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预防阿尔茨海默症的方法 – 译学馆
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预防阿尔茨海默症的方法

What you can do to prevent Alzheimer's | Lisa Genova

在座有多少人希望能活到八十岁以上?
How many people here would like to live to be at least 80 years old?
好。
Yeah.
我认为我们有希望去期待
I think we all have this hopeful expectation
随着年老带来的生活
of living into old age.
让我们穿越到未来,
Let’s project out into the future,
未来的你们
to your future “you’s,”
假设都已85岁。
and let’s imagine that we’re all 85.
我们随便挑选两个人,
Now, everyone look at two people.
其中一人就可能患有老年痴呆症。
One of you probably has Alzheimer’s disease.
(笑声)
(Laughter)
好吧,好吧。
Alright, alright.
也许你会想:“反正不会是我”。
And maybe you’re thinking, “Well, it won’t be me.”
那么好的 你是一名照顾人
Then, OK. You are a caregiver.
所以……
So —
(笑声)
(Laughter)
所以某种意义上来说,
so in some way,
这个可怕的疾病可能 会影响我们每一个人。
this terrifying disease is likely to affect us all.
对于老年痴呆的恐惧部分源于
Part of the fear around Alzheimer’s stems from the sense
我们对此的无能为力。
that there’s nothing we can do about it.
抛开几十种研究,我们仍然没有治疗装饰性疾病的方法
Despite decades of research, we still have no disease-modifying treatment
并且不能治愈
and no cure.
如果我们有幸长命百岁,
So if we’re lucky enough to live long enough,
老年痴呆似乎是我们大脑的宿命。
Alzheimer’s appears to be our brain’s destiny.
情况也许没有这么糟。
But maybe it doesn’t have to be.
如果我告诉你,我们可以改变现状,
What if I told you we could change these statistics,
就是改变我们大脑的命运,
literally change our brain’s destiny,
不依赖于任何疗法或是药物的发展呢?
without relying on a cure or advancements in medicine?
让我们先看看目前
Let’s begin by looking at what we currently understand
神经学上对老年痴呆的了解。
about the neuroscience of Alzheimer’s.
这是一张两个神经元连接的图。
Here’s a picture of two neurons connecting.
连接的部位,也就是红色圈出的这块,
The point of connection, this space circled in red,
叫做突触。
is called the synapse.
突触是神经递质释放的场所,
The synapse is where neurotransmitters are released.
这是信号传送、交流的场所。
This is where signals are transmitted, where communication happens.
这是我们思考、感受、视听、欲望
This is where we think, feel, see, hear, desire …
和记忆的场所。
and remember.
而突触也正是老年痴呆发病的地方。
And the synapse is where Alzheimer’s happens.
让我们把突触放大,
Let’s zoom in on the synapse
看一则动画演示。
and look at a cartoon representation of what’s going on.
在信息沟通的过程中,
During the business of communicating information,
除了释放谷氨酸等神经递质到突触,
in addition to releasing neurotransmitters like glutamate into the synapse,
神经元还释放了一种 名为β淀粉样蛋白的小肽。
neurons also release a small peptide called amyloid beta.
原则上讲
Normally, amyloid beta is cleared away metabolized by microglia,
我们大脑的联系细胞
the janitor cells of our brains.
尽管分子层面引发 老年痴呆的原因还争论不休,
While the molecular causes of Alzheimer’s are still debated,
许多神经学科学家认为疾病开始于
most neuroscientists believe that the disease begins
当类淀粉的β不断积累时
when amyloid beta begins to accumulate.
释放了太多,或者是未能完全清理,
Too much is released, or not enough is cleared away,
突触因此便开始堆积β淀粉样蛋白。
and the synapse begins to pile up with amyloid beta.
若这一事件发生 突触逐渐束缚了自己,
And when this happens, it binds to itself,
产生一种叫做淀粉样斑块 的黏糊糊的聚合体。
forming sticky aggregates called amyloid plaques.
在座的有多少人已经四十多岁了?
How many people here are 40 years old or older?
你不想承认了吗?
You’re afraid to admit it now.
老年痴呆症的起步,
This initial step into the disease,
淀粉样斑块的累积,
this presence of amyloid plaques accumulating,
也许已经在你的大脑初步产生。
can already be found in your brains.
我们唯一能确认的方式是PET扫描,
The only way we could be sure of this would be through a PET scan,
因为现在你对此毫无知觉。
because at this point, you are blissfully unaware.
你还没有任何记忆、 语言、或是认知方面的问题…
You’re not showing any impairments in memory, language, or cognition …
现在还没有。
yet.
我们认为淀粉样斑块的累积 至少需要15至20年时间
We think it takes at least 15 to 20 years of amyloid plaque accumulation
才会到达它的临界点,
before it reaches a tipping point,
随后引发分子的连锁反应
then triggering a molecular cascade
导致了这一疾病的临床症状。
that causes the clinical symptoms of the disease.
在这一临界点之前,
Prior to the tipping point,
你的记忆衰退可能会像这样:
your lapses in memory might include things like,
“我为什么到这间屋子来?”
“Why did I come in this room?”
或是“呃,他叫什么来着?”
or “Oh … what’s his name?”
或是“我把钥匙放哪了?”
or “Where did I put my keys?”
现在,在你们惊慌失措之前,
Now, before you all start freaking out again,
我知道你们中的半数在过去的 24小时内至少有过上述之一,
because I know half of you did at least one of those in the last 24 hours —
这些都是正常的遗忘类型。
these are all normal kinds of forgetting.
实际上,我的看法是这些示例,
In fact, I would argue that these examples
甚至都与你的记忆没什么关系,
might not even involve your memory,
因为你没有将过多的注意
because you didn’t pay attention to
放在你放钥匙的地方
where you put your keys in the first place.
在临界点之后,
After the tipping point,
记忆、语言和认知的偏差是不一样的。
the glitches in memory, language and cognition are different.
最后发现钥匙并不在你的大衣口袋,
Instead of eventually finding your keys in your coat pocket
或是不在门边的桌上,
or on the table by the door,
你在冰箱里找到了你的钥匙,
you find them in the refrigerator,
或者你找到钥匙后想,
or you find them and you think,
“这玩意是干嘛的?”
“What are these for?”
所以当淀粉样斑块积累到 临界点后会发生什么?
So what happens when amyloid plaques accumulate to this tipping point?
我们的看护细胞小神经 胶质细胞变得过度活跃,
Our microglia janitor cells become hyper-activated,
释放出导致炎症和 细胞损伤的化学物质。
releasing chemicals that cause inflammation and cellular damage.
1
We think they might actually start clearing away
1
the synapses themselves.
一种叫做tau蛋白的神经 转运蛋白变得过度磷酸化
A crucial neural transport protein called “tau” becomes hyperphosphorylated
并转化成叫做神经纤维缠结的物质,
and twists itself into something called “tangles,”
从内部阻塞了神经元。
which choke off the neurons from the inside.
在老年痴呆症的中期, 大量的炎症和神经纤维缠结
By mid-stage Alzheimer’s, we have massive inflammation and tangles
以及突触处的全面战争
and all-out war at the synapse
以及细胞的凋亡。
and cell death.
如果你是一位想要 治愈该病的科学家,
So if you were a scientist trying to cure this disease,
最佳介入时机是什么时候呢?
at what point would you ideally want to intervene?
许多科学家赌在了 最简单的解决方法上:
Many scientists are betting big on the simplest solution:
避免淀粉样斑块达到临界点,
keep amyloid plaques from reaching that tipping point,
1
which means that drug discovery is largely focused on developing a compound
1
that will prevent, eliminate, or reduce amyloid plaque accumulation.
所以老年痴呆症的治疗方法 很有可能是一种预防性的药物。
So the cure for Alzheimer’s will likely be a preventative medicine.
我们需要在临界点到达之前,
We’re going to have to take this pill before we reach that tipping point,
在连锁反应产生之前,
before the cascade is triggered,
在我们把钥匙落在冰箱前 服用这种药物。
before we start leaving our keys in the refrigerator.
我们认为这也是迄今为止 这类药物在临床试验上
We think this is why, to date, these kinds of drugs have failed
失败的原因。
in clinical trials —
并不是因为科学技术不够可靠,
not because the science wasn’t sound,
而是因为在临床试验的人们 都已是老年痴呆的患者。
but because the people in these trials were already symptomatic.
这就为时已晚。
It was too late.
试想淀粉样斑块是已经点燃的火柴。
Think of amyloid plaques as a lit match.
在临界点后,火柴的火引燃了整片森林。
At the tipping point, the match sets fire to the forest.
一旦森林起火,
Once the forest is ablaze,
吹灭火柴早已于事无补。
it doesn’t do any good to blow out the match.
你需要在火柴引燃 森林前就把火柴熄灭。
You have to blow out the match before the forest catches fire.
即使科学家还尚未解决问题,
Even before scientists sort this out,
这一好消息确实振奋人心,
this information is actually really good news for us,
1
because it turns out that the way we live can influence the accumulation
1
of amyloid plaques.
我们可以做许多小事
And so there are things we can do
来避免达到临界点。
to keep us from reaching that tipping point.
不妨把患老年痴呆的风险比作天平。
Let’s picture your risk of Alzheimer’s as a see-saw scale.
把可能增加风险的因素放在一端,
We’re going to pile risk factors on one arm,
如果一端触到地面,那么你将患病。
and when that arm hits the floor, you are symptomatic
并被诊断为老年痴呆。
and diagnosed with Alzheimer’s.
假设你已五十岁。
Let’s imagine you’re 50 years old.
你已不再年轻,
You’re not a spring chicken anymore,
随年岁增长你已积累了部分淀粉样斑块。
so you’ve accumulated some amyloid plaques with age.
你的天平已经微微倾斜。
Your scale is tipped a little bit.
现在观察一下你的DNA。
Now let’s look at your DNA.
我们的基因全部遗传自我们的父母。
We’ve all inherited our genes from our moms and our dads.
一些基因会增加风险 还有一些会降低风险。
Some of these genes will increase our risk and some will decrease it.
如果你像《依然爱丽丝》中的爱丽丝一样,
If you’re like Alice in “Still Alice,”
你遗传的一种罕见的基因突变, 粗制滥造着β淀粉样蛋白,
you’ve inherited a rare genetic mutation that cranks out amyloid beta,
单单这一点就会使你的天平一端着地。
and this alone will tip your scale arm to the ground.
不过对于大多数人而言 该基因只会使天平稍稍倾斜。
But for most of us, the genes we inherit will only tip the arm a bit.
举个例子,APOE4是一种 增加淀粉样蛋白的变异基因,
For example, APOE4 is a gene variant that increases amyloid,
你可能会从父母那里 遗传一份APOE4的基因
but you can inherit a copy of APOE4 from mom and dad
不过却不会患上老年痴呆,
and still never get Alzheimer’s,
这也就意味着对大多数人而言,
which means that for most of us,
我们的DNA并不是决定 老年痴呆的唯一要素。
our DNA alone does not determine whether we get Alzheimer’s.
那么什么决定呢?
So what does?
我们对于衰老无能为力 也无法决定我们遗传的基因。
We can’t do anything about getting older or the genes we’ve inherited.
到现在我们还没有 改变我们大脑的宿命。
So far, we haven’t changed our brain’s destiny.
关于睡眠呢?
What about sleep?
1
In slow-wave deep sleep, our glial cells rinse cerebral spinal fluid
1
throughout our brains,
清除掉积累在突触的代谢废物
clearing away metabolic waste that accumulated in our synapses
当我们清醒时。
while we were awake.
深度睡眠就好像是大脑的强效净化。
Deep sleep is like a power cleanse for the brain.
那么如果你在睡眠方面亏待了自己呢?
But what happens if you shortchange yourself on sleep?
许多科学家坚信
Many scientists believe
不良的睡眠卫生可能 是老年痴呆的前兆。
that poor sleep hygiene might actually be a predictor of Alzheimer’s.
缺乏仅仅一晚的睡眠就会 增加β淀粉样蛋白。
A single night of sleep deprivation leads to an increase in amyloid beta.
而淀粉样蛋白的累积 已被证实会影响睡眠,
And amyloid accumulation has been shown to disrupt sleep,
从而导致了更多淀粉样蛋白的累积。
which in turn causes more amyloid to accumulate.
所以现在我们有了正反馈循环,
And so now we have this positive feedback loop
将会加剧天平的倾倒。
that’s going to accelerate the tipping of that scale.
还有别的吗?
What else?
心血管的健康。
Cardiovascular health.
高血压、糖尿病、肥胖、 吸烟、高胆固醇,
High blood pressure, diabetes, obesity, smoking, high cholesterol,
这些都证明会增加患老年痴呆的风险。
have all been shown to increase our risk of developing Alzheimer’s.
一些验尸报告表明
Some autopsy studies have shown
有80%的老年痴呆患者
that as many as 80 percent of people with Alzheimer’s
同样患有心血管疾病。
also had cardiovascular disease.
1
Aerobic exercise has been shown in many studies to decrease amyloid beta
1
in animal models of the disease.
所以有益心脏健康的 地中海式生活方式和饮食
So a heart-healthy Mediterranean lifestyle and diet
可以有效扳回倾斜的天平。
can help to counter the tipping of this scale.
所以我们能做很多事
So there are many things we can do
来预防或者延缓老年痴呆症的到来。
to prevent or delay the onset of Alzheimer’s.
不过假设你并没有做任何事。
But let’s say you haven’t done any of them.
并且你已经六十五岁了,
Let’s say you’re 65;
1
there’s Alzheimer’s in your family, so you’ve likely inherited a gene or two
1
that tips your scale arm a bit;
你的生命之火渐渐微弱,
you’ve been burning the candle at both ends for years;
你喜欢培根,
you love bacon;
除非有人追你你懒得跑动。
and you don’t run unless someone’s chasing you.
(笑声)
(Laughter)
假设你的淀粉样斑块已经达到临界点。
Let’s imagine that your amyloid plaques have reached that tipping point.
你天平的一端已坠地。
Your scale arm has crashed to the floor.
你触发了连锁反应,
You’ve tripped the cascade,
引发了森林火灾,
setting fire to the forest,
导致了炎症、神经纤维 缠结以及细胞凋亡。
causing inflammation, tangles, and cell death.
你表现出老年痴呆的症状。
You should be symptomatic for Alzheimer’s.
你在措辞和找钥匙时会碰到麻烦
You should be having trouble finding words and keys
并且回想不起我一开始讲的内容。
and remembering what I said at the beginning of this talk.
也许你不会这样。
But you might not be.
另外还有一件事可以帮助你
There’s one more thing you can do to protect yourself
免于老年痴呆的症状,
from experiencing the symptoms of Alzheimer’s,
哪怕你的大脑已病入膏肓。
even if you have the full-blown disease pathology ablaze in your brain.
它需解决神经可塑性 和认知储备问题。
It has to do with neural plasticity and cognitive reserve.
记住,老年痴呆症的发作
Remember, the experience of having Alzheimer’s
是突触损失的最终后果。
is ultimately a result of losing synapses.
一般大脑有超过万亿的突触,
The average brain has over a hundred trillion synapses,
这很不可思议, 我们有这么庞大的数量。
which is fantastic; we’ve got a lot to work with.
而这一数字不是一成不变。
And this isn’t a static number.
我们在一个叫做神经可塑性的过程之中,
We gain and lose synapses all the time,
不断生成和消耗着突触。
through a process called neural plasticity.
每当我们习得新东西,
Every time we learn something new,
我们建立并强化新的神经连接,
we are creating and strengthening new neural connections,
新的突触产生了。
new synapses.
在Nun研究中,
In the Nun Study,
研究开始时,678位修女全都年过七十五岁,
678 nuns, all over the age of 75 when the study began,
进行了二十多年的研究。
were followed for more than two decades.
她们会定期接受身体检查和认知测试,
They were regularly given physical checkups and cognitive tests,
如果不行去世,她们的大脑 都捐献出去用于验尸。
and when they died, their brains were all donated for autopsy.
科学家们在一些大脑中 发现了一些神奇的东西。
In some of these brains, scientists discovered something surprising.
尽管样斑块、神经纤维 缠结和大脑的萎缩,
Despite the presence of plaques and tangles and brain shrinkage —
这些现象似乎是老年痴呆症无疑,
what appeared to be unquestionable Alzheimer’s —
1
the nuns who had belonged to these brains showed no signs
1
of having the disease while they were alive.
这是怎么回事呢?
How can this be?
我们认为这是因为这些 修女拥有高级的认知储备,
We think it’s because these nuns had a high level of cognitive reserve,
意味着她们有功能更强的突触。
which is a way of saying that they had more functional synapses.
接受正式教育的时间越长的人,
People who have more years of formal education,
拥有较强读写能力的人,
who have a high degree of literacy,
定期参加刺激心理活动的人,
who engage regularly in mentally stimulating activities,
这些人都有更高的认知储备。
all have more cognitive reserve.
他们有着大量甚至多余的神经连接。
They have an abundance and a redundancy in neural connections.
所以即使他们患上老年痴呆等疾病
So even if they have a disease like Alzheimer’s
损伤了部分突触,
compromising some of their synapses,
他们依然有充足的额外后备连接,
they’ve got many extra backup connections,
而这减缓了他们的大脑产生混乱。
and this buffers them from noticing that anything is amiss.
让我们来看一个简单的例子。
Let’s imagine a simplified example.
假设你只知道关于某一主题的一件事。
Let’s say you only know one thing about a subject.
比方说是关于我的。
Let’s say it’s about me.
你知道丽莎·吉诺瓦 写下了《依然爱丽丝》,
You know that Lisa Genova wrote “Still Alice,”
这是你唯一知道的关于我的事。
and that’s the only thing you know about me.
你拥有一处单一的神经连接,
You have that single neural connection,
那一个特定突触。
that one synapse.
如果现在你患上了老年痴呆。
Now imagine you have Alzheimer’s.
你有样斑块、神经纤维缠结和炎症
You have plaques and tangles and inflammation
以及小神经胶质细胞吞噬了那一突触。
and microglia devouring that synapse.
现在若有人问起你 “嘿,谁写了《依然爱丽丝》?“
Now when someone asks you, “Hey, who wrote ‘Still Alice?'”
你无法回想起来了,
you can’t remember,
因为那个突触要么衰弱要么消失了。
because that synapse is either failing or gone.
你把我忘得一干二净。
You’ve forgotten me forever.
但是如果你对我了解更深呢?
But what if you had learned more about me?
比如你了解我的四件事情。
Let’s say you learned four things about me.
现在如果你患上了老年痴呆,
Now imagine you have Alzheimer’s,
即使三处突触已损伤或者毁坏。
and three of those synapses are damaged or destroyed.
你依然有一条路来 绕过阻碍找到我的信息。
You still have a way to detour the wreckage.
你依然记得我的名字。
You can still remember my name.
1
So we can be resilient to the presence of Alzheimer’s pathology
1
through the recruitment of yet-undamaged pathways.
同时我们通过学习新事物,
And we create these pathways, this cognitive reserve,
创造了新的通路,改变着认知储备。
by learning new things.
理想情况下,我们希望 这些新事物的意义尽可能丰富,
Ideally, we want these new things to be as rich in meaning as possible,
吸纳视觉与听觉的联合感受。
recruiting sight and sound and associations and emotion.
所以这并不意味着 去做横纵字谜游戏。
So this really doesn’t mean doing crossword puzzles.
你不希望去重拾 那些你早已学会的信息,
You don’t want to simply retrieve information you’ve already learned,
这就好比游览老旧的熟悉街道,
because this is like traveling down old, familiar streets,
那些周边环境你早已了然于心。
cruising neighborhoods you already know.
你想要开辟新的神经道路。
You want to pave new neural roads.
使你的大脑抵抗老年痴呆
Building an Alzheimer’s-resistant brain
意味着学习说意大利语,
means learning to speak Italian,
去遇见新朋友,
meeting new friends,
读一本书,
reading a book,
或是听一场精彩的TED演讲。
or listening to a great TED Talk.
如果做了所有的这一切之后 有一天你被诊断为老年痴呆,
And if, despite all of this, you are someday diagnosed with Alzheimer’s,
我从我的祖母以及我认识的许多患者中
there are three lessons I’ve learned from my grandmother
学习到了三件事情。
and the dozens of people I’ve come to know living with this disease.
诊断并不意味着死期将至。
Diagnosis doesn’t mean you’re dying tomorrow.
顽强地活下去吧。
Keep living.
你不会丢失你的情感记忆。
You won’t lose your emotional memory.
你依然可以理解爱与喜悦。
You’ll still be able to understand love and joy.
你也许不会记得我五分钟前的话语,
You might not remember what I said five minutes ago,
但是你依然会记得我带给你的感受。
but you’ll remember how I made you feel.
你远胜于你所能记住的一切。
And you are more than what you can remember.
谢谢。
Thank you.
(掌声)
(Applause)

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视频概述

如何预防老年痴呆症(阿尔茨海默症)的方法。

听录译者

收集自网络

翻译译者

?

审核员

Z

视频来源

https://www.youtube.com/watch?v=twG4mr6Jov0

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