1 / 24

Third in the Annual R13 AGS Conference Series, “From Bedside to Bench”

“Does Mental and Physical Activity Promote Cognitive Vitality in Late Life?” Philadelphia, PA March 1-3, 2006. Third in the Annual R13 AGS Conference Series, “From Bedside to Bench”. “Does Mental and Physical Activity Promote Cognitive Vitality in Late Life?”.

kineks
Download Presentation

Third in the Annual R13 AGS Conference Series, “From Bedside to Bench”

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. “Does Mental and Physical Activity Promote Cognitive Vitality in Late Life?”Philadelphia, PAMarch 1-3, 2006 Third in the Annual R13 AGS Conference Series, “From Bedside to Bench”

  2. “Does Mental and Physical Activity Promote Cognitive Vitality in Late Life?” • Sponsor: American Geriatrics Society • Julie Zaharatos, MPH, Manager, Governance & Public Policy • Support: National Institute of Aging • Judith Salerno, MD, MS, Deputy Director • Chairperson and Organizer: Howard Fillit, MD • Committee Members: • Michelle C. Carlson, PhD • William T. Greenough, PhD • Arthur Kramer, PhD • George Rebok, PhD • Robert Wilson, PhD • Stephanie Studenski, MD, MPH, AGS Research Committee Chair

  3. Defining Current Issues in Cognitive Vitality with Aging • What is cognitive vitality with aging? • What causes age-related cognitive decline? • What is the clinical and societal significance of age-related cognitive decline? • Can age-related cognitive decline be prevented or treated?

  4. Normal Cognitive Aging From: T. Salthouse, PhD

  5. Normal Cognitive Aging: Considerable Variability At All Ages From: T. Salthouse, PhD

  6. Normal Cognitive Aging: Conclusions • Decline is ubiquitous but not universal • Changes in cognitive function are pervasive, but possibly preventable • Do lifestyle interventions • Alter rate of aging? • Delay time to a functional threshold? From: T. Salthouse, PhD

  7. Possible Effects of Lifestyle Interventions on Cognition Reverse Improved level of performance Slow rate No effect on rate Cognitive Performance Additional time above threshold Chronological Age From: T. Salthouse, PhD

  8. Clinical Syndromes of Cognitive Decline Cognitive Vitality? Age-Associated Cognitive Impairment Cognitive Function Mild Cognitive Impairment Alzheimer’s Disease 50 60 70 80 Age

  9. Clinical Syndromes of Cognitive Decline With Aging • Age-Associated Memory Impairment (AAMI)– 1 memory test > 1 SD below mean– 1% estimated annual dementia incidence– 40% of 65+ population or 16 million • Mild Cognitive Impairment (MCI)– Delayed recall impairment, other syndromes– 15% estimated annual dementia incidence – 10% of 65+ population or 4 million • Dementia • Global cognitive impairment • 5% of people over 65, 25% over 75

  10. Prevention and Cognitive Health • Primary prevention: maintain cognitive vitality, prevent cognitive decline with aging • Secondary prevention: prevent dementia • Tertiary prevention: prevent the progression of dementia

  11. Preventing Cognitive Decline With Aging: Medical Co-morbidities • Hypertension • Diabetes • Cholesterol, heart disease and stroke • Hormones • Inflammation

  12. Preventing Cognitive Decline: Lifestyle Factors Nutritional • Folate, B6 and B12 and homocysteine • Anti-oxidants • vitamin C and E, and other anti-oxidants (red wine, dark vegetables and fruits)? • Omega-3-fatty acids, DHA • Caloric restriction • Head trauma • Smoking • Alcohol • Stress

  13. Preventing Cognitive Decline: Lifestyle Factors Building “cognitive reserve” throughout life • Education, social and occupational engagement • Physical exercise • Mental exercise

  14. Risk Factors and Alzheimer’s Disease Risk Factors Neuronal injury Overproduction of beta-amyloid Amyloid plaque formation Neuronal injury and death Loss of cognitive function

  15. Are There Proven Benefits of Physical and Mental Activity on Cognitive Health in Aging? • Epidemiologic and intervention trials support physical activity benefits on promoting cognitive health and preventing cognitive decline including dementia • Benefits of mental activity less clear • Epidemiologic studies generally support life long education, continuing social and occupational engagement, mental “exercise” in preventing cognitive decline and dementia • However, more intervention studies needed • Is the evidence good enough to make population recommendations at this time?

  16. Is Cognitive Vitality in Aging Important?It Depends on Your Perspective…. • Achieving and maintaining cognitive vitality and preventing Alzheimer’s disease is a highly valued outcome among older persons, affecting primarily quality of life • For physicians, society, and payers, the value of cognitive vitality is not as clear • Cognitive vitality is important only if we can define it and achieve it and demonstrate value

  17. Physician • Clinical impact • Society/Payers • Population perspective • Seeks cost-effectiveness What is the Value of Cognitive Vitality with Aging? It Depends on Your Perspective • Individual • QOL QOL=quality of life.

  18. Complex Relationships: Cognition, Function, Quality of Life, Costs and Activity • Ability to function is a key objective measure of quality of life (QOL)—important to individuals • Are there functional deficits associated with cognitive decline in aging?– important in medical care • Are there excess costs associated with cognitive decline with aging? – important to society and payers • If activity improves cognitive health, does it improve quality of life, function and reduce costs?

  19. Possible Sources of Excess Costs Due to Cognitive Decline • Functional impairment • Accidents • Medication noncompliance and poor control of medical comorbidities • Loss of productivity • Caregiver burden Source: Hill JW, et al. Neurology. 2002;58:62-70.

  20. The Secure Horizons (United Healthcare) Population-Based Program For Cognitive Vitality • A population-based program currently available to 180,000 Medicare Advantage managed care members in multiple regions of the US • Approved by CMS as part of health plan Medicare benefit • Part of an overall wellness program that also includes nutrition, financial and other health promotion components • Includes telephonic health coaching and free access to a senior fitness program • Free access to comprehensive “memory wellness” program that includes mental exercise

  21. The Secure Horizons (United Healthcare) Population-Based Program For Cognitive Vitality Population Based Telephonic Screening Case Referral Telephonic Assessment Triage Dementia (< 5%) Normal (60%) At risk (35%) Monitoring Prevention Care Management Health coaching, Memory Wellness, Fitness Training

  22. Using Technology to Advance Cognitive Health in Primary Care • Neuropsychometric testing is important, but time consuming, expensive and not readily available or practical in primary care • Computerized methods for cognitive screening and assessment make neuropsych testing practical in primary care • Computerized methods for cognitive training can also be implemented in primary care and in the community

  23. Goals of Session • To define normal cognitive aging • To summarize current knowledge regarding the biological mechanisms underlying the effect of activity on cognitive health • To summarize evidence in humans that mental and physical activity promotes cognitive health with aging • To review clinical and population-based interventions that have been employed to disseminate this new knowledge • To create a research agenda to define outstanding issues and develop strategies to further define the role of physical and mental activity in promoting cognitive health with aging

  24. Summary • Achieving and maintaining cognitive vitality with aging is possible • Cognitive vitality has value to individuals, in health care, and to society. • Physical and mental activity contribute significantly to cognitive health in aging

More Related