Use It or Lose It: Preventing Cognitive Decline

Cognitive Aging

Changes in cognitive function, such as slow speed of information processing, are common in normal aging. However, there is considerable variation among individuals, and cognitive decline is not inevitable.

man running on beach In fact, many older adults appear to avoid cognitive decline into their ninth decade of life, and some even beyond. The best news of all is that some risk factors for cognitive decline are potentially manageable, according to researchers.

Cognition is a combination of skills including:

  • Attention
  • Learning
  • Memory
  • Language and speech
  • Fine motor skills
  • Visuospatial orientation
  • Executive functions, such as
    • Goal-setting
    • Planning
    • Judgment

Slow speed of information processing, which may cause other deficits in cognitive functioning, is a hallmark of normal aging. Structural changes in the brain are associated with cognitive decline in apparently normal aging; however, the cause of these changes remains unknown. Three types of cognitive decline with aging have been recognized:

  • Age-associated Memory Impairment (AAMI) mild memory impairment that can occur with normal aging but cannot be detected with objective psychometric testing for the persons age group
  • Mild Cognitive Impairment (MCI) mild memory loss that can be detected with objective psychometric testing for the persons age group
  • Dementia (includes Alzheimers disease )chronic, progressive, irreversible, global cognitive impairment and memory loss that are severe enough to affect daily functioning

Good News About the Aging Brain According to the Mayo Foundation for Medical Education and Research, as you age, your brain remains capable of adapting to stimuli. Although declines occur in certain cognitive functions, other cognitive functions increase with age and can compensate for the functions that may decline. Researchers found that people who age with greater stores of knowledge may show increased adaptation. Vocabulary also tends to improve with age. Certain activities can assist older adults in increasing their capacity to learn and adapt as they age. Risk Factors for Cognitive Decline A number of research studies have identified common, potentially modifiable risk factors for cognitive decline. These risk factors include: Lack of mental activity Substance use and abuse, including: SmokingIllicit drugsAlcohol Lack of physical exerciseMalnutritionStress Certain medical conditions, including: High blood pressure Diabetes High cholesterol and atherosclerosis (hardening of the arteries) Depression Multiple medicationsImpairment in vision and hearingHead traumaSleep disorders Lack of involvement in social activities
Vital Activities for a Vital Mind The Institute for the Study of Aging and the International Longevity Center-USA recommend the following strategies to keep your mind functioning as effectively as possible as you age: Stay Socially Active A study in the Annals of Internal Medicine found that having no social ties was an independent risk factor for cognitive decline in older persons. Therefore, maintenance of many social connections and a high level of participation in social activities are recommended. Researchers suggest that participation in social activities helps prevent cognitive decline by stimulating the mind and challenging people to communicate. Working at a paid or volunteer job may help prevent cognitive decline in a similar manner. Complex intellectual work has been found to increase the cognitive function of older workers. Work also provides an opportunity for social interactions and developing a sense of personal mastery, both of which may be important in maintaining the vitality of the brain. Keep Learning Some studies suggest that having a low level of formal education and poor linguistic skills is a risk factor for cognitive decline in later life. However, other studies have not found this association. Nonetheless, many studies on humans and animals suggest that lifelong learning is beneficial in preserving cognitive vitality in later life.
One such study, published in the Journal of the American Medical Association, found that frequent participation in mentally stimulating activities is associated with a reduced risk of Alzheimers disease. Mental stimulation is not limited to formal education and can include everyday activities such as: Reading books, newspapers, or magazines Playing games such as: CardsCheckersCrosswords, or other puzzles Going to museums A number of studies have also shown that older adults with mild cognitive decline can improve cognitive functioning (including reasoning, memory, visual perception, attention, and skill coordination) through special training. However, training is often specific to the skills trained and learned. Exercise Some studies show improved cognitive functioning in older adults who exercise. Its possible that exercise may contribute to cognitive vitality by improving mood and reducing stress and other risk factors that contribute to cognitive decline. Although more research is needed, the latest data suggest that engaging in physical exercise, including enjoyable leisure activities, may help prevent cognitive decline. Eat a Nutritious, Low-fat Diet
Malnutrition and vitamin deficienciesparticularly deficiencies of vitamin B12 can lead to cognitive disorders (including dementia) in older people. Some studies suggest that antioxidants, such as vitamin E and vitamin C , may protect against cognitive decline and dementia. It is unclear at this time whether supplement intake of those vitamins may further decrease the risk. A nutritious and low-fat diet may therefore protect against cognitive decline by providing these and other necessary nutrients and reducing the risk of diseases that contribute to cognitive decline such as high blood pressure, type 2 diabetes, high cholesterol, and atherosclerosis. Practice Stress Management Acute stress, particularly long-term stress, is associated with cognitive impairment, especially in older adults. Stress management training or counseling may be beneficial in facilitating more adaptive responses to stress, and thereby promoting cognitive vitality in older persons. Seek Help for Sleep Disorders Sleep disorders and sleep disruption are common in older people and may adversely affect cognitive function, particularly memory and learning. In addition, older adults with sleep disorders may experience adverse cognitive effects associated with the use of sedatives and hypnotics, which are often prescribed as treatment for insomnia. Older adults with sleep disorders may benefit from strategies to promote sleep hygiene and avoiding daytime naps, as well as other treatment.
Seek Help for Other Underlying Medical Conditions Cognitive decline in older adults is often associated with underlying medical conditions (listed above). Furthermore, many older people have more than one of these conditions, which may increase their risk for cognitive impairment. Cognitive vitality may be restored when certain underlying conditions are successfully treated. Talk to Your Doctor If youre concerned about memory loss or other cognitive impairment, do not try to diagnose or treat yourself. Your doctor can provide assessment, counsel and, if necessary, treatment. Cognitive decline is not an inevitable part of aging. Research increasingly suggests that staying mentally, socially, and physically active and healthy can increase cognitive vitality and therefore play an important role in quality of life and survival. In addition, there is a growing interest in the development of drug treatments that may enhance cognitive vitality in older people who are experiencing normal aging. RESOURCES: National Council on Aging http://www.ncoa.org National Institute on AgingNational Institutes of Health http://www.nia.nih.gov United States Administration on Aging
http://www.aoa.gov References: Bassuk SS, Glass TA, and Berkman LF. Social disengagement and incident cognitive decline in community-dwelling elderly persons. Ann Intern Med . 1999;131: 165-173. Fillit HM, Butler RN, OConnell AW, et al. Achieving and maintaining cognitive vitality with aging. Mayo Clin Proc . 2002; 77: 681-696. The Institute for the Study of Aging and the International Longevity Center-USA website. Available at: http://www.aging-institute.org . Accessed on December 19, 2002. Wilson RS, Mendes de Leon CF, et al. Participation in cognitively stimulating activities and risk of incident Alzheimers disease. J Am Med Assoc . 2002; 287:742-748. Yaffe K, Blackwell T, Gore R, et al. Depressive symptoms and cognitive decline in nondemented elderly women. Arch Gen Psychiatry . 1999;56: 425-430. Last reviewed April 2006 by Marcin Chwistek, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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