New Course: Epidemiology of Alzheimer’s Disease

| EPI-BIO

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Alzheimer’s disease has become a global epidemic that will continue to increase as the baby boom generation enters the age of highest risk.  Dementia is an umbrella term for problems with thinking and memory that develop in about half the population that lives to age 90-95; Alzheimer’s disease makes up about 70-80% of the dementias. Alzheimer’s disease manifests clinically typically after age 65, but there is increasing evidence to suggest that the prodromal phase lasts up to two decades and that the pathology likely accumulates over many decades. In this course, we take a life-course perspective of Alzheimer’s in order to understand its roots in genetics and its clinical expression later in life related to ‘brain reserve,’ that permits onset to be delayed despite the accumulation of pathology.  If we could delay disease onset for 5 years in the population, we could cut the incidence in half.  How can we prevent AD? Right now there is no disease-modifying treatment and the best known preventions are lifestyle changes, which ideally should be started in mid-life or earlier.

This course on the epidemiology of Alzheimer’s disease will inform students about why prevention is the best way forward and how we can accomplish it. To do this, we must know about how the disease works at a biological and clinical level.  Dr. David Morgan, Scientific Director of the Byrd Alzheimer’s Disease Center and Institute in Tampa, FL, guest lectures on the neurobiology of Alzheimer’s disease.  In separate modules, we cover the clinical presentation and clinical research criteria for dementia disorders, discuss progression and staging, survival and mortality.  Dr. James A. Mortimer, an Alzheimer’s disease epidemiologist, discusses the neuropathology and genetics of the disease. Descriptive information on the proportion of people who have Alzheimer’s disease and the rate of developing it is given. The concept of brain reserve is introduced, and from this theoretical model we argue that while the causes of the disease are primarily genetic, the expression of the disease is governed to a great extent by life experiences and environment.  Given that Alzheimer’s disease likely develops over the life course with expression in late life, we explore the risk factors for the disease, starting with childhood exposures and progressing through adulthood considering diet, exercise, social engagement, cognitive activities and many other risk factors, including vascular conditions and head injury. We also explore early detection modalities and ongoing efforts to intervene and prevent the disease.

The course requires knowledge of epidemiology as would be obtained in an introductory graduate-level course on this subject.