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

Prevodilac: Mile Živković Lektor: Milenka Okuka

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

Koliko vas koji ste ovde bi volelo da doživi bar 80 godina?

Yeah.

Da.

I think we all have this hopeful expectation

Mislim da svi mi gajimo tu nadu

of living into old age.

da ćemo doživeti duboku starost.

Let's project out into the future,

Hajde da odemo u budućnost,

to your future "you's,"

gde se nalazite budući vi,

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

i da zamislimo da svi imamo 85 godina.

Now, everyone look at two people.

Sad neka svako od vas pogleda dve osobe.

One of you probably has Alzheimer's disease.

Jedna od njih verovatno ima Alchajmerovu bolest.

(Laughter)

(Smeh)

Alright, alright.

Dobro, dobro.

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

Možda i mislite: „Pa, to nisam ja."

Then, OK. You are a caregiver.

U redu, onda ste vi staratelj.

So --

Tako da...

(Laughter)

(Smeh)

so in some way,

na neki način,

this terrifying disease is likely to affect us all.

će ova užasavajuća bolest verovatno pogoditi svakog od nas.

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

Jednim delom strah od Alchajmera nastaje iz saznanja

that there's nothing we can do about it.

da se ništa ne može učiniti.

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

Uprskos decenijskim istraživanjima, još uvek ne postoji tretman,

and no cure.

niti lek.

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

Tako da, ako budemo imali tu sreću da poživimo dugo,

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

izgleda da će Alchajmer biti sudbina našeg mozga.

But maybe it doesn't have to be.

Ali možda i ne mora da bude.

What if I told you we could change these statistics,

Šta ako vam kažem da možemo da promenimo statistiku,

literally change our brain's destiny,

da doslovno promenimo sudbinu mozga,

without relying on a cure or advancements in medicine?

a da se ne oslanjamo na lek, ni na napredovanja u medicini?

Let's begin by looking at what we currently understand

Počnimo sa razmatranjem onoga što trenutno znamo

about the neuroscience of Alzheimer's.

o neurološkoj strani Alchajmera.

Here's a picture of two neurons connecting.

Ovo je slika dva povezana neurona.

The point of connection, this space circled in red,

Mesto gde se povezuju, označeno crvenim krugom,

is called the synapse.

naziva se sinapsa.

The synapse is where neurotransmitters are released.

U sinapsu se ispuštaju neurotransmiteri.

This is where signals are transmitted, where communication happens.

To je mesto gde se prenose signali, gde se odigrava komunikacija.

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

Tu razmišljamo, osećamo, vidimo, čujemo, želimo...

and remember.

I pamtimo.

And the synapse is where Alzheimer's happens.

I sinapsa je mesto na koje utiče Alchajmer.

Let's zoom in on the synapse

Hajde da zumiramo sinapsu,

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

i da pogledamo grafički prikaz onoga što se događa.

During the business of communicating information,

Kada se odigrava razmena informacija,

in addition to releasing neurotransmitters like glutamate into the synapse,

pored ispuštanja neurotransmitera u sinapsu, kao što je glutamin,

neurons also release a small peptide called amyloid beta.

neuroni ispuštaju i mali peptid koji se zove amiloid beta.

Normally, amyloid beta is cleared away metabolized by microglia,

Obično bi amiloid beta bio uklonjen tako što ga metabolizuju mikroglije,

the janitor cells of our brains.

ćelije koje su „domari" našeg mozga.

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

Iako se o molekularnim razlozima Alchajmera još uvek raspravlja,

most neuroscientists believe that the disease begins

većina neuronaučnika veruje da se bolest aktivira

when amyloid beta begins to accumulate.

kada amiloid beta počne da se gomila.

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

Previše se ispusti, ili se premalo ukloni,

and the synapse begins to pile up with amyloid beta.

i u sinapsi počne da se nagomilava amiloid beta.

And when this happens, it binds to itself,

A kada do toga dođe, vezuju se jedan za drugog,

forming sticky aggregates called amyloid plaques.

stvarajući lepljivu masu ili takozvane amiloidne naslage.

How many people here are 40 years old or older?

Koliko vas koji ste ovde ima 40 godina ili više?

You're afraid to admit it now.

Sad se plašite da priznate.

This initial step into the disease,

Prvi znak koji vodi ka bolesti,

this presence of amyloid plaques accumulating,

prisustvo amilodnih naslaga koje se nagomilavaju,

can already be found in your brains.

već se može naći u vašem mozgu.

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

To jedino možemo da potvrdimo ako se uradi PET snimak,

because at this point, you are blissfully unaware.

jer sada živite u blaženom neznanju.

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

Ne pokazujete znake oštećenja pamćenja, jezika ili razumevanja...

yet.

Još uvek.

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

Smatramo da je potrebno da prođe 15 do 20 godina nagomilavanja amiloidnih naslaga

before it reaches a tipping point,

da bi se došlo do prelomne tačke,

then triggering a molecular cascade

što bi aktiviralo molekularne reakcije,

that causes the clinical symptoms of the disease.

i dovelo do ispoljavanja kliničkih simptoma bolesti.

Prior to the tipping point,

Pre prelomne tačke,

your lapses in memory might include things like,

vaši gubici u memoriji mogu biti stvari kao što su:

"Why did I come in this room?"

„Zašto sam došla u ovu sobu?"

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

Ili „...Kako se on zove?"

or "Where did I put my keys?"

Ili „Gde sam ostavila ključeve?"

Now, before you all start freaking out again,

Pre nego što svi počnete da paničite,

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

jer znam da se skoro svima dogodila makar jedna od ovih stvari u poslednja 24 časa,

these are all normal kinds of forgetting.

to su sve normalne vrste zaboravljanja.

In fact, I would argue that these examples

Zapravo, sigurna sam da se ovi primeri

might not even involve your memory,

čak i ne tiču vašeg pamćenja,

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

jer prvenstveno, niste obraćali pažnju

in the first place.

gde ste spustili ključeve.

After the tipping point,

Nakon prelomne tačke,

the glitches in memory, language and cognition are different.

propusti u pamćenju, jeziku i razumevanju su drugačiji.

Instead of eventually finding your keys in your coat pocket

Umesto da pronađete ključeve u džepu kaputa,

or on the table by the door,

ili na stolu pored vrata,

you find them in the refrigerator,

pronađete ih u frižideru

or you find them and you think,

ili ih pronađete i pomislite:

"What are these for?"

„Za šta su ovi ključevi?"

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

Šta se dešava kada se amiloidne naslage nagomilaju do prelomne tačke?

Our microglia janitor cells become hyper-activated,

Naši domari mikroglije postaju hiperaktivni,

releasing chemicals that cause inflammation and cellular damage.

i oslobađaju hemikalije koje uzrokuju upale i ćelijska oštećenja.

We think they might actually start clearing away

Mislimo da čak počinju da uklanjaju

the synapses themselves.

i same sinapse.

A crucial neural transport protein called "tau" becomes hyperphosphorylated

Dolazi do hiperfosforilacije bitnog neuro transportnog proteina „tau",

and twists itself into something called "tangles,"

koji se savija u nešto što se zove čvor

which choke off the neurons from the inside.

i ubija neurone iznutra.

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

Kad Alchajmer stigne do srednje faze, dolazi do teških zapaljenja i čvorova,

and all-out war at the synapse

i sveopšteg napada na sinapsu,

and cell death.

i odumiranja ćelija.

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

Ako ste vi naučnik koji pokušava da izleči ovu bolest,

at what point would you ideally want to intervene?

tokom koje faze bi bilo najbolje da intervenišete?

Many scientists are betting big on the simplest solution:

Mnogi naučnici se klade na najjednostavnije rešenje:

keep amyloid plaques from reaching that tipping point,

sprečiti amiloidne pločice da dođu do prelomne tačke,

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

što znači da je istraživanje za lek fokusirano na razvijanje jedinjenja

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

koje će sprečiti, ukloniti ili smanjiti gomilanje amiloidnih pločica.

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

Tako da će to verovatno biti preventivni lek za Alchajmer.

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

Moraćemo da uzimamo tabletu pre nego što dođemo do prelomne tačke,

before the cascade is triggered,

pre nego što se pokrene urušavanje,

before we start leaving our keys in the refrigerator.

pre nego što počnemo da ostavljamo ključeve u frižideru.

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

Mislimo da zato lekovi koji se koriste danas nemaju dejstva

in clinical trials --

u kliničkim ispitivanjima,

not because the science wasn't sound,

ne zato što nauka nije ispravna,

but because the people in these trials were already symptomatic.

nego zato što su ljudi koji su ispitivani već pokazivali simptome bolesti.

It was too late.

I već je bilo kasno.

Think of amyloid plaques as a lit match.

Mislite o amiloidnim pločicama kao o zapaljenoj šibici.

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

Na prelomnoj tački, šibica je zapalila šumu.

Once the forest is ablaze,

Kada se šuma zapali,

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

više nema potrebe gasiti šibicu.

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

Ona mora da se ugasi pre nego što šumu zahvati plamen.

Even before scientists sort this out,

Dok naučnici to razreše,

this information is actually really good news for us,

ovo je zapravo dobra informacija za nas,

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

jer se ispostavilo da naš način života utiče na nagomilavanje

of amyloid plaques.

amiloidnih pločica.

And so there are things we can do

Tako da ima stvari koje možemo uraditi

to keep us from reaching that tipping point.

kako ne bismo stigli do prelomne tačke.

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

Hajde da predstavimo rizik od Alchajmera na klackalici.

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

Na jednu stranu ćemo staviti rizične faktore,

and when that arm hits the floor, you are symptomatic

i kada ona dođe do zemlje, ispoljavate simptome,

and diagnosed with Alzheimer's.

i imate Alchajmera.

Let's imagine you're 50 years old.

Recimo da imate 50 godina.

You're not a spring chicken anymore,

Niste više tako mladi,

so you've accumulated some amyloid plaques with age.

i sa godinama su se nagomilale amiloidne pločice.

Your scale is tipped a little bit.

Klackalica se malo nagla.

Now let's look at your DNA.

Sad pogledajmo vaš DNK.

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

Svi smo nasledili gene od majki i očeva.

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

Neki od njih povećavaju rizik, a neki ga umanjuju.

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

Ako ste kao Alis u „I dalje Alis",

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

nasledili ste retku genetsku mutaciju koja ispušta mnogo amiloid bete,

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

i samo zbog toga će vaša klackalica dotaći pod.

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

Ali za većinu, geni koje smo nasledili će je samo malo nagnuti.

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

Na primer, APOE4 je varijanta gena koja povećava amiloide,

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

ali možete naslediti kopiju APOE4 od majke i oca,

and still never get Alzheimer's,

a da nikada ne obolite od Alchajmera,

which means that for most of us,

što znači da za većinu nas,

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

DNK nije jedini koji određuje da li ćemo oboleti od Alchajmera.

So what does?

Šta onda određuje?

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

Ne možemo da uradimo ništa povodom starenja ili gena koje smo nasledili.

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

Još uvek nismo izmenili sudbinu našega mozga.

What about sleep?

Šta je sa snom?

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

U dubokom snu sporih talasa, naše glijalne ćelije ispiraju naš mozak

tečnošču iz kičmene moždine

throughout our brains,

clearing away metabolic waste that accumulated in our synapses

i čiste sav metabolički otpad koji se nagomilao 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 kao čišćenje pod pritiskom.

But what happens if you shortchange yourself on sleep?

Ali šta se dešava ako sami sebe zakidate na snu?

Many scientists believe

Mnogi naučnici veruju

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

da loš san zapravo može biti rani znak nastajanja Alchajmera.

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

Jedna noć manjka sna dovodi do povećanja amiloida beta.

And amyloid accumulation has been shown to disrupt sleep,

Dokazano je da nagomilavanje amiloida izaziva poremećaje spavanja,

which in turn causes more amyloid to accumulate.

što dalje prouzrokuje još skupljanja amiloida.

And so now we have this positive feedback loop

Sada imamo ovu pozitivnu petlju koja se nastavlja

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

i koja ubrzava neravnotežu.

What else?

Šta još?

Cardiovascular health.

Kardiovaskularno zdravlje.

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

Visok krvni pritisak, dijabetes, gojaznost, pušenje, visok holesterol,

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

za sve je dokazano da povećavaju rizik nastanka Alchajmera.

Some autopsy studies have shown

Neke autopsije pokazale su

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

da čak do 80% ljudi sa Alchajmerom

also had cardiovascular disease.

takođe ima kardiovaskularne bolesti.

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

Dokazano je da aerobičke vežbe smanjuju amiloid beta

in animal models of the disease.

u istraživanjima sa životinjama.

So a heart-healthy Mediterranean lifestyle and diet

Mediteranski stil života i ishrana sa zdravim srcem mogu pomoći

can help to counter the tipping of this scale.

da se uspori razvoj bolesti.

So there are many things we can do

Postoje mnoge stvari koje možemo da uradimo

to prevent or delay the onset of Alzheimer's.

kako bismo sprečili ili odložili nastanak Alchajmera.

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

Ali recimo da niste uradili bilo šta od toga.

Let's say you're 65;

Recimo da imate 65 godina,

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

u vašoj porodici ima bolesti, verovatno ste nasledili gen ili dva

that tips your scale arm a bit;

koji će malo iskriviti klackalicu,

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

gorite sveću sa oba kraja već godinama;

you love bacon;

obožavate slaninu;

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

ne trčite osim ako vas neko juri.

(Laughter)

(Smeh)

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

Zamislimo da su vaše naslage amiloida dostigle tu kritičnu tačku.

Your scale arm has crashed to the floor.

Kazaljka na vagi pala je na pod.

You've tripped the cascade,

Pokrenuli ste slap,

setting fire to the forest,

zapalili šumu

causing inflammation, tangles, and cell death.

i doveli do upale, mršenja i umiranja ćelija.

You should be symptomatic for Alzheimer's.

Trebalo bi da imate simptome Alchajmera.

You should be having trouble finding words and keys

Trebalo bi da imate problema da pronađete reči i ključeve

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

i setite se onoga što sam rekla na početku ovog govora.

But you might not be.

Ali možda i ne.

Postoji još nešto što možete uraditi kako biste se zaštitili

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

from experiencing the symptoms of Alzheimer's,

od simptoma Alchajmera,

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

čak i ako imate razvijenu patologiju bolesti u svom mozgu.

It has to do with neural plasticity and cognitive reserve.

Ima veze sa neuronskom plastičnošću i kognitivnim rezervama.

Remember, the experience of having Alzheimer's

Prisetite se da je doživljaj Alchajmera

is ultimately a result of losing synapses.

na kraju samo posledica gubljenja sinapsi.

The average brain has over a hundred trillion synapses,

Prosečan mozak ima preko sto triliona sinapsi,

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

što je fantastično, imamo dosta toga sa čime možemo da radimo.

And this isn't a static number.

A ovo nije fiksiran broj.

We gain and lose synapses all the time,

Stalno dobijamo i gubimo sinapse,

through a process called neural plasticity.

kroz proces zvani neuronska plastičnost.

Every time we learn something new,

Svaki put kada naučimo nešto novo,

we are creating and strengthening new neural connections,

stvaramo i ojačavamo nove neuronske veze,

new synapses.

nove sinapse.

In the Nun Study,

U istraživanju sa kaluđericama,

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

678 kaluđerica, sve starije od 75 godina u vreme početka istraživanja,

were followed for more than two decades.

praćene su više od dve decenije.

They were regularly given physical checkups and cognitive tests,

Redovno su imale lekarske preglede i kognitivna ispitivanja

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

i kada su umrle, njihovi mozgovi donirani su za autopsiju.

In some of these brains, scientists discovered something surprising.

U nekim od ovih mozgova, naučnici su otkrili nešto iznenađujuće.

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

Uprkos prisustvu naslaga i čvorova i smanjenju mozga -

what appeared to be unquestionable Alzheimer's --

što je bez pogovora bio Alchajmer -

the nuns who had belonged to these brains showed no signs

kaluđerice koje su imale ove mozgove nisu pokazivale nikakve znakove toga

of having the disease while they were alive.

da su imale bolest dok su bile žive.

How can this be?

Kako je ovo moguće?

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

Mislimo da je zato što su ove kaluđerice imale velike kognitivne rezerve,

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

što je drugi način da se kaže da su imale funkcionalnije sinapse.

People who have more years of formal education,

Ljudi koji imaju više godina formalnog obrazovanja,

who have a high degree of literacy,

koji imaju viši nivo pismenosti,

who engage regularly in mentally stimulating activities,

koji se redovno bave aktivnostima koje stimulišu mentalno,

all have more cognitive reserve.

svi imaju veće kognitivne rezerve.

They have an abundance and a redundancy in neural connections.

Imaju obilje i višak nervnih veza.

So even if they have a disease like Alzheimer's

Tako da čak i ako imaju bolest poput Alchajmera

compromising some of their synapses,

koja kompromituje neke od njihovih sinapsi,

they've got many extra backup connections,

imaju mnogo dodatnih rezervnih veza

and this buffers them from noticing that anything is amiss.

i ovo ih sprečava da primete da se nešto loše dešava.

Let's imagine a simplified example.

Uzmimo pojednostavljen primer.

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

Recimo da znate samo jednu stvar o nečemu.

Let's say it's about me.

Recimo da je to o meni.

You know that Lisa Genova wrote "Still Alice,"

Znate da je Lisa Đenova napisala "I dalje Alis",

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

i to je jedina stvar koju znate o meni.

You have that single neural connection,

Imate tu jednu nervnu vezu,

that one synapse.

jednu sinapsu.

Now imagine you have Alzheimer's.

Sada zamislite da imate Alchajmera.

You have plaques and tangles and inflammation

Imate naslage i čvorove i upale

and microglia devouring that synapse.

i mikroglije koji napadaju tu sinapsu.

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

Sada kada vas neko pita: "Hej, ko je napisao 'I dalje Alis?'",

you can't remember,

ne možete da se setite,

because that synapse is either failing or gone.

jer ta sinapsa ili propada, ili je nestala.

You've forgotten me forever.

Zaboravili ste me zauvek.

But what if you had learned more about me?

Ali šta kada biste saznali više o meni?

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 imate Alchajmera

and three of those synapses are damaged or destroyed.

i da se oštete ili unište tri te sinapse.

You still have a way to detour the wreckage.

Još uvek imate način da ispravite štetu.

You can still remember my name.

Još se sećate mog imena.

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

Možemo biti otporni na prisustvo patologije Alchajmera

through the recruitment of yet-undamaged pathways.

kroz regrutovanje onih putanja koje još nisu oštećene.

And we create these pathways, this cognitive reserve,

Mi stvaramo te putanje, te kognitivne rezerve,

by learning new things.

tako što učimo nove stvari.

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

Idealno bi bilo da te nove stvari budu što bogatije u značenju

recruiting sight and sound and associations and emotion.

i da angažuju vid i sluh i asocijacije i emocije.

So this really doesn't mean doing crossword puzzles.

Ovo ne podrazumeva da rešavamo ukrštenice.

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

Ne želite da prosto posežete za već naučenim informacijama

because this is like traveling down old, familiar streets,

jer je ovo poput putovanja starim, poznatim ulicama,

cruising neighborhoods you already know.

prolaženja krajevima koje već znate.

You want to pave new neural roads.

Želite da stvarate nove nervne puteve.

Building an Alzheimer's-resistant brain

Pravljenje mozga otpornog na Alchajmera

means learning to speak Italian,

podrazumeva da učite italijanski,

meeting new friends,

upoznajete nove prijatelje,

reading a book,

čitate knjige

or listening to a great TED Talk.

ili slušate sjajan TED govor.

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

Ako uprkos svemu ovome jednog dana imate dijagnozu Alchajmera,

there are three lessons I've learned from my grandmother

postoje tri lekcije koje sam naučila od moje bake

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

i desetine ljudi koje sam upoznala koji žive sa ovom bolešću.

Diagnosis doesn't mean you're dying tomorrow.

Dijagnoza ne znači da ćete sutra umreti.

Keep living.

Nastavite da živite.

You won't lose your emotional memory.

Nećete izgubiti svoje emotivno pamćenje.

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

Moći ćete da razumete ljubav i radost.

You might not remember what I said five minutes ago,

Možda se nećete sećati onoga što sam rekla pre pet minuta,

but you'll remember how I made you feel.

ali ćete se sećati toga kako sam vas naterala da se osećate.

And you are more than what you can remember.

Vi ste više od onoga čega možete da se prisetite.

Thank you.

Hvala vam.

(Applause)

(Aplauz)