have normal memory and cognition, so we have to think of these things as diseases and not just a foregone conclusion of aging. so what is dementia? this is sort of a technical definition, but basically, damage it is an acquired problem with memory, language, navigation, behavior that gets worse over time and leads to a decline in function, so it gets in the way of your day-to-day life, and there are many different forms of dementia that we recognize, although we know of simas disease is the most common form. that is why i think many of us focus on this disease, and that is what i want to talk about in terms of diagnosis and treatment today. one of the new imaging resellers since is we recognize we can diagnose risk factors for alzheimer's disease much earlier than when someone is actually demented. you may hear about something called mild competition

impairment, and this is also when we noticed that we have a memory problem, but that we can actually compensate for us. it is not actually preventing us from what we need to do. in the future and with our new recommendations, we hope that more people will be diagnosed earlier with memory problems, possibly in a stage of my of cognitive impairment because it is at this stage that we the new treatments and interventions will be most effective. even treatments we have now we think are likely to be effective in many cases during these early stages. there are many different ways to treat alzheimer's disease and dementia, including medications that we, as a neurologist and other physicians, prescribed. i'm not going to go through all of these in detail, but there are four commonly as medications, and we think they are actually quite a separate series i like to think of them as sort of an inch in treatment

for the mine. they help the mind to work more smoothly. they oil the gears of the mind, and in the face of alzheimer's disease, they can help people function better. while they do not treat the underlying disease, the actual brain damage that is caused by alzheimer's disease, there are many new treatments we are working on that we hope will have this effect. despite the difficulties with treating the underlying disease, i wanted to give you another example of how we think that foreign medications really do help treat alzheimer's disease. so this is a study by a colleague who looked at whether treatment with any of the available medications helps prevent people being placed in nursing homes. you can see in the black line at the bottom, this is people who received no treatment on average being placed in a nursing home much more quickly than people

who received one of the inhibitors, and a new treatment, is combined with one of these medications in the green line on the top, people were able to do better and stay out of nursing homes. although we cannot treat the underlying biology, i think there is an lot of hope for making people's lives better and helping them to function better in the community. next slide. so where are we going with all of this, and why am i so excited and hopeful for the future of alzheimer's treatment? we know if we look at someone with alzheimer's disease's brand and the microscope, we see two toxic, sticky proteins, and these are what are causing the brain damage. on the left, you see these things, and we know there is a toxic protein in these.

on the right, you see tangles made of another toxic protein. all of the new treatments that we're working on and many of the new diagnostic techniques are a bit either removing these toxic proteins from the brain, blocking their build up, or detecting them really early. so one of the exciting new technologies that is being worked on here and around the country is to take the deadliest of lookit these and turn them into diagnostic tools. basically, it uses a dye that we use for staining brain specimens. but it actually turns this into a brain scan, so you can see on the left, that is a section of a normal elderly person's brain, and on the right, you see this red and yellow thing.

that is indicating that the person with alzheimer's disease has a huge amount of this protein in the brain, so now, we can detect this toxic protein to target for new treatments in living individuals. what is particularly exciting about this is that we can even with and people have very early stages. if we look at people who are completely normal, we find that 20 percent or 25 percent of people have this kind of rain, and we think this will allow us to detect the disease very early, maybe before anyone has problems. another important advance in developing new treatments has been our ability to generate mice that get alzheimer's disease. these mice cannot find their cheese. they get lost and eventually died because they build up this

toxic protein in their brains. i think an exciting development over the past 10 years is that we can cure that. so our challenge is to translate those treatments into human alzheimer's treatments, and there are many studies under way where we take treatments that jim rice and tried to apply them to humans, and i think we are starting to see some limited evidence of success. i think i am going to skip this slide, but to give you an idea of all of the different molecules, so there are many different targets. this is actually a nerve cell, and these are the different proteins, and all of these arrows indicate steps that we have identified in the mice that we can use to develop to treat humans, and all of these different yellow light arrow's on drugs that are in human clinical studies right now.

i say we are proud to be in the bay area where many of us are leaders in the field of alzheimer's research. one of the drugs that has been studied recently in a human clinical trial, there was some evidence that it was able to either slow the decline of memory problems or slow the rate of brain shrinkage, in the blue line at the top, you see people who were treated with the drug over time. they have less of a decline in the people who were not treated. this does not look like a huge effect, but these people were also on the standard treatments for alzheimer's disease, so while it is not an absolute cure, we think that this is really hopeful because this is a drug that we think takes the toxic drugs out of the brain, so these new technologies if used properly may really help us. another drug developed in russia but also use in san francisco

teary we see people who were treated with this as compared to a new medication at all actually improved over the first 12 months of treatment and were able to stabilize. again, there are really excited -- exciting new treatments on the horizon. they are not ready for prime time, but hopefully, within the next 10 years, we will have at least one of these. as i mentioned, with these new technologies, the real key will be early diagnosis and early treatment. the recommendations that the panel tried to come up with where to try to anticipate this because we think that while things are tough to do right now, within five or 10 years, these new technologies will merely make our lives and traditions easier. first of all, we know that alzheimer's disease starts very early on. we think with technologies like that brain scan i showed you, we may even be able to detect

alzheimer's disease in people who have no symptoms. if we could do this and initiate treatment, perhaps we could prevent people from ever even developing alzheimer's disease, and they could remain normal. i'm just going to stick to the last slide because i see that i am almost out of time. there we go. how do i see how we will treat dementia in 10 or 15 years? i think many of us believe that the technology is almost ready. we are not quite there yet, but it seems possible within our lifetime, we will be able to think of alzheimer's disease like we think of cancer. right now, we screen for colon cancer, for prostate cancer, for breast cancer with diagnostic tests that can detected very early on so we can treat it when it is very mild.

similarly with alzheimer's disease, there may be some new blood test available that can indicate risk of alzheimer's disease. if someone, let's say, at age 50 is found to have this increased risk, we could use our new technology to really know if they have toxic protein in their brain. they still have no memory complaints. they are still as far as we know clinically normal, but we could initiate treatment with one of these new drugs and hopefully maintain their cognitive function so that they never even experience in a clinical symptoms. i think this is the future of alzheimer's disease treatment. while i think times are tough right now, i think this technology is slowly working its way into all of our practices and maybe by the time all of our recommendations are and lamented, we will also be able to rely on this to health care for people in san francisco.

thank you very much. [applause]

>> are we on? are our microphones on? can anyone here? no? >> good morning. >> you can hear philip, but not me? ladies? hello? louder? so you can hear that? we are going to speak right

into the microphones. you do not know each other, so i wanted to start by having each of you introduce yourself to reach out there. we go on long way back. i am going to start with you. >> my name is harris. >> montoya. >> the lead. >> jim. >> anne hinton, for those of you who did not meet me earlier in the day. but we have in common is dementia. -- what we have in common is dementia. maybe we could introduce ourselves? how is it you came to be a panelist? you are a care giver, i believe. >> eye care for my has been. i am four years younger than him. i said i was going to take care

of him. in the good ones and the bad ones. here we are, taking care of him. >> i am eric caregiver for my has been. he had alzheimer's for six years. i think i was a caregiver long before the diagnosis was made. all of the symptoms and signs were there, but i was ignoring them, in denial. i fought it until finally i had to give up and say i need help. >> actually, i am privileged that dr. boxer is here. he is my doctor.

he had to in 2006, when i was -- what is it called? -- diagnosed -- i feel that i am so privileged to be here. especially with dr. boxer. all of these folks who are going to fix this thing. i look forward to that. >> i am a principal caregiver for my partner, my life partner and friend, and i share those responsibilities with the community and i am privilege to be here as well.

i am a little depressed to hear about the future treatments. i make caregiver for a man who was early diagnosed with dementia. not alzheimer's. while i hope that everything gets better in the future, it is depressing to note that these treatments are just out of reach and to feel sort of condemned to live in the present with so little options other than care and support. >> i think there are a lot of us in the room that are thrilled for the folks who are here like jim who are benefiting and that the same time understanding the lost that many of us have experienced. there is no going back on that. there were two questions discussed earlier when we met today. we came prepared -- i have noticed -- the first question was, what was that he wanted to share with the audience? the second question -- i will

get to that in one minute. philippe, tell us about what it is you -- you had three items you wanted to mention today. what was it? >> at the first thing that gets made, that i provide care for a young man who is a young man in today's world. he was about 52 years old, now 57 when we diagnosed the onset of dementia. early dementia is a very difficult thing to diagnose. he looked so strong and he is so weak. the system can handle the driller -- drooler, but not the person who becomes aggressive and does not understand how to stand up when he is 50 years

old and nobody gets it. you look at him and you think he can do anything anyone else can because he is not all. he knows nothing between the hand and the eye and the foot. it is difficult. those are difficulties. drugs -- everyone wants to go to drugs. i am hopeful about amyloid drugs and i am hopeful about drugs that deal with the root causes. but behavioral drugs -- you want to give them drugs to sit down and then they even further lose their contact with reality. that is a fight. going through the terrible two's at 58 is terrible. especially for a person with strength. there is an inherent conflict in the care model. we are dealing with the inevitable tension between the

group and the individual. every time the care model focuses on the individual, you have limited resources that you take away from the group when you find someone who can handle the individual, that individual cannot care for the rest of the group. that is institutional settings. i could go on and on. [laughter] i want to talk to you about support, too, but maybe i can come back to that. i am so grateful for the community that i live in and they support that i get. catherine over there -- she jumped in early when i needed help. and with my mother, who was dying at the same time. it gets overwhelming. read jump in. carmen. people who have some understanding of their resources and the community came to help. i was with a community with

kathi joanne sarah and with stephanie -- with kathi joe, and sarah, and with stephanie. i will stop talking. without the wall, i could not do this. so grateful. >> a couple of items that you also mentioned that you thought were important to share with the audience? >> just to back up a little bit, i wanted you to know that i care for my has been, who has had the dreaded disease for six years. i was married 57 years, 363 days. he died just two days shy of my anniversary. i thought he died to avoid giving me an anniversary present. but he forgot to give me a present before he died, so i cannot blame that.

it is interesting to sit and know there's something wrong -- because i've been with them all those years -- i could tell there was something wrong. i knew the memory was going. i knew he was getting more irrigable -- more irrigable. he accused me of stealing. so much going on. they -- they would say he talks fine to me. i thought it was just me. he is getting older. but finally -- and i am a nurse -- supposed to know better. but finally, i went to the neurologist, and sure enough he confirmed what i knew exactly all the time. one of the interesting things about my husband -- he had a way of hiding his decline. the matter of fact, the neurologist was giving him tasks, and he said to me, i am

not going to play the stupid games -- he just pretended. this was his way of not dealing. to me, the most important thing was trying to learn to take care of myself. that was the most difficult part. harri cared little about myself, probably because of the bill. i have been with him all these years. my right to do so. you must take care of yourself. that is not being selfish. it is only being realistic. if you do not take care of yourself, there is no way you can take care of anyone else. [applause] i say that, that it was very hard for me to ask for help.

when i was getting so frustrated and stressed, i thought i need to reach out to the family. i asked for help. you'd be surprised what three hours a day did for my mental health. by the same token, i was still feeling guilt, because i would feel -- i would leave the house knowing someone was with him but i felt i need to hurry back. he is all alone it is very difficult. i think our own attitude is truly the barrier for learning how to take care of yourself. take care of yourself. it is important. i leave you with that. [applause] >> everyone here has a unique situation. you have a particularly unique situation in that you have children at home. you are caregiving for children

and you have a husband with dementia. i was struck by the things that you wanted to share with the group. would you mentioned some of those things, please? >> i have two teenagers. it was so hard to tell them what was wrong with his father. there were -- they were sad. he would say bad words. i say, because of this disease. little by little i have been learning through the family caregiving association and i have been teaching them how to cope with that disease. now the family is like a normal family. i tried to make him participate when we cook dinner. even though he will peel the potatoes twice.

he is participating with us. we say he has to go with the children. i tell the children, you remember when the father used to do this for you? now they are helping a lot. i am happy to be with this group because they have been helping me a lot. by caring and loving him, it keeps me going. >> was struck by a story that she was telling me earlier on. her husband has been confusing her with some other women. [laughter] we have that in common. my mother and i look exactly

alike. by fathered one. confused me with my mother and tried to chase me are rounded turnstile in a department store. i was mortified. i took him back and ran back to my sister, who said, where was your sense of humor? could you share with the group a little bit about the things that you mentioned when we talked about the things that you would like to share with this group today? that you would like them to take home from this experience? >> tom, where are you in the audience? they thought you were but going to be sitting on the stage to get there. then we saw how small the stage was. >> his fault. >> let me give you the mike. >> i said that i was diagnosed

in 2006. and the first thing -- the first year -- i was so angry. so angry. and i have never felt that. scared. i did not tell anybody in here we did this is -- and i did not tell anybody. this is going over a year or two. unfortunately, like i said, the folks that take care of me, tom, dr boxer, sort of told me to sit up, fix it, do it, something like this. i still have problems.

the like -- i would say three out of two i will put the issue on the wrong foot. -- the shoe on teh wrong foot. these are real. i had to release that anger. sure enough, i will do it probably tomorrow. it is rather odd that these things happen. and i hope it is because of the alzheimer's. [laughter] i am so privileged with the folks that are taking care of me. [applause]

>> tom -- as the daughter of a man who had alzheimer's, a have a question that i did not prompt you for earlier, but are you glad you got a diagnosis -- are you glad that you understand the diagnosis and what is going on with do? >> akko, yes. -- oh, yes. that is where the anger came from -- why the hell am i doing this? excuse me. having the knowledge is just so important. >> i would say as the daughter thelee, -- daughter ofl