What You Can Do to Prevent Alzheimer's | Lisa Genova | TED

Translator: Mariazell-Eugénia Bosch Fábregas Reviewer: Carme Rossell

How many people here would like to live to be at least 80 years old?

A quants de vostès els agradaria viure fins als 80 anys?

Yeah.

Exacte.

I think we all have this hopeful expectation

Crec que tots tenim l'esperança

of living into old age.

de viure fins a una edat avançada.

Let's project out into the future,

Fem veure que som al futur,

to your future "you's,"

vostès d'aquí a uns anys,

and let's imagine that we're all 85.

Imaginem que tots tenim 85 anys.

Now, everyone look at two people.

Ara mirin a dues persones.

One of you probably has Alzheimer's disease.

Un de vostès probablement té Alzheimer.

(Laughter)

(Riure)

Alright, alright.

D'acord, d'acord.

And maybe you're thinking, "Well, it won't be me."

I potser pensen, "no seré pas jo".

Then, OK. You are a caregiver.

Bé, d'acord. Vostè és el cuidador.

So --

Així que...

(Laughter)

(Rialles)

so in some way,

d'alguna manera,

this terrifying disease is likely to affect us all.

és possible que aquesta malaltia tan terrible ens afecti a tots.

Part of the fear around Alzheimer's stems from the sense

Part de la por que genera l'Alzheimer prové de la idea

that there's nothing we can do about it.

que no podem fer-hi res.

Despite decades of research, we still have no disease-modifying treatment

Tot i que s'ha investigat durant dècades, encara no hi ha cap tractament

and no cure.

ni cura.

So if we're lucky enough to live long enough,

Si tenim la sort de viure molts anys,

Alzheimer's appears to be our brain's destiny.

sembla que l'Alzheimer sigui el destí del nostre cervell.

But maybe it doesn't have to be.

Però potser no ha de ser així.

What if I told you we could change these statistics,

I si us digués que es poden canviar aquestes estadístiques,

literally change our brain's destiny,

literalment, canviar el destí del cervell,

without relying on a cure or advancements in medicine?

sense dependre d'una cura o avenços en la medicina?

Let's begin by looking at what we currently understand

Comencem veient el que entenem ara per ara

about the neuroscience of Alzheimer's.

sobre la neurociència de l'Alzheimer.

Here's a picture of two neurons connecting.

Us mostro una imatge de dues neurones connectades.

The point of connection, this space circled in red,

El punt de connexió, l'espai en vermell,

is called the synapse.

es diu sinapsi.

The synapse is where neurotransmitters are released.

La sinapsi és des d'on s'emeten els neurotransmissors.

This is where signals are transmitted, where communication happens.

Aquí és on es transmeten els senyals, on té lloc la comunicació.

This is where we think, feel, see, hear, desire ...

Aquí és on pensem, sentim, veiem, escoltem, desitgem...

and remember.

i recordem.

And the synapse is where Alzheimer's happens.

I la sinapsi és on té lloc l'Alzheimer.

Let's zoom in on the synapse

Apropem-nos a la sinapsi

and look at a cartoon representation of what's going on.

i mirem el que passa, en aquest gràfic.

During the business of communicating information,

Durant el procés de comunicar informació,

in addition to releasing neurotransmitters like glutamate into the synapse,

a més d'emetre neurotransmissors com glutamats a la sinapsi,

neurons also release a small peptide called amyloid beta.

les neurones també emeten un petit pèptid: el beta amiloide.

Normally, amyloid beta is cleared away metabolized by microglia,

Normalment, el beta amiloide s'elimina, metabolitzat per les micròglies,

the janitor cells of our brains.

les cèl·lules protectores del cervell.

While the molecular causes of Alzheimer's are still debated,

Tot i que les causes mol·leculars de l'Alzheimer encara es debaten,

most neuroscientists believe that the disease begins

la majoria de neurocientífics creuen que la malaltia comença

when amyloid beta begins to accumulate.

quan els beta amiloides s'acumulen.

Too much is released, or not enough is cleared away,

Se n'emeten massa o no se n'eliminen prou,

and the synapse begins to pile up with amyloid beta.

i la sinapsi es comença a omplir de beta amiloides.

And when this happens, it binds to itself,

I quan això succeeix, s'enllaça,

forming sticky aggregates called amyloid plaques.

formant les plaques amiloides, uns agregats enganxifosos.

How many people here are 40 years old or older?

Quants de vostès tenen 40 anys o més?

You're afraid to admit it now.

Ara no ho volen admetre.

This initial step into the disease,

Aquesta etapa inicial a la malaltia,

this presence of amyloid plaques accumulating,

la presència de plaques d'amiloides que s'acumulen

can already be found in your brains.

ja es poden trobar als seus cervells.

The only way we could be sure of this would be through a PET scan,

La manera de saber-ho del cert seria amb un escàner PET,

because at this point, you are blissfully unaware.

ja que ara mateix en sou feliçment inconscients.

You're not showing any impairments in memory, language, or cognition ...

No mostreu cap deteriorament de memòria, llenguatge o capacitats cognitives...

yet.

encara.

We think it takes at least 15 to 20 years of amyloid plaque accumulation

Creiem que cal una acumulació de plaques d'amiloides de 15 a 20 anys

before it reaches a tipping point,

fins que s'arriba a un punt crític,

then triggering a molecular cascade

es desencadena una cascada mol·lecular

that causes the clinical symptoms of the disease.

que causa els símptomes clínics de la malaltia.

Prior to the tipping point,

Abans d'arribar a aquest punt crític,

your lapses in memory might include things like,

els lapsus de la memòria poden incloure coses com

"Why did I come in this room?"

"Per què he entrat a aquesta habitació?"

or "Oh ... what's his name?"

o "Com es diu aquest?"

or "Where did I put my keys?"

o "On he deixat les claus?"

Now, before you all start freaking out again,

Però abans no s'espantin un altre cop,

because I know half of you did at least one of those in the last 24 hours --

perquè la meitat n'ha fet una d'aquestes en les darreres 24 hores,

these are all normal kinds of forgetting.

són tipus d'oblits normals.

In fact, I would argue that these examples

De fet, diria que aquests exemples

might not even involve your memory,

ni tan sols no impliquen la memòria,

because you didn't pay attention to where you put your keys

ja que no paraven atenció a on deixaven les claus

in the first place.

per començar.

After the tipping point,

Després d'aquest punt crític,

the glitches in memory, language and cognition are different.

els problemes de memòria, llenguatge i cognició són diferents.

Instead of eventually finding your keys in your coat pocket

En comptes d'acabar trobant les claus a la butxaca,

or on the table by the door,

o a la tauleta del rebedor,

you find them in the refrigerator,

les troba a la nevera,

or you find them and you think,

o les troba i pensa,

"What are these for?"

"Per a què serveixen?"

So what happens when amyloid plaques accumulate to this tipping point?

Què passa quan les plaques d'amiloides s'acumulen fins a aquest punt crític?

Our microglia janitor cells become hyper-activated,

Les cèl·lules micròglies netejadores passen a estar hiperactivades,

releasing chemicals that cause inflammation and cellular damage.

i emeten unes substàncies que causen inflamació i dany cel·lular.

We think they might actually start clearing away

Pensem que potser comencen a eliminar

the synapses themselves.

les sinapsis.

A crucial neural transport protein called "tau" becomes hyperphosphorylated

Una proteïna neuronal important, la tau, passa a estar hiperfosforilada

and twists itself into something called "tangles,"

s'entortolliga en un 'cabdell',

which choke off the neurons from the inside.

que escanya les neurones des de dins.

By mid-stage Alzheimer's, we have massive inflammation and tangles

En la fase mitjana de l'Alzheimer tenim una gran inflamació, cabdells,

and all-out war at the synapse

una guerra a la sinapsi

and cell death.

i mort cel·lular.

So if you were a scientist trying to cure this disease,

Si fossin científics intentant curar aquesta malaltia,

at what point would you ideally want to intervene?

quan pensen que seria ideal intervenir?

Many scientists are betting big on the simplest solution:

Molts científics aposten per la solució més senzilla:

keep amyloid plaques from reaching that tipping point,

impedir que les plaques amiloides arribin al punt crític,

which means that drug discovery is largely focused on developing a compound

vol dir que el descobriment de fàrmacs se centra en crear una combinació

that will prevent, eliminate, or reduce amyloid plaque accumulation.

que previngui, elimini o redueixi l'acumulació de plaques amiloides.

So the cure for Alzheimer's will likely be a preventative medicine.

La cura de la malaltia sembla que serà una medicina de prevenció.

We're going to have to take this pill before we reach that tipping point,

Pendrem una pastilla abans d'arribar al punt crític,

before the cascade is triggered,

abans que es desencadeni la cascada,

before we start leaving our keys in the refrigerator.

abans que comencem a deixar les claus a la nevera.

We think this is why, to date, these kinds of drugs have failed

Per això, creiem que els medicaments han fallat

in clinical trials --

en estudis clínics -

not because the science wasn't sound,

no perquè la ciència no sigui correcta,

but because the people in these trials were already symptomatic.

sinó perquè les persones en les proves ja mostraven símptomes.

It was too late.

Ja era massa tard.

Think of amyloid plaques as a lit match.

Pensin en les plaques amiloides com un llumí.

At the tipping point, the match sets fire to the forest.

En el punt crític, el llumí cala foc al bosc.

Once the forest is ablaze,

Quan el bosc està en flames,

it doesn't do any good to blow out the match.

ja no soluciona res apagar el llumí.

You have to blow out the match before the forest catches fire.

S'ha d'apagar abans que el bosc s'incendiï.

Even before scientists sort this out,

Abans que se solucioni això,

this information is actually really good news for us,

aquesta informació ja és una bona notícia

because it turns out that the way we live can influence the accumulation

perquè sembla que la manera de viure pot influenciar l'acumulació

of amyloid plaques.

de plaques amiloides.

And so there are things we can do

Hi ha coses que podem fer

to keep us from reaching that tipping point.

per evitar d'arribar al punt crític.

Let's picture your risk of Alzheimer's as a see-saw scale.

Imaginem el seu risc d'Alzheimer en una balança.

We're going to pile risk factors on one arm,

Apilem els factors de risc en un braç,

and when that arm hits the floor, you are symptomatic

i quan el braç toca a terra, ja són simptomàtics

and diagnosed with Alzheimer's.

i se'ls diagnostica l'Alzheimer.

Let's imagine you're 50 years old.

Imaginem que tenen 50 anys.

You're not a spring chicken anymore,

Ja no són jovenets,

so you've accumulated some amyloid plaques with age.

i amb l'edat ja s'han acumulat les plaques amiloides.

Your scale is tipped a little bit.

La seva balaça s'inclina una mica.

Now let's look at your DNA.

Ara mirem el seu ADN.

We've all inherited our genes from our moms and our dads.

Hem heretat els gens de les nostres mares i pares.

Some of these genes will increase our risk and some will decrease it.

Alguns d'aquests gens augmentaran el risc i d'altres el disminuiran.

If you're like Alice in "Still Alice,"

Si són l'Alice, de "Sempre Alice",

you've inherited a rare genetic mutation that cranks out amyloid beta,

han heretat una mutació genètica rara que produeix beta amiloides sense parar,

and this alone will tip your scale arm to the ground.

i això sol inclinarà la balança cap a terra.

But for most of us, the genes we inherit will only tip the arm a bit.

Per la majoria, els gens que hem heretat només desviaran una mica el braç.

For example, APOE4 is a gene variant that increases amyloid,

Per exemple, l'ApoE4 és un gen variant que augmenta els amiloides,

but you can inherit a copy of APOE4 from mom and dad

però es pot heretar una còpia del ApoE4 de la mare i el pare

and still never get Alzheimer's,

i no desenvolupar mai Alzheimer,

which means that for most of us,

que significa que, per a la majoria,

our DNA alone does not determine whether we get Alzheimer's.

el nostre ADN sol no determina si tindrem la malaltia.

So what does?

I què ho fa, doncs?

We can't do anything about getting older or the genes we've inherited.

No podem impedir fer-nos grans, ni els gens heretats.

So far, we haven't changed our brain's destiny.

Fins ara, no hem canviat el destí del cervell.

What about sleep?

I quan dormim?

In slow-wave deep sleep, our glial cells rinse cerebral spinal fluid

En el son profund, les cèl·lules glials esbandeixen líquid cefalorraquidi

throughout our brains,

per tot el cervell,

clearing away metabolic waste that accumulated in our synapses

netegen residus metabòlics que s'han acumulat a les sinapsis

while we were awake.

quan estàvem desperts.

Deep sleep is like a power cleanse for the brain.

El son profund és una neteja a fons del cervell.

But what happens if you shortchange yourself on sleep?

Què passa si no es dorm el necessari?

Many scientists believe

Molts científics creuen

that poor sleep hygiene might actually be a predictor of Alzheimer's.

que una mala higiene del son podria ser un predictor de l'Alzheimer.

A single night of sleep deprivation leads to an increase in amyloid beta.

Privar el son una sola nit condueix a un augment de beta amiloides.

And amyloid accumulation has been shown to disrupt sleep,

I l'acumulació d'amiloides s'ha demostrat que altera el son,

which in turn causes more amyloid to accumulate.

la qual cosa comporta més acumulació d'amiloides.

And so now we have this positive feedback loop

Ara tenim aquest cercle positiu que es retroalimenta

that's going to accelerate the tipping of that scale.

i accelerarà la desviació de la balança.

What else?

I què més?

Cardiovascular health.

La salut cardiovascular.

High blood pressure, diabetes, obesity, smoking, high cholesterol,

Hipertensió, diabetis, obesitat, fumar i el colesterol alt

have all been shown to increase our risk of developing Alzheimer's.

s'ha demostrat que augmenten el risc de desenvolupar Alzheimer.

Some autopsy studies have shown

Estudis d'autopsia han mostrat

that as many as 80 percent of people with Alzheimer's

que fins a un 80 per cent de gent amb Alzheimer

also had cardiovascular disease.

també tenien problemes cardiovasculars.

Aerobic exercise has been shown in many studies to decrease amyloid beta

Estudis confirmen que l'exercici l'aeròbic redueix la beta amiloide

in animal models of the disease.

en models animals de la malaltia.

So a heart-healthy Mediterranean lifestyle and diet

Un cor sa, una vida i dieta mediterrànies

ajuden a contrarrestar la desviació de la balança.

can help to counter the tipping of this scale.

Hi ha moltes coses que podem fer

So there are many things we can do

to prevent or delay the onset of Alzheimer's.

per prevenir o retardar l'inici de l'Alzheimer.

But let's say you haven't done any of them.

Però diguem que n'heu fet cap.

Imaginem que teniu 65 anys; i teniu Alzheimer a la família.

Let's say you're 65;

there's Alzheimer's in your family, so you've likely inherited a gene or two

Algun gen heu pogut heretar

that tips your scale arm a bit;

i pot desviar la balança una mica,

you've been burning the candle at both ends for years;

fa anys que us excediu;

us encanta la cansalada;

you love bacon;

and you don't run unless someone's chasing you.

i només correu quan us persegueixen.

(Laughter)

(Rialles)

Let's imagine that your amyloid plaques have reached that tipping point.

Imaginem: les plaques amiloides són al punt crític.

Your scale arm has crashed to the floor.

La balança s'ha precipitat al terra

You've tripped the cascade,

S'ha activat la cascada,

setting fire to the forest,

s'ha calat foc al bosc,

causing inflammation, tangles, and cell death.

i causa inflamació, cabdells i mort cel·lular.

You should be symptomatic for Alzheimer's.

Començaríeu amb els símptomes de la malaltia.

You should be having trouble finding words and keys

Tindríeu problemes per trobar les paraules i les claus,

and remembering what I said at the beginning of this talk.

per recordar el què he dit a l'inici de la xerrada.

O podria no ser així.

But you might not be.

Encara podeu fer una cosa per protegir-vos

There's one more thing you can do to protect yourself

from experiencing the symptoms of Alzheimer's,

d'experimentar els símptomes de l'Alzheimer,

even if you have the full-blown disease pathology ablaze in your brain.

encara que la patologia de la malaltia us cremi al cervell.

It has to do with neural plasticity and cognitive reserve.

Té a veure amb la plasticitat neuronal i la reserva cognitiva.

Recordeu, el fet de tenir Alzheimer

Remember, the experience of having Alzheimer's

is ultimately a result of losing synapses.

és el resultat de perdre les sinapsis.

The average brain has over a hundred trillion synapses,

Un cervell normal té més de cent bilions de sinapsis.

which is fantastic; we've got a lot to work with.

Fantàstic. Tenim molt de material.

And this isn't a static number.

No és un nombre estàtic.

We gain and lose synapses all the time,

Guanyem i perdem sinapsis constantment,

through a process called neural plasticity.

a través de la plasticitat neuronal.

Every time we learn something new,

Quan aprenem una cosa nova,

we are creating and strengthening new neural connections,

creem i enfortim noves connexions,

new synapses.

noves sinapsis.

In the Nun Study,

A l'"Estudi de les monges"

678 nuns, all over the age of 75 when the study began,

es va fer el seguiment

de 678 monges de més de 75 anys al principi de l'estudi,

were followed for more than two decades.

durant més de dues dècades.

They were regularly given physical checkups and cognitive tests,

Se'ls feien exàmens físics i tests cognitius regularment,

and when they died, their brains were all donated for autopsy.

i quan morien, es donaven els cervells per a autòpsia.

In some of these brains, scientists discovered something surprising.

En alguns dels cervells es va descobrir una cosa inesperada.

Despite the presence of plaques and tangles and brain shrinkage --

Tot i la presència de plaques, cabdells i reducció del cervell

what appeared to be unquestionable Alzheimer's --

que semblava indubtablement Alzheimer.

the nuns who had belonged to these brains showed no signs

Les monges no havien mostrat senyals

of having the disease while they were alive.

d'Alzheimer en vida.

Com és possible?

How can this be?

We think it's because these nuns had a high level of cognitive reserve,

Creiem que aquestes monges tenien un alt nivell de reserva cognitiva,

which is a way of saying that they had more functional synapses.

que vol dir que tenien més sinapsis funcionals.

People who have more years of formal education,

Les persones amb més anys d'educació formal,

who have a high degree of literacy,

amb un nivell més alt de coneixements,

who engage regularly in mentally stimulating activities,

que fan activitats d'estimulació mental,

all have more cognitive reserve.

tenen més reserva cognitiva.

They have an abundance and a redundancy in neural connections.

Tenen abundància i redundància de connexions neuronals.

Tot i tenir una malaltia com l'Alzheimer,

So even if they have a disease like Alzheimer's

compromising some of their synapses,

que els afecta algunes sinapsis,

they've got many extra backup connections,

tenen connexions extres de reserva,

and this buffers them from noticing that anything is amiss.

que fa que no s'adonin que alguna cosa va malament

Let's imagine a simplified example.

Imaginem un exemple senzill.

Let's say you only know one thing about a subject.

Imaginem que només saben una cosa d'un tema.

Let's say it's about me.

Sobre mi.

You know that Lisa Genova wrote "Still Alice,"

Saben que Lisa Genova va escriure 'Sempre Alice',

and that's the only thing you know about me.

i és l'únic que saben sobre mi.

You have that single neural connection,

Tenen una sola connexió neuronal,

that one synapse.

una sola sinapsis.

Now imagine you have Alzheimer's.

Imaginin que tenen Alzheimer.

You have plaques and tangles and inflammation

Tenen plaques i cabdells i inflamació

and microglia devouring that synapse.

i micròglies que devoren la sinapsi.

Now when someone asks you, "Hey, who wrote 'Still Alice?'"

Si algú els pregunta "Qui ha escrit aquest llibre?"

you can't remember,

No ho recorden

because that synapse is either failing or gone.

perquè la sinapsis falla o ja no hi és.

M'han oblidat per sempre.

You've forgotten me forever.

But what if you had learned more about me?

I si haguessin après més coses sobre mi?

Diguem que han après quatre coses.

Let's say you learned four things about me.

Now imagine you have Alzheimer's,

Ara tenen Alzheimer,

and three of those synapses are damaged or destroyed.

i tres de les sinapsis s'han espatllat o destruit.

You still have a way to detour the wreckage.

Encara tenen una manera per evitar el desastre.

You can still remember my name.

Encara poden recordar el meu nom.

So we can be resilient to the presence of Alzheimer's pathology

Podem ser resistents a la presència de patologia de la malaltia

through the recruitment of yet-undamaged pathways.

si busquem camins encara no fets malbé.

And we create these pathways, this cognitive reserve,

Creem camins, reserva cognitiva,

by learning new things.

aprenent coses noves.

Ideally, we want these new things to be as rich in meaning as possible,

Haurien de ser coses molt riques en significat,

recruiting sight and sound and associations and emotion.

que impliquin vista i oïda, associacions i emocions.

So this really doesn't mean doing crossword puzzles.

No vol dir que fem mots encreuats.

You don't want to simply retrieve information you've already learned,

No volem només recuperar el que ja hem après,

because this is like traveling down old, familiar streets,

perquè això és com viatjar per llocs familiars,

cruising neighborhoods you already know.

com anar per barris que ja coneixem.

You want to pave new neural roads.

S'han d'asfaltar nous camins de neurones

Building an Alzheimer's-resistant brain

Crear un cervell resistent a l'Alzheimer

és aprendre a parlar Italià,

means learning to speak Italian,

meeting new friends,

fer nous amics,

reading a book,

llegir un llibre,

or listening to a great TED Talk.

o escoltar una bona xerrada de TED.

And if, despite all of this, you are someday diagnosed with Alzheimer's,

I si, tot i això, un dia us diagnostiquen Alzheimer,

there are three lessons I've learned from my grandmother

us deixo amb tres lliçons de la meva àvia

and the dozens of people I've come to know living with this disease.

i de molta altra gent que he conegut amb aquesta malaltia.

Diagnosis doesn't mean you're dying tomorrow.

El diagnòstic no vol dir morir-se demà.

Continueu vivint.

Keep living.

You won't lose your emotional memory.

No perdreu la vostra memòria emocional.

You'll still be able to understand love and joy.

Encara podreu entendre l'amor i l'alegria.

You might not remember what I said five minutes ago,

Pot ser que no recordeu el que he dit fa cinc minuts,

but you'll remember how I made you feel.

però recordareu com us he fet sentir.

And you are more than what you can remember.

I, al final, som més del que recordem.

Gràcies.

Thank you.

(Aplaudiments)

(Applause)