Synaptitude Brain Health - Assessing and Improving Brain Health

1. www.centreforbrainhealth.ca In partnership with:

2. DjavadMowafaghian Centre for Brain Health www.centreforbrainhealth.ca

3. Assessing and Improving Brain Health

5. The Problem Cognitive Performance with Age

6. The Alzheimer’s Continuum Jack CR et al., Lancet Neurology, 2010

7. SYNAPTITUDE BRAIN HEALTH The Synaptitude Program Assessing and Improving Brain Health BC Care Providers Association April 19, 2018

8. Our Solution • Partnership with seniors’ care providers • Proprietary analysis • Personalized brain health care • Prevention • Precisely targeted solutions

9. Synaptitude Brain Health • Who We Are • Vancouver-based brain health and wellness company • Our Mission • To apply scientifically rigorous, evidence-based approaches in identifying risks, optimizing brain health and improving quality of life • To provide the most comprehensive brain health and wellness program available today • Our Approach: The Synaptitude Program • We combine neuroimaging and cognitive risk assessments with personalized programs to improve cognition, sleep, diet, physical activity, focus and reduce stress.

10. The Synaptitude Team Executive Team Dr. Max Cynader Chief Executive Officer Professor, UBC Dr. Teresa Liu-Ambrose Chief Operating Officer Associate Professor, UBC Mike Volker Chief Financial Officer Director, SFU Innovation Dr. Carles Vilariño-Güell Director of Genetics Assistant Professor, UBC Dr. Alex MacKay Director of Imaging Professor, UBC • Scientific Advisory Board • John Fleming, MD, Former Director, UBC Sleep Laboratory • David Ostrow, MD, Former CEO, VCH • Robert McMaster, PhD, VP Research, VCH

11. Assessments

12. The Synaptitude Program Assessing risk: Cognitive Assessments • Identify cognitive strengths and weakness • Assess risk for dementia • Compare results to extensive normative dataset

13. Cognitive Assessment • Cognition is a multi-dimensional construct • Memory • Executive functions • Planning, decision making, multi-tasking • Attention • Visual-spatial ability • Processing speed • Language • Assess individual strengths and weaknesses, hence, the importance of a baseline as well as follow-up assessments

14. The Synaptitude Program EEG assessments Neuroimaging assessment

15. The Synaptitude Program Assessing risk: Neuroimaging Assessment • Examine brain structure and function • Access to clinically-certified 3T MRI scanner • Compare structural volumes to extensive normative dataset

16. Neuroimaging Assessment • Measurement of key brain structures • Low white matter and hippocampal volumes predict dementia risk • Reduced cortical thickness and hippocampal volume among factors that predict conversion from MCI to Alzheimer’s disease • Hippocampal volume can be modified (Erickson, PNAS, 2011)

18. Vascular Cognitive Impairment: Silent Strokes • White matter hyperintensities, or lesions, are common in the population • Due to small vessel disease • High blood pressure • High cholesterol • Increases risk for future stroke and dementia

20. Functional Architecture of An Idle Mind Source: The Globe and Mail

21. Functional Architecture of An Idle Mind Plaque distribution in Alzheimer’s Default network • Brain cells in the Default Mode network, highlighted in blue on the left, communicate with each other more often than other brain areas. • This may be why these same areas are often hit first by Alzheimer’s plaques, which are highlighted in red in the brain images on the right. • (Credit: Journal of Neuroscience)

22. Brain Fitness Programs

24. Next Generation Brain Fitness • Sleep • Focus, attention and memory • Stress management • Personalized brain exercises • Physical activity/falls prevention

25. Tips for Getting a Good Night’s Sleep • Set a schedule • Exercise • Avoid caffeine, nicotine, and alcohol • Relax before bed and develop pre-sleep rituals • Sleep until sunlight • Don’t lie in bed awake – if you can’t fall asleep, leave the room and do a quiet activity until you feel tired • Keep your bedroom dark, quiet, and a little cool • Avoid using the bed for activities other than sleep or intimacy

26. Physical Activity Matters Erickson et al., PNAS, 2011 • Aerobic training increased hippocampal volume leading to improved spatial memory in older adults • Exercise was effective at reversing hippocampal volume decreases associated with aging

27. Baby neurons in the hippocampus Your hippocampus is about 2/3 as old as you are

28. Brain Training Matters Ball et al., JAMA, 2002 • Advanced Cognitive Training in Vital Elderly (ACTIVE) study in which older adult participants were trained on episodic memory, reasoning or visual processing speed training tasks • Cognitive improvements were shown in all training groups immediately after training period and up to 2 years post-training • Processing speed training reduced risk of dementia by 48% over 10 years (Edwards et al., APA, 2016)

29. Lifestyle Matters • Risk of cognitive decline was lowered with lifestyle intervention • Improved overall cognitive test scores, executive functioning and processing speed were observed post-intervention Ngandu et al., The Lancet, 2015

30. The Synaptitude Program Mitigating risk and optimizing brain health • Brain Fitness Program • Reduce risk factors and improve brain health • In-person consultations with experts • Optimize sleep, physical activity, attention • Reduce stress • Written reports with practical recommendations distributed to both care providers and residents • Ongoing monitoring and support

31. Referrals • Residents with: • Sleep complaints/concerns • Memory complains/concerns • History of repeated concussions • Family history of dementia • Risk for cognitive impairment • High stress levels • Risk for cardiovascular conditions Plaque distribution in Alzheimer’s Default network

32. Case Study #1 • 74 year old male • Family history of dementia • Mild coronary artery disease • Reported head trauma Plaque distribution in Alzheimer’s Default network

33. Baseline Sleep Assessment Baseline Duration = 417 min Efficiency = 90.2% Fragmentation = 27.0 Target Duration > 450 min Efficiency > 90.0% Fragmentation < 20.0 Probable Sleep Apnea

34. 2nd Sleep Assessment Post-Intervention Duration = 470 min Efficiency = 92.9% Fragmentation = 16.1 Target Duration > 450 min Efficiency > 90.0% Fragmentation < 20.0

35. 2nd Cognitive Assessments Post-Intervention * Episodic memory Working memory * Receptive vocabulary * Reading decoding Inhibitory control Cognitive flexibility * Processing speed

36. Case Study #2 • 50 year old female • Anxiety treated with moderate success • Sleep complaints/concerns Plaque distribution in Alzheimer’s Default network

37. Recommendations • Sleep, stress assessments • Meditation techniques • Online cognitive behavioral therapy • Optimize sleep, diet, physical activity Plaque distribution in Alzheimer’s Default network

38. The Synaptitude Program • Partnership with seniors’ care providers • Help with resident management • Complementary care • Sharing data with care providers • Prevention • Our goal is to help you to help your residents.

39. The Synaptitude Program • Individual programs

40. The Synaptitude Program • Group programs: $120/month per participant • Individual cognitive assessments • Group lectures • Group cognitive training sessions • Training of care facility staff • Tailored to the needs of the care facility

41. SYNAPTITUDE BRAIN HEALTH The Synaptitude Program Assessing and Improving Brain Health QUESTIONS?

42. The Synaptitude Program Assessing risk: EEG Assessment • Examine brain activity • Establish baseline • Track changes in brain activity over time

43. Next Generation Brain Fitness • Personalized • Precisely targeted • Preventative • Plasticity-based

44. Sleep Matters • Sleep consolidation is associated with Alzheimer disease (AD) risk • Interaction between APOE genotype and sleep may impact cognitive function • Better sleep consolidation reduced effect of APOE Ɛ4 allele on: • Risk of incident AD • Annual rate of cognitive decline • Neurofibrillary tangle density Lim et al., JAMA Neurology, 2013