Head trauma and dementia risk. An important risk factor for Alzheimer’s disease is head trauma and the chronic traumatic encephalopathy that can result. It is causing us to rethink everything from  how we view high school tackle football consideration to whether headers should be allowed in high school soccer play.

Michael Alosco PhD is  co-director of the Boston University Alzheimer’s Disease Research Center Clinical Core. He completed his undergraduate studies at Providence College and he earned his doctoral degree in clinical psychology from Kent State University. He is an Associate Professor of Neurology at the Boston University School of Medicine. Dr. Alosco has >150 peer-reviewed publications.

 

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Robert Lufkin 0:01
CTE calcium score is usually thought of as a test for heart disease. But did you know that it’s also for Alzheimer’s disease, diabetes, stroke, cancer, and other chronic diseases? Stay tuned and we’ll find out why. This talk is dedicated to my friend Steve, who is thin and healthy and decided to get a CT calcium score. We’ll come back to what happened to him in a bit. Now, there are many tests that will calculate your risk of cardiac disease such as history, lipids, etc. Few tests will actually detect the heart disease itself. This is one of them that does. Its full name is the computed tomography coronary artery calcium score. coronary artery calcium is the most reliable element in cardiovascular risk stratification, in terms of its precision of predictive ability. And it’s not just for heart disease risk, because of the common inflammatory metabolic factors underlying all chronic disease. The CTE calcium score is also an important independent risk factor for dementia, stroke, diabetes, hypertension, hip fracture, cancer, and other chronic diseases.

It has even been suggested as a clock for biological age and longevity studies, similar to the epigenetic DNA methylation clocks. Now, vascular calcification was accepted until recently as an inevitable result of aging. And the development of coronary artery calcification was considered a a passive process. It’s now understood to be an active pathogenic process that is not inevitable, and in fact, influenced by inflammatory and metabolic factors driven by our lifestyle choices. calcium scoring has emerged as a widely available, consistent and reproducible means of assessing risk of major cardiovascular outcomes and other diseases. It’s the single most predict predictive cardiovascular risk marker in asymptomatic individuals. So here’s how it’s done. The study is performed on a CT scanner, but does not involve any injections or contrast material. It takes only five to 10 minutes to perform. calcium in the coronary arteries is easily seen on the CT scans as areas of dense white material superimposed on the normal gray signal of the heart muscle. The amount of the calcification seen in each coronary vessel is measured, and from this a calcium score is created from zero to 1000. A score of zero means that no calcium was seen at all, a zero score has emerged to be a reliable negative risk factor identifying patients at low risk for both cardiovascular and non cardiovascular mortality. How common is a zero calcium score? Well, roughly 50% of 50 year olds have a score of zero, and that percentage unfortunately decreases with aging. A score of one to 100 is increased risk, with roughly twice the risk of death. A score above 100 means increasing risk with 10 to 37 times the risk of death from heart attack, as well as these other chronic diseases. Some studies have reported that the value of CT calcium for ruling out obstructive coronary artery disease is higher than the reported results of any stress imaging testing, including stress echocardiography and SPECT myocardial perfusion imaging. One group has even proposed using CT calcium scores to rule out heart attack in the emergency setting.

What about follow up? Since the Interscan variability of CT calcium score is low, quantitative estimates of the score progression are possible. Calcium scores typically increased by about 20 to 25% per year as the disease progresses About 20% of individuals with a score of zero progress to a score greater than zero within four to five years. For those with a zero score, because the risk of progression even in those with a zero score, we recommend follow up in that group in three to five years. Those with elevated scores should be in an aggressive lifestyle program to stop disease progression, and they can recheck in 12 months to monitor progress. Success in managing the disease rarely results in reversal of the score, since the calcium is actually located in the scar of the vessel itself. Instead, the goal of slowing progression to 5% or less per year is associated with a greatly improved risk profile. As mentioned, the calcium score is not just about heart attacks. Given its role as a sort of risk integrator there is increasing interest in the role in predicting in this role of a score in predicting non cardiovascular outcomes. The calcium score has been shown to predict incident cancer, diabetes, chronic kidney disease, stroke, chronic obstructive pulmonary disease, Alzheimer’s disease, and hip fracture, independent of age, sex or other risk factors. As such, it may play a role in longevity management as sort of a biological clocks similar to the DNA epigenetic methylation clocks that we mentioned. Now, what about my friend Steve, he had his test and was surprised to find his score was elevated to 163. He immediately spoke with his cardiologist who reassured him that such a score is normal or expected for 70 year olds, most of whom have elevated scores. Now, although he is technically correct, we have to remember that what is normal or expected in 70 year olds is also heart attacks, stroke, hypertension, diabetes, and dementia. No matter what your age, you don’t want to have an elevated score. So instead of normal, our goal should be optimal, which is a zero calcium score, or if it is elevated, then immediate aggressive lifestyle changes should be undertaken to stop any progression of disease. On a subsequent follow up scan 12 months later. CT coronary artery calcium scoring is a fascinating and unfortunately underutilized technology that we will be doing deeper dives in future programs. Thanks for watching.

Unknown Speaker 8:12
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