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, 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. Lifestyle Interventions on Cognition
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
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
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. What is the Value of Cognitive Vitality with Aging
What is the Value of Cognitive Vitality with Aging? It Depends on Your Perspective
Society/Payers
Population perspective
Seeks cost-effectiveness
Physician
Clinical impact
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. Health coaching, Memory Wellness, Fitness Training
The Secure Horizons (United Healthcare) Population-Based Program For Cognitive Vitality
Population Based Telephonic Screening
Case Referral
Telephonic Assessment
Triage
Normal (60%)
At risk (35%)
Dementia (< 5%)
Prevention
Monitoring
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