Health & Nutrition How 90-year-olds can help us live well

How 90-year-olds can help us live well

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“If we live long we want to live well,” Dana Greenia told the crowd gathered for “Lessons from the Oldest Old: The 90+ Study,” a presentation held at the Lunt Auditorium in Falmouth in early April. Greenia, who has more than 30 years of experience in health care, administration and research, was in Maine to provide an overview of the work being done at the University of California, Irvine in the research study of people over the age of 90.

Originally from New York, Greenia has been part of the university’s Department of Neurology and the Institute for Memory Impairments and Neurological Disorders for 12 years, the last seven of which as a clinical researcher, administrator and co-investigator for the 90+ study.

The presentation, sponsored by Memory Works, a Portland nonprofit offering resources for the dementia community, along with support from the Alzheimer’s Foundation, OceanView at Falmouth and Port Resources in South Portland, offered a closer look at what Greenia said is the fastest-growing segment of the population and one that is often excluded from other studies.

“Of the children born today worldwide, more that 50 percent are predicted to live to 100,” said Greenia. “By 2050 there will be 10 million people over the age of 90 in the United States. We’re living longer and longer. The public health impact is huge and requires study.”

Grennia coordinates multiple categories of aging research, which, she said, includes “longitudinal studies, PET (positron emission tomography) and MRI (magnetic resonance imaging) trials, and genetic and other biomarkers associated with cognitive and functional abilities in the elderly.”

She also presents findings at scientific meetings, national conferences and, over the past year has given numerous community lectures, such as those she gave at OceanView and Port Resources on April 2, about the work she is engaged in.

In 2014 she coordinated the taping of “The 90+ Study: Living to 90 and Beyond,” which aired on the CBS show “60 Minutes.”

“The show was such a success, it prompted ‘60 Minutes Australia’ to visit and do another taping,” said Greenia of the broadcast that will air in the near future. “I worked closely with the producers of both shows providing content and expertise in this challenging field of aging and dementia.”

My Generation had an opportunity to ask Greenia about her work with the study, why it is so important and how newer technologies are helping with research efforts.

Q What does your role in the 90+ Study as a clinical research coordinator and co-investigator entail?

A I am a registered nurse, clinical researcher and co-investigator in the 90+ Study, a NIH-NIA funded population-based investigation of people over the age of 90. I serve as a clinical research administrator responsible for research planning and oversight, clinical management services, clinical trials implementation, personnel administration, financial and grants administration, and clinical management services within the aging and dementia program.

Initiated in 2003, the 90+ Study is based in Laguna Woods, Calif., and has enrolled more than 1,600 participants, making it likely the largest study of its kind in the world. I supervise the staff at the Clinic for Aging Research and Education and the flow of work on the study. I head case conferences, complete dementia questionnaires, and coordinate in-person visits for our participants both locally and across the United States. I oversee the financial components of various contracts and grants and clinical trials associated with the study and manage the education components of undergraduate and graduate students as well as post-doctoral fellows that rotate through our lab.

Q In your opinion, why is this project so important for Alzheimer’s research? Why is it important to you?

A It is important because people in their 90s represent the fastest-growing segment of the population and little is known about them. In 2000 there were 2 million people in the U.S. over 90. By 2050 there will be 10 million people. They are the largest consumers of health care and will represent a huge public-health impact due to their frailty, disability, high rates of sensory loss, etc. Alzheimer’s disease costs more than heart disease and all cancers combined. We need to find out what we can do to help these people age successfully.

Q From a medical standpoint, what have you found to be the most surprising aspect of the study?

A High blood pressure in 90 year olds seems to be protective for dementia. It is not true for people in their 50s, 60s, or 70s. We are trying to figure out why this is the case that maybe what a normal blood pressure is for younger elderly is not normal for a 90 or 100 year old.

Almost half of “normal” 90-year-olds have Alzheimer’s disease in their brains upon autopsy. We need to find out what is protecting these individuals from not developing symptoms.

Age matters: We know that the risk of dementia doubles every five years from age 65 and over. In our study we have found that the risk of dementia increases dramatically with age over 90. It is up to a 40 percent risk by age 100 so the risk skyrockets over 90.

Q The study is looking at a specific group of people who are now in advanced ages. Do you think what has been and continues to be learned from them will carry to the next and future generations?

A Yes, definitely. The legacy of 90-plus-year-olds will help improve the health-care needs for all people including those who get Alzheimer’s disease at age 65 or 75.

Q Do you have concerns that differences between generations in environmental and societal factors will change outcomes?

A Yes, they will absolutely change outcomes but it doesn’t mean we can’t learn from them or translate what we learn from them to current generations.

Q You manage the amyloid imaging PET scans and MRI studies. Have newer technologies helped with the research? How?

A Yes, absolutely. They allow us to see things in the brain that previously we only could with autopsy; for example, the presence of amyloid plaques (misfolded protein structures) in the brain. With the burgeoning new technologies, we will be able to study people during life and follow changes as they age. We worked on a clinical industry trial where PET scans were done to visualize amyloid load with the help of a radiotracer and then compare what was found on the PET scan to what was seen in the brain upon autopsy. We published a paper that showed an increase in amyloid load was associated with poorer cognition and faster decline in non-demented oldest old at risk of developing Alzheimer’s disease.

With more research we will better understand the events related to amyloid deposition and the role of these studies in the diagnosis and treatment of Alzheimer’s disease. We are now looking at MRIs to see what relates to cognitive decline in 90 year olds, such as white matter disease or hippocampal volume. And we are seeing how low levels or modest levels of multiple pathologies are associated with a faster decline and higher rates of dementia. So we are asking our participants to complete one MRI and one PET scan as we follow them every 6 months and agree to autopsy.

Q What are your hopes for the study?

A To learn important things about our oldest old, and to improve their lives, and all of us who hope to reach 90 in good shape rather than bad.

“If we live long we want to live well,” Dana Greenia told the crowd gathered for “Lessons from the Oldest Old: The 90+ Study,” a presentation held at the Lunt Auditorium in Falmouth in early April. Greenia, who has more than 30 years of experience in health care, administration and research, was in Maine to provide an overview of the work being done at the University of California, Irvine in the research study of people over the age of 90.

Originally from New York, Greenia has been part of the university’s Department of Neurology and the Institute for Memory Impairments and Neurological Disorders for 12 years, the last seven of which as a clinical researcher, administrator and co-investigator for the 90+ study.

The presentation, sponsored by Memory Works, a Portland nonprofit offering resources for the dementia community, along with support from the Alzheimer’s Foundation, OceanView at Falmouth and Port Resources in South Portland, offered a closer look at what Greenia said is the fastest-growing segment of the population and one that is often excluded from other studies.

“Of the children born today worldwide, more that 50 percent are predicted to live to 100,” said Greenia. “By 2050 there will be 10 million people over the age of 90 in the United States. We’re living longer and longer. The public health impact is huge and requires study.”

Grennia coordinates multiple categories of aging research, which, she said, includes “longitudinal studies, PET (positron emission tomography) and MRI (magnetic resonance imaging) trials, and genetic and other biomarkers associated with cognitive and functional abilities in the elderly.”

She also presents findings at scientific meetings, national conferences and, over the past year has given numerous community lectures, such as those she gave at OceanView and Port Resources on April 2, about the work she is engaged in.

In 2014 she coordinated the taping of “The 90+ Study: Living to 90 and Beyond,” which aired on the CBS show “60 Minutes.”

“The show was such a success, it prompted ‘60 Minutes Australia’ to visit and do another taping,” said Greenia of the broadcast that will air in the near future. “I worked closely with the producers of both shows providing content and expertise in this challenging field of aging and dementia.”

My Generation had an opportunity to ask Greenia about her work with the study, why it is so important and how newer technologies are helping with research efforts.

Q What does your role in the 90+ Study as a clinical research coordinator and co-investigator entail?

A I am a registered nurse, clinical researcher and co-investigator in the 90+ Study, a NIH-NIA funded population-based investigation of people over the age of 90. I serve as a clinical research administrator responsible for research planning and oversight, clinical management services, clinical trials implementation, personnel administration, financial and grants administration, and clinical management services within the aging and dementia program.

Initiated in 2003, the 90+ Study is based in Laguna Woods, Calif., and has enrolled more than 1,600 participants, making it likely the largest study of its kind in the world. I supervise the staff at the Clinic for Aging Research and Education and the flow of work on the study. I head case conferences, complete dementia questionnaires, and coordinate in-person visits for our participants both locally and across the United States. I oversee the financial components of various contracts and grants and clinical trials associated with the study and manage the education components of undergraduate and graduate students as well as post-doctoral fellows that rotate through our lab.

Q In your opinion, why is this project so important for Alzheimer’s research? Why is it important to you?

A It is important because people in their 90s represent the fastest-growing segment of the population and little is known about them. In 2000 there were 2 million people in the U.S. over 90. By 2050 there will be 10 million people. They are the largest consumers of health care and will represent a huge public-health impact due to their frailty, disability, high rates of sensory loss, etc. Alzheimer’s disease costs more than heart disease and all cancers combined. We need to find out what we can do to help these people age successfully.

Q From a medical standpoint, what have you found to be the most surprising aspect of the study?

A High blood pressure in 90-year-olds seems to be protective for dementia. It is not true for people in their 50s, 60s or 70s. Treatment is mandatory to reduce the risk of dementia with hypertension in younger elderly. We are trying to figure out why this is the case, that maybe what a normal blood pressure is for the younger elderly is not normal for a 90- or 100-year-old.

Almost half of “normal” 90-year-olds have Alzheimer’s disease in their brains upon autopsy. We need to find out what is protecting these individuals from not developing symptoms.

Age matters: We know that the risk of dementia doubles every five years from age 65 and over. In our study we have found that the risk of dementia increases dramatically with age over 90. It is up to a 40 percent risk by age 100 so the risk skyrockets over 90.

Q The study is looking at a specific group of people who are now in advanced ages. Do you think what has been and continues to be learned from them will carry to the next and future generations?

A Yes, definitely. The legacy of 90-plus-year-olds will help improve the health-care needs for all people including those who get Alzheimer’s disease at age 65 or 75.

Q Do you have concerns that differences between generations in environmental and societal factors will change outcomes?

A Yes, they will absolutely change outcomes but it doesn’t mean we can’t learn from them or translate what we learn from them to current generations.

Q You manage the amyloid imaging PET scans and MRI studies. Have newer technologies helped with the research? How?

A Yes, absolutely. They allow us to see things in the brain that previously we only could with autopsy; for example, the presence of amyloid plaques (misfolded protein structures) in the brain. With the burgeoning new technologies, we will be able to study people during life and follow changes as they age. We worked on a clinical industry trial where PET scans were done to visualize amyloid load with the help of a radiotracer and then compare what was found on the PET scan to what was seen in the brain upon autopsy. We published a paper that showed an increase in amyloid load was associated with poorer cognition and faster decline in non-demented oldest old at risk of developing Alzheimer’s disease.

With more research we will better understand the events related to amyloid deposition and the role of these studies in the diagnosis and treatment of Alzheimer’s disease. We are now looking at MRIs to see what diseases found relate to cognitive decline in 90-year-olds, such as white matter disease or hippocampal sclerosis. And we are seeing how low levels or modest levels of multiple pathologies are associated with a faster decline and higher rates of dementia. So we are asking our participants to complete one MRI and one PET scan as we follow them every six months and agree to autopsy.

Q What are your hopes for the study?

A To learn important things about our oldest old, and to improve their lives, and all of us who hope to reach 90 in good shape rather than bad.

MyGenerationDana Greenia offered highlights of what has been learned thus far from studying a group of nearly 1,700 individuals of advanced age for the past 12 years with regard to aging and issues related to dementia.A large crowd turned out on April 2 at the Lunt Auditorium at OceanView in Falmouth for a presentation given by Dana Greenia, a clinical researcher and co-investigator in “The 90+ Study,” an ongoing population-based investigation of people over the age of 90. Staff photos by Faith GillmanDana Greenia was in Maine recently for a presentation on “The 90+ Study,” a project at the University of California, Irvine that is uncovering lessons from research on the “oldest old” segment of the population. Greenia, who is a registered nurse, serves as the clinical research administrator and co-investigator for the study. Staff photo by Faith Gillman

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