TED2017
Lisa Genova: What you can do to prevent Alzheimer's
Lisa Genova: Què podem fer per prevenir l'Alzheimer.
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L'Alzheimer no ha de ser el destí del seu cervell, diu la neurocientífica i autora de 'Sempre Alice', Lisa Genova, qui comparteix les darreres investigacions científiques sobre la malaltia, i les investigacions més prometedores del que podem fer, cada un de nosaltres, per construir un cervell resistent a l'Alzheimer.
Lisa Genova - Neuroscientist, novelist
Through her fiction, Lisa Genova beckons us into the lives of people with neurological disease, making their worlds real and relatable. Full bio
Through her fiction, Lisa Genova beckons us into the lives of people with neurological disease, making their worlds real and relatable. Full bio
Double-click the English transcript below to play the video.
00:13
How many people here would like to live
to be at least 80 years old?
to be at least 80 years old?
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A quants de vostès els agradaria viure
fins als 80 anys?
fins als 80 anys?
00:18
Yeah.
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Exacte.
00:19
I think we all have
this hopeful expectation
this hopeful expectation
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Crec que tots tenim l'esperança
00:22
of living into old age.
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de viure fins a una edat avançada.
00:24
Let's project out into the future,
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Fem veure que som al futur,
00:26
to your future "you's,"
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vostès d'aquí a uns anys,
00:28
and let's imagine that we're all 85.
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Imaginem que tots tenim 85 anys.
00:31
Now, everyone look at two people.
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Ara mirin a dues persones.
00:35
One of you probably has
Alzheimer's disease.
Alzheimer's disease.
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Un de vostès probablement té Alzheimer.
00:39
(Laughter)
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(Riure)
00:42
Alright, alright.
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D'acord, d'acord.
00:44
And maybe you're thinking,
"Well, it won't be me."
"Well, it won't be me."
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I potser pensen, "no seré pas jo".
00:49
Then, OK. You are a caregiver.
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Bé, d'acord. Vostè és el cuidador.
00:53
So --
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Així que...
00:54
(Laughter)
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(Rialles)
00:57
so in some way,
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d'alguna manera,
00:58
this terrifying disease
is likely to affect us all.
is likely to affect us all.
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és possible que aquesta malaltia
tan terrible ens afecti a tots.
tan terrible ens afecti a tots.
01:02
Part of the fear around Alzheimer's
stems from the sense
stems from the sense
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Part de la por que genera l'Alzheimer
prové de la idea
prové de la idea
01:05
that there's nothing we can do about it.
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que no podem fer-hi res.
01:08
Despite decades of research, we still
have no disease-modifying treatment
have no disease-modifying treatment
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Tot i que s'ha investigat durant dècades,
encara no hi ha cap tractament
encara no hi ha cap tractament
01:13
and no cure.
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ni cura.
01:15
So if we're lucky enough
to live long enough,
to live long enough,
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Si tenim la sort de viure molts anys,
01:17
Alzheimer's appears to be
our brain's destiny.
our brain's destiny.
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sembla que l'Alzheimer sigui el destí
del nostre cervell.
del nostre cervell.
01:21
But maybe it doesn't have to be.
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Però potser no ha de ser així.
01:23
What if I told you we could
change these statistics,
change these statistics,
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I si us digués que es poden canviar
aquestes estadístiques,
aquestes estadístiques,
01:26
literally change our brain's destiny,
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literalment, canviar el destí del cervell,
01:29
without relying on a cure
or advancements in medicine?
or advancements in medicine?
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sense dependre d'una cura
o avenços en la medicina?
o avenços en la medicina?
01:33
Let's begin by looking at
what we currently understand
what we currently understand
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Comencem veient el que entenem
ara per ara
ara per ara
01:36
about the neuroscience of Alzheimer's.
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sobre la neurociència de l'Alzheimer.
01:39
Here's a picture
of two neurons connecting.
of two neurons connecting.
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Us mostro una imatge de dues neurones
connectades.
connectades.
01:42
The point of connection,
this space circled in red,
this space circled in red,
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El punt de connexió, l'espai en vermell,
01:46
is called the synapse.
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es diu sinapsi.
01:47
The synapse is where
neurotransmitters are released.
neurotransmitters are released.
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La sinapsi és des d'on s'emeten
els neurotransmissors.
els neurotransmissors.
01:51
This is where signals are transmitted,
where communication happens.
where communication happens.
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Aquí és on es transmeten els senyals,
on té lloc la comunicació.
on té lloc la comunicació.
01:55
This is where we think,
feel, see, hear, desire ...
feel, see, hear, desire ...
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Aquí és on pensem, sentim, veiem,
escoltem, desitgem...
escoltem, desitgem...
02:00
and remember.
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i recordem.
02:02
And the synapse
is where Alzheimer's happens.
is where Alzheimer's happens.
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I la sinapsi és on té lloc l'Alzheimer.
02:05
Let's zoom in on the synapse
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Apropem-nos a la sinapsi
02:07
and look at a cartoon representation
of what's going on.
of what's going on.
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i mirem el que passa, en aquest gràfic.
02:10
During the business
of communicating information,
of communicating information,
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Durant el procés de comunicar informació,
02:13
in addition to releasing neurotransmitters
like glutamate into the synapse,
like glutamate into the synapse,
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a més d'emetre neurotransmissors com
glutamats a la sinapsi,
glutamats a la sinapsi,
02:17
neurons also release a small peptide
called amyloid beta.
called amyloid beta.
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les neurones també emeten
un petit pèptid: el beta amiloide.
un petit pèptid: el beta amiloide.
02:22
Normally, amyloid beta is cleared away
metabolized by microglia,
metabolized by microglia,
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Normalment, el beta amiloide s'elimina,
metabolitzat per les micròglies,
metabolitzat per les micròglies,
02:27
the janitor cells of our brains.
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les cèl·lules protectores del cervell.
02:30
While the molecular causes
of Alzheimer's are still debated,
of Alzheimer's are still debated,
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Tot i que les causes mol·leculars
de l'Alzheimer encara es debaten,
de l'Alzheimer encara es debaten,
02:34
most neuroscientists believe
that the disease begins
that the disease begins
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la majoria de neurocientífics creuen que
la malaltia comença
la malaltia comença
02:37
when amyloid beta begins to accumulate.
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quan els beta amiloides s'acumulen.
02:40
Too much is released,
or not enough is cleared away,
or not enough is cleared away,
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Se n'emeten massa o no se n'eliminen prou,
02:43
and the synapse begins
to pile up with amyloid beta.
to pile up with amyloid beta.
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i la sinapsi es comença a omplir
de beta amiloides.
de beta amiloides.
02:47
And when this happens, it binds to itself,
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I quan això succeeix, s'enllaça,
02:49
forming sticky aggregates
called amyloid plaques.
called amyloid plaques.
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formant les plaques amiloides,
uns agregats enganxifosos.
uns agregats enganxifosos.
02:53
How many people here
are 40 years old or older?
are 40 years old or older?
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Quants de vostès tenen 40 anys o més?
02:57
You're afraid to admit it now.
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Ara no ho volen admetre.
02:59
This initial step into the disease,
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Aquesta etapa inicial a la malaltia,
03:01
this presence of amyloid
plaques accumulating,
plaques accumulating,
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la presència de plaques d'amiloides
que s'acumulen
que s'acumulen
03:05
can already be found in your brains.
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ja es poden trobar als seus cervells.
03:08
The only way we could be sure of this
would be through a PET scan,
would be through a PET scan,
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La manera de saber-ho del cert
seria amb un escàner PET,
seria amb un escàner PET,
03:11
because at this point,
you are blissfully unaware.
you are blissfully unaware.
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ja que ara mateix en sou
feliçment inconscients.
feliçment inconscients.
03:15
You're not showing any impairments
in memory, language, or cognition ...
in memory, language, or cognition ...
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No mostreu cap deteriorament de memòria,
llenguatge o capacitats cognitives...
llenguatge o capacitats cognitives...
03:19
yet.
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encara.
03:21
We think it takes at least 15 to 20 years
of amyloid plaque accumulation
of amyloid plaque accumulation
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Creiem que cal una acumulació de plaques
d'amiloides de 15 a 20 anys
d'amiloides de 15 a 20 anys
03:26
before it reaches a tipping point,
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fins que s'arriba a un punt crític,
03:28
then triggering a molecular cascade
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es desencadena una cascada mol·lecular
03:30
that causes the clinical
symptoms of the disease.
symptoms of the disease.
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que causa els símptomes clínics
de la malaltia.
de la malaltia.
03:33
Prior to the tipping point,
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Abans d'arribar a aquest punt crític,
03:35
your lapses in memory
might include things like,
might include things like,
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els lapsus de la memòria
poden incloure coses com
poden incloure coses com
03:39
"Why did I come in this room?"
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"Per què he entrat a aquesta habitació?"
03:41
or "Oh ... what's his name?"
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o "Com es diu aquest?"
03:44
or "Where did I put my keys?"
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o "On he deixat les claus?"
03:47
Now, before you all
start freaking out again,
start freaking out again,
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Però abans no s'espantin un altre cop,
03:50
because I know half of you did at least
one of those in the last 24 hours --
one of those in the last 24 hours --
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perquè la meitat n'ha fet
una d'aquestes en les darreres 24 hores,
una d'aquestes en les darreres 24 hores,
03:55
these are all normal kinds of forgetting.
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són tipus d'oblits normals.
03:58
In fact, I would argue that these examples
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De fet, diria que aquests exemples
04:01
might not even involve your memory,
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ni tan sols no impliquen la memòria,
04:03
because you didn't pay attention
to where you put your keys
to where you put your keys
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ja que no paraven atenció
a on deixaven les claus
a on deixaven les claus
04:06
in the first place.
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per començar.
04:07
After the tipping point,
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Després d'aquest punt crític,
04:09
the glitches in memory,
language and cognition are different.
language and cognition are different.
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els problemes de memòria, llenguatge i
cognició són diferents.
cognició són diferents.
04:12
Instead of eventually finding
your keys in your coat pocket
your keys in your coat pocket
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En comptes d'acabar trobant les claus
a la butxaca,
a la butxaca,
04:15
or on the table by the door,
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o a la tauleta del rebedor,
04:17
you find them in the refrigerator,
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les troba a la nevera,
04:20
or you find them and you think,
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o les troba i pensa,
04:22
"What are these for?"
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"Per a què serveixen?"
04:24
So what happens when amyloid plaques
accumulate to this tipping point?
accumulate to this tipping point?
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Què passa quan les plaques d'amiloides
s'acumulen fins a aquest punt crític?
s'acumulen fins a aquest punt crític?
04:30
Our microglia janitor cells
become hyper-activated,
become hyper-activated,
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Les cèl·lules micròglies netejadores
passen a estar hiperactivades,
passen a estar hiperactivades,
04:33
releasing chemicals that cause
inflammation and cellular damage.
inflammation and cellular damage.
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i emeten unes substàncies que causen
inflamació i dany cel·lular.
inflamació i dany cel·lular.
04:37
We think they might actually
start clearing away
start clearing away
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Pensem que potser comencen a eliminar
04:40
the synapses themselves.
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les sinapsis.
04:42
A crucial neural transport protein
called "tau" becomes hyperphosphorylated
called "tau" becomes hyperphosphorylated
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Una proteïna neuronal important,
la tau, passa a estar hiperfosforilada
la tau, passa a estar hiperfosforilada
04:46
and twists itself
into something called "tangles,"
into something called "tangles,"
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s'entortolliga en un 'cabdell',
04:49
which choke off the neurons
from the inside.
from the inside.
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que escanya les neurones des de dins.
04:52
By mid-stage Alzheimer's,
we have massive inflammation and tangles
we have massive inflammation and tangles
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En la fase mitjana de l'Alzheimer
tenim una gran inflamació, cabdells,
tenim una gran inflamació, cabdells,
04:56
and all-out war at the synapse
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una guerra a la sinapsi
04:58
and cell death.
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i mort cel·lular.
05:00
So if you were a scientist
trying to cure this disease,
trying to cure this disease,
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Si fossin científics intentant curar
aquesta malaltia,
aquesta malaltia,
05:03
at what point would you ideally
want to intervene?
want to intervene?
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quan pensen que seria ideal intervenir?
05:07
Many scientists are betting big
on the simplest solution:
on the simplest solution:
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Molts científics aposten per la solució
més senzilla:
més senzilla:
05:11
keep amyloid plaques
from reaching that tipping point,
from reaching that tipping point,
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impedir que les plaques amiloides
arribin al punt crític,
arribin al punt crític,
05:14
which means that drug discovery is largely
focused on developing a compound
focused on developing a compound
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vol dir que el descobriment de fàrmacs
se centra en crear una combinació
se centra en crear una combinació
05:18
that will prevent, eliminate, or reduce
amyloid plaque accumulation.
amyloid plaque accumulation.
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que previngui, elimini o redueixi
l'acumulació de plaques amiloides.
l'acumulació de plaques amiloides.
05:24
So the cure for Alzheimer's will likely be
a preventative medicine.
a preventative medicine.
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La cura de la malaltia sembla que serà
una medicina de prevenció.
una medicina de prevenció.
05:30
We're going to have to take this pill
before we reach that tipping point,
before we reach that tipping point,
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Pendrem una pastilla
abans d'arribar al punt crític,
abans d'arribar al punt crític,
05:33
before the cascade is triggered,
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abans que es desencadeni la cascada,
05:35
before we start leaving
our keys in the refrigerator.
our keys in the refrigerator.
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abans que comencem a deixar
les claus a la nevera.
les claus a la nevera.
05:39
We think this is why, to date,
these kinds of drugs have failed
these kinds of drugs have failed
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Per això, creiem que els medicaments
han fallat
han fallat
05:43
in clinical trials --
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en estudis clínics -
05:44
not because the science wasn't sound,
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no perquè la ciència no sigui correcta,
05:46
but because the people in these trials
were already symptomatic.
were already symptomatic.
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sinó perquè les persones en les proves
ja mostraven símptomes.
ja mostraven símptomes.
05:50
It was too late.
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Ja era massa tard.
05:52
Think of amyloid plaques as a lit match.
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Pensin en les plaques amiloides
com un llumí.
com un llumí.
05:55
At the tipping point, the match
sets fire to the forest.
sets fire to the forest.
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En el punt crític, el llumí cala foc
al bosc.
al bosc.
05:59
Once the forest is ablaze,
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Quan el bosc està en flames,
06:01
it doesn't do any good
to blow out the match.
to blow out the match.
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ja no soluciona res apagar el llumí.
06:04
You have to blow out the match
before the forest catches fire.
before the forest catches fire.
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S'ha d'apagar
abans que el bosc s'incendiï.
abans que el bosc s'incendiï.
06:08
Even before scientists sort this out,
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Abans que se solucioni això,
06:10
this information is actually
really good news for us,
really good news for us,
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aquesta informació ja és una bona notícia
06:13
because it turns out that the way we live
can influence the accumulation
can influence the accumulation
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perquè sembla que la manera de viure
pot influenciar l'acumulació
pot influenciar l'acumulació
06:17
of amyloid plaques.
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de plaques amiloides.
06:18
And so there are things we can do
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Hi ha coses que podem fer
06:20
to keep us from reaching
that tipping point.
that tipping point.
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per evitar d'arribar al punt crític.
06:23
Let's picture your risk
of Alzheimer's as a see-saw scale.
of Alzheimer's as a see-saw scale.
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Imaginem el seu risc d'Alzheimer
en una balança.
en una balança.
06:27
We're going to pile
risk factors on one arm,
risk factors on one arm,
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Apilem els factors de risc en un braç,
06:29
and when that arm hits the floor,
you are symptomatic
you are symptomatic
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i quan el braç toca a terra,
ja són simptomàtics
ja són simptomàtics
06:31
and diagnosed with Alzheimer's.
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i se'ls diagnostica l'Alzheimer.
06:34
Let's imagine you're 50 years old.
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Imaginem que tenen 50 anys.
06:36
You're not a spring chicken anymore,
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Ja no són jovenets,
06:38
so you've accumulated
some amyloid plaques with age.
some amyloid plaques with age.
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i amb l'edat ja s'han acumulat
les plaques amiloides.
les plaques amiloides.
06:41
Your scale is tipped a little bit.
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La seva balaça s'inclina una mica.
06:44
Now let's look at your DNA.
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Ara mirem el seu ADN.
06:46
We've all inherited our genes
from our moms and our dads.
from our moms and our dads.
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Hem heretat els gens
de les nostres mares i pares.
de les nostres mares i pares.
06:50
Some of these genes will increase our risk
and some will decrease it.
and some will decrease it.
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Alguns d'aquests gens augmentaran
el risc i d'altres el disminuiran.
el risc i d'altres el disminuiran.
06:54
If you're like Alice in "Still Alice,"
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Si són l'Alice, de "Sempre Alice",
06:56
you've inherited a rare genetic mutation
that cranks out amyloid beta,
that cranks out amyloid beta,
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han heretat una mutació genètica rara
que produeix beta amiloides sense parar,
que produeix beta amiloides sense parar,
07:01
and this alone will tip
your scale arm to the ground.
your scale arm to the ground.
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i això sol inclinarà la balança
cap a terra.
cap a terra.
07:04
But for most of us, the genes we inherit
will only tip the arm a bit.
will only tip the arm a bit.
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Per la majoria, els gens que hem heretat
només desviaran una mica el braç.
només desviaran una mica el braç.
07:08
For example, APOE4 is a gene variant
that increases amyloid,
that increases amyloid,
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Per exemple, l'ApoE4 és un gen variant
que augmenta els amiloides,
que augmenta els amiloides,
07:13
but you can inherit a copy of APOE4
from mom and dad
from mom and dad
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però es pot heretar una còpia del ApoE4
de la mare i el pare
de la mare i el pare
07:16
and still never get Alzheimer's,
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i no desenvolupar mai Alzheimer,
07:19
which means that for most of us,
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que significa que, per a la majoria,
07:21
our DNA alone does not determine
whether we get Alzheimer's.
whether we get Alzheimer's.
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el nostre ADN sol no determina
si tindrem la malaltia.
si tindrem la malaltia.
07:25
So what does?
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I què ho fa, doncs?
07:27
We can't do anything about getting older
or the genes we've inherited.
or the genes we've inherited.
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No podem impedir fer-nos grans,
ni els gens heretats.
ni els gens heretats.
07:31
So far, we haven't changed
our brain's destiny.
our brain's destiny.
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Fins ara, no hem canviat el destí
del cervell.
del cervell.
07:35
What about sleep?
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I quan dormim?
07:37
In slow-wave deep sleep, our glial cells
rinse cerebral spinal fluid
rinse cerebral spinal fluid
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En el son profund, les cèl·lules glials
esbandeixen líquid cefalorraquidi
esbandeixen líquid cefalorraquidi
07:41
throughout our brains,
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per tot el cervell,
07:42
clearing away metabolic waste
that accumulated in our synapses
that accumulated in our synapses
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netegen residus metabòlics
que s'han acumulat a les sinapsis
que s'han acumulat a les sinapsis
07:46
while we were awake.
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quan estàvem desperts.
07:48
Deep sleep is like
a power cleanse for the brain.
a power cleanse for the brain.
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El son profund és una neteja a fons
del cervell.
del cervell.
07:51
But what happens if you shortchange
yourself on sleep?
yourself on sleep?
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Què passa si no es dorm el necessari?
07:55
Many scientists believe
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Molts científics creuen
07:56
that poor sleep hygiene might actually
be a predictor of Alzheimer's.
be a predictor of Alzheimer's.
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que una mala higiene del son podria ser
un predictor de l'Alzheimer.
un predictor de l'Alzheimer.
08:01
A single night of sleep deprivation
leads to an increase in amyloid beta.
leads to an increase in amyloid beta.
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Privar el son una sola nit
condueix a un augment de beta amiloides.
condueix a un augment de beta amiloides.
08:07
And amyloid accumulation
has been shown to disrupt sleep,
has been shown to disrupt sleep,
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I l'acumulació d'amiloides
s'ha demostrat que altera el son,
s'ha demostrat que altera el son,
08:10
which in turn causes
more amyloid to accumulate.
more amyloid to accumulate.
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la qual cosa comporta més acumulació
d'amiloides.
d'amiloides.
08:13
And so now we have
this positive feedback loop
this positive feedback loop
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Ara tenim aquest cercle positiu
que es retroalimenta
que es retroalimenta
08:15
that's going to accelerate
the tipping of that scale.
the tipping of that scale.
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i accelerarà la desviació de la balança.
I què més?
08:19
What else?
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La salut cardiovascular.
08:20
Cardiovascular health.
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08:23
High blood pressure, diabetes,
obesity, smoking, high cholesterol,
obesity, smoking, high cholesterol,
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Hipertensió, diabetis, obesitat,
fumar i el colesterol alt
fumar i el colesterol alt
08:26
have all been shown to increase our risk
of developing Alzheimer's.
of developing Alzheimer's.
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s'ha demostrat que augmenten el risc
de desenvolupar Alzheimer.
de desenvolupar Alzheimer.
Estudis d'autopsia han mostrat
08:30
Some autopsy studies have shown
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08:32
that as many as 80 percent
of people with Alzheimer's
of people with Alzheimer's
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que fins a un 80 per cent de gent
amb Alzheimer
amb Alzheimer
08:35
also had cardiovascular disease.
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també tenien problemes cardiovasculars.
Estudis confirmen que l'exercici
l'aeròbic redueix la beta amiloide
l'aeròbic redueix la beta amiloide
08:38
Aerobic exercise has been shown
in many studies to decrease amyloid beta
in many studies to decrease amyloid beta
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en models animals de la malaltia.
08:43
in animal models of the disease.
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Un cor sa, una vida i dieta mediterrànies
08:45
So a heart-healthy
Mediterranean lifestyle and diet
Mediterranean lifestyle and diet
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ajuden a contrarrestar la
desviació de la balança.
desviació de la balança.
08:49
can help to counter
the tipping of this scale.
the tipping of this scale.
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Hi ha moltes coses que podem fer
08:52
So there are many things we can do
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per prevenir o retardar l'inici de
l'Alzheimer.
l'Alzheimer.
08:55
to prevent or delay
the onset of Alzheimer's.
the onset of Alzheimer's.
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Però diguem que n'heu fet cap.
08:57
But let's say
you haven't done any of them.
you haven't done any of them.
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Imaginem que teniu 65 anys;
i teniu Alzheimer a la família.
i teniu Alzheimer a la família.
09:00
Let's say you're 65;
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09:02
there's Alzheimer's in your family,
so you've likely inherited a gene or two
so you've likely inherited a gene or two
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Algun gen heu pogut heretar
09:06
that tips your scale arm a bit;
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i pot desviar la balança una mica,
09:08
you've been burning the candle
at both ends for years;
at both ends for years;
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fa anys que us excediu;
us encanta la cansalada;
09:11
you love bacon;
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i només correu quan us persegueixen.
09:12
and you don't run unless
someone's chasing you.
someone's chasing you.
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(Rialles)
09:14
(Laughter)
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09:16
Let's imagine that your amyloid plaques
have reached that tipping point.
have reached that tipping point.
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Imaginem: les plaques amiloides
són al punt crític.
són al punt crític.
La balança s'ha precipitat al terra
09:19
Your scale arm has crashed to the floor.
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S'ha activat la cascada,
09:21
You've tripped the cascade,
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s'ha calat foc al bosc,
09:23
setting fire to the forest,
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09:25
causing inflammation, tangles,
and cell death.
and cell death.
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i causa inflamació, cabdells i
mort cel·lular.
mort cel·lular.
Començaríeu amb els símptomes
de la malaltia.
de la malaltia.
09:29
You should be symptomatic for Alzheimer's.
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Tindríeu problemes
per trobar les paraules i les claus,
per trobar les paraules i les claus,
09:31
You should be having trouble
finding words and keys
finding words and keys
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09:35
and remembering what I said
at the beginning of this talk.
at the beginning of this talk.
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per recordar el què he dit
a l'inici de la xerrada.
a l'inici de la xerrada.
O podria no ser així.
09:38
But you might not be.
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Encara podeu fer una cosa
per protegir-vos
per protegir-vos
09:41
There's one more thing you can do
to protect yourself
to protect yourself
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09:43
from experiencing
the symptoms of Alzheimer's,
the symptoms of Alzheimer's,
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d'experimentar els símptomes
de l'Alzheimer,
de l'Alzheimer,
09:46
even if you have the full-blown disease
pathology ablaze in your brain.
pathology ablaze in your brain.
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encara que la patologia de la malaltia
us cremi al cervell.
us cremi al cervell.
Té a veure amb la plasticitat neuronal
i la reserva cognitiva.
i la reserva cognitiva.
09:50
It has to do with neural plasticity
and cognitive reserve.
and cognitive reserve.
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Recordeu, el fet de tenir Alzheimer
09:55
Remember, the experience
of having Alzheimer's
of having Alzheimer's
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és el resultat de perdre les sinapsis.
09:57
is ultimately a result of losing synapses.
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Un cervell normal té més de cent bilions
de sinapsis.
de sinapsis.
10:01
The average brain has
over a hundred trillion synapses,
over a hundred trillion synapses,
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Fantàstic. Tenim molt de material.
10:04
which is fantastic;
we've got a lot to work with.
we've got a lot to work with.
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No és un nombre estàtic.
10:07
And this isn't a static number.
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10:09
We gain and lose synapses all the time,
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Guanyem i perdem sinapsis constantment,
10:11
through a process
called neural plasticity.
called neural plasticity.
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a través de la plasticitat neuronal.
Quan aprenem una cosa nova,
10:14
Every time we learn something new,
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10:16
we are creating and strengthening
new neural connections,
new neural connections,
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creem i enfortim noves connexions,
noves sinapsis.
10:20
new synapses.
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10:22
In the Nun Study,
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A l'"Estudi de les monges"
10:24
678 nuns, all over the age of 75
when the study began,
when the study began,
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es va fer el seguiment
de 678 monges de més de 75 anys
al principi de l'estudi,
al principi de l'estudi,
10:29
were followed for more than two decades.
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durant més de dues dècades.
Se'ls feien exàmens físics i
tests cognitius regularment,
tests cognitius regularment,
10:31
They were regularly given
physical checkups and cognitive tests,
physical checkups and cognitive tests,
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10:35
and when they died, their brains
were all donated for autopsy.
were all donated for autopsy.
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i quan morien, es donaven els cervells
per a autòpsia.
per a autòpsia.
En alguns dels cervells es va descobrir
una cosa inesperada.
una cosa inesperada.
10:39
In some of these brains, scientists
discovered something surprising.
discovered something surprising.
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10:43
Despite the presence of plaques
and tangles and brain shrinkage --
and tangles and brain shrinkage --
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Tot i la presència de plaques, cabdells
i reducció del cervell
i reducció del cervell
que semblava indubtablement Alzheimer.
10:48
what appeared to be
unquestionable Alzheimer's --
unquestionable Alzheimer's --
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10:51
the nuns who had belonged
to these brains showed no signs
to these brains showed no signs
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Les monges no havien mostrat senyals
10:54
of having the disease
while they were alive.
while they were alive.
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d'Alzheimer en vida.
Com és possible?
10:58
How can this be?
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11:00
We think it's because these nuns
had a high level of cognitive reserve,
had a high level of cognitive reserve,
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Creiem que aquestes monges tenien un alt
nivell de reserva cognitiva,
nivell de reserva cognitiva,
que vol dir que tenien
més sinapsis funcionals.
més sinapsis funcionals.
11:04
which is a way of saying that they had
more functional synapses.
more functional synapses.
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Les persones amb més anys
d'educació formal,
d'educació formal,
11:08
People who have more years
of formal education,
of formal education,
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amb un nivell més alt de coneixements,
11:10
who have a high degree of literacy,
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11:12
who engage regularly
in mentally stimulating activities,
in mentally stimulating activities,
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que fan activitats d'estimulació mental,
tenen més reserva cognitiva.
11:16
all have more cognitive reserve.
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11:19
They have an abundance
and a redundancy in neural connections.
and a redundancy in neural connections.
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Tenen abundància i redundància
de connexions neuronals.
de connexions neuronals.
Tot i tenir una malaltia
com l'Alzheimer,
com l'Alzheimer,
11:23
So even if they have a disease
like Alzheimer's
like Alzheimer's
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que els afecta algunes sinapsis,
11:25
compromising some of their synapses,
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11:28
they've got many extra backup connections,
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tenen connexions extres de reserva,
11:31
and this buffers them from noticing
that anything is amiss.
that anything is amiss.
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que fa que no s'adonin
que alguna cosa va malament
que alguna cosa va malament
Imaginem un exemple senzill.
11:34
Let's imagine a simplified example.
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Imaginem que només saben
una cosa d'un tema.
una cosa d'un tema.
11:37
Let's say you only know one thing
about a subject.
about a subject.
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Sobre mi.
11:40
Let's say it's about me.
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11:41
You know that Lisa Genova
wrote "Still Alice,"
wrote "Still Alice,"
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Saben que Lisa Genova va escriure
'Sempre Alice',
'Sempre Alice',
11:43
and that's the only thing
you know about me.
you know about me.
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i és l'únic que saben sobre mi.
11:46
You have that single neural connection,
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Tenen una sola connexió neuronal,
una sola sinapsis.
11:48
that one synapse.
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11:50
Now imagine you have Alzheimer's.
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Imaginin que tenen Alzheimer.
11:52
You have plaques and tangles
and inflammation
and inflammation
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Tenen plaques i cabdells
i inflamació
i inflamació
11:55
and microglia devouring that synapse.
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i micròglies que devoren la sinapsi.
11:58
Now when someone asks you,
"Hey, who wrote 'Still Alice?'"
"Hey, who wrote 'Still Alice?'"
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Si algú els pregunta
"Qui ha escrit aquest llibre?"
"Qui ha escrit aquest llibre?"
No ho recorden
12:02
you can't remember,
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12:04
because that synapse
is either failing or gone.
is either failing or gone.
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perquè la sinapsis falla
o ja no hi és.
o ja no hi és.
M'han oblidat per sempre.
12:07
You've forgotten me forever.
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I si haguessin après més coses sobre mi?
12:09
But what if you had learned more about me?
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Diguem que han après quatre coses.
12:12
Let's say you learned
four things about me.
four things about me.
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Ara tenen Alzheimer,
12:14
Now imagine you have Alzheimer's,
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i tres de les sinapsis s'han espatllat
o destruit.
o destruit.
12:16
and three of those synapses
are damaged or destroyed.
are damaged or destroyed.
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Encara tenen una manera
per evitar el desastre.
per evitar el desastre.
12:20
You still have a way
to detour the wreckage.
to detour the wreckage.
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Encara poden recordar el meu nom.
12:22
You can still remember my name.
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Podem ser resistents a la presència
de patologia de la malaltia
de patologia de la malaltia
12:25
So we can be resilient
to the presence of Alzheimer's pathology
to the presence of Alzheimer's pathology
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si busquem camins encara no fets malbé.
12:29
through the recruitment
of yet-undamaged pathways.
of yet-undamaged pathways.
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12:32
And we create these pathways,
this cognitive reserve,
this cognitive reserve,
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Creem camins, reserva cognitiva,
aprenent coses noves.
12:36
by learning new things.
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Haurien de ser coses
molt riques en significat,
molt riques en significat,
12:38
Ideally, we want these new things
to be as rich in meaning as possible,
to be as rich in meaning as possible,
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12:43
recruiting sight and sound
and associations and emotion.
and associations and emotion.
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que impliquin vista i oïda, associacions
i emocions.
i emocions.
No vol dir que fem mots encreuats.
12:48
So this really doesn't mean
doing crossword puzzles.
doing crossword puzzles.
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12:51
You don't want to simply retrieve
information you've already learned,
information you've already learned,
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No volem només recuperar el que
ja hem après,
ja hem après,
perquè això és com viatjar per
llocs familiars,
llocs familiars,
12:55
because this is like traveling
down old, familiar streets,
down old, familiar streets,
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com anar per barris que ja coneixem.
12:59
cruising neighborhoods you already know.
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S'han d'asfaltar nous camins de neurones
13:02
You want to pave new neural roads.
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Crear un cervell resistent a l'Alzheimer
13:04
Building an Alzheimer's-resistant brain
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és aprendre a parlar Italià,
13:07
means learning to speak Italian,
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fer nous amics,
13:09
meeting new friends,
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llegir un llibre,
13:11
reading a book,
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13:12
or listening to a great TED Talk.
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o escoltar una bona xerrada de TED.
13:15
And if, despite all of this, you are
someday diagnosed with Alzheimer's,
someday diagnosed with Alzheimer's,
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I si, tot i això, un dia
us diagnostiquen Alzheimer,
us diagnostiquen Alzheimer,
us deixo amb tres lliçons de la meva àvia
13:20
there are three lessons I've learned
from my grandmother
from my grandmother
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13:23
and the dozens of people I've come to know
living with this disease.
living with this disease.
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i de molta altra gent que he conegut
amb aquesta malaltia.
amb aquesta malaltia.
El diagnòstic no vol dir morir-se demà.
13:28
Diagnosis doesn't mean
you're dying tomorrow.
you're dying tomorrow.
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Continueu vivint.
13:31
Keep living.
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13:33
You won't lose your emotional memory.
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No perdreu la vostra memòria emocional.
13:35
You'll still be able
to understand love and joy.
to understand love and joy.
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Encara podreu entendre l'amor i l'alegria.
Pot ser que no recordeu el que he dit
fa cinc minuts,
fa cinc minuts,
13:38
You might not remember
what I said five minutes ago,
what I said five minutes ago,
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però recordareu com us he fet sentir.
13:42
but you'll remember how I made you feel.
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I, al final,
som més del que recordem.
som més del que recordem.
13:44
And you are more than what
you can remember.
you can remember.
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Gràcies.
13:48
Thank you.
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(Aplaudiments)
13:49
(Applause)
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ABOUT THE SPEAKER
Lisa Genova - Neuroscientist, novelistThrough her fiction, Lisa Genova beckons us into the lives of people with neurological disease, making their worlds real and relatable.
Why you should listen
Lisa Genova wields her ability to tell a story and her knowledge of the human brain to talk about medical conditions like Alzheimer’s in warmly human terms. Her writing, often focusing on those who are misunderstood, explores the lives of people living with neurological diseases and disorders. A bestselling author, her work has been transformed into an Oscar-winning film, Still Alice, but the real triumph is Genova’s ability to help us empathize with a person’s journey we otherwise couldn’t even begin to understand.
Her newest book, Inside the O’Briens, is about Huntington’s disease.
Lisa Genova | Speaker | TED.com