Presentation on theme: "Third in the Annual R13 AGS Conference Series, “From Bedside to Bench”"— Presentation transcript:
1 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, 2006Third 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 SocietyJulie Zaharatos, MPH, Manager, Governance & Public PolicySupport: National Institute of AgingJudith Salerno, MD, MS, Deputy DirectorChairperson and Organizer: Howard Fillit, MDCommittee Members:Michelle C. Carlson, PhDWilliam T. Greenough, PhDArthur Kramer, PhDGeorge Rebok, PhDRobert Wilson, PhDStephanie 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?
5 Normal Cognitive Aging: Considerable Variability At All Ages From: T. Salthouse, PhD
6 Normal Cognitive Aging: ConclusionsDecline is ubiquitous but not universalChanges in cognitive function are pervasive, but possibly preventableDo lifestyle interventionsAlter rate of aging?Delay time to a functional threshold?From: T. Salthouse, PhD
7 Lifestyle Interventions on Cognition Possible Effects ofLifestyle Interventions on CognitionReverseImproved levelof performanceSlow rateNo effecton rateCognitive PerformanceAdditional timeabove thresholdChronological AgeFrom: T. Salthouse, PhD
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 millionMild Cognitive Impairment (MCI) – Delayed recall impairment, other syndromes – 15% estimated annual dementia incidence – 10% of 65+ population or 4 millionDementiaGlobal cognitive impairment5% of people over 65, 25% over 75
10 Prevention and Cognitive Health Primary prevention: maintain cognitive vitality, prevent cognitive decline with agingSecondary prevention: prevent dementiaTertiary prevention: prevent the progression of dementia
11 Preventing Cognitive Decline With Aging: Medical Co-morbidities HypertensionDiabetesCholesterol, heart disease and strokeHormonesInflammation
12 Preventing Cognitive Decline: Lifestyle Factors NutritionalFolate, B6 and B12 and homocysteineAnti-oxidantsvitamin C and E, and other anti-oxidants (red wine, dark vegetables and fruits)?Omega-3-fatty acids, DHACaloric restrictionHead traumaSmokingAlcoholStress
13 Preventing Cognitive Decline: Lifestyle Factors Building “cognitive reserve” throughout lifeEducation, social and occupational engagementPhysical exerciseMental exercise
14 Risk Factors and Alzheimer’s Disease Neuronal injuryOverproduction of beta-amyloidAmyloid plaque formationNeuronal injury and deathLoss 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 dementiaBenefits of mental activity less clearEpidemiologic studies generally support life long education, continuing social and occupational engagement, mental “exercise” in preventing cognitive decline and dementiaHowever, more intervention studies neededIs the evidence good enough to make population recommendations at this time?
16 Is Cognitive Vitality in Aging Important 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 lifeFor physicians, society, and payers, the value of cognitive vitality is not as clearCognitive vitality is important only if we can define it and achieve it and demonstrate value
17 What is the Value of Cognitive Vitality with Aging What is the Value of Cognitive Vitality with Aging? It Depends on Your PerspectiveSociety/PayersPopulation perspectiveSeeks cost-effectivenessPhysicianClinical impactIndividualQOLQOL=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 individualsAre there functional deficits associated with cognitive decline in aging?– important in medical careAre there excess costs associated with cognitive decline with aging? – important to society and payersIf 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 impairmentAccidentsMedication noncompliance and poor control of medical comorbiditiesLoss of productivityCaregiver burdenSource: 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 USApproved by CMS as part of health plan Medicare benefitPart of an overall wellness program that also includes nutrition, financial and other health promotion componentsIncludes telephonic health coaching and free access to a senior fitness programFree access to comprehensive “memory wellness” program that includes mental exercise
21 Health coaching, Memory Wellness, Fitness Training The Secure Horizons (United Healthcare) Population-Based Program For Cognitive VitalityPopulation Based Telephonic ScreeningCase ReferralTelephonic AssessmentTriageNormal (60%)At risk (35%)Dementia (< 5%)PreventionMonitoringCare ManagementHealth 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 careComputerized methods for cognitive screening and assessment make neuropsych testing practical in primary careComputerized 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 healthTo summarize evidence in humans that mental and physical activity promotes cognitive health with agingTo review clinical and population-based interventions that have been employed to disseminate this new knowledgeTo 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 SummaryAchieving and maintaining cognitive vitality with aging is possibleCognitive vitality has value to individuals, in health care, and to society.Physical and mental activity contribute significantly to cognitive health in aging