Cognitive health is a critical component of healthy aging. As the U.S. population ages, dementia and other cognitive health conditions are likely to increase. As a result, the cost of providing services to individuals with these conditions is also likely to grow. An estimated six million people in the U.S. are living with dementia today. By 2050, that number is expected to more than double to 14 million. This affects the quality of life of both individuals with these conditions and their families. It also strains health resources. In 2021, unpaid family caregivers provided 36 billion hours of care. That unpaid labor was valued at $600 billion.
Health is a critical component of healthy aging. 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 report refuted the common misperception that cognitive decline is an inevitable part of aging. The report—by the National Academy of Medicine (NAM)—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. Some cognitive functions, such as wisdom, knowledge, happiness, and life satisfaction, can improve with age.
There are no cures yet for Alzheimer’s disease or other causes of dementia. But, growing evidence suggests that physical exercise, proper nutrition, social interaction, effective stress and depression management, healthy sleep habits, and mental engagement can help maintain cognition. They can also potentially reduce the risks of cognitive impairment and dementia.
A 2017 NAM report cited a strong and growing base of evidence that older adults can reduce their risks of dementia and other kinds of cognitive decline as they age. The committee concluded that there were beneficial effects of three classes of interventions that are “supported by encouraging, although inconclusive, evidence: cognitive training, blood pressure management in people with hypertension, and increased physical activity.” When people think of cognitive functioning, they often consider the brain in isolation from the body. Research shows that cognitive and physical health share a strong connection. According to the 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.
Several other factors 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. It implies that factors such as loneliness and lack of cognitive stimulation are associated with decline.
Scientists have seen impressive growth in evidence indicating how intergenerational programs can positively impact a person’s cognitive health and well-being. This includes participants of all ages improving knowledge and skills, community engagement, health, arts and recreational 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 third-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 classes learn to read at a pace above their grade level and often outperform students who do not participate in the classes.
Encouragingly, the overall incidence of dementia among older adults in the U.S. 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 first decade of the 21st century. 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. Despite this promising research, the number of people living with Alzheimer’s disease and related types of dementia is projected to increase. This is 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, society and communities across the country need to act proactively to respect, empower, engage, and embrace people with dementia. Communities should support the well-being of people in all stages of dementia trying to live everyday lives there (see also Dementia Treatment in this chapter for recommendations on treating people with dementia in health care systems).
As people live longer, the need for easy-to-understand, trustworthy information on how to maintain cognitive health will be greater than ever.
COGNITIVE HEALTH: Policy
COGNITIVE HEALTH: Policy
Cognitive health as a public health priority
Policymakers should make the maintenance of cognitive health a public health priority. This includes:
- funding and promoting more research on the risk of cognitive impairment and interventions aimed at preventing or reducing cognitive decline,
- maintaining cognitive health, and
- identifying cost-effective approaches for delivering high-quality dementia care.
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.
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.
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 lifespan. Policymakers should develop and conduct culturally sensitive, linguistically appropriate educational programs on cognitive health. Individuals and organizations that improve interventions and care for dementia should be recognized and promoted in their communities.
Ensuring appropriate regulation
The federal government should ensure appropriate regulatory review, policies, and guidelines for interventions that claim to maintain cognitive health and prevent or reduce cognitive decline.