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

Prevoditelj: Sanda L Recezent: Tilen Pigac - EFZG

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

Koliko ljudi ovdje bi htjelo doživjeti barem 80 godina?

Yeah.

Da.

I think we all have this hopeful expectation

Mislim da svi imamo ovakvo očekivanje puno nade

of living into old age.

od života u kasnoj dobi.

Let's project out into the future,

Prebacimo se u budućnost,

to your future "you's,"

na vaše buduće 'vi',

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

i zamislimo da svi imamo 85 godina.

Now, everyone look at two people.

Sada neka svatko pogleda dvije osobe.

One of you probably has Alzheimer's disease.

Jedna od vas vjerojatno ima Alzheimerovu bolest.

(Laughter)

(Smijeh)

Alright, alright.

U redu.

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

I možda mislite, "Pa, to neću biti ja."

Then, OK. You are a caregiver.

U redu. Onda ste njegovatelj.

So --

Dakle --

(Laughter)

(Smijeh)

so in some way,

na neki način,

this terrifying disease is likely to affect us all.

ova zastrašujuća bolest vjerojatno će pogoditi sve nas.

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

Dio straha vezanog za Alzheimera proizlazi iz osjećaja

that there's nothing we can do about it.

da ništa ne možemo učiniti po tom pitanju.

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

Unatoč desetljećima istraživanja, još nemamo način utjecaja na bolest

and no cure.

kao ni lijek.

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

Pa ako imamo dovoljno sreće i dugo živimo,

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

čini se da je naš mozak osuđen na Alzheimera.

But maybe it doesn't have to be.

A možda i ne mora biti tako.

What if I told you we could change these statistics,

Što kada bih vam rekla da možemo izmijeniti ovu statistiku,

literally change our brain's destiny,

doslovno promijeniti sudbinu našeg mozga,

without relying on a cure or advancements in medicine?

bez oslanjanja na lijekove ili napretke u medicini?

Let's begin by looking at what we currently understand

Počnimo od promatranja onoga što trenutno razumijemo

about the neuroscience of Alzheimer's.

iz neuroznanosti vezano za Alzheimera.

Here's a picture of two neurons connecting.

Ovo je slika dva povezana neurona.

The point of connection, this space circled in red,

Točka spajanja, ovaj prostor zaokružen crveno,

is called the synapse.

zove se sinapsa.

The synapse is where neurotransmitters are released.

Na sinapsi se oslobađaju neurotransmiteri.

This is where signals are transmitted, where communication happens.

Tu se prenose signali i događa komunikacija.

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

To je mjesto gdje razmišljamo, osjećamo, vidimo, čujemo, žudimo...

and remember.

i pamtimo.

And the synapse is where Alzheimer's happens.

A upravo na sinapsi se javlja Alzheimer.

Let's zoom in on the synapse

Uvećajmo prikaz sinapse

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

i pogledajmo crtani prikaz onoga što se ovdje događa.

During the business of communicating information,

Za vrijeme procesa prijenosa informacija,

in addition to releasing neurotransmitters like glutamate into the synapse,

uz otpuštanje neurotransmitera, poput glutamina, u sinapse,

neurons also release a small peptide called amyloid beta.

neuroni otpuštaju i mali peptid, nazvan beta amiloid.

Normally, amyloid beta is cleared away metabolized by microglia,

Redovno, beta amiloid se čisti i metabolizira od strane mikroglije,

the janitor cells of our brains.

čistača stanica u našem mozgu.

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

Dok se o molekularnim uzrocima Alzheimera još uvijek raspravlja,

most neuroscientists believe that the disease begins

većina neuroznanstvenika vjeruje da bolest počinje

when amyloid beta begins to accumulate.

kada se beta amiloid počinje nakupljati.

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

Previše je otpušteno, ili je nedovoljno pročišćeno,

and the synapse begins to pile up with amyloid beta.

i sinapsa počinje gomilati beta amiloid.

And when this happens, it binds to itself,

I kada se to dogodi, veže ga za sebe,

forming sticky aggregates called amyloid plaques.

stvarajući ljepljive nakupine nazvane amiloidni plakovi.

How many people here are 40 years old or older?

Koliko ljudi ovdje ima 40 godina ili više?

You're afraid to admit it now.

Bojite se to sada priznati.

This initial step into the disease,

Taj početni korak u bolesti,

this presence of amyloid plaques accumulating,

to prisustvo amiloidnih plakova koji se nakupljaju

can already be found in your brains.

već može biti u vašem mozgu.

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

Jedini način da budemo sigurno u to bio bi putem PET pretrage,

because at this point, you are blissfully unaware.

jer u ovom trenutku, vi ste posve nesvjesni toga.

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

Ne pokazujete nikakva oštećenja u pamćenju, jeziku ili spoznaji...

yet.

još.

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

Mislimo da je potrebno najmanje 15 do 20 godina nakupljanja amiloidnog plaka

before it reaches a tipping point,

prije negoli on dosegne prijelomnu točku,

then triggering a molecular cascade

aktivirajući tada molekularni niz

that causes the clinical symptoms of the disease.

koji uzrokuje kliničke simptome bolesti.

Prior to the tipping point,

Prije te prekretnice,

your lapses in memory might include things like,

gubici u vašoj memoriji mogu uključivati stvari poput

"Why did I come in this room?"

"Zašto sam došao/došla u ovu prostoriju?"

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

ili "Oh... kako se on zove?"

or "Where did I put my keys?"

ili "Kamo sam stavio/stavila ključeve?"

Now, before you all start freaking out again,

Prije negoli svi ponovno počnete paničariti,

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

jer znam da je polovina vas učinila bar jedno od ovoga u zadnja 24 sata...

these are all normal kinds of forgetting.

ovo su sve normalni oblici zaboravljanja.

In fact, I would argue that these examples

Zapravo, rekla bih da ovi primjeri

might not even involve your memory,

ne moraju čak ni uključivati vašu memoriju,

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

jer niste obraćali pažnju na to gdje ste ostavili ključeve

in the first place.

na početku.

After the tipping point,

Nakon prijelomne točke,

the glitches in memory, language and cognition are different.

zastoji u memoriji, jeziku i spoznaji su različiti.

Instead of eventually finding your keys in your coat pocket

Umjesto da kasnije nađete ključeve u džepu svog kaputa,

or on the table by the door,

ili na stoliću pored vrata,

you find them in the refrigerator,

nađete ih u hladnjaku,

or you find them and you think,

ili ih nađete i pomislite

"What are these for?"

"Čemu ovo služi?"

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

Što se, dakle, događa kada se amiloidni plakovi nakupe do te prijelomne točke?

Our microglia janitor cells become hyper-activated,

Naše mikroglija stanice, čistači, postaju prekomjerno aktivne,

releasing chemicals that cause inflammation and cellular damage.

otpuštajući tvari koje uzokuju upalu i stanično oštećenje.

We think they might actually start clearing away

Mislimo da možda počinju sa čišćenjem

the synapses themselves.

i samih sinapsi.

A crucial neural transport protein called "tau" becomes hyperphosphorylated

Protein ključan za neuronski prijenos, zvan 'tau', postaje hiperfosforiliran

and twists itself into something called "tangles,"

i uvija se u nešto slično spirali, čvorovima,

which choke off the neurons from the inside.

što pritišće neurone iznutra.

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

U srednjoj fazi Alzheimera imamo brojne upale i čvorove,

and all-out war at the synapse

sveobuhvatni rat na sinapsi

and cell death.

te odumiranje stanice.

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

Dakle, ako biste bili znanstvenik koji pokušava izliječiti ovu bolest,

at what point would you ideally want to intervene?

na kojem točno dijelu biste intervenirali?

Many scientists are betting big on the simplest solution:

Mnogi znanstvenici klade se u najjednostavnije rješenje:

keep amyloid plaques from reaching that tipping point,

spriječiti amiloidne plakove da dosegnu prijelomnu točku,

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

što znači da je pronalazak lijeka najviše fokusiran na razvoj sastojka

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

koji će spriječiti, odstraniti ili smanjiti nakupljanje amiloidnog plaka.

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

Stoga će lijek za Alzheimerovu bolest vjerojatno biti preventivna medicina.

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

Morat ćemo uzeti tabletu prije nego dosegnemo tu prijelomnu točku,

before the cascade is triggered,

prije nego se molekularni niz aktivira,

before we start leaving our keys in the refrigerator.

prije negoli počnemo ostavljati svoje ključeve u hladnjaku.

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

Mislimo da zbog toga, do danas, ovakvi lijekovi nisu učinkoviti

in clinical trials --

u kliničkim pokusima,

not because the science wasn't sound,

ne zato što znanost nije na dobrom putu,

but because the people in these trials were already symptomatic.

već stoga što su ljudi u tim pokusima već imali simptome.

It was too late.

Bilo je prekasno.

Think of amyloid plaques as a lit match.

Zamislite amiloidni plak kao šibicu.

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

Na prijelomnoj točki, šibica prouzrokuje požar u šumi.

Once the forest is ablaze,

Jednom kada je šuma u plamenu,

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

nema nikakve koristi od gašenja šibice.

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

Šibicu moraš ugasiti prije negoli šuma počne gorjeti.

Even before scientists sort this out,

Čak i prije negoli znanstvenici ovo riješe,

this information is actually really good news for us,

ova informacija je zapravo vrlo dobra vijest za nas,

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

jer se ispostavlja da način na koji živimo može utjecati na nakupljanje

of amyloid plaques.

amiloidnih plakova.

And so there are things we can do

I stoga možemo nešto učiniti

to keep us from reaching that tipping point.

kako ne bismo dosegnuli tu prijelomnu točku.

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

Predočimo vaš rizik od Alzheimera kao na klackalici.

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

Na jednoj ruci skupljat ćemo rizične čimbenike,

and when that arm hits the floor, you are symptomatic

i kada ta ruka udari u pod, imate simptome

and diagnosed with Alzheimer's.

i dijagnozu Alzheimerove bolesti.

Let's imagine you're 50 years old.

Zamislimo da imate 50 godina.

You're not a spring chicken anymore,

Niste više u cvijetu mladosti,

so you've accumulated some amyloid plaques with age.

i s godinama ste nakupili određenu količinu amiloidnih plakova.

Your scale is tipped a little bit.

Vaša klackalica se malo nagnula.

Now let's look at your DNA.

Pogledajmo sada vašu DNK.

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

Svi smo mi naslijedili gene od svojih majki i očeva.

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

Neki od tih gena povećat će naš rizik, a neki smanjiti.

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

Ako ste poput Alice u filmu 'I dalje Alice',

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

naslijedili ste rijetku genetsku mutaciju koja proizvodi beta amiloid

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

i samo to će već nagnuti vašu klackalicu do poda.

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

No za većinu nas, geni koje nasljeđujemo samo će malo nagnuti ruku na tu stranu.

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

Na primjer, APOE4 je varijanta gena koja povećava amiloid,

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

no možete naslijediti APOE4 od mame ili tate,

and still never get Alzheimer's,

a ipak ne dobiti Alzheimera,

which means that for most of us,

što znači da za većinu nas,

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

sama naša DNK ne određuje hoćemo li dobiti Alzheimera.

So what does?

Što onda određuje?

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

Ne možemo ništa učiniti u vezi starenja, ili gena koje nasljeđujemo.

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

Za sada nismo izmijenili sudbinu našeg mozga.

What about sleep?

Što je sa spavanjem?

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

Kod sporih valova u dubokom snu, naše glijalne stanice

throughout our brains,

čiste cerebralnu spinalnu tekućinu po čitavom mozgu

clearing away metabolic waste that accumulated in our synapses

odstranjujući metabolički otpad koji se nakupljao u našim sinapsama

while we were awake.

dok smo bili budni.

Deep sleep is like a power cleanse for the brain.

Duboki san je za mozak poput moćnog čistača.

But what happens if you shortchange yourself on sleep?

No, što se događa ako si uskraćujete san?

Many scientists believe

Mnogi znanstvenici vjeruju

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

da loša higijena spavanja zapravo može predskazati Alzheimera.

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

Samo jedna noć uskraćivanja sna dovodi do povećanja beta amiloida.

And amyloid accumulation has been shown to disrupt sleep,

A pokazalo se kako nakupljanje amiloida ometa spavanje,

which in turn causes more amyloid to accumulate.

što zauzvrat uzrokuje više amiloida koji se može nakupljati.

And so now we have this positive feedback loop

I tako sada imamo tu pozitivnu povratnu vezu

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

koja će ubrzati prevagu.

What else?

Što još?

Cardiovascular health.

Zdravlje srca i krvnih žila.

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

Visoki krvni tlak, dijabetes, pretilost, pušenje, visoki kolesterol,

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

svi su ukazali na povećanje našeg rizika od razvoja Alzheimera.

Some autopsy studies have shown

Neke studije s obdukcija pokazale su

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

da čak 80% ljudi koji su bolovali od Alzheimera,

also had cardiovascular disease.

imali su i neku bolest krvožilnog sustava.

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

Aerobna vježba pokazala se u mnogim studijama da smanjuje beta amiloid

in animal models of the disease.

na životinjskim modelima bolesti.

So a heart-healthy Mediterranean lifestyle and diet

Dakle, mediteranski način života i prehrane, dobar za srce

can help to counter the tipping of this scale.

može pomoći i prevagnuti na suprotnu stranu.

So there are many things we can do

Dakle, ima mnogo toga što možemo učiniti

to prevent or delay the onset of Alzheimer's.

da spriječimo ili odgodimo početak Alzheimera.

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

No, recimo da niste učinili ništa od toga.

Let's say you're 65;

Pretpostavimo da imate 65 godina;

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

Alzheimerova bolest postoji u vašoj obitelji, i vjerojatno ste naslijedili koji gen,

that tips your scale arm a bit;

što čini malu prevagu na ovu stranu

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

Godinama ste se naprezali,

you love bacon;

volite slaninu,

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

i ne trčite osim ako vas netko ne lovi.

(Laughter)

(Smijeh)

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

Zamislimo da su vaši amiloidni plakovi dosegnuli prijelomnu točku.

Your scale arm has crashed to the floor.

Vaša ruka prevagom je tresnula o pod,

You've tripped the cascade,

aktivirali ste molekularni niz,

setting fire to the forest,

zapalili vatru u šumi,

causing inflammation, tangles, and cell death.

što je dovelo do izgaranja, čvorova te odumiranja stanica.

You should be symptomatic for Alzheimer's.

Trebali biste imati simptome Alzheimera.

You should be having trouble finding words and keys

Trebalo bi vam biti teško pronaći ispravnu riječ, ključeve,

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

ili zapamtiti što sam rekla na početku ovog govora.

But you might not be.

No, možda i nije.

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

Ima još nešto što možete učiniti kako biste se zaštitili

from experiencing the symptoms of Alzheimer's,

od proživljavanja simptoma Alzheimera,

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

čak i ako u svom mozgu imate patologiju bolesti u punom zamahu.

It has to do with neural plasticity and cognitive reserve.

To je vezano za neuralnu plastičnost i kognitivne rezerve.

Remember, the experience of having Alzheimer's

Zapamtite, iskustvo koje imate bolujući od Alzheimera

is ultimately a result of losing synapses.

rezultat je gubitka sinapsi.

The average brain has over a hundred trillion synapses,

Prosječan mozak ima preko stotinu trilijuna sinapsi,

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

što je fantastično, imamo mnogo toga s čime možemo raditi.

And this isn't a static number.

I to nije samo statičan broj.

We gain and lose synapses all the time,

Mi neprestano stječemo i gubimo sinapse,

through a process called neural plasticity.

kroz proces koji se zove neuralna plastičnost.

Every time we learn something new,

Svaki puta kada naučimo nešto novo,

we are creating and strengthening new neural connections,

stvaramo i jačamo nove neuralne veze,

new synapses.

nove sinapse.

In the Nun Study,

U jednoj studiji o redovnicama,

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

njih 678, sve su bile stare preko 75 godina kada je studija počela,

were followed for more than two decades.

i promatrane su preko dva desetljeća.

They were regularly given physical checkups and cognitive tests,

Redovito su bile podvrgnute sistematskim pregledima i kognitivnim testovima,

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

i kada su umrle, mozgovi svih njih bili su donirani za potrebe obdukcije.

In some of these brains, scientists discovered something surprising.

U nekim od tih mozgova, znanstvenici su otkrili nešto iznenađujuće.

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

Unatoč postojanju plakova, čvorova, te smanjivanju mozga,

what appeared to be unquestionable Alzheimer's --

što je neupitno ukazivalo na Alzheimera,

the nuns who had belonged to these brains showed no signs

mozgovi tih redovnica nisu pokazivali znakove

of having the disease while they were alive.

postojanja bolesti dok su bile žive.

How can this be?

Kako je to moguće?

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

Mislimo da je to stoga što su imale visoki stupanj kognitivne rezerve,

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

što bi značilo da su imale funkcionalnije sinapse.

People who have more years of formal education,

Osobe koje imaju više godina formalnog obrazovanja,

who have a high degree of literacy,

koje imaju visok stupanj pismenosti,

who engage regularly in mentally stimulating activities,

koje su redovito zaokupljene mentalno stimulativnim aktivnostima,

all have more cognitive reserve.

sve te osobe imaju veće kognitivne rezerve.

They have an abundance and a redundancy in neural connections.

One imaju obilje i višak neuralnih veza.

So even if they have a disease like Alzheimer's

Pa čak i ako imaju bolest poput Alzheimera,

compromising some of their synapses,

koja ugrožava neke od njihovih sinapsi,

they've got many extra backup connections,

one imaju i još mnogo dodatnih rezervnih veza,

and this buffers them from noticing that anything is amiss.

koje ublažavaju dojam da nešto nije u redu.

Let's imagine a simplified example.

Zamislimo pojednostavljeni primjer.

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

Recimo da znate samo jedan podatak o nekoj temi.

Let's say it's about me.

Recimo da se radi o meni.

You know that Lisa Genova wrote "Still Alice,"

Znate da je Lisa Genova napisala 'I dalje Alice',

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

i to je jedino što znate o meni.

You have that single neural connection,

Imate tu jedinu neuralnu vezu,

that one synapse.

tu jednu sinapsu.

Now imagine you have Alzheimer's.

Sada zamislite da bolujete od Alzheimera.

You have plaques and tangles and inflammation

Imate plakove, čvorove i upale

and microglia devouring that synapse.

te mikrogliju koja guta tu sinapsu.

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

I sada, kada vas netko pita, "Hej, tko je napisao 'I dalje Alice?'"

you can't remember,

vi se ne možete sjetiti,

because that synapse is either failing or gone.

jer je ta sinapsa ili zakazala ili odumrla.

You've forgotten me forever.

Zauvijek ste me zaboravili.

But what if you had learned more about me?

Ali što ako ste o meni znali nešto više?

Let's say you learned four things about me.

Recimo da ste naučili četiri stvari o meni.

Now imagine you have Alzheimer's,

Sada zamislite da bolujete od Alzheimera,

and three of those synapses are damaged or destroyed.

i tri od tih sinapsi su oštećene ili uništene.

You still have a way to detour the wreckage.

I dalje imate način da zaobiđete prepreku.

You can still remember my name.

I dalje se sjećate mog imena.

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

Znači, možemo biti prilagodljivi na prisustvo patologije Alzheimera

through the recruitment of yet-undamaged pathways.

aktiviranjem još neoštećenih puteva.

And we create these pathways, this cognitive reserve,

I mi stvaramo te puteve, te kognitivne rezerve,

by learning new things.

kada učimo nove stvari.

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

U idealnom slučaju, želimo da te nove stvari budu što bogatije značenjem,

recruiting sight and sound and associations and emotion.

aktivirajući vid, zvuk, asocijacije i emocije.

So this really doesn't mean doing crossword puzzles.

Dakle, to zaista ne znači rješavanje križaljki.

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

Ne želite samo izvlačiti informacije koje ste već naučili,

because this is like traveling down old, familiar streets,

jer to je poput vožnje starim, poznatim cestama,

cruising neighborhoods you already know.

kružeći četvrtima koja već poznajete.

You want to pave new neural roads.

Vi želite stvoriti nove neuralne puteve,

Building an Alzheimer's-resistant brain

stvarati mozak koji će biti otporan na Alzheimera

means learning to speak Italian,

znači naučiti govoriti talijanski,

meeting new friends,

steći nove prijatelje,

reading a book,

pročitati knjigu,

or listening to a great TED Talk.

ili odslušati neki odličan TED govor.

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

I ako unatoč svemu ovome, jednog dana dobijete dijagnozu Alzheimera,

there are three lessons I've learned from my grandmother

tri su lekcije koje sam naučila od svoje bake

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

i deseci ljudi koje sam upoznala i koji žive s ovom bolešću.

Diagnosis doesn't mean you're dying tomorrow.

Dijagnoza ne znači da ćete sutra umrijeti.

Keep living.

Nastavite živjeti.

You won't lose your emotional memory.

Nećete izgubiti svoju emocionalnu memoriju.

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

I dalje ćete moći razumjeti ljubav i radost.

You might not remember what I said five minutes ago,

Možda se nećete sjećati što sam rekla prije pet minuta,

but you'll remember how I made you feel.

ali ćete se sjećati kakav osjećaj sam izazvala u vama.

And you are more than what you can remember.

I vi ste mnogo više od onoga čega se možete sjetiti.

Thank you.

Hvala vam.

(Applause)

(Pljesak)