TO DO:
This discussion is based on: Blazer et al., 2015; Peters, 2006; Understanding Dementia video; Reducing your Risk Factors video; MIND Diet video.
– Read – Blazer et al. (2015) and Peters (2006) – Video: Understand dementia:
– https://www.youtube.com/watch?v=gKZhp2JNYyI&t=117s – Reducing your risk factor:
– https://www.youtube.com/watch?v=W40Nh-vVbcI&t=1s – MIND Diet
– https://www.youtube.com/watch?v=ROAFiwE7zZs
For the “3-2-1” post and reply, students are expected to post the following information on the discussion board for each week:
● 3 concepts you learned from the readings/videos/audio (3 sentences total; 2 point each)
○ Ie. what was something you found interesting? What is something new you learned?
○ Please post well-thought responses. An example of a well-thought response: “I learned that dementia is an umbrella term to describe subtypes of cognitive impairment that cause impairment in daily functioning.” An example of a poorly thought response: “I learned what dementia means.”
● 2 questions you have about the readings/videos/audio (2 sentences total; 2 points each)
○ What continues to pique your curiosity after completing the reading, watching the video, or listening to the audio? What questions did the reading/video/audio not answer for you?
○ Please post well-thought questions. An example of a well-thought question: “Isolation may become a problem for older adults, but what are the best way for them to make friends?” An example of a poorly thought question: “Old people are lame. Anyone agree?”
○ Please do not edit your questions once you have posted them, as this will confuse other students who have/have not replied to a post and myself during the grading process.
● 1 reply to peer ○ Make your best attempt to answer one question posted by a peer. When I
say best attempt, I mean that your answer is not graded for being right or wrong. Some questions may not even have a right answer. Therefore, you
are expected to use the knowledge you have to answer the question. Make it brief!
○ For example, if I were to answer this question: “Isolation may become a problem for older adults, but what is the best way for them to make friends?” I could say, “I think a good way for older adults to make friends would be to go to a gym for seniors and take exercise classes. At the gym I go to there is a walking group for seniors called Silver Sneakers. – seems to be quite popular.”
Copyright 2015 American Medical Association. All rights reserved.
Cognitive Aging A Report From the Institute of Medicine
The Institute of Medicine recently released a report entitled Cognitive Aging: Progress in Understanding and Opportunities for Action, which addresses the emerging concept of cognitive aging, the importance of this issue for the nation’s public health, and actions the nation needs to take to better understand and maintain the cognitive health of older adults.1
Cognitive aging is a lifelong process of gradual, on- going, yet highly variable changes in cognitive function that occur as people get older. Some cognitive func- tions decrease predictably, such as memory and reac- tion time, whereas some other functions are either main- tained or may even increase, such as wisdom and knowledge. Characteristics of cognitive aging are pre- sented in the Box.
Cognitive aging is not a disease or a quantifiable level of dysfunction. It is distinct from Alzheimer disease and other neurocognitive and psychiatric disorders that affect older adults’ cognitive health, so it is best mea- sured and studied longitudinally among adults who are free of these disorders. Animal models of aging demon- strate that neurons do not die with aging, but their syn- aptic structure and function are diminished, particu- larly in prefrontal cortical regions. The committee that prepared the report on cognitive aging concluded this finding is important because it suggests the possibility for improving cognitive health.
Cognition and cognitive health are matters of the life span. Cognitive health is described as the mainte- nance of optimal cognitive function with age. The evi- dence showed that cognitive aging and its influence on cognitive health are matters of pressing public health importance.
Individuals are deeply concerned about declines in memory and decision-making abilities as they age. They may worry that these declines are early signs of a neu- rodegenerative disease, particularly Alzheimer dis- ease, and they fear losing their independence and a wors- ening quality of life. Maintenance of cognitive function, or “staying mentally sharp,” may be the primary health concern of older adults.2 Cognitive decline also affects older adults’ family members and friends, who are con- cerned about the older person’s continued ability to drive or make financial decisions and who often are called to assist them even if the older adult does not meet crite- ria for a diagnosable disorder.
An individual and society can be affected by cogni- tive aging because of 2 issues. First, older adults lose an estimated $2.9 billion a year, directly and indirectly, to financial fraud.3 To address this, the committee called for financial institutions and relevant government agen- cies to develop and improve programs and services used by older adults to help them avoid exploitation, opti-
mize independence, and make sound financial deci- sions. Second, older adults may develop problems with driving, especially because reaction time is critical and decision making must be at times almost instanta- neous. Although most older adults are more experi- enced drivers, their driving capability may be compro- mised and recognition of these deficits and programs to help correct them will be essential.
Although the study of cognitive aging, especially clinical trials of interventions, is in its infancy, well- designed studies support some actions that individu- als can take to promote their cognitive health: be physically active; reduce and manage cardiovascular disease risk factors, including high blood pressure, diabetes, and smoking; and regularly discuss and review with a health care professional the medica- tions that might influence cognitive health. None of these findings are unique to cognitive aging—each is good advice for many health conditions—yet the find- ing that these actions may promote cognitive health as persons age emphasizes the importance of public health resources and programs to promote them. Although the evidence is not as strong, other actions may promote cognitive health: be socially and intel- lectually active; continually seek opportunities to learn; get adequate sleep; and seek professional treat- ment for sleep disorders, if needed.
Health care systems and health care professionals will play a key role in educating patients and their families about cognitive aging and in implementing interventions to ensure optimal cognitive health across the life cycle. The committee noted the impor- tance of programs to avoid delirium associated with medications or hospitalizations. Educating the patient and family members should include these clear mes- sages: the brain ages, just like other parts of the body; cognitive aging is not a disease; cognitive aging is dif- ferent for every individual (there is wide variability across persons of similar age); some cognitive func- tions improve with age and neurons are not dying as in Alzheimer disease (hence, realistic hope is inherent in cognitive aging); and patients can take certain steps to help protect their cognitive health.
Society can also contribute to cognitive health. The committee recommended that the US Food and Drug Administration and Federal Trade Commission should determine the appropriate regulatory review, policies, and guidelines for products advertised to consumers to improve cognitive health, such as medications, nutri- tional supplements, and cognitive training. Many medications and brain-stimulating activities are being marketed directly to the public. Even though the com- mittee did not evaluate each of these separately, it did
VIEWPOINT
Dan G. Blazer, MD, MPH, PhD School of Medicine, Duke University, Durham, North Carolina.
Kristine Yaffe, MD School of Medicine, University of California at San Francisco.
Jason Karlawish, MD Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Author Reading at jama.com
Corresponding Author: Dan G. Blazer, MD, MPH, PhD, Division of Community and Family Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 3521 Hospital S, PO Box 3003, Durham, NC 27710 (blaze001 @mc.duke.edu).
Opinion
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find that overall the evidence for their effectiveness, especially the transfer of cognitive gains to real-life situations and the long-term benefit of the interventions, remains to be clearly demonstrated. Nevertheless, new data will undoubtedly emerge and could allow better evaluation of these interventions.
Cognitive aging is not a disease, but it is a major public health issue. Despite the public health importance of cognitive aging, there is limited research available on this process, especially research into basic biological mechanisms leading to cognitive
aging and research into potential interventions through controlled clinical trials. The activities of multiple groups—advocacy groups, research organizations, government agencies, communities, health care professionals, senior centers, financial institutions, and depart- ments of transportation—will be necessary for society to both bet- ter understand cognitive aging and promote cognitive health in later life. Patients are already concerned. The time has come for physicians, other health care professionals, and researchers to enter the conversation with them.
ARTICLE INFORMATION
Published Online: April 15, 2015. doi:10.1001/jama.2015.4380.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Yaffe reports serving on a data and safety monitoring board for Takeda Inc and for the National Institute on Aging. No other disclosures were reported.
Funding/Support: The IOM report described in this Viewpoint was sponsored by the McKnight Brain Research Foundation, National Institute on Aging, National Institute of Neurological Disorders and Stroke, Centers for Disease Control and Prevention, Retirement Research Foundation, and AARP.
Additional Contributions: Members of the IOM Committee on Public Health Dimensions of Cognitive Aging convened by the IOM who authored the report: Dan Blazer (chair), Kristine Yaffe (vice-chair), Marilyn Albert, Sara Czaja, Donna Fick, Lisa Gwyther, Felicia Hill-Briggs, Sharon Inouye, Jason Karlawish, Arthur Kramer, Andrea LeCroix, John Morrison, Tia Powell, David Reuben, Leslie Snyder, and Robert Wallace.
REFERENCES
1. Blazer DG, Yaffe K, Liverman CT, eds. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: National Academies Press; 2015. http://www.iom.edu/cognitiveaging. Accessed April 14, 2015.
2. AARP. 2012 Member opinion survey issue spotlight: Interests-concerns. http://www.aarp.org /politics-society/advocacy/info-01-2013/interests -concerns-member-opinion-survey-issue -spotlight.html. 2013. Accessed December 4, 2014.
3. MetLife Mature Market Institute, National Committee for the Prevention of Elder Abuse, and Virginia Tech. The MetLife study of elder financial abuse: Crimes of occasion, desperation, and predation against America’s elders. New York: MetLife Mature Market Institute. https://www .metlife.com/assets/cao/mmi/publications/studies /2011/mmi-elder-financial-abuse.pdf. 2011. Accessed March 17, 2015.
Box. Characteristics of Cognitive Aging
Key Features Inherent in humans and animals as they age
Occurs across the spectrum of individuals as they age regardless of initial cognitive function
Highly dynamic process with variability within and between individuals
Includes some cognitive domains that may not change, may decline, or may improve with aging, and there is the potential for older adults to strengthen some cognitive abilities
Only now beginning to be understood biologically yet clearly involves structural and functional brain changes
Not a clinically defined neurological or psychiatric disease and does not inevitably lead to neuronal death and neurodegenerative dementia (such as in Alzheimer disease)
Risk and Protective Factors Health and environmental factors over the life span influence cognitive aging
Modifiable and nonmodifiable factors include genetics, culture, education, medical comorbidities, acute illness, physical activity, and other health behaviors
Cognitive aging can be influenced by development beginning in utero, infancy, and childhood
Assessment Cognitive aging is not easily defined by a clear threshold on cognitive tests because many factors—including culture, occupation, education, environmental context, and health variables (eg, medications)—influence test performance and norms
For an individual, cognitive performance is best assessed at several points in time
Effect on Daily Life Day-to-day functions may be affected, such as driving, making financial and health care decisions, and understanding instructions given by health care professionals
Experience, expertise, and environmental support aids (eg, lists) can help compensate for declines in cognition
The challenges of cognitive aging may be more apparent in environments that require individuals to engage in highly technical and fast-paced or timed tasks, situations that involve new learning, or stressful situations (eg, emotional, physical, or health-related) and are less apparent in highly familiar situations
Opinion Viewpoint
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