Kirk R. Daffner, MD
It is extremely common for adults over the age of 50 to be concerned about a decline in their cognitive abilities. Some studies have suggested that upwards of 80 percent of these individuals have these kind of concerns. It is predictable that certain kinds of things will change as we get older. These kinds of things include speed of processing, the ability to do more than one type of mental task at a time. The ability to rapidly retrieve information or to problem solve.
There is relative preservation of certain kinds of mental activities like verbal skills or our knowledge of general information or our ability to recognize various kinds of things that we have remembered. Now it’s really common to for people to rapidly retrieve someone’s name as they get older. For example when they see a face, a celebrity or acquaintance; however, it’s concerning if a person can’t recognize the face as someone they knew or had met in the past.
It’s also really common for people to have occasional problems finding words, but much more concerning if a person exhibits very frequent word finding pauses or substitution of words.
What’s important to know is that normal cognitive aging allows a person to remain independent, and socially active. It really becomes much more concerning as people get older if they become increasingly dependent on others to manage their daily living activities.
People want to know what they can do to promote their own cognitive well-being or health as they get older. It’s important to know that there are lots of activities under our personal control that may support or promote cognitive aging. For now I’ll highlight two for which there’s a lot of converging supportive evidence – participating in intellectually stimulating activities and vigorous physical activity.
There are epidemiological studies that follow individuals over many years if not decades that have shown that adults that who are engaged in intellectually stimulating activities and a variety of hobbies have a lower risk of developing dementia as they grow older. The bottom line is that there is strong and exciting evidence that aging brains are capable of changing and of plasticity.
And there are intervention studies where people are randomized to aerobic exercise or not and those who participate in aerobic exercise demonstrate a growth in the size of the hippocampus, this memory area in the brain, and improvement on cognitive test performance.
So the bottom line is that there is growing evidence that staying physically, cognitively and socially active, eating a heart healthy Mediterranean style diet that emphasizes fruit and vegetables, and fishes and limits intake of meat, being aware and treating things like hypertension and diabetes, avoiding things that injure our brains like head trauma or toxic substances, can all come together to promote healthy brain aging and plasticity.
There is a lot of exciting research that is being done at the Brigham and Women’s Hospital, trying to advance this field. Our lab is actively investigating factors that promote healthy cognitive aging in older folks. Our study, entitled SAGE or Successful Aging and Enrichment, is the first study to try to carry out a head to head comparison of the effect of different types of structure – be it physical or mental stimulation over a five week training period. So basically participants are being randomized to either a physical exercise program, computerized cognitive stimulation program or mindfulness attention training program, all of which take place in the homes of each of the participants.
This study should be able to provide some vital information about the most effective ways that older individuals can improve cognitive health given the limited time we all have. It should also help elucidate mechanisms that underlie changes in cognitive performance.
There are other exciting studies at the Brigham and Women’s Hospital that are focused on early detection and treatment of cognitive decline. So for example, a colleague of mine, Dr. Reisa Sperling, is the principal investigator, of a trial call the Anti-Amyloid Asymptomatic in Alzheimer’s study, which is a mouthful, fondly known as the A4 Trial, which aims at treating underlying Alzheimer’s disease before symptoms develop. It is the first study of its kind and people are very excited about moving forward with it.
Patients who have Alzheimer’s disease and related disorders are really facing complex and devastating conditions that often impact on every aspect of a person’s life. It’s our view that optimal care requires an integrated team approach that involves experts as cognitive neurologists, as neuropsychiatrists, neuropsychologists and social workers.
The first meeting that a person has with our group is with a physician who takes time to gather a detailed medical history from the patient. We strongly encourage patients to bring family members in who can provide additional perspective and support.
People can expect to receive a series of assessments that will be carried to better understand a person’s predicament. The major goal really is to find the pattern of deficits that can identify the underlying neurologic condition. We aim to systematically narrow the list of possibilities in order to reach a definitive diagnosis.
Members of our group also are part of the Center for Alzheimer’s Disease Research and Treatment that aims to provide patients at all stages of the illness with experimental medications that hopefully may change the course of the illness and effect the underlying disease process. At the same time we have close ties with members of the Center for Neurologic Diseases under the direction of Dennis Selkoe who are at the cutting edge of understanding the biology of these diseases with the groups of clinical care, translational research and basic care work together to try to provide patients with the most up to date, cutting-edge treatment strategies that can provide them with an opportunity to have access to what’s most recently learned about the illness and what might prove to be most helpful.
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