The Unknowns of Aging

The Institute of Scientific Research and Advanced Technology Services of Panama is carrying out the first study of how Panamanians age, with a focus on how cognitive abilities change as we get older.

By: Ana Teresa Benjamín
Photos : Javier Pinzón

Gabrielle Britton, who holds a Ph.D. in Neuroscience and Psychology, worked for many years as a professor of Statistics, Neurophysiology, and Experimental Design at Lafayette College, a small college in Pennsylvania (United States). Now she is the principal investigator of a study that began in Panama in 2011 and promises to shed light on how the country’s inhabitants age and what factors influence the quality of their aging process.

The Panama Aging Research Initiative (PARI) study has collected data from more than 700 people 60 years and older. Analysis of the data revealed several facts: Panamanians live long lives; elderly Panamanians suffer from several chronic diseases; and, as in other countries, a genetic factor predisposes inhabitants of this Central American nation to Alzheimer’s, the most common form of dementia among the elderly.

I understand that you lived in the United States. Why did you return to Panama and why are you interested in studying the aging process?

I studied and worked in the United States for more than twenty years. In 2006, I returned to Panama as part of the National Secretariat of Science, Technology, and Research’s initiative to “repatriate” Panamanian talent. It was a difficult decision, because I was working at a university in the United States at the time, and I had worked hard to get there.

I’m a neuroscientist and a psychologist and I’ve always been interested in all things related to learning and memory. Other researchers arrived around the same time and we sat down to discuss the topics we thought were a priority for the country and together chose the issue of aging. The study has been going on for seven years now and is longitudinal, meaning we study a group of older adults and follow them over time to track their changes.

Where did you find your senior recruits and what are you looking for exactly?

We began at the Complejo Hospitalario de la Caja de Seguro Social (Social Security Hospital Complex), which treats 70% of Panama’s population. The first group was comprised of people 65 years old and older. We ran different tests over a period of four years to see how their health changed; some (older adults) develop cognitive impairment and others do not. Some present few chronic diseases and a healthy aging process while others aren’t as healthy. We then performed a number of important studies to determine the factors that cause Alzheimer’s and mild cognitive impairment in Panamanians. Once that protocol was complete, we designed a second protocol. We are now in this second phase, doing recruiting in the community.

There was no need to reinvent the wheel; these protocols are standard, but they’ve been going on for twenty or thirty years in developed countries, whereas in Panama, this was the first study of its kind.

Which parameters do you use to determine if a senior adult is in good condition for his or her age?

The evaluations we perform determine the condition of each adult, based on his or her age. The tests we perform are similar to the intelligence tests given to a ten-year-old child: they ascertain the cognitive levels in a variety of areas such as attention, concentration, memory, etc.

You study the diseases associated with aging and measure “normal” cognitive decline and the incidence of Alzheimer’s. So what you’re trying to determine are the factors that lead to Alzheimer’s.

Exactly. That’s the most valuable thing about this type of study, because when you’re over forty you start to suffer from chronic diseases associated with aging. These causes of death in Panama include cancer, cardiovascular accidents, and neurological or brain diseases, all of which are associated with aging and have the same risk factors: obesity, diabetes, untreated hypertension… It turns out that even those who age normally will show signs of cognitive deterioration, which is normal. Many of us will show signs of deterioration, in varying degrees, and increases in other areas such as general knowledge: older people possess more information and have a larger vocabulary than younger people.

So we’re taking a look over time: if we take blood samples and other measurements from a group of seniors today and then see them and perform the same tests two years later, we’re hoping to find out who has changed during those two years, and whether the changes are associated with blood-based markers, such as inflammatory proteins, and genetic markers, such as the apolipoprotein ApoE4.

With mammograms, for example, when a doctor sees a spot and then runs a genetic test, what he or she finds is the BRCA marker, which indicates that you have cancer. The only 100% effective way to identify Alzheimer’s, however, is post mortem… By the time a living person has developed all the clinical symptoms (forgetfulness, inability to care for themselves, difficulties with daily activities) it’s already too late to do anything, because Alzheimer’s is incurable. What is the goal? We hope to identify those who will develop Alzheimer’s, but twenty years earlier than we can now, through blood samples and the presence of the ApoE4 marker.

The idea is to use the information to take steps to delay the onset of the disease. This is what we’re trying to do and we’re not working alone: Panama is part of an international group that is studying something called blood-based biomarkers. The idea is to continue recruiting until we have a good idea of the predictive value of blood samples. This can take 8-15 years.

How can the onset of Alzheimer’s be delayed?

Let’s say you get tested and you’re at risk because you’re a diabetic and you’re carrying a genetic marker. If you’re detected at age 45, the first thing you should do is, for example, if you’re overweight, lose weight; if you’re hypertensive, keep your blood pressure under control; if you have a sedentary lifestyle, start exercising… Certain estimates predict that by controlling these factors between the ages of forty and sixty, we could reduce Alzheimer’s by 30%.

Predicting one’s risk of Alzheimer’s is also an ethical question. How are you handling this issue?

It’s a very complex question because of the bioethical implications. Some people say, “I’d rather not know” and others say, “I want to know.” We believe that patients have the right to know if they so desire, and doctors are responsible for developing the proper ways to inform their patients of these risks.

What does it mean for a country like Panama to host a study on aging and Alzheimer’s?

The main achievement after seven years is that, for the first time, Panama has the necessary infrastructure to conduct studies with older adults. The Gorgas Institute (Instituto Conmemorativo Gorgas, in Spanish) approached us with an interest in seeing how older adults with HIV are faring. The interesting thing about HIV is that it used to be an infectious disease, but now, with retroviral treatment, it’s considered a chronic disease. For the first time, people living with the virus are aging. These people have a type of cognitive impairment referred to as HIV Associated Neurocognitive Disorder, but it’s different from the deterioration we see with Alzheimer’s. We have yet to analyze and characterize it at the genetic and proteomic level. We’ve just written up a proposal and are waiting for funding to be approved in order to begin the study.