Tema 1 EVSC - Introducció - PART 1.pdf

Estils de Vida i Salut Cerebral Curs 2023/2024 Organització de l’assignatura • Horari: Divendres de 10:00h a 12:00h. • Lloc: Seminari 2 de la Facultat de Medicina i Ciències de la Salut (Seminaris – Aula 8). • Professors: Dr. K. Abellaneda, Dra. L. Vaqué i Dr. D. Bartrés. Curs 2023/2024 Planifi...

Estils de Vida i Salut Cerebral Curs 2023/2024 Organització de l’assignatura • Horari: Divendres de 10:00h a 12:00h. • Lloc: Seminari 2 de la Facultat de Medicina i Ciències de la Salut (Seminaris – Aula 8). • Professors: Dr. K. Abellaneda, Dra. L. Vaqué i Dr. D. Bartrés. Curs 2023/2024 Planificació de l’assignatura Avaluació de l’assignatura L’avaluació de l’assignatura es divideix en els següents eixos: • 25% - Assistència. • 25% - Treball en Grup (Seminaris). • 50% - Prova de Síntesi. Assistència: Pràctiques al CAP Tema 1. Estils de vida i salut cerebral INTRODUCCIÓ Dr. Kilian Abellaneda Pérez [email protected] Unitat de Psicologia Mèdica, Departament de Medicina Facultat de Medicina i Ciències de la Salut Universitat de Barcelona Llibre recomanat Com definiries… • Salut? • Salut cerebral? • Salut mental? • Salut cognitiva? Definició de SALUT Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity • Biopsychosocial model of health: Physiological, psychological and social factors in health and illness, and interactions between these factors. • NO! differs from the traditional medical model, which defines health as the absence of illness or disease and emphasizes the role of clinical diagnosis and intervention. • Health explicitly linked with wellbeing -> refers to a positive rather than neutral state, framing health as a positive aspiration. • Conceptualizes health as a human right requiring physical and social resources to achieve and maintain. Definició de SALUT Determinants of health: Individual and environmental interaction 1. Social and economic environment 2. The physical environment 3. The person’s individual characteristics and behaviors To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact. Definició de SALUT Main Factors: • The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. • Individuals are unlikely to be able to directly control many of the determinants of health. • These determinants—or things that make people healthy or not—include: Definició de SALUT Main Factors: • Income and social status: higher income and social status are linked to better health. • Education: low education levels are linked with poor health. • Physical environment: safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. • Social support networks: greater support from communities is linked to better health. • Genetics: inheritance plays a part in determining lifespan health. • Personal behaviour and coping skills: balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health. • Health services: access and use of health services influences health. • Gender: Men and women suffer from different types of diseases at different ages. Definició de SALUT MENTAL / CEREBRAL MENTAL HEALTH is a state of wellbeing in which every individual realizes 1) his or her own potential, 2) can cope with normal stresses of life, 3) can work productively and fruitfully, and is able to 4) make a contribution to his or her community’ • Mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. • 13% rise in mental health conditions and substance use disorders in the last decade • Mental health conditions now cause 1 in 5 years lived with disability (YLD). • Around 20% of the world’s children and adolescents have a mental health condition. • Suicide is the second leading cause of death among 15-29-year-olds (!). Definició de SALUT MENTAL / CEREBRAL Key facts: • Mental health is integral to our wellbeing. • Affordable, effective and feasible strategies exist to promote, protect and restore mental health. • The need for action on mental health is indisputable and urgent. • Two of the most common mental health conditions, depression and anxiety, cost the global economy US$ 1 trillion each year. • The global median of government health expenditure that goes to mental health is less than 2%. Definició de SALUT CEREBRAL • ability to remember, learn, plan, concentrate and maintain a clear, active mind • is all about (1) making the most of your brain and helping (2) reduce some risks to it as you age Definició de SALUT CEREBRAL Brain health refers to how well a person’s brain functions across several areas. Aspects of brain health include: Cognitive health how well you think, learn, and remember Emotional function how well you interpret and respond to emotions (both pleasant and unpleasant) Motor function how well you make and control movements, including balance Tactile function how well you feel and respond to sensations of touch (including pain) SALUT CEREBRAL: SALUT COGNITIVA Focus on ‘modifiable’ Focus on ‘lifespan/aging’ Definició de SALUT CEREBRAL American Heart Association American Stroke Association (AHA/ASA) stroke prevention and its relationship to brain health Definició de SALUT CEREBRAL PROFESSIONALS INDIVIDUALS HEALTH CARE SYSTEM AHA’s Life’s Simple 7 indicates that these factors play a role in the preservation of cognition and can be measured, modified, and monitored Definició de SALUT CEREBRAL Definició de SALUT CEREBRAL Definicions de Salut Cerebral i Mental WHO NIANIH Lifespan perspective X X Psychological well-being X Summary of Institutional definitions of Brain and Mental Health Emotional well-being Able to cope / Stress management X Cognitive (thinking, learning) X Social Connection / Community X US Healt h Dept. X X X X X X X X X X X X X NHSUK X X Physical well-being Risk reduction / pathology Am. Heart Ass. X X Què és salut cerebral? • • • Un estat de benestar (well-being) amb qualitat de vida (quality of life) al llarg dels anys (lifespan). Funcionament quotidià òptim (coping with daily stressors). Relacionat amb ‘fer activitats’ (lifestyles) per reduir risc de malalties / condicions que afecten la salut. Què NO és salut cerebral? • • Viure amb pobra qualitat de vida i benestar. Tenir una malaltia del cervell (neurològica o psiquiàtrica). Absència de malaltia no és sinònim de Salut Cerebral, però cal dedicar molts esforços a prevenir-les! The Global Burden of Disease (GBD) provides a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities eliminated. AVAD o DALY, Disability-Adjusted Life Years: Años de vida ajustados por discapacidad Absència de malaltia no és sinònim de Salut Cerebral, però cal dedicar molts esforços a prevenir-les! https://vizhub.healthdata.org/gbd-compare/ Examining trends from 1990 to the present and making comparisons across populations enables understanding of the changing health challenges facing people across the world in the 21st century. Absència de malaltia no és sinònim de Salut Cerebral, però cal dedicar molts esforços a prevenir-les! https://vizhub.healthdata.org/gbd-compare/ Absència de malaltia no és sinònim de Salut Cerebral, però cal dedicar molts esforços a prevenir-les! https://vizhub.healthdata.org/gbd-compare/ 1 174 surveys N=829.673 63 countries 2 3 • 1/5 common mental disorders (12-month). • 29% ( almost 1/3) lifetime prevalence common mental disorder • robust gender effect across the clinical subdomains of mental disorder Lifetime prevalence is the proportion of a population who at some point in life has ever had the characteristic Period prevalence Lifetime prevalence 174 surveys N=829.673 63 countries • 1/5 common mental disorders (12-month). • 29% lifetime prevalence common mental disorder • robust gender effect across the clinical subdomains of mental disorder Period prevalence is the proportion of a population that has the characteristic at any point during a given time period of interest. “Past 12 months” is a commonly used period. L’envelliment és un cas particularment important DALYs = disability-adjusted life-years Healthy ageing as “the process of developing and maintaining the functional ability that enables older people to do what they value” (WHO, 2015) SALUT CEREBRAL i ENVELLIMENT Canvis cognitius associats a l’envelliment Park and Reuter-Lorenz, Annu Rev Psychol. 2009 SALUT CEREBRAL i ENVELLIMENT Brain Atrophy REDUCED GREY MATTER and INCREASED CSF Driscoll et al., 2009. Neurology. SALUT CEREBRAL i ENVELLIMENT Fjell et al., 2014. Progress in Neurobiology SALUT CEREBRAL i ENVELLIMENT Lee et al., 2018. Journal of Alzheimer’s Disease SALUT CEREBRAL i ENVELLIMENT White Matter Lesions White Matter Integrity INCREASED WM LESIONS DECREASED WM INTEGRITY Westlye et al., 2010. Cereb. Cortex. SALUT CEREBRAL i ENVELLIMENT Axial slices at four different sections of the brain at baseline (upper panel) and during follow up (lower panel) in a 79 year old male patient with Alzheimer’s disease and progression of white matter lesions (WML). Arrows indicate some examples of emergence or progression of WML. SALUT CEREBRAL i ENVELLIMENT SALUT CEREBRAL i ENVELLIMENT Elevada variabilitat interindividual a nivell cognitiu Nyberg et al., 2012. Trends in Cognitive Sciences SALUT CEREBRAL i ENVELLIMENT Elevada variabilitat interindividual a nivell cognitiu Depp & Jeste, Josefsson et al. J Am Geriatr Soc 2012; Nyberg & Pudas, Ann Rev Psychol 2019; Yaffe et al., 2009. Neurology SALUT CEREBRAL i ENVELLIMENT Successful AGING 1. 2. Low probability of disease High physical and cognitive functional capacity 3. Social integration and productivity ‘be able to do what one wants to do (WHO)’ Brenda Milner, “fundadora de la neuropsicologia" Naixement: 15 de juliol de 1918 SALUT CEREBRAL i ENVELLIMENT SUPERAGERS: Neuroscientific perspective Superagers are older adults who exhibit episodic memory abilities (RAVLT/CVLT) matching younger counterparts and have average or better processing speed (TMT) for their age Integrity and connectivity of DMN and salience network similar to young individuals (Sun et al. Jneurosci 2016; Zahng et al. Cerebral Cortex 2018) Maintenance of neural integrity in the MTL and NFT free cortex Rogalski et al. Hippocampus 2019 SALUT CEREBRAL i ENVELLIMENT Determinants de la Salut Cerebral Determinants de Salut Cerebral Què determina la salut cerebral? Determinants WHO Socioeconomical Environment Biological Psychological status (SES) X X X X X X X X X X NIA-NIH US Health Dept. American Heart Ass. NHS-UK X BLUE ZONES Minessota Arriben als 100 anys amb 10 vegades més de probabilitat que als Estats Units https://www.bluezones.com/ BLUE ZONES Loma Linda • Barbagia region of Sardinia – Mountainous highlands of inner Sardinia with the world’s highest concentration of male centenarians. • Ikaria, Greece – Aegean Island with one of the world’s lowest rates of middle age mortality and the lowest rates of dementia. Nicoya Okinawa • Nicoya Peninsula, Costa Rica – World’s lowest rates of middle age mortality, second highest concentration of male centenarians. • Loma Linda, California - They live 10 years longer than their North American counterparts. • Okinawa, Japan – Females over 70 are the longest-lived population in the world. Ikaria Sardinia BLUE ZONES • Les “blue zones” representen aquelles regions del món amb una expectativa de vida més elevada. Ex: Sentit de comunitat • S’han estudiat els hàbits i estils de vida d’aquestes persones i s’ha explorat com aquests poden estar relacionats amb la seva longevitat. Blue Zones Ex: Pastors - Sardenya Ex: Ikigai - Okinawa Ex: Adventists pray Ikarians take a nap Ex: Moais - Okinawa Ex: Proverbi de Confuci - Okinawa La importància dels “moais” Mo•ai (/mo,eye/) Japan Noun 1. A group of lifelong friends. 2. A social support group that forms in order to provide varying support from social, financial, health, or spiritual interests Experiment a Albert Lea