Cognitive Health

Background

Cognitive health is a critical component of healthy aging. Yet too often the discussion around cognitive health focuses on disease. According to a 2015 AARP survey, three out of four adults age 40 and older are concerned about their brain health declining in the future.

A groundbreaking 2015 Institute of Medicine (IOM) report refuted the common misperception that cognitive decline is an inevitable part of aging. The report presented a scientific consensus that cognitive aging—as distinct from disease—is a natural, lifelong process that happens to everyone as they get older. It stressed that cognitive aging is different for every individual, and that some cognitive functions, such as wisdom, knowledge, happiness, and life satisfaction, can improve with age.

While there is no cure yet for Alzheimer’s or other related types of dementia, the IOM report cited a strong and growing base of evidence that older adults can reduce their risks of cognitive decline as they age. When people think of cognitive functioning, they often consider the brain in isolation from the body, but research shows that cognitive and physical health share a strong connection. According to the IOM report, staying physically active and reducing cardiovascular risk factors are the two most important steps that individuals can take to maintain their cognitive health. In addition, the report stated that the built environment is critical for maintaining cognitive health. For example, walkable communities with safe streets and parks make it easier for individuals to be physically active.

There are several other factors that can play a role in cognitive health. For example, recent studies have demonstrated links between hearing loss and cognitive decline, suggesting that more aggressive treatment to correct hearing could benefit cognition. Research also points to a link between an individual’s social environment and their cognitive health, implying that factors such as loneliness and lack of cognitive stimulation are associated with decline.

Scientists have seen impressive growth in evidence indicating ways in which intergenerational programs can have a positive impact on a person’s cognitive health and well-being. This includes participants of all ages improving knowledge and skills, community engagement, health, arts and recreation pursuits, social relationships, self-fulfillment and sense of purpose, cultural pride, and identity.

For example, a 2015 study found that AARP Foundation Experience Corps volunteers age 60 and older who provided an average of 15 hours of tutoring per week in kindergarten through 3rd-grade classrooms experienced less deterioration of the hippocampus and prefrontal regions of the brain than a control group of non-volunteers. Additional research found that students in Experience Corps’ classrooms often outperform those who are not, and learn to read at a pace faster than their grade level.

Encouragingly, the overall incidence of dementia among older adults in the US may be declining. A 2014 longitudinal analysis of four decades of the Framingham Heart Study found the rate of dementia among people age 60 and older had declined by 42 percent from the 1970s to the 2000s. Adults age 60–69 experienced the greatest improvements. The authors cited increased education level attainment and the prevention or management of heart disease as potential causes. Yet despite this promising research, the number of people living with Alzheimer’s disease and related types of dementia is projected to increase, simply because more people are living longer: Advanced age is the leading risk factor for dementia.

In addition to promoting age-friendly communities that support body and brain health for people of all ages, AARP believes that society and communities across the country need to act proactively to respect, empower, engage, and embrace people with dementia. Communities should become “dementia-friendly” by supporting the well-being of people in all stages of dementia who are trying to live normal lives there. (For recommendations on treating people with dementia in health care systems, see this chapter’s section Specific Needs and Services—Dementia Treatment.)

As people live longer, the need for clear, trust­worthy information on brain health will be greater than ever. This need should be met with unbiased consumer education. Medical professionals will also require evidence-based guidelines for developing and reviewing interventions to prevent or reduce cognitive decline and maintain cognitive health.

Cognitive Health: Policy

Brain health as a priority

In this policy: FederalLocalState

policymakers should emphasize and promote cognitive health as part of healthy living, which should be a public health priority.

Research

In this policy: FederalLocalState

policymakers should increase research on the risk of cognitive impairment and interventions aimed at preventing or reducing cognitive decline and maintaining cognitive health, in addition to identifying cost-effective approaches for delivering high-quality dementia care.

Education

In this policy: FederalLocalState

health care systems and private and public health insurance companies should develop, as appropriate, evidence-based intergenerational programs and materials on cognitive health across the life span. Policymakers should develop and conduct culturally sensitive, linguistically appropriate educational programs on brain health. Individuals and organizations that improve interventions and care for dementia should be recognized and promoted in their communities.

Interventions

In this policy: FederalLocalState

public and private-sector programs should support healthy living to help reduce the risk of cognitive impairment. Policymakers should expand and bring to scale demonstrations that are cost-effective and proven to reduce risk. Age-friendly communities, which encourage and facilitate lifestyles conducive to both good physical and brain health, should continue to be supported and expanded. Public policymakers and the private sector should develop and expand intergenerational programs to promote brain health and to care for those with cognitive impairment.

Regulation

In this policy: FederalLocalState

the federal government should ensure appropriate regulatory review, policies, and guidelines for prescription and over-the-counter medications that may affect cognitive function, and for interventions that claim to prevent or reduce cognitive decline and maintain cognitive health.