Progress in Understanding and Opportunities for Action
Committee on the Public Health Dimensions
of Cognitive Aging
Board on Health Sciences Policy
Dan G. Blazer, Kristine Yaffe, and Catharyn T. Liverman, Editors
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This project was supported by the McKnight Brain Research Foundation; by Contract No. HHSN26300034 between the National Academy of Sciences and the National Institutes of Health (National Institute of Neurological Disorders and Stroke, National Institute on Aging); by Contract No. 200-2011-38807 between the National Academy of Sciences and the Centers for Disease Control and Prevention; by The Retirement Research Foundation; and by AARP. The views presented in this publication are those of the editors and attributing authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
Library of Congress Cataloging-in-Publication Data
Institute of Medicine (U.S.). Committee on the Public Health Dimensions of Cognitive Aging, author.
Cognitive aging : progress in understanding and opportunities for action / Committee on the Public Health Dimensions of Cognitive Aging, Board on Health Sciences Policy, Institute of Medicine of the National Academies ; Dan G. Blazer, Kristine Yaffe, and Catharyn T. Liverman, editors.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-309-36862-9 (hardcover) — ISBN 978-0-309-36863-6 (pdf)
I. Blazer, Dan G., II (Dan German), 1944- , editor. II. Yaffe, Kristine, editor. III. Liverman, Catharyn T., editor. IV. Title.
[DNLM: 1. Aging—physiology. 2. Cognition—physiology. 3. Cognition Disorders—prevention & control. 4. Health Policy. 5. Policy Making. 6. Risk Factors. WT 145]
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Suggested citation: IOM (Institute of Medicine). 2015. Cognitive aging: Progress in understanding and opportunities for action. Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
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COMMITTEE ON THE PUBLIC HEALTH DIMENSIONS OF COGNITIVE AGING
DAN G. BLAZER (Chair), J. P. Gibbons Professor of Psychiatry Emeritus, Duke University Medical Center
KRISTINE YAFFE (Vice Chair), Scola Endowed Chair, Professor of Psychiatry, Neurology and Epidemiology, University of California, San Francisco
MARILYN ALBERT, Professor of Neurology, Director of the Division of Cognitive Neuroscience, Johns Hopkins University School of Medicine
SARA J. CZAJA, Leonard M. Miller Professor of Psychiatry and Behavioral Sciences, Scientific Director, Center on Aging, University of Miami Miller School of Medicine
DONNA FICK, Distinguished Professor of Nursing, Co-Director, Hartford Center of Geriatric Nursing Excellence, Pennsylvania State University
LISA P. GWYTHER, Director, Family Support Program, Center for Aging, Duke University
FELICIA HILL-BRIGGS, Professor of Medicine, Departments of Physical Medicine and Rehabilitation, and Health Behavior and Society, Johns Hopkins University
SHARON K. INOUYE, Professor of Medicine, Harvard Medical School; Milton and Shirley F. Levy Family Chair; and Director, Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife
JASON KARLAWISH, Professor of Medicine, Medical Ethics and Health Policy, University of Pennsylvania
ARTHUR F. KRAMER, Professor and Director, Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign
ANDREA Z. LACROIX, Professor and Chief of Epidemiology and Director, Women’s Health Center of Excellence, University of California, San Diego
JOHN H. MORRISON, Dean of Basic Sciences and the Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai
TIA POWELL, Director, Montefiore Einstein Center for Bioethics, Professor of Clinical Epidemiology and Clinical Psychiatry, Albert Einstein College of Medicine
DAVID REUBEN, Director, Multicampus Program in Geriatric Medicine and Gerontology, Chief, Division of Geriatrics, University of California, Los Angeles
LESLIE SNYDER, Professor, Department of Communication Sciences, University of Connecticut
ROBERT B. WALLACE, Irene Ensminger Stecher Professor of Epidemiogy and Internal Medicine, Center on Aging, University of Iowa College of Public Health
CATHY LIVERMAN, Study Director
SARAH DOMNITZ, Program Officer
CLAIRE GIAMMARIA, Research Associate
JUDY ESTEP, Program Associate
JEANETTE GAIDA, Senior Program Assistant
ANDREW M. POPE, Director, Board on Health Sciences Policy
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Julie Bynum, The Geisel School of Medicine at Dartmouth
Laura Carstensen, Stanford University
Mark E. Frisse, Vanderbilt University
Fred Gage, The Salk Institute for Biological Studies
Adam Gazzaley, University of California, San Francisco
Charlene Harrington, University of California, San Francisco
Dilip V. Jeste, University of California, San Diego
K. Ranga Krishnan, Duke-National University of Singapore Graduate Medical School
Nancy E. Lane, University of California, Davis, Health System
Kenneth M. Langa, University of Michigan, Ann Arbor
Eric B. Larson, Group Health Research Institute
Sally C. Morton, University of Pittsburgh
Ruth M. Parker, Emory University
Ronald C. Petersen, Mayo Clinic
Brenda Plassman, Duke University School of Medicine
Thomas R. Prohaska, George Mason University
George Rebok, Johns Hopkins University
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Nancy Fugate Woods, Dean Emeritus, University of Washington School of Nursing, and Bradford H. Gray, Editor Emeritus, The Urban Institute. Appointed by the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Of the abilities people hope will remain intact as they get older, perhaps the most treasured is to “stay sharp”—to think clearly, remember accurately, and make decisions with careful thought. Yet the brain ages. Cognitive functioning in older adults can improve in some areas, such as those related to wisdom and experience, and can decline in others, such as memory, attention, and speed of processing. Individuals vary widely in the specific cognitive changes that occur with age, in the nature and extent of cognitive aging, as well as in the ways these changes affect daily life.
This Institute of Medicine (IOM) study focused on the public health dimensions of cognitive aging as separate from neurodegenerative diseases, such as Alzheimer’s disease and other dementias. To accomplish its task, the IOM committee looked at cognitive aging through a broad lens and explored its implications for individuals, for their families, and for society. Its report comes at a time ripe for change in how society responds to cognitive aging. The population of older Americans is rapidly growing, and this frontier of science and health is achieving a marked increase in understanding of the brain, cognition, and aging.
The report greatly benefited from the efforts of many individuals and organizations. We thank the study sponsors for their support and for their work in bringing the topic of cognitive aging to the forefront of discussion: the McKnight Brain Research Foundation, the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, the Centers for Disease Control and Prevention, The Retirement Research Foundation, and AARP. Further, we thank each of the workshop speakers
for their presentations and for the time and expertise that they and others shared with the committee. We are grateful to the reviewers whose insights strengthened this report.
The committee is especially indebted to the IOM staff who worked with us tirelessly and most competently. Cathy Liverman led the effort with her usual quiet and effective guidance. She was assisted by Sarah Domnitz, Claire Giammaria, Judy Estep, and Jeanette Gaida. Katie Maslow, IOM Scholar-in-Residence, provided a wealth of insights into this complex topic. As is usually the case, staff were full colleagues in the process of producing this report while retaining their specific duties in support of the committee. We also thank Andrew Pope, Director of the Board on Health Sciences Policy, who shepherded the report from its inception to completion.
The report’s findings and recommendations result from the deliberations of a dedicated and hardworking committee. It was our pleasure and privilege to have the opportunity to work with these colleagues—each of whom brought energy, commitment, and intellectual curiosity and rigor to this endeavor. This committee was intrigued and engaged by this most challenging of public health issues encountered by older adults, and such engagement was crucial in our deliberations.
We and our colleagues on the committee hope this report focuses attention and action on cognitive aging. Much can be done by older adults and their families and a wide range of stakeholders—at every level of society, from the local community to national policy and research priorities—to address the opportunities and challenges of cognitive aging and to ensure that older adults live the full and independent lives they desire.
Dan G. Blazer, Chair
Kristine Yaffe, Vice-Chair
Committee on the Public Health Dimensions of Cognitive Aging
2 CHARACTERIZING AND ASSESSING COGNITIVE AGING
3 POPULATION-BASED INFORMATION ABOUT COGNITIVE AGING
4A RISK AND PROTECTIVE FACTORS AND INTERVENTIONS: LIFESTYLE AND PHYSICAL ENVIRONMENT
4B RISK AND PROTECTIVE FACTORS AND INTERVENTIONS: HEALTH AND MEDICAL FACTORS
4C RISK AND PROTECTIVE FACTORS AND INTERVENTIONS: GENERAL COGNITIVE AGING INTERVENTIONS AND NEXT STEPS