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| Subscribe to Clinical Compass™ | VOLUME 2, ISSUE 6 - MARCH 13, 2007 | |||||||||||||||||||||||||||
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FROM THE CLINICAL KNOWLEDGE CENTER Predicting Factors That Predispose the Elderly to Cognitive Decline by Jill Shuman, MS, ELS March 11-17, 2007, has been designated as Brain Awareness Week, an international effort organized by the Dana Alliance for Brain Initiatives to advance public awareness about the progress and benefits of brain research. The Dana Alliance is joined in the campaign by partners in the United States and around the world, including medical and research organizations; patient advocacy groups; the National Institutes of Health, and other government agencies; service groups; hospitals and universities; K-12 schools; and professional organizations. One of the more challenging aspects of brain research and neuroscience is the area of cognitive decline over the lifespan, particularly in the elderly. There is an abundant body of research comparing seniors with normal mental function to those with dementia; however, there is a paucity of data as to whether older women who maintain optimal cognitive function into old age differ from those who experience minor cognitive decline typically associated with normal aging. In other words, is dementia necessarily a component of the aging process? And if not, is there a way to predict factors that predispose older people to various levels of cognitive decline? A newly published study has analyzed cognitive data on approximately 9700 women originally enrolled in a study of osteoporotic fractures. The women, who had an average age of 72 at the start of the study, were followed for 15 years. Mini-mental status exams - a brief test of global cognitive function that evaluates concentration, language, and memory - were administered at the outset of the study and four times more over the 15-year follow-up. The objective of the study was to identify a group of older women who experienced long-term maintenance of cognitive function into late life and to determine whether they differed from those who experienced minor cognitive decline typically associated with normal aging. At the initial study visit, the women were asked about their age, years of education, alcohol intake during the previous 30 days, smoking history, history of comorbid health conditions (e.g., stroke, diabetes mellitus, hypertension), and whether they had fallen during the previous 12 months. The women were asked to assess their physical activity, their health status (excellent, good, fair, or poor), and their ability to carry out activities of daily living (ADL). At year two, depressive symptoms were assessed using the Geriatric Depression Scale; social network and family connections were also evaluated. By the end of the study, 9% of the women had suffered no decline in cognitive function, while 58% showed a minor decline and 33% experienced significant cognitive decline. The mean age of study participants at the end of follow-up was 85, indicating that these women typically maintained optimal cognitive function into old age. Women who maintained optimal cognitive function were noted to have different health and lifestyle characteristics than those who experienced minor cognitive decline, although both groups would likely be considered cognitively "normal" at this age. After adjustment for key confounders, the women who experienced no cognitive decline were almost twice as likely to be free of diabetes, 20% more likely to have normal blood pressure, and 70% less likely to smoke than their counterparts who showed a minor decline. They were also 20% more likely to consume alcohol (in moderation), 40% less likely to have difficulties with ADL, and 20% more likely to have strong family and social networks. The researchers note several limitations to this study. Most of the women were white, so there is no way to know whether these findings are generalizable to other racial or ethnic groups. In addition, the mini mental status exam is relatively insensitive to mild cognitive deficits and is poorly correlated with changes in functional status, so they recommend that future studies use a more-detailed cognitive battery that includes measures of executive function. The data suggest that the above-noted health and lifestyle factors may be more protective in older adults at the upper end of the cognitive decline continuum, rather than preventing cognitive decline in those who have already started to "slip." Although these findings do not prove that a healthful lifestyle and on-going socialization can sustain cognitive function in all older women, they present an intriguing opportunity for prevention earlier in the lifecycle. Do you have feedback for the author? Click here to send us an email. References
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