Attachment 1 IDEAL Recruitment Presentation

Attachment 1 — IDEAL Recruitment Presentations
The diverse interests and understandings of the audiences to whom IDEAL study staff present as well as
operational changes have required some changes and additions to the information provided in the
recruitment presentation. These power point presentations are identified herein as Attachment 1a
(General Presentation) and Attachment 1b (Scientific Presentation). Attachment 1a has undergone
minor revisions, whereas Attachment 1b constitutes the addition of scientifically focused slides to the
recruitment presentation.
The changes to Attachment 1a are as follows:
1. Modifications of the content due to operational changes
a. Under Eligibility criteria no longer excludes participation for those using
“hyperlipidemia” medications.
b. MedStar has been added to the title of the hospital, now known as MedStar Harbor
Hospital
c. All reference to Home Visit for Physical Screening has been removed as all screening is
conducted at MedStar Harbor Hospital for the IDEAL cohort.
d. An update to the role that Dr. Ferrucci now holds was added — Luigi Ferrucci, M.D.,
Ph.D, Scientific Director of NIA, Principal Investigator, NIA, NIH
2. Addition of content to present scientific observations
a. In addition to the slides which provide a general overview of the study and its purpose a
series of slides which depict specific methods and examples of observations occurring
during the testing and what this information is indicative of have been added. This
information was previously limited to those who qualified for the physical exam.

Insight
Determinants
Exceptional
Aging
Longevity
into the

and

of

The average age of our population is increasing at
unprecedented rates. The current life expectancy
for Americans is around 77.9 years. Improved
medical care and prevention efforts mean that for
the first time in history, older people have an
opportunity to avoid major chronic diseases and
remain healthy, active, and productive. But more
research is needed to understand healthy aging.

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Eligibility criteria (cont’d)

Have no major medical conditions, including no
history of:
 Any medical condition that requires chronic
drug treatment except drugs for hypertension
and hyperlipidemia
 Severe gastrointestinal or stomach diseases
 Significant vision and hearing problems

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Luigi Ferrucci, M.D., Ph.D., Scientific Director of NIA,
Principal Investigator, NIA, NIH

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Aging and Trajectory of Function

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The Process of Aging and Diseases

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Changes in
Body Composition

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Weight, Muscle and Fat
Longitudinal Changes in Body Composition with Age

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Mid-Thigh Muscle Cross-Sect Area (mm2)

Differences in Muscle Mass by Age
Men

20000

Women

15000

10000

5000

20

40

60
Age (years)

80

100

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Decrease in Muscle Strength by Age
200
Men
Quadriceps Isokinetic Peak
Torque (180'/sec) (N.m)

Women
150

100

50

0
20

40

60

80

100

Age (years)

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Percent Change Compared to the
Average for the Younger Age Group

Both Muscle Mass and Muscle Strength
Decrease with Age
25-34
versus
<25

35-44
versus
25-34

45-54
versus
35-44

55-64
versus
45-54

65-74
versus
55-64

75-84
versus
65-74

85+
versus
75-84

5%
0%
-5%
-10%
-15%
-20%
-25%
-30%
-35%
-40%

Strength

Mass

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Muscle
Mid-Thigh CT Images for Women (BMI 30-32)
33 Years

55 Years

80 Years

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Energy Imbalance
Production Utilization

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Energy Budget
Reserve energy for
sustained or intense
activity
Energy for
casual walking

Sources of Energy Waste
Excess cost of Movement
due to Energetic Inefficiency

Instability, infirmity &
inefficiency
Repair, recovery
& regulation

Minimum energy
to sustain life
in “good health”

Homeostatic Effort due to
Diseases and/or Aging

Basal Energy
60-70% of 24 h
consumption

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How We Measure Energy Efficiency

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Organs and Tissues
Respiratory Testing

CV Testing

• Oxygen uptake
efficiency slope

• Cardiac function (Echo)
• Vascular stiffness (PWV)
• Capillary density (biopsy)

• Spirometer (FEV1)

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Cell Biology
Cell Biology and MRS
• Mito volume
(microscopy + EM)
• Mito content (cardiolipin)
• ADP-ATP phosphorylation
(ATPmax) (31P MRS)
• Phase III mitochondrial
respiration (oxygraph)
• ECT enzyme activity
(NADH oxidase)

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Physics and Biomechanics
Gait Testing
• Muscle
strength/mass
• Balance
• Joint pathology
• Sensory impairment

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Development of a Short Physical
Battery to Predict Disability

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Lower-Extremity Function in
Persons over the Age of 70 Years as a
Predictor of Subsequent Disability

Jack M. Guralnik, MD, PhD
Luigi Ferrucci, MD, PhD
Eleanor M. Simonsick, PhD
Marcel E. Salive, MD, MPH
Robert B. Wallace, MD

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Walking Speed
A Powerful Predictor of Mortality
100%
Percent Survivors

Faster 80%

75%
Cancer
Slowest 20%

The slowest 20% had a lower survival rate
after 6 years than participants with cancer.

50%
0

2

4

6

Years

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Homeostatic Dysregulation

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Fat and Where it is Located
is Related to Glucose Intolerance in Older Adults

Glucose AUC (mg*h/dl; median)

Early Liver Uptake

Late Liver Uptake

REFERENCE

Lean

Belly Fat

Fat all Over

Fall all Over but
no Extra Belly Fat

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The Mild Pro-Inflammatory State of Aging

n of SD from the sex-specific mean

IL-6 in Men

IL-6 in Women

1.5

1.5

1

1

0.5

0.5

0

0

-0.5

-0.5

-1

-1
1

20-39

40-49 50-64 65-74 75-84

Age Groups

85+

20-39

40-49 50-64 65-74

75-84

85+

Age Groups

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Interleukin-6 Serum Levels in Older Adults
Predict Incident Disability 4 years later
95% CI

Probability of Mobility Disability

1.0
0.8

Adjusted
probability

2.5 pg/ml

0.6
0.4

95% CI

0.2
0
-0.5

0

0.5

1

1.5

2

2.5

3

Ln (IL-6)

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Neurodegeneration

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Annual Rates of Cortical Thinning
over 8 Years in Normal Aging & Cognitive Impairment
Cognitively Normal (n=96)

-0.04 -0.01 0.01

Cognitively Impaired (n=25)

0.04

-0.04 -0.01 0.01

0.04

CI > CN

-4

-2

2

4

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Amyloid Plaques Precede
Memory Problems

Memory Problems
4 years later

Stable Memory

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Measures in the BLSA
Paradigm – A Hierarchical Network of Measures

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Lessons from the BLSA

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Get Moving

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Pay Attention to Weight and Shape

LEAN

PEAR

APPLE

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Think About What you Eat

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Participate in Activities you Enjoy

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The BLSA
Baltimore Longitudinal Study of Aging

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What Can We Learn From IDEAL?

What differentiates people who survive to old age maintaining an
IDEAL condition compared to those who also survive to old age
but develop diseases and functional impairments?

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What Can We Learn From IDEAL?

(cont’d)

What are the risk factors for mortality or losing IDEAL status
in IDEAL persons

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1-855-80 IDEAL (1-855-804-3325)
www.nia.nih.gov/ideal

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A Study for our Children
and the Children of our Children

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QUESTIONS?

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