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Wednesday, April 22, 2015

Cognitive Aging

Cognitive AgingA Report From the Institute of Medicine FREE ONLINE FIRST

Dan G. Blazer, MD, MPH, PhD1; Kristine Yaffe, MD2; Jason Karlawish, MD3
JAMA. Published online April 15, 2015. doi:10.1001/jama.2015.4380
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The Institute of Medicine recently released a report entitled Cognitive Aging: Progress in Understanding and Opportunities for Action, which addresses the emerging concept of cognitive aging, the importance of this issue for the nation’s public health, and actions the nation needs to take to better understand and maintain the cognitive health of older adults.1
Cognitive aging is a lifelong process of gradual, ongoing, yet highly variable changes in cognitive function that occur as people get older. Some cognitive functions decrease predictably, such as memory and reaction time, whereas some other functions are either maintained or may even increase, such as wisdom and knowledge. Characteristics of cognitive aging are presented in the Box.
Characteristics of Cognitive Aging
Key Features
  • Inherent in humans and animals as they age
  • Occurs across the spectrum of individuals as they age regardless of initial cognitive function
  • Highly dynamic process with variability within and between individuals
  • Includes some cognitive domains that may not change, may decline, or may improve with aging, and there is the potential for older adults to strengthen some cognitive abilities
  • Only now beginning to be understood biologically yet clearly involves structural and functional brain changes
  • Not a clinically defined neurological or psychiatric disease and does not inevitably lead to neuronal death and neurodegenerative dementia (such as in Alzheimer disease)
Risk and Protective Factors
  • Health and environmental factors over the life span influence cognitive aging
  • Modifiable and nonmodifiable factors include genetics, culture, education, medical comorbidities, acute illness, physical activity, and other health behaviors
  • Cognitive aging can be influenced by development beginning in utero, infancy, and childhood
  • Cognitive aging is not easily defined by a clear threshold on cognitive tests because many factors—including culture, occupation, education, environmental context, and health variables (eg, medications)—influence test performance and norms
  • For an individual, cognitive performance is best assessed at several points in time
Effect on Daily Life
  • Day-to-day functions may be affected, such as driving, making financial and health care decisions, and understanding instructions given by health care professionals
  • Experience, expertise, and environmental support aids (eg, lists) can help compensate for declines in cognition
  • The challenges of cognitive aging may be more apparent in environments that require individuals to engage in highly technical and fast-paced or timed tasks, situations that involve new learning, or stressful situations (eg, emotional, physical, or health-related) and are less apparent in highly familiar situations

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