1. How To Grow Your Hippocampus in Three Months Majid Fotuhi, MD PhD Founder and Chief Medical Officer NeurExpand Brain Center Nothing to disclose

2. New Perspectives 2

3. Objectives  Why hippocampus shrinks with aging?  How can we grow the size of hippocampus in a clinical setting?  Brain Fitness Program 3

4. Hippocampal Atrophy is the Most Robust Marker for Dementia Duara et al., Neurology 71:1986–92, 2008

5. Main Factors Contributing to Atrophy in Hippocampus “Plaques” and “Tangles” Inflammation Concussion/TBI Vascular disease (obesity, OSA, hypertension, diabetes, CHF, CAD, A Fib, strokes) Depression (anxiety, stress, PTSD)

6. Plaques and Tangles

7. Vascular Factors Zlokovic et al. Neurosurgery 43(4), 877–78, 1998

8. Sleep Apnea Shrinks Hippocampus Am J Respir Crit Care Med 2002; 166:1382–7 8

9. Obesity Shrinks Hippocampus  Associated with reduced brain volume Ward, et al., 2005  Slows cognitive function Debette, et al., 2011  Brains of overweight and obese individuals appeared 8 and 16 years older, respectively Raji, et al., 2010 9 Brain Research Volume 1280, 14 July 2009, Pages 186–194

10. Stress Shrinks Brain Cells in Hippocampus Stress Control 14

11. Depression Shrinks the Brain  The number of days of depression is associated with the severity of hippocampal atrophy Sheline, et al, (1996). PNAS, 93(9);3908-13.  Depression is associated with impaired memory, executive function and processing speed Egger et al, (2008). Psychiatry Research: Neuroimaging; 164(3): 237-44) Sheline, (1996). PNAS, 93(9);3908-13. 15

12. Figure 2 Comparison of studies of hippocampal volume in clinical depression and PTSD Fotuhi, M. et al. (2012) Modifiable factors that alter the size of the hippocampus with ageing Nat. Rev. Neurol. doi:10.1038/nrneurol.2012.27

13. Figure 2 Factors that could cause brain atrophy and cognitive impairment Fotuhi, M. et al. (2009) Changing perspectives regarding late-life dementia Nat. Rev. Neurol. doi:10.1038/nrneurol.2009.175

14. Multiple Risk Factors Shrink the Hippocampus Multiple Risk Factors No Risk Factors Hippocampus 14

15. 15 Diabetes Hypertension Obesity Sleep Apnea Head Trauma Genes Stress Brain-healthy Diet Physical Fitness Cognitive Stimulation Meditation

16. Objectives  Why hippocampus shrinks with aging?  How can we grow the size of hippocampus in a clinical setting?  Brain Fitness Program 16

17. 1. Hippocampus Grows Bigger with Getting Fit Erikson, PNAS 2011 17

18. Arch Gen Psychiatry, 2010 Hippocampus Grows Bigger with Exercise, Even After 3 Months After Before 18

19. Draganski et al. J Neurosci 2006; 26:6314–7 2. Hippocampus Grows Bigger with Memorization Training 19

20. 3. Hippocampus Grows Bigger with Eating Well & Taking DHA 20

21. More DHA-EPA: Bigger Hippocampus 21 Pottala J V et al. Neurology 2014;82:435-442

22. Fotuhi et al., Nature Clinical Practice Neurol 5(3):140–52, 2009

23. 23 4. Hippocampus Grows Bigger with Treatment of Sleep Apnea Canesa, American Journal of Respiratory Medicine, 2011

24. 5. Hippocampus Grows Bigger with Relaxing Your Mind Holzel, Psychiatric Research, 2011 24

25. Figure 3 Pathways leading to hippocampal growth or atrophy Fotuhi, M. et al. (2012) Modifiable factors that alter the size of the hippocampus with ageing Nat. Rev. Neurol. doi:10.1038/nrneurol.2012.27

26. Objectives  Why hippocampus shrinks with aging?  How can we grow the size of hippocampus in a clinical setting?  Brain Fitness Program 26

27. Brain Fitness Program  A multidisciplinary program devoted to: Improving memory and brain performance Enhancing long-term brain health Reducing risk for dementia, Alzheimer’s disease and stroke in the future  Each patient receives a comprehensive baseline assessment followed by a personalized treatment plan  This program is based on latest research and has shown remarkable results 27

28. Comprehensive Diagnostics Customized “Brain Fitness Program” NeurExpand’s Unique Integrative Approach 28

30. Figure 2

31. 71 year-old man with AAMI

32. MRI Results Hippocampus After Before 32

33. 2.86 cm 3 3.14 cm 3

34. THANK YOU MFOTUHI@NEUREXPAND.COM 34