when he got older himself and was in his eighties, he actually reversed this statement and said it’s not true, but by that stage people were not listening to it anymore. So older people should be offered psychotherapy, if appropriate. And it has been shown, in research studies, that people who are psychologically-minded benefit very well from, for example, cognitive behavioural therapy, even if they’re older. What is a challenge in the health system in Australia, is that very often, there is a lack of therapists who are specialising in older people with mental health problems.

一个常见的神话是,老年人较少能够从心理治疗中受益。这一切都回到了西格蒙德·弗洛伊德时代,他说如果一个人年龄大于50岁,他们就太老了,内心僵硬得无法受益于心理治疗。这是很有趣的,因为当他年龄增长,在他八十多岁时,他实际上扭转了这个声明,并说,这不是真的,但在那个阶段,人们没有听到他的声明了。因此,如果合适的话,老年人应该得到心理治疗。并且相关研究已表明,老年人也能从例如认知行为治疗中获益良好。经常缺乏专门解决老年精神健康问题的治疗师。

是澳大利亚卫生系统的一个挑战。


One important message is that older people with depression should receive adequate treatment and there are regular mistakes happening in this field. One common mistake is that healthcare providers give a too low dose of an anti-depressant, for example, because they are anxious it could have negative side effects. On one hand, obviously it’s important to be careful and older people often do need lower doses, but we see in clinical practice that very often the dosage is not increased to an adequate level, or not given long enough, and then often it’s wrongly concluded that the medication is not working. It’s really important to treat long enough, with the right medication, at the right dosage. This is also important because the longer the older person lives with clinically relevant depression, the more it increases the risk that their cognition is impacted negatively and it increases their risk of dementia.

一个重要的信息是,老年抑郁症患者应该得到充分的治疗,这是在这个领域常犯的错误。一个常见的错误是,医疗保健提供者给予过低剂量的抗抑郁剂,例如,因为他们担心它可能有副作用。一方面,显然重要的是要小心,因为老年人通常需要较低的剂量,但我们在临床实践中看到,剂量通常不会增加到足够的水平,或用药时间不够长,然后往往错误地得出药物不起作用的结论。选择合适的药物、使用正确的剂量、进行足够长时间的治疗,这是非常重要。这也很重要,因为老年人患临床相关抑郁症的时间越长,他们的认知受到负面影响的风险就越高,从而增加了他们患认知症的风险。


Another important aspect is how our society thinks about ageing. An argument you hear quite often, for example, from nursing homes is, “Oh yes, if I lived like this person, I would be depressed as well.” So it’s normal for this person to be depressed, so we don’t need to treat it. As a society we need to work on that we all change these attitudes, and say an older person is as much entitled to the best possible healthcare as a younger person, and that this is really a sign of ageism, if we conclude, as younger people, that it’s not worth the effort, or that it’s normal for an older person to suffer.

另一个重要的方面是我们的社会如何看待老龄化。例如,从养老院听到的一个谈论是,“哦,是的,如果我像这个人一样生活,我也会抑郁。”所以这个人会郁闷是正常的,所以我们不需要治疗它。作为一个社会,我们需要努力改变这些态度,并说,老年人尽可能有权活得像年轻人一样的最好的医疗保健服务。如果我们得出结论,对老年人像对年轻人的那样的努力是不值得,或一个老年人受苦是正常的,这是真正的年龄歧视的迹象。


Depression as a symptom is one of the most common non-cognitive symptoms of dementia. People who have dementia, for whatever cause or reason, have a much higher risk of experiencing symptoms of depression than an older person who does not have dementia. Screening for, and detecting, depression in patients who experience dementia, is very important as, again, it has very poor outcomes for them, if the depression is not recognised. There are quite interesting studies that report very high numbers of depression in, for example, residential care.

作为症状的话,抑郁症是认知症的最常见的非认知症状之一。无论什么原因,认知症的老年患者比没有认知症的老年人具有更高的经历抑郁症状的风险。筛查和检测认知症患者是否经历抑郁症的是非常重要的,因为如果抑郁症不被识别,结果会很差。有相当有趣的研究报告了非常多的抑郁症,例如,住院护理。


Interestingly, when it comes to treatment of depression in people with dementia, more recent research has shown that, unfortunately, the currently available anti-depressant medication is less effective, for example, in people with Alzheimer's disease and, furthermore, that people with dementia often have a higher risk of experiencing negative side effects of the medication. It is important to take that into account when a treatment plan is put together. However, the current recommendation is still, if a person is significantly depressed with dementia, medical treatment with an anti-depressant should be considered. If the depression is rather of a milder nature, then the recommendation is maybe not to use anti-depressants as a first line treatment, but rather try non-pharmacological approaches. So that could mean increasing pleasant activities, making sure the person’s not isolated, increasing social contact, increasing physical activity, nutrition and diet and all these things, and see if that already makes a good impact.

有趣的是,当涉及到认知症患者的抑郁症的治疗时,最近的研究表明不幸的是目前可用的抗抑郁药物在像阿尔茨海默病患者中效果较差,此外,认知症患者通常具有经历药物副作用的较高风险。当治疗计划放在一起时,必须考虑到这一点。然而,目前的建议仍然是,如果一个认知症患者的抑郁症显著,应该考虑使用抗抑郁药物的治疗。如果是轻微的抑郁症,那么可能推荐不使用抗抑郁剂作为一线治疗,而是去尝试非药物的方法。所以这可能意味着增加愉快的活动,确保不被孤立,增加社交联系,增加体育活动,注意营养和饮食和所有这些事情,并看看是否已经产生了良好的效果。


A rather new, but very important field of research, is investigating what we can do to prevent the onset of depression in the first place. So if we could think of a health care system where we reduce, from the outset, the risk for an older person to experience late-onset depression, that would be perfect. The knowledge in this area is still very limited. Again, there is some interesting research highlighting that prevention of depression might be possible, and factors to think about and look at more closely are the social environment of an older person, trying to avoid that the person is isolated or feels disconnected from their community, feels they’re a burden, or can’t actively contribute any more to society, would be important. But equally, to look at their physical health, to manage optimally chronic disease, as it is a strong risk factor for depression. Other areas are, for example, hearing loss and loss of vision, which both are strong risk factors for depression in older people, to screen for that regularly. So it looks like there are quite a number of things we can do as a society to reduce, in general, the onset of depression, and that subsequently obviously also help to reduce the onset of cognitive impairment and dementia.

一个相当新的,但非常重要的研究领域,是调查我们可以做些什么来预防抑郁症的发生。因此如果我们能想到一个能从一开始就减少老年人经历迟发性抑郁症的风险的医疗保健系统,这将是完美的。这方面的知识仍然非常有限。其次,有一些有趣的研究强调,预防抑郁症的或许是可能的,并且需要考虑和更仔细地看待的因素是老年人的社会环境。努力避免他们被隔离或感觉与他们的社区分离,避免让他们感觉自己是负担或不能积极地贡献社会,这些是很重要的。但同样,检查他们身体是否健康,以便理想地管理慢性疾病,因为这是抑郁症的一个强大的风险因素。其他领域是,例如,定期筛查听力损失和视力丧失,这两者都是老年人抑郁症的强烈风险因素。所以看起来,作为一个社会,我们可以做许多事情,一般来说减少抑郁症的发病,显然随后也有助于减少认知损伤和患认知症。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-31
(27)教育和认知症风险-Education?and Dementia Risk

课程视频:http://player.youku.com/embed/XMjY3ODM4MzMzNg




Prof. Carol Brayne

Carol Brayne教授


What are the detailed effects of education? I think that is a very challenging question, because it could be argued that a poor education or low access to education, is itself a risk factor, and that maybe high education is separately a protective factor, and an average education is maybe the neutral state. I would argue that we probably don’t really know the answer to that question. There is the opportunity across the world to examine it because there are many populations in which access to education is very limited. And, of course, we’re talking about findings from a country in which education has been the norm for a long time. So we’re looking at variations in education, rather than no access, or absolutely minimal access. So I think we’ll understand a lot more about education in the years to come.

教育的具体影响是什么?我认为这是一个非常具有挑战性的问题,因为可以争论教育水平低或教育机会太少本身是否就是一个患认知症的风险因素,也许高等教育是一个保护因素,普通教育可能是中立状态。我认为我们可能并不真的知道这个问题的答案。我们会有机会检查它,因为在世界上很多人能获得的教育是非常有限的。当然,我们正在谈论一个国家的相关发现,在这个国家,教育已经成为长期的规范。因此,我们正在研究教育的变化,而不是没有接受教育的途径,或绝对最小的接触。所以我想我们将更多地了解教育在未来几年的情况。


So the EClipSE Study is a grouping of three population based studies of dementia. One is of the 65 plus population; one is of the 75 plus population and one is of the 85 plus population and there are two in the UK and one in Finland. These studies have all studied dementia in the population. But what makes them stand out, is that they’ve also had a brain donation program associated with them. So in that research, we have gone out and asked people whether they were willing to consider donating their brains to medical research after they died, and their families as well, so we talk with their families. Between them those studies have collected a thousand donations. The reason why we brought them together was because, individually, each study is not powerful enough to look at the relationship between what you see in the brain and what you’ve measured during life, taking into account the various different factors. So we wanted to have the ability to look at what might be protective factors and compensatory factors in people’s lives that influence how they might or might not have had dementia.

因此,EClipSE研究是一个基于认知症研究的三组人群的组合。一组是65岁以上的人群,一组是75岁以上的人群,一组是85岁以上的人群,有两个在英国和一个在芬兰。这些研究都调查了人口中的认知症患者。但是使他们脱颖而出的是他们也有一个大脑捐赠计划与他们相关联。因此,在这项研究中,我们已经去问过人们是否愿意考虑在他们去世后捐赠他们和家人的大脑进行医学研究,所以我们也与他们的家人谈话。在他们之间,这些研究已收集了一千个捐赠。我们把他们聚在一起的原因是,每个研究都不能强大到能够看到你在大脑中看到的和你在生活中测量到的之间的关系,从而考虑到各种不同的因素。所以我们想要有能力去看看什么可能是人们的生活中的保护因素和补偿因素,从而影响他们将来可能会或不会得认知症。


In that study we explored the hypothesis that education is associated with less dementia. Now that’s a question that’s been addressed many times in ordinary cohort studies, in ordinary longitudinal studies, and we know that education is protective of later development of dementia, from a whole range of studies. What we wanted to do with this study was see what was the brain mechanism for that. And what we found was that if you have a certain amount of the changes associated with dementia in your brain, and if you have high education compared to low education, that the people in the high education group have less dementia during life. So just rephrasing that, if you hold the amount of neuropathology steady in a brain, whether you have more education or not influences whether you develop dementia during life or not. So that tells us that there are other things going on in the brain which allow us not to express dementia during life, even if we have say Alzheimer’s or vascular changes in our brain.

在这项研究中,我们探讨了教育与较少的认知症相关的假说。现在这是一个问题,在普通队列研究中已经被多次提到,在普通纵向研究中,我们知道从整个研究范围来看,教育是后续发展痴呆的保护因素。我们想要做的这项研究是搞清这是什么大脑机制造成的。我们发现,如果你在大脑中有一定量的与认知症有关的变化,如果你受过相对于较低教育的高等教育,那么受过高等教育的人在生活中较少有认知症。所以只是改述一下,如果你在脑中保持神经病理学的稳定,无论你有没有受过更多的教育都会影响你是否会在生活中发展为认知症。这告诉我们,即使我们说阿尔茨海默病或我们的大脑中的血管变化,在大脑中还有其他事情发生,从而使我们不在生命历程中患认知症。


What we looked at was the dose of education and the dose of education seemed to be important. Not just the availability of education, so it’s not just confounded by other things. But it seems almost certain that there are a variety of ways in which the measure of education could be associated with protection from expression of dementia. So it could be having a bigger brain at the beginning. It could be higher IQ because there’s an association between those two. It could be higher access to educational exposure. And then it can be the things that a higher education then is associated with in later life. Because we also know that more intellectually stimulating occupations and later life engagement, also have a protective effect, and each of those, they’re associated with each other, but we know they also have independent effects.

我们看到的是教育的剂量,教育的剂量似乎很重要。不只是教育的可用性,所以它不仅仅混淆其他事情。但是,似乎几乎可以肯定的是,有多种方式的教育措施可以与保护免于表现认知症相关联。所以它在刚开始时可能有一个更大的脑子。它可能是更高的智商,因为这两者之间有一个关联。它可能更容易接受教育。然后它可以是高等教育,然后与后来的生活相关联。因为我们也知道有更多智力刺激的职业与后来的生活参与,也有保护作用,并且它们的每一个都彼此相关联,但我们知道它们也有独立的影响。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-31
(28)认知储备-Cognitive Reserve

课程视频:http://player.youku.com/embed/XMjY3ODM4MzY5Ng




Difference between pathology and dementia

Dr David Ward

David Ward博士


When we talk about the developments of dementia, there are two distinct events that are worth mentioning. The first is the development of the disease. So in the case of Alzheimer's that's the amyloid plaques and the neurofibrillary tangles, and these can cause some detrimental effects such as atrophy or shrinkage to the brain. Now the other event that occurs, is obviously the onset of dementia, so that's the cognitive impairment, and the deficits in memory and attention that are associated with Alzheimer's disease.

当我们谈论认知症的发展时,有两个不同的事件值得一提。首先是疾病的发展。因此,在阿尔茨海默病的情况下,会出现淀粉样斑块和神经原纤维缠结,并且这些可以引起一些像大脑萎缩或收缩有害的结果。其次发生的其他事件,显然是指认知症的发作,所以这是认知损伤,以及与阿尔茨海默病相关的记忆和注意力的缺陷。


Interestingly we know that there isn't a direct relationship between the level of damage in someone's brain and their cognitive function. For instance, some people can have quite a high load of damage, a large presence of Alzheimer's pathology, yet they're still functioning normally, and they aren't suffering from any of these detrimental memory deficits.

有趣的是,我们知道在某人的大脑的损伤水平和认知功能之间没有直接的联系。例如,一些人可能具有相当高的损伤负荷,大量存在阿尔茨海默氏病理现象,但认知功能仍然正常运行,并且他们没有遭受任何这些有害的记忆缺陷。


Other people can have just a small level of damage to their brain, yet they start showing these deficits on a day-to-day basis, and they have more difficulty with memory function and planning. We aren't exactly sure why some people seem to be more resilient to Alzheimer's, while other people seem to be more susceptible to its effects, but one of the factors that may partially account for some of these individual differences in when dementia symptoms begin to emerge, is cognitive reserve.

其他人的大脑可能只受到小小的伤害,但他们开始在日常生活的基础上显示缺陷,他们在记忆功能和计划方面有更多的困难。我们不能确定为什么有些人似乎对阿尔茨海默氏病更有韧性,而其他人似乎更容易受到其影响,但是其中一个因素可能部分地解释了,当认知症状开始时一些个体差异的出现,这就是认知储备。


Introduction to cognitive reserve

认知储备的介绍


Dr David Ward

What we see is that the level of protection that someone has from the emergence of dementia is related to their cognitive reserve, and cognitive reserve seems to be built from a lifetime of exposure to cognitive stimulation. Simply put, if you live a life that is more cognitively engaged and you're more involved with these complex learning activities, then, on average, you'll have a lower risk for dementia later in life. For example, we might have two individuals, person A, and person B, and they both have exactly the same level of damage within their brain as a result of Alzheimer's disease. However, person A has greater cognitive reserve, and what that means is that they don't display any of these deficits, any of these dementia symptoms, and they're going about their business fairly normally. Person B however, they have less cognitive reserve, and although they only have the same level of damage as person A, what we see is that they might start showing some of these day-to-day difficulties in memory and attention, some of the earlier symptoms of Alzheimer's disease.

我们知道某人痴呆出现的保护水平与他们的认知储备有关,而认知储备似乎是建立在一生的接触认知刺激上。简单地说,如果你生活在一个更具认知参与性的生活环境,并且你更多地参与这些复杂的学习活动,那么一般来说,你患认知症的风险会较低。例如,我们可能有A和B两个人,阿尔茨海默病在他们的大脑内造成的损害完全相同。然而,A具有更大的认知储备,这意味着他们不显示任何这些缺陷、任何认知症状,并且他们正常地进行他们的业务。然而B的认知储备较少,虽然他们只有与A相同程度的伤害,但我们所看到的是他们可能开始在日常记忆和注意力上显示出一些困难,表现出阿尔茨海默病的早期症状。


However, something worth mentioning is that cognitive reserve is a theoretical construct. Now a theoretical construct is something that we believe to exist, because it explains a number of associations, but we can't directly measure it or observe it. In the case of cognitive reserve, it provides a great explanation for why people with more years of education have a lower risk of dementia, but we can't directly measure it. We can't go into someone's brain and look at a specific structure that seems to expand when they're exposed to more years of education. Despite this, we do have a few ideas as to how cognitive reserve does look in the brain, and we can start to differentiate between brains that have high cognitive reserve and low cognitive reserve, based on their structure and function.

但值得一提的是,认知储备是一种理论结构。理论结构是指我们认为存在的某样东西,因为它解释了一些关联,但我们不能直接测量或观察它。认知储备为有更多的受教育年数的人具有较低的痴呆风险这一现象提供了一个很好的解释,但我们不能直接测量它。当人们接触更多的教育时,大脑特定的结构似乎在扩大, 但我们无法进入某人的大脑来看这个结构。尽管如此,我们确实有一些关于如何在大脑中观察认知储备的想法,我们可以基于它们的结构和功能开始区分具有高认知储备和低认知储备的大脑。


What cognitive reserve looks like in the brain

认知储备在大脑看起来怎样?


Dr David Ward

What we think happens, is when a brain is exposed to this prolonged engagement in challenging cognitive stimulation, this induces changes to the structure and the function of the brain, to make it more resilient and more flexible. There are two main components here at work. The first is neural resilience. Neural resilience refers to differences in the efficiency of the neural networks within a brain. Neural flexibility, on the other hand, refers to differences in the ability to recruit additional neural networks to process a task, when the original network is disrupted by pathology. A neural network is a collection of neurons and synapses within the brain that work together to help process a task. So, in one case it might be if you enter a supermarket and you forgot your shopping list, there might be a number of networks involved with trying to remember those items. If there is damage to these networks, or they can't function normally, then that's when you start to have difficulties remembering, and with other cognitive processes.

我们认为当大脑暴露于这种长期参与认知刺激的挑战时,会诱导大脑的结构和功能发生变化,使其更具弹性和更灵活。这里有两个主要组成部分。首先是神经韧性。神经韧性是指脑内神经网络效率的差异。另一方面,神经灵活性是指当原始网络被病理学破坏时,招募额外神经网络以处理任务的能力的差异。神经网络是大脑内的神经元和突触的集合,它们一起工作以帮助处理任务。所以,假如你进入一个超市,你忘了你的购物清单,可能有一些网络涉及尝试记住这些项目。如果这些网络有损坏,或者它们不能正常工作,那么你就会开始在记忆和与其他认知过程上有困难。


Neural resilience and flexibility

神经弹性和灵活性


Dr David Ward

To better understand how these differences in neural resilience and neural flexibility may actually operate, a nice metaphor may be to use a delivery van driving along city streets. In this metaphor, the delivery van represents a neural impulse that's travelling across the brain to help process one of those tasks, such as remembering the items on the shopping list, and the city streets represents the neural networks within your brain, and the pathways. If you have high cognitive reserve, then you have greater neural resilience and greater efficiency within your neural networks. When the delivery van is driving along a street and it wants to make a delivery at the other side of town, if it's driving along a nice high quality street, then it's not going to face any difficulties at all. Even if a bit of damage starts to occur to this road, because of its pre-existing high quality, quite a large amount of damage needs to occur before that delivery van starts to have difficulties in actually making its delivery, and a very high amount of damage needs to occur before it can't make its delivery.

为了更好地了解这些神经弹性和神经灵活性的差异实际上如何运作,一个很好的比喻可能是使用一辆送货车沿着城市街道驾驶。在这个比喻中,送货车代表一个神经冲动,它穿越大脑,帮助处理这些任务之一,例如记住购物清单上的项目,城市街道代表你的大脑和路径中的神经网络。如果你有高认知储备,那么在你的神经网络里你有更大的神经弹性和更大的效率。当沿着一条街道驾驶送货车,并想要在城市的另一边交货的话,如果沿着一个相当的高品质的街道,那么不会遇到任何困难,即使在这条道路上开始发生一点损坏。由于道路预先存在的高质量,只有发生相当大的损坏,然后才会导致运输车实际进行其运输开始有困难,并且只有道路发生非常高的损害量,运输车才无法送货。


However, if you compare that to an individual with low cognitive reserve and low neural resilience, then the delivery van is driving along a road that's already pretty poor quality. There might be a few potholes and it's pretty clear that the council's been neglecting it over the last few years. The delivery van can still make its delivery, but if any further damage occurs to that road, then it's probably going to be un-driveable pretty quickly. Neural resilience refers to the differences in the quality of the pathways, the differences in the quality of the neural networks and their efficiency, whereas neural flexibility refers to the differences in the ability to recruit additional roads to make your delivery if necessary. So let's go back to the delivery van, and what we might see is that the van is driving along, and so much damage has occurred to that road that it can no longer pass and it's making its delivery more difficult. If someone has high neural flexibility, they'll be able to back up the van and they'll be able to think, “Well, if I take a left here, and then I take a right, then I'll still get to my destination, even though I'm not travelling along the road I'm intending to travel along.” We compare that to someone with lower neural flexibility, and what we might see is the van backs up, but because there aren't so many options within the street, the van has no way to get to its destination other than travelling along that damaged road, which it can't do. To sum up, neural resilience refers to the differences in the quality of the roads, whereas neural flexibility refers to the differences in the number of options.

但如果你比喻一个具有低认知储备和低神经韧性的人,那就是送货车沿着已经相当差的道路驾驶。可能有几个坑洼,很明显,在过去几年里,市政委员会一直忽视它。送货车仍然可以送货,但如果那条道路发生任何进一步的损坏,那么送货车可能会很快不能送货。神经韧性指的是道路质量的差异,神经网络质量的差异及其效率,而神经灵活性是指在必要时招募额外道路以完成你的交付任务的能力差异。所以让我们回到送货车,我们可以看到的是,送货车正在沿这条道路行驶,由于这条道路已经发生了如此多的损失,以至于无法再通过,使得送货变得更困难。如果有人有高度的神经灵活性,他们会将运货车后退,他们将能够这样想,“嗯,如果我在这里左转一下,然后我再右转一下,然后我仍然会到达我的目的地,即使我不是沿着我平时的那条路线行驶。“我们比较那些具有较低的神经灵活性的人,我们可能看到的是货车后退了,但因为没有多种道路选择,除了沿着损坏的道路行驶没有别的选择,从而没有办法到达目的地。总之,神经韧性是指道路质量的差异,而神经柔性是指选择数量的差异。


How can you increase your cognitive reserve?

我们能够如何增加认知储备?


Dr David Ward

The question of how can we increase our cognitive reserve is really important. If there were a way to lower your risk of dementia, and many people in the world, or just in Australia, undertook that activity, then we would have a much lower prevalence of dementia. Typically, if an individual wants to increase their cognitive reserve, the best activities are those activities that involve prolonged engagement with cognitively challenging activities, that preferably involve new learning, learning of new knowledge or skills.

我们如何增加认知储备?这个问题是非常重要的。如果有办法降低痴呆的风险,世界上许多人,或只在澳大利亚采取行动的话,那么我们的认知症患病率会低得多。通常,如果个体想要增加他们的认知储备,最好的活动是那些涉及长期参与认知上有挑战性的活动,尤其是涉及新的学习,新的知识或技能的学习。


A great example of an activity that involves prolonged engagement in a cognitively challenging task, is learning a second language. When you learn a second language you're taking in new vocabulary, you're learning how to structure your sentences properly, and it takes quite a long time. It's quite difficult, but it's also achievable, and that's a really key point. There's no point throwing yourself into a task that is so difficult that you can't actually see yourself getting better at it.

对于涉及长期参与挑战性认知任务的活动,学习第二语言是一个很好的例子。当你学习第二种语言,你正在学习新的词汇,你正在学习如何正确地造句,它需要相当长的时间。虽然这是非常困难的,但是它也可以实现的,这是一个真正的关键点。让自己陷入一项艰巨的任务,无法确实看到自己做得越来越好是没有任何意义的。


As a result of this activity, your brain has to change, it has to restructure and reorganise itself, and that's what we think increase in cognitive reserve looks like in a brain. Although it's helpful to give a few examples of certain activities that might be good for increasing cognitive reserve, typically in the research and in the literature, we talk about more broad categories of lifetime exposures. What we find is that people who have more years of education have a lower risk of dementia later in life. It's not just limited to education however, and people who are involved in occupations that involve more complexity, with people or things, have a lower risk of dementia as well. A great example of these occupations are those positions that involve management of people, because that's a difficult and challenging thing to accomplish. An individual's engagement in cognitively stimulating leisure activities also seems to be associated with a reduced risk of dementia. We think that people who read more books or visit museums more regularly have a higher cognitive reserve than those who do these activities less frequently. The take home message, however, if you want to increase your cognitive reserve, is that you need to be challenging yourself with new learning on a regular basis.

作为这个活动的结果,你的大脑必须改变,它必须重建和重组自己,这就是我们认为增加的认知储备看起来像在大脑中。虽然提供一些可能有益于增加认知储备活动的例子是有帮助的,特别是在研究和文献中,我们谈论‘一生暴露’的更广泛的类型。我们发现,受教育年数越多的人将来患痴呆的风险越低。然而它不仅局限于教育,而且从事涉及更复杂人或事的职业的人也具有较低的痴呆风险。这些职业的一个很好的例子是那些涉及人员管理的职位,因为这是一个要完成艰难和具有挑战性事情的职位。个人参与认知刺激的休闲活动也似乎与降低痴呆的风险有关。我们认为,阅读更多书籍或经常访问博物馆的人比没有经常参加这些活动的人具有更高的认知储备。但是,需要带回家的消息是,如果你想增加你的认知储备,你需要定期学习新事物来挑战自己。


Brain reserve vs. cognitive reserve

大脑储备vs认知储备


Dr David Ward

To make things a bit more complicated, you can split this up, these protective effects, into cognitive reserve and brain reserve, and that's quite a useful distinction to make. To understand the differences between cognitive reserve and brain reserve better, we can use a hardware and software metaphor. Brain reserve refers to the hardware, so it's what you have in your brain. It's how big your brain is, it's how many neurons you have, and it's how many synapses you have, among other things. Interestingly, if you have a larger head circumference, that is associated with a reduced risk of dementia. It's quite a crude measure, but what we think happens there is that the more brain you have, the more brain you have to lose, before you start showing some of these clinical deficits associated with Alzheimer's disease. Cognitive reserve, on the other hand, refers to the more software side of things, so that refers to the differences in how you use what you have. As discussed, there are differences in neural efficiency and neural flexibility, and these can lead to a brain that's big that's not very efficient, or it can lead to a brain that's small that's very efficient.

为了使事情有点复杂,你可以把这些保护效应分成认知储备和脑储备,这是一个有用的区别。为了更好地理解认知储备和脑储备之间的差异,我们可以使用硬件和软件隐喻。脑储备是指硬件,所以它是指在你的大脑中有啥。它是指你的大脑有多大,有多少神经元,有多少突触,等等。有趣的是,如果你有一个更大的头围,这是与痴呆的风险降低相关联。这是一个相当粗略的措施,但我们认为如果你有更多的大脑,你必须失去更多的大脑,才能开始显示一些这些临床障碍与阿尔茨海默病相关联。另一方面,认知储备更多是指软件方面的东西,指的是如何使用你所拥有的差异。如前面所讨论的在神经效率和神经灵活性上的差异可以导致大的,不是非常有效率,或者它可以导致小的,非常有效的大脑。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-31
(29)一生的经历-A Lifetime of Experience

课程视频:http://player.youku.com/embed/XMjY3ODM4NDA5Mg



Associate Professor Michael Valenzuela


Cognitive lifestyle is a concept that I’ve been interested in for a while now, which is really trying to think about the patterns of usage of your brain over your whole lifespan. What do you typically do with your brain? Are you someone who is always trying to find new information, learn new things, or are you quite happy not to learn new things, and just stay with the status quo? So I guess that’s the general concept, and we’ve done quite a bit of work trying to - being able to measure cognitive lifestyle in a more formal way.

现在我感兴趣的事情是认知生活方式,它是指你一生中使用大脑的方式。你通常如何对待你的大脑,你是个总想发现新信息,学习新事物的人吗?或者是个乐于不学习新事物,仅维持现状的人? 所以我猜这是广义概念,我们已经做了很多工作去试图能够以更正式的方式来测量认知方式。


Cognitive lifestyle, more and more research is showing, has a link to dementia risk in a similar way to when we’ve been considering social activity. People with, what I call, a poor or an unstimulated cognitive lifestyle, have high risk for dementia, and those individuals who have a very rich cognitive lifestyle, have a lower risk for dementia. Some years ago now, when we put this research together, we found that people with a very active or enriched cognitive lifestyle were about half the risk of dementia compared to an unenriched or low cognitive lifestyle. So that’s quite a big difference. And that’s true now, I’ve been shown in dozens of population health studies from around the world.

越来越多的研究表明,认知生活方式与认知症风险的联系类似于我们已经考虑过的社会活动。具有较差和不刺激的认识方式的个人具有高风险,而具有丰富认知生活方式的个人有较低的患认知症的风险。几年前的现在,当我们把这一研究放在一起时,我们发现具有活跃或丰富认知方式的人患认知症的风险只有不丰富或低认知生活方式的人的一半。所以这有很大的不同。而且现在确实如此。我已经展示了很多全世界的人群健康研究。


So when we talk about cognitive lifestyle, we talk about the lifespan. So some of that gets set up in young adulthood, particularly through education. Then, in the mid-life years, a lot of our cognitive lifestyle is related to the type of occupation we may be involved with, and then, in later life, particularly after retirement, it’s about those voluntary activities, where we’re getting out there and learning new things, meeting new people, and just doing things for interest that work our brain. So it depends what phase of life we’re talking about. If we’re talking about later life, then it’s really about the frequency of learning new material that challenges your mind, and also how challenging that is. Whether it’s just doing a crossword, which may be minimal, to learning a new language, which could be quite challenging.

所以当我们谈到认知生活方式时,我们要提到寿命。有些认知方式在成人之后特别是通过教育确立的。然后在中年,我们的认知生活方式和从事的职业有关。到了老年,特别是退休以后,这包括一些志愿活动,从中学习新事物,结交新朋友,或做一些有趣动脑的事情。所以这取决于我们谈论的是生命的哪个阶段。当我们谈论的是老年期的认知生活方式时,主要是指学习新材料挑战自己的频率,另外还有挑战的难度如何,是否只做了填字游戏这样的小挑战,还是学习一种新语言这样的大挑战。


The kind of research linking cognitive lifestyle to dementia breaks down in a few different ways. There’s been a lot of work in population health or the public health area, where you’re tracking, say, thousands of people for a number of years, and seeing who does develop dementia versus who doesn’t, and trying to work out what may be a risk factor or a protective factor. Time and again, it’s been shown that a more rich cognitive lifestyle is linked to lower dementia risk. More lately, my group and others have become quite interested in the idea of, well, if you’re presented with someone, an older person for example, what they’ve done early in life that’s fixed, what can they do going forward to enrich their cognitive lifestyle? And we’ve become very interested in brain training, or using cognitive exercises on the computer, as a kind of very formalised and encapsulated way of stimulating a cognitive lifestyle. So thinking of the brain like a muscle, brain training is like going to the gym and doing exercises for the brain.

将认知方式和认知症关联的这类研究可以以几种不同的方式分解。有很多人口健康和公共卫生领域的工作,在数年间随访了数千人,观察谁得了认知症,谁没得认知症,试图搞清什么是风险因素或保护因素。屡次表明认知方式越丰富,患认知症的风险越低。我的组和其他人对这一想法很感兴趣。如果某人呈现在你面前,例如一位老人,他们在生命早期的所做所为已经固定了,他们能做些什么来丰富他们的认知方式?并且我们对大脑训练或在电脑上使用认知练习,这类十分促进认知方式的非常正式化和概括性的手段感兴趣。所以训练大脑就像去健身房和进行体育锻炼来训练肌肉一样。


We can’t get too prescriptive about what type of cognitive lifestyle is best for an individual, because there’ll always be a wide diversity of things. We may recommend one thing but, if the person doesn’t enjoy it, they won’t be able to sustain it for the rest of their life. So I think it really comes down to personal choice. Some people may be more attracted to kind of complex lifestyle activities. For example, like dancing, which may have a cognitive component, a physical component and a social component, and so that’s a kind of holistic cognitive lifestyle intervention. On the other hand, cognitive or brain training is quite specific, and is really trying to target specific cognitive skills in a repetitive way. I don’t think there’s any particular magic cognitive lifestyle activity to recommend. Rather, we have to do a lot of research and try and work out what are the strengths and weaknesses of all of those.

我们无法规定哪种类型的认知方式对一个人最好,因为这总是有多种类型的。但我们或许可以建议的是如果一个人对它不感兴趣,他就无法在以后的生命中坚持下来,所以我觉得这真的取决于个人的选择。有些人或许喜爱复杂的认知方式,例如跳舞具有认知成分,运动成分和社会成分,所以这是一类整体认知方式的介入。在另一方面,认知或大脑训练师很特殊,这确实是以重复的方式试图针对特定的认知技巧。我不认为有任何神奇的特殊的认知方式。甚至我们不得不做很多研究试图搞清所有这些认知方式的优缺点。


We developed a “lifetime of experiences” questionnaire because, at the time, there wasn’t really a good tool or assessment option to try and quantify someone’s cognitive lifestyle, whether they had a kind of impoverished or low cognitive lifestyle, intermediate, or quite enriched or high cognitive lifestyle. We developed this questionnaire which is intended to be filled out or carried out by an older person after retirement. Part of it we’re talking about, or asking them to reflect on what they did in the past as a young adult, in terms of education, during their working life, all the different occupations they participated in, and then there’s a very large section of the lifetime of experiences questionnaire where we try and really work out - what is the person doing now to stimulate the brain? What kind of activities are they participating in, how diverse they are, and how challenging they are. At the end of the day, we’re trying to put a number on cognitive lifestyle and then, through large studies, being able to determine a kind of bell curve for cognitive lifestyle, so that we could give someone like a percentile on this assessment tool.

我们开发了一个名叫“一生的经历”的问卷调查,因为当时没有一个真正好的工具或评估选择来试图量化某个人的认知方式,从而确定他们是否有较差的认知方式,中等的认知方式,非常丰富的或较高的认知方式。 我们开发这个问卷调查目的是想让老人退休后填写。我们所讨论的部分,或让他们反映他们年轻时受过什么教育,工作后从事过什么不同的职业,我们通过“一生的经历”问卷调查很大部分是试图弄清一个人现在做的事情是如何激励大脑?他们参与的各种活动种类是如何多样,具有多大的挑战性。在一天的调查结束时,我们试图给一个认知生活方式打分,然后,通过大型研究,能够确定认知生活方式的一种贝尔曲线,以便我们可以给某人一个在这一评价工具上的百分位数。


So the lifetime of experiences questionnaire is broken up into phases of life. So we have early or young adulthood, where most of the questions are about education. How far did they get through the educational system? Then there’s mid-life, where a lot of the questions are about the different occupations they participated in. Not just the titles or the status, but also how many people were they in charge of? - what we call managerial experience. And then, for late life, which is I guess right now, what is the person doing with their brain now? What numbers of activities, diversity of activities, and how challenging those are.

所以我们可以将经验问卷的生命周期分成几个生命阶段。因此我们有早期或年轻的成年期,其中大部分问题是关于教育。他们通过教育系统有多远?然后有中年的生活,很多问题是关于他们从事的不同职业,不只是头衔或地位,还有他们负责多少人? - 我们称之为管理经验。然后,对于晚年生活,这是我现在猜想,现在的人在做什么与他们的大脑有关的活动?什么数量的活动,活动的多样性如何,以及这些活动具有多大的挑战性。


In terms of which activities may be more important for lowering your risk for dementia, using our lifetime of experiences questionnaire, we don’t have that information yet, but I think that will be coming in the future, because, to answer that question, you really need data from thousands of individuals, tracked for many years, in order to know which activities specifically are protective or increase your risk for dementia. So we’re doing that right now in terms of pooling data from Australia, from France, from the UK, from the USA, so we have, at the end of the day, a really large sample and can drill down to specific activities. So it’s a great question, but we just don’t know the answer just yet.

通过使用我们的一生的经历这一调查问卷,我们还没有获得关于哪些活动对于降低痴呆风险可能更加重要这类信息,但我认为我们以后会知道的,因为,为了回答这个问题,你真地需要随访多年的成千上万个人的数据,以便知道哪些活动具体是特别有保护性或增加痴呆的风险。因此,我们现在正在汇集来自澳大利亚,法国,英国和美国的数据,以便我们在一天结束时有一个非常大的样本,可以深入到具体的活动。所以这是一个很好的问题,只是我们还不知道答案。


Is it ever too late to start engaging in activities and thinking about your brain as a muscle? I don’t think so. I think more and more evidence, particularly clinical trials evidence, is showing that starting new challenging activities for your mind, such as brain training or complex leisure activities, is linked to better brain health, better cognitive outcomes. Whether that actually leads to lowering the incidence of dementia or the development of dementia, that’s still an open question, but we do know that it improves cognitive function and, in some cases, leads to better brain outcomes. So I think it’s never too late to think of your brain as a muscle and start new exercises for it.

现在才开始从事活动和考虑把你的大脑作为一个肌肉进行锻炼,是否为时已晚?我不这样认为。我认为越来越多的证据,特别是临床试验证据,表明开始新的具有挑战性的活动,如脑部训练或复杂的休闲活动,与更好的大脑健康,更好的认知结果相关联。无论是否实际上导致降低痴呆的发病率或痴呆的发展,这仍然是一个开放性的问题,但我们知道,它能提高认知功能,并在某些情况下,导致更好的大脑结果。所以我认为,把你的大脑当成肌肉开始新的锻炼从来不是太晚。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任


塔斯马尼亚大学预防认知症MOOC
2018-05-31