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

Translator: Ana Rozados Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

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

A canta xente de aquí lle gustaría vivir ata ter polo menos 80 anos?

Yeah.

Si.

I think we all have this hopeful expectation

Penso que todos temos esta esperanza

of living into old age.

de vivir ata a vellez.

Let's project out into the future,

Imos proxectarnos no futuro,

to your future "you's,"

nos "vostedes" futuros,

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

e imos imaxinar que todos temos 85 anos.

Now, everyone look at two people.

Agora mírense uns aos outros.

One of you probably has Alzheimer's disease.

Un de vostedes probablemente terá alzhéimer.

(Laughter)

(Risos)

Alright, alright.

Vale, vale.

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

E se cadra están a pensar: "Ben, non serei eu".

Then, OK. You are a caregiver.

Entón é vostede un coidador.

So --

Así que...

(Laughter)

(Risos)

so in some way,

dalgún xeito,

this terrifying disease is likely to affect us all.

esta terrible doenza é probable que nos afecte a todos.

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

Parte do medo que rodea o alzhéimer provén da idea

that there's nothing we can do about it.

de que non hai nada que poidamos facer.

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

Malia décadas de investigación, aínda non temos tratamento contra esta doenza

and no cure.

nin curación.

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

Se temos sorte dabondo para vivirmos moitos anos,

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

parece que o alzhéimer será o destino do noso cerebro.

But maybe it doesn't have to be.

Mais se cadra non ten por que ser.

What if I told you we could change these statistics,

E se lles digo que podemos mudar as estatísticas,

literally change our brain's destiny,

literalmente mudar o destino do noso cerebro,

without relying on a cure or advancements in medicine?

sen depender dunha curación ou dos avances da medicina?

Let's begin by looking at what we currently understand

Comecemos por revisar o que se sabe actualmente

about the neuroscience of Alzheimer's.

sobre a neurociencia do alzhéimer.

Here's a picture of two neurons connecting.

Aquí teñen un debuxo de dúas neuronas conectadas.

The point of connection, this space circled in red,

O punto de conexión, este espazo cun círculo vermello,

is called the synapse.

chámase sinapse.

The synapse is where neurotransmitters are released.

A sinapse é onde se liberan os neurotransmisores.

This is where signals are transmitted, where communication happens.

Aquí é onde se transmiten os sinais, onde se produce a comunicación.

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

Aquí é onde pensamos, sentimos, vemos, oímos, desexamos...

and remember.

e lembramos.

And the synapse is where Alzheimer's happens.

E na sinapse é onde se produce o alzhéimer.

Let's zoom in on the synapse

Imos ampliar a sinapse

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

e mirar unha representación con debuxos do que acontece.

During the business of communicating information,

Durante o proceso de comunicación da información,

in addition to releasing neurotransmitters like glutamate into the synapse,

ademais de liberar neurotransmisores coma o glutamato na sinapse,

neurons also release a small peptide called amyloid beta.

as neuronas tamén liberan un pequeno péptido chamado amiloide beta.

Normally, amyloid beta is cleared away metabolized by microglia,

Normalmente o amiloide beta elimínase metabolizado polas microglías,

the janitor cells of our brains.

as células conserxe do noso cerebro.

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

Mentres que aínda están en debate as causas moleculares do alzhéimer,

most neuroscientists believe that the disease begins

a maioría dos neurocientíficos cre que a doenza comeza

when amyloid beta begins to accumulate.

cando os amiloides beta empezan a se acumularen.

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

Libéranse demasiados ou non se eliminan os suficientes,

and the synapse begins to pile up with amyloid beta.

e a sinapse comeza a acumular amiloides beta.

And when this happens, it binds to itself,

Cando acontece isto, únense a si mesmos,

forming sticky aggregates called amyloid plaques.

formando adherencias chamadas placas amiloides.

How many people here are 40 years old or older?

Canta xente de aquí ten 40 anos ou máis?

You're afraid to admit it now.

Teñen medo de recoñecelo agora.

This initial step into the disease,

Este paso inicial da doenza,

this presence of amyloid plaques accumulating,

esta presenza de placas amiloides que se acumulan,

can already be found in your brains.

xa se pode atopar nos seus cerebros.

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

O único xeito de estarmos seguros disto sería facer un escáner TEP,

because at this point, you are blissfully unaware.

porque neste momento vivimos nunha feliz ignorancia.

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

Non amosamos ningunha deterioración da memoria, linguaxe ou coñecemento...

yet.

aínda.

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

Pensamos que se tarda entre 15 e 20 anos en acumular placa amiloide

before it reaches a tipping point,

antes de que alcance o punto crítico,

then triggering a molecular cascade

logo desencadea un cadoiro molecular

that causes the clinical symptoms of the disease.

que provoca os síntomas da doenza.

Prior to the tipping point,

Antes do punto crítico,

your lapses in memory might include things like,

os lapsos da memoria poden incluír cousas coma:

"Why did I come in this room?"

"Por que entrei neste cuarto?"

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

ou "Oh... Como se chama?"

or "Where did I put my keys?"

ou "Onde botei as chaves?"

Now, before you all start freaking out again,

Agora, antes de que todos se asusten de novo

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

(porque sei que polo menos a metade tivo algún destes nas últimas 24 horas)

these are all normal kinds of forgetting.

trátase de esquecementos normais.

In fact, I would argue that these examples

De feito, eu sostería que estes exemplos

might not even involve your memory,

poderían non involucrar a súa memoria,

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

porque non prestou atención a onde botou as chaves

in the first place.

en primeiro lugar.

After the tipping point,

Tras o punto crítico,

the glitches in memory, language and cognition are different.

os problemas de memoria, linguaxe e coñecemento son diferentes.

Instead of eventually finding your keys in your coat pocket

No canto de atopar as chaves no peto do abrigo

or on the table by the door,

ou na mesa que está onda a porta,

you find them in the refrigerator,

atópaas no frigorífico,

or you find them and you think,

ou atópaas e pensa:

"What are these for?"

"Isto para que é?"

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

Que acontece cando as placas amiloides se acumulan ata este punto crítico?

Our microglia janitor cells become hyper-activated,

As nosas células conserxe microglías tórnanse hiperactivas

releasing chemicals that cause inflammation and cellular damage.

e liberan substancias químicas que causan dano celular e inflamación.

We think they might actually start clearing away

Pensamos que poderían en realidade comezar a eliminar

the synapses themselves.

a sinapses elas mesmas.

A crucial neural transport protein called "tau" becomes hyperphosphorylated

Unha proteína neurotransportadora crucial denominada "tau" vólvese hiperfosforilada

and twists itself into something called "tangles,"

e retórcese en vultos denominados "nobelos",

which choke off the neurons from the inside.

que cortan as neuronas desde o interior.

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

Na fase intermedia do alzhéimer, temos inflamación masiva e nobelos,

and all-out war at the synapse

unha guerra sen cuartel na sinapse

and cell death.

e morte celular.

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

Se vostede fose un científico que tenta curar esta doenza,

at what point would you ideally want to intervene?

cal sería o punto ideal no que desexaría intervir?

Many scientists are betting big on the simplest solution:

Moitos científicos están apostando alto pola solución máis simple:

keep amyloid plaques from reaching that tipping point,

manter as placas amiloides lonxe de alcanzar o punto crítico,

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

polo que a investigación farmacéutica céntrase en desenvolver un composto

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

que evite, elimine ou reduza a acumulación de placa amiloide.

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

Así que a cura do alzhéimer probablemente será a medicina preventiva.

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

Imos ter que tomar esta pastilla antes de alcanzar o punto crítico,

before the cascade is triggered,

antes de que se desencadee o cadoiro,

before we start leaving our keys in the refrigerator.

antes de que empecemos a deixar as chaves no frigorífico.

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

Pensamos que esta é a razón de que, ata agora, fallasen este tipo de fármacos

in clinical trials --

en ensaios clínicos...

not because the science wasn't sound,

non por non contar cunha ciencia sólida

but because the people in these trials were already symptomatic.

senón porque as persoas destes ensaios xa manifestaban síntomas.

It was too late.

Era demasiado tarde.

Think of amyloid plaques as a lit match.

Imaxinen que as placas amiloides son mistos acendidos.

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

No punto crítico, o misto incendia o monte.

Once the forest is ablaze,

Cando o monte está a arder,

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

non serve de nada soprarlle ao misto.

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

Hai que soprarlle ao misto antes de que o monte se incendie.

Even before scientists sort this out,

Incluso antes de que os científicos o solucionen,

this information is actually really good news for us,

esta información en realidade son boas novas para nós,

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

porque resulta que o noso xeito de vivir pode ter influencia sobre a acumulación

of amyloid plaques.

de placas amiloides.

And so there are things we can do

Así que podemos facer algo

to keep us from reaching that tipping point.

para estarmos lonxe de alcanzar o punto crítico.

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

Poñamos o risco de que sufran alzhéimer coma nunha balanza.

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

Imos acumular factores de risco nun brazo

and when that arm hits the floor, you are symptomatic

e, cando ese brazo choque no chan, vostede ten síntomas

and diagnosed with Alzheimer's.

e diagnostícanlle alzhéimer.

Let's imagine you're 50 years old.

Imaxine que ten 50 anos.

You're not a spring chicken anymore,

xa non é un rapaz,

so you've accumulated some amyloid plaques with age.

así que leva acumuladas placas amiloides coa idade.

Your scale is tipped a little bit.

A súa balanza inclínase un pouquiño.

Now let's look at your DNA.

Agora observemos o seu ADN.

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

Herdamos os nosos xenes das nosas nais e dos nosos pais.

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

Algúns destes xenes aumentarán o risco e outros diminuirano.

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

Se vostede é como Alice en Still Alice,

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

herdou unha mutación xenética rara que produce amiloides beta,

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

e isto só inclinará a súa balanza ata o chan.

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

Pero na maioría de nós, os xenes herdados só inclinarán un pouco o brazo.

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

Por exemplo, o APOE4 é unha variante xenética que aumenta o amiloide,

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

pero pódese herdar unha copia da APOE4 da nai e do pai

and still never get Alzheimer's,

e nunca ter alzhéimer,

which means that for most of us,

o que significa que na maioría de nós

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

o noso ADN só non determina se imos padecer alzhéimer.

So what does?

Entón que o determina?

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

Non podemos evitar envellecer nin os xenes que herdamos.

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

Ata agora, non cambiamos o destino do noso cerebro.

What about sleep?

Que pasa co sono?

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

No sono profundo, as nosas células gliais limpan o fluído espinal cerebral

throughout our brains,

por todo o cerebro,

clearing away metabolic waste that accumulated in our synapses

eliminando os refugallos metabólicos que se acumulan nas nosas sinapses

while we were awake.

mentres estamos espertos.

Deep sleep is like a power cleanse for the brain.

O sono profundo é coma un potente limpador para o cerebro.

But what happens if you shortchange yourself on sleep?

Pero que ocorre se non se aproveita ben o sono?

Many scientists believe

Moitos científicos cren

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

que unha mala hixiene de sono pode realmente predicir o alzhéimer.

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

Unha soa noite de privación do sono provoca un incremento de amiloides beta.

And amyloid accumulation has been shown to disrupt sleep,

E demostrouse que a acumulación de amiloides altera o sono,

which in turn causes more amyloid to accumulate.

que á súa vez provoca máis acumulación de amiloides.

And so now we have this positive feedback loop

Entón agora temos esta retroalimentación positiva

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

que vai acelerar a inclinación da balanza.

What else?

Que máis?

Cardiovascular health.

Saúde cardiovascular.

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

Tensión arterial alta, diabetes, obesidade, tabaquismo e colesterol alto...

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

está demostrado que incrementan o noso risco de padecer alzhéimer.

Some autopsy studies have shown

Algunhas autopsias demostraron

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

que un 80 por cento de persoas con alzhéimer

also had cardiovascular disease.

tamén ten trastornos cardiovasculares.

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

Moitos estudos demostraron que o exercicio aeróbico diminúe os amiloides beta

in animal models of the disease.

en modelos animais da doenza.

So a heart-healthy Mediterranean lifestyle and diet

Así que o estilo de vida e a dieta mediterránea, saudable para o corazón,

can help to counter the tipping of this scale.

poden axudar a contrarrestar a inclinación da balanza.

So there are many things we can do

Así que hai moitas cousas que podemos facer

to prevent or delay the onset of Alzheimer's.

para previr ou atrasar a aparición do alzhéimer.

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

Pero poñamos que non fixeron nada diso.

Let's say you're 65;

Digamos que teñen 65 anos;

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

hai alzhéimer na súa familia, así que é probable que herdasen un xene ou dous

that tips your scale arm a bit;

que inclina o brazo da balanza un pouco;

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

estiveron anos queimando a candea polos dous extremos;

you love bacon;

encántalles o touciño;

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

e non corren a non ser que alguén os persiga.

(Laughter)

(Risos)

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

Imaxinemos que as súas placas amiloides alcanzaron o punto crítico.

Your scale arm has crashed to the floor.

O brazo da balanza chegou ata o chan.

You've tripped the cascade,

Desencadeouse o cadoiro,

setting fire to the forest,

prendeu lume no monte,

causing inflammation, tangles, and cell death.

provocando inflamación, nobelos e morte celular.

You should be symptomatic for Alzheimer's.

Deben ter síntomas de alzhéimer.

You should be having trouble finding words and keys

Deben ter problemas para atopar palabras e as chaves

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

e lembrar o que dixen ao comezo desta charla.

But you might not be.

Pero poida que non.

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

Hai unha cousa máis que poden facer para se protexer

from experiencing the symptoms of Alzheimer's,

de experimentar os síntomas do alzhéimer,

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

mesmo se teñen toda a patoloxía da doenza desencadeada no seu cerebro.

It has to do with neural plasticity and cognitive reserve.

Ten que ver coa neuroplasticidade e a reserva cognitiva.

Remember, the experience of having Alzheimer's

Lembren que a experiencia de padecer alzhéimer

is ultimately a result of losing synapses.

é o resultado final da perda de sinapses.

The average brain has over a hundred trillion synapses,

Un cerebro medio ten máis de cen billóns de sinapses,

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

o que é fantástico; temos moito co que traballar.

And this isn't a static number.

E non se trata dun número estático.

We gain and lose synapses all the time,

Gañamos e perdemos sinapses continuamente,

through a process called neural plasticity.

a través dun proceso denominado neuroplasticidade.

Every time we learn something new,

Cada vez que aprendemos algo novo,

we are creating and strengthening new neural connections,

estamos a crear e fortalecer novas conexións neurais,

new synapses.

novas sinapses.

In the Nun Study,

Nun estudo con monxas,

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

678 monxas, todas de máis de 75 anos cando comezou o estudo,

were followed for more than two decades.

sometéronse a un seguimento durante máis de dúas décadas.

They were regularly given physical checkups and cognitive tests,

Facíanlles regularmente revisións físicas e tests cognitivos,

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

e cando faleceron, doaron os cerebros para realizar unha autopsia.

In some of these brains, scientists discovered something surprising.

Nalgúns destes cerebros, os científicos descubriron algo sorprendente.

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

Malia a presenza de placas, nobelos e perda cerebral,

what appeared to be unquestionable Alzheimer's --

o que semellaba ser alzhéimer de xeito incuestionable,

the nuns who had belonged to these brains showed no signs

as monxas ás que pertencían eses cerebros non manifestaban signos

of having the disease while they were alive.

de padecer a doenza mentres estaban vivas.

How can this be?

Como é posible?

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

Pensamos que se debe a que estas monxas tiñan un alto nivel de reserva cognitiva,

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

que é un xeito de dicir que tiñan máis sinapses funcionais.

People who have more years of formal education,

As persoas que teñen máis anos de formación académica,

who have a high degree of literacy,

que teñen un alto grao de alfabetización,

who engage regularly in mentally stimulating activities,

que se implican habitualmente en actividades que estimulan a mente,

all have more cognitive reserve.

dispoñen de máis reserva cognitiva.

They have an abundance and a redundancy in neural connections.

Teñen unha abundancia e redundancia de conexións neurais.

So even if they have a disease like Alzheimer's

Así que aínda que teñan unha doenza coma o alzhéimer,

compromising some of their synapses,

que afecta algunhas das súas sinapses,

they've got many extra backup connections,

teñen moitas conexións extra de reserva,

and this buffers them from noticing that anything is amiss.

e isto protéxeas de notar que existe unha perda.

Let's imagine a simplified example.

Imaxinemos un exemplo simplificado.

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

Poñamos que só saben unha cousa sobre un tema.

Let's say it's about me.

Digamos que é sobre min.

You know that Lisa Genova wrote "Still Alice,"

Saben que Lisa Genova escribiu Still Alice,

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

e iso é o único que saben sobre min.

You have that single neural connection,

Teñen esa única conexión neural,

that one synapse.

esa única sinapse.

Now imagine you have Alzheimer's.

Agora imaxinen que padecen Alzheimer.

You have plaques and tangles and inflammation

Teñen placas, nobelos, inflamación

and microglia devouring that synapse.

e as microglías que devoran esa sinapse.

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

Agora cando alguén lles pregunta se saben quen escribiu Still Alice

you can't remember,

non se lembran,

because that synapse is either failing or gone.

porque esa sinapse está a fallar ou desapareceu.

You've forgotten me forever.

Esquecéronme para sempre.

But what if you had learned more about me?

Pero que acontece se teñen máis información sobre min?

Let's say you learned four things about me.

Digamos que aprenderon catro cousas de min.

Now imagine you have Alzheimer's,

Imaxinemos que padecen alzhéimer,

and three of those synapses are damaged or destroyed.

e tres desas sinapses están deterioradas ou destruídas.

You still have a way to detour the wreckage.

Aínda teñen un xeito de desviar o desastre.

You can still remember my name.

Aínda poden lembrar o meu nome.

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

Así que podemos ser resilientes á presenza da enfermidade de alzhéimer

through the recruitment of yet-undamaged pathways.

a través da captación de vías aínda non deterioradas.

And we create these pathways, this cognitive reserve,

E creamos estas vías, esta reserva cognitiva,

by learning new things.

aprendendo cousas novas.

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

O ideal é que estas cousas novas sexan tan ricas en significado como for posible,

recruiting sight and sound and associations and emotion.

captando vista e oído, así como asociacións e emoción.

So this really doesn't mean doing crossword puzzles.

Así que isto en realidade non significa facer encrucillados.

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

Non se trata de simplemente recuperar información que xa aprenderon,

because this is like traveling down old, familiar streets,

porque iso é como viaxar ao pasado, a rúas familiares,

cruising neighborhoods you already know.

atopándose con veciños que xa coñecen.

You want to pave new neural roads.

Trátase de asfaltar novas vías neurais.

Building an Alzheimer's-resistant brain

Crear un cerebro resistente ao alzhéimer

means learning to speak Italian,

significa aprender a falar italiano,

meeting new friends,

coñecer novos amigos,

reading a book,

ler un libro

or listening to a great TED Talk.

ou escoitar unha gran charla TED.

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

E se, malia todo isto, algún día lle diagnostican alzhéimer,

there are three lessons I've learned from my grandmother

hai tres leccións que aprendín da miña avoa

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

e da ducia de persoas que coñecín que viven con esta doenza.

Diagnosis doesn't mean you're dying tomorrow.

O diagnóstico non significa que vaian morrer mañá.

Keep living.

Sigan vivindo.

You won't lose your emotional memory.

Non han perder a súa memoria emocional.

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

Aínda poderán entender o amor e a alegría.

You might not remember what I said five minutes ago,

Poden non lembrar o que dixeron hai cinco minutos,

but you'll remember how I made you feel.

mais lembrarán como os fixo sentir.

And you are more than what you can remember.

E vostedes son máis do que lembran.

Thank you.

Grazas.

(Applause)

(Aplausos)