I am not alone in my greatest fear of old age: losing my mind. Okay, these days the more polite terms are dementia and Alzheimer's but the words amount to the same thing.
”In 2013, a YouGov survey...found that Americans of age 60 years and older were more afraid of Alzheimer's disease or dementia than cancer, heart disease, stroke, or diabetes.”
That survey is noted on page 305 of a huge new study from the U.S. Institute of Medicine about ageing and the brain, that was released in April. The title provides us with a new-ish phrase we need to learn:Cognitive Aging, subtitled Progress in Understanding and Opportunities for Action.
The Journal of the American Medical Association (JAMA) defines the phrase for us:
”Cognitive aging is a lifelong process of gradual, ongoing, yet highly variable changes in cognitive function that occur as people get older.
“Some cognitive functions decrease predictably, such as memory and reaction time, whereas some other functions are either maintained or may even increase, such as wisdom and knowledge.
“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 measured and studied longitudinally among adults who are free of these disorders.”
So cognitive aging is nowhere near the same thing as Alzheimer's disease. Here is a chart from the study comparing the two:
|Chronic neurodegenerative disease||Part of aging|
|Extensive neuron loss||Neuron number remains relatively stable but neuronal function may decline|
|Affects approximately 10% of older Americans||Occurs in everyone but the extent and nature of changes varies widely|
|Declines are often severe and progressive||Changes are variable and gradual|
There is a handy box at the JAMA website with a list of key features of cognitive aging.
The full study [pdf], which you can download for free at The National Academies Press website, is nearly 400 pages. I've skimmed it, reading more carefully in some places but for this short report, I've mostly relied on others. One of them, from AARP, provides a good overview of the most salient points.
The long-time usual suspects for promoting and maintaining good physical health are equally important for cognitive health: get plenty of aerobic exercise, stay intellectually active, control blood pressure, get a good night's sleep. And this:
”...eating less meat and consuming more nuts and beans, whole grains, vegetables and olive oil. Omega-3 fatty acids, found in fatty fish such as salmon, have been shown to help cognition in some studies, yet not in others.”
You have probably heard, too, the list of things that are detrimental to brain health: depression, hearing and vision loss, stress and hospitalization, excessive use of alcohol. In addition,
”Adults between ages 65 and 69 use an average of 14 different prescription drugs per year, often leading to serious complications.
“The report singles out strong anticholinergic drugs (including antihistamines such as Benadryl and some antidepressants) as well as benzodiazepines (such as Valium and Xanax, used to treat anxiety and sleeplessness) as being linked to delirium, cognitive impairment and dementia.
“'We aren’t saying don’t take them ever,' [study author, Dan G.] Blazer said. 'But you need to watch out and be aware of the side effects.'”
The report includes an important list of widely-used products that have no proven effect in preserving cognitive function: dietary supplements including vitamins B6 and B12, vitamin D, vitamin E and ginkgo biloba. Not to mention (emphasis is mine):
”Although research shows that brain training on computers and video games can improve attention and memory as they relate to the games, few studies show that those skills transfer to real life.
“The report recommends that consumers carefully evaluate claims of companies selling brain games. 'People may fall prey to using products that have not been proven to be effective and think they will help them in all areas of their lives,' Blazer said.”
As we have discussed here many times, among our worries are that forgetting a name or the reason we have walked into the bedroom could be harbingers of dementia. We cling to “advice” that as long as we can remember what the can opener does, even if we can't find it, it's not incipient Alzheimer's.
What is important about this report for elders ourselves (as opposed to health care professionals and researchers and others who work in age-related fields) is to understand the difference between dementia and this new phrase, cognitive aging. It is good to finally have a name for it.
If you are not up for reading the entire book (it is written in layman's language so it is not difficult to get through), the links I have provided above to The Journal of the American Medical Association and AARP explain the study well.