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ISOA (www.aging-institute.org) Does Mental and Physical Activity Promote Cognitive Vitality in Late Life? Philadelphia, PA March 1-3, 2006 Third in the.

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Presentation on theme: "ISOA (www.aging-institute.org) Does Mental and Physical Activity Promote Cognitive Vitality in Late Life? Philadelphia, PA March 1-3, 2006 Third in the."— Presentation transcript:

1 ISOA (www.aging-institute.org) 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

2 ISOA (www.aging-institute.org) 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 ISOA (www.aging-institute.org) 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 ISOA (www.aging-institute.org) Normal Cognitive Aging From: T. Salthouse, PhD

5 ISOA (www.aging-institute.org) Normal Cognitive Aging: Considerable Variability At All Ages From: T. Salthouse, PhD

6 ISOA (www.aging-institute.org) 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? Normal Cognitive Aging: Conclusions From: T. Salthouse, PhD

7 ISOA (www.aging-institute.org) Chronological Age Cognitive Performance Reverse Slow rate No effect on rate Possible Effects of Lifestyle Interventions on Cognition From: T. Salthouse, PhD Additional time above threshold Improved level of performance

8 ISOA (www.aging-institute.org) Clinical Syndromes of Cognitive Decline Mild Cognitive Impairment Alzheimers Disease Age-Associated Cognitive Impairment Age Cognitive Function Cognitive Vitality?

9 ISOA (www.aging-institute.org) 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 ISOA (www.aging-institute.org) 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 ISOA (www.aging-institute.org) Preventing Cognitive Decline With Aging: Medical Co-morbidities Hypertension Diabetes Cholesterol, heart disease and stroke Hormones Inflammation

12 ISOA (www.aging-institute.org) 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 Preventing Cognitive Decline: Lifestyle Factors Head trauma Smoking Alcohol Stress

13 ISOA (www.aging-institute.org) Building cognitive reserve throughout life Education, social and occupational engagement Physical exercise Mental exercise Preventing Cognitive Decline: Lifestyle Factors

14 ISOA (www.aging-institute.org) Risk Factors and Alzheimers Disease Neuronal injury Overproduction of beta-amyloid Amyloid plaque formation Loss of cognitive function Risk Factors Neuronal injury and death

15 ISOA (www.aging-institute.org) 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 ISOA (www.aging-institute.org) Is Cognitive Vitality in Aging Important? It Depends on Your Perspective…. Achieving and maintaining cognitive vitality and preventing Alzheimers 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 ISOA (www.aging-institute.org) Society/Payers Population perspective Population perspective Seeks cost-effectiveness Seeks cost-effectiveness Physician Clinical impact What is the Value of Cognitive Vitality with Aging? It Depends on Your Perspective QOL=quality of life. Individual QOL

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

22 ISOA (www.aging-institute.org) 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 ISOA (www.aging-institute.org) Goals of Session 1.To define normal cognitive aging 2.To summarize current knowledge regarding the biological mechanisms underlying the effect of activity on cognitive health 3.To summarize evidence in humans that mental and physical activity promotes cognitive health with aging 4.To review clinical and population-based interventions that have been employed to disseminate this new knowledge 5.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 ISOA (www.aging-institute.org)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


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