Cognitive Aging Progress in Understanding and Opportunities for Action (2015) / Chapter Skim
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4C Risk and Protective Factors and Interventions: General Cognitive Aging Interventions and Next Steps
4C Risk and Protective Factors and Interventions: General Cognitive Aging Interventions and Next Steps
Pages 187-208
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From page 187... ...
COGNITIVE STIMULATION AND TRAINING There has been considerable scholarly and commercial interest over the past several years in the question of whether cognitive stimulation, either through such everyday activities as completing crossword puzzles, participating in a book club, playing card games, learning to play a musical instrument, and learning a new language (see Chapter 4A) or through more formal training, can assist in the maintenance or enhancement of cognitive function as people age.
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From page 188... ...
. Another approach to strengthening cognitive skills for older adults has been the use of video games, which employ a somewhat different set of training strategies than the computer-based training.
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From page 189... ...
points to the need for careful evaluation of these efforts. Given the early stage of research in this field and the need to demonstrate and validate transfer effects from cognitive training products to real-life situations, consumers need information from independent evaluations of commercial cognitive training products.
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. As the developers of cognitive training products strive to demonstrate the benefits of these products in real-life situations, claims regarding the effectiveness of their products will require careful evaluation by consumers and in regulatory review.
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PHARMACOLOGICS, NOOTROPICS, AND SUPPLEMENTS Pharmacologics and Nootropics Continued controversy exists on the usefulness of medications and pharmacologics for preventing cognitive decline and for enhancing or improving cognitive function in older adults. Several medications evaluated over the past decade are thought to have cognitive-enhancing properties either directly or through disease modification.
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A 4-year RCT of hormone treatment in postmenopausal women with cardiovascular disease did not find improvements in cognitive function compared to the use of a placebo (Grady et al., 2002)
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Some of the studies cited above were designed to evaluate other questions or conditions such as cardiovascular disease or dementia. The studies that showed minor improvements in cognitive measures did not demonstrate clinically important changes, and their impact on cognitive functioning and daily life was less clear.
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. Given the current results of RCTs, gingko is not considered effective in preventing cognitive decline.
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. Among 2,475 women age 65 years and older who were at high vascular risk and participated in the Women's Antioxidant Cardiovascular Study, consumption of caffeinated coffee, but not tea, cola, or chocolate intake, was asso ciated with a slower cognitive decline, including slower declines in global cognition, verbal memory, and category fluency (Vercambre et al., 2013)
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From page 196... ...
and efficacy is needed before tDCS can be recommended for improving cognition and before it is known which situations are appropriate for such stimulation. MULTI-DOMAIN TRIALS Given that some of the modifiable risk factors for cognitive decline are interrelated and that an intervention with multiple components might be more beneficial for cognitive health than one involving a single factor, multi-domain interventions are emerging as a new strategy.
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From page 197... ...
NEXT STEPS AND RECOMMENDATIONS This and the two preceding chapters have described strengths and limitations in the evidence base for preventing and mitigating cognitive decline and promoting cognitive health. The following recommendations offer actions that individuals and their families can take, policy and regulatory efforts that are needed, and priority areas for future research.
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At present there is a great deal of research focused on cognitive training and on games aimed at improving cognitive function. Among the issues being explored in this research are the retention of training effects and how best to transfer the gains made in gaming/training into changes in cognitive function in daily life and into related areas of cognition.
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From page 199... ...
Minimizing cultural, ethnic, racial, and socioeconomic biases in the measurement of risk factors and outcomes is an additional concern. Recommendation 4: Increase Research on Risk and Protective Factors and Interventions to Promote Cognitive Health and Prevent or Reduce Cognitive Decline The National Institutes of Health, the Centers for Disease Control and Prevention, other relevant government agencies, nonprofit organiza tions, and research foundations should expand research on risk and protective factors for cognitive aging and on interventions aimed at pre venting or reducing cognitive decline and maintaining cognitive health.
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From page 200... ...
• Assess cognitive outcomes in clinical trials that target the reduction of cardiovascular and other risk factors likely related to cognitive health. • Explore older adults' preferences and values regarding cog nitive health and aging and regarding specific cognitive in terventions and training modalities.
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For products that claim to enhance cognitive function or to maintain current levels of function (including cognitive training products, nutriceuticals, supplements, or medications) , a review of policies and regulatory guidance is needed.
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Recommendation 5: Ensure Appropriate Review, Policies, and Guide lines for Products That Affect Cognitive Function or Assert Claims Regarding Cognitive Health The Food and Drug Administration and the Federal Trade Commis sion, in conjunction with other relevant federal agencies and consumer organizations, should determine the appropriate regulatory review, policies, and guidelines for • over-the-counter medications (such as antihistamines, seda tives, and other medications that have strong anticholinergic activity) that may affect cognitive function, and • interventions (such as cognitive training, nutriceuticals, sup plements, or medications)
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2013a. Video games as a means to reduce age-related cognitive decline: Attitudes, compliance, and effectiveness.
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2014. Effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery: A meta analysis.
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2013. Anodal transcra nial direct current stimulation temporarily reverses age-associated cognitive decline and functional brain activity changes.
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2007. Protocol for fit bodies, fine minds: A randomized controlled trial on the affect of exercise and cognitive training on cognitive functioning in older adults.
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2009. Ginkgo biloba for pre venting cognitive decline in older adults: A randomized trial.
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