cognitive impairment in the elderly
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Introduction
Also see:
- subjective memory problems in the elderly
- prevention of Alzheimer's disease
- prevention of cognitive impairment
- dementia
- Alzheimer's disease
- minimal cognitive impairment
- psychosis & agitation in the elderly
- plasma factors associated with cognitive function
Etiology
- dementia
- delirium
- psychosis
- nightmares in middle-age & older adults[55]
- intracranial atherosclerosis[38]
- retinopathy may be risk factor[40]
- chronic systolic hypertension in middle-age[11]
- late life systolic hypertension not associated with cognitive decline[11]
- lowering of blood pressure in the elderly may adversely affect cognitive function[18]
- higher BP is associated with better cognitive function in the oldest old (>= 85 years of age)[25]
- daytime systolic blood pressure < 130 mm Hg may be associated with faster cognitive decline in cognitively impaired elderly treated with antihypertensives[17]
- systolic blood pressure variability is associated with cognitive impairment in the elderly[31]
- hospitalization of community-dwelling elderly is associated with accelerated cognitive impairment[3]
- executive dysfunction & diminished ventricular size after hospitalization of older adults
- frailty increases risk for mild cognitive impairment & dementia[46]
- regional adiposity accumulating in skeletal muscle[61]
- most (59%) of the determining factors for cognitive decline are idiopathic[8]
- depression worsens cognitive decline in the elderly[12][28]
- social isolation & loneliness contribute higher risk of cognitive impairment & nursing home placement[32][51]
- perceived psychosocial stress is associated with both prevalent & incident cognitive impairment (RR=1.4-1.6)[59]
- orthostatic hypotension renders elderly with mild cognitive impairment twice as likely to become demented[26]
- low levels of leisure-time physical activity associated with greater decline in cognitive performance (executive function, semantic memory, & processing speed scores)[30]
- sleep disordered breathing[34]
- sensory impairment:
- hearing impairment, visual impairment[52], anosmia
- olfactory impairment is an independent risk factor for cognitive impairment in the elderly[21]
- anxiety & beta-amyloid may amplify risk of cognitive impairment[48]
- personality traits associated with risk of cognitive impairment & demenia[37]
- neuroticism
- being less agreeable
- being less conscientious
- exposure to lead-contaminated drinking water in childhood is associated with cognitive impairment in later life (age 72 years)[56]
- general anesthesia may increase risk of cognitive impairment in the elderly[62][63]
* personal education important predictor (25%), followed by race, household wealth & income, parental education, occupation, & depression
- contributions of sedentary lifestyle, chronic diseases, obesity, smoking, vigorous activity, childhood health, nutrition, gender, marital status, & religion < 5%[58]
Epidemiology
- 13% of adults > 60 years of age report memory problems or confusion during preceding year[6]
- women may have greater cognitive reserve but faster cognitive decline than men[47]
Pathology
- cognitive aging distinct from Alzheimer's disease & other neurodegenerative disorders is proposed[19]
- in animal models, cognitive aging is associated with synaptic dysfunction rather than neuronal loss, particulary in the prefrontal cortex[19]
- deficits in dopaminergic systems for reward prediction may make it difficult to appreciate the potential negative consequences of a choice[5]
- plasma contains factors that affect cognitive function
- hypoxia, hypoglycemia & ischemia may be common factors
Genetics
- apoE4 allele worsens negative effect of depression on cognitive decline in the elderly[12]
Clinical manifestations
Cognitive changes with normal aging:
- attention: diminished attention, divided & sustained
- language:
- diminished fluency, word finding & confrontation naming
- vocabulary largely unchanged
- vocabulary may increase with advanced age, provided there is opportunity & exposure to new words
- increased vocabulary is accompanied by enhanced comprehension[32]
- memory:
- diminished episodic memory
- diminished working memory[32]
- remote memory generally remains intact[32]
- thus decline in remote recall suggest abnormal cognition*
- no change in ability to retain learned information
- visuospatial function: diminished visuospatial skills
- executive function
- cognitive processing speed decreases
- abstractions become more concrete
- memory impairments are pathological if they interfere with activities of daily living (ADL) (i.e. forgetting to pay bills)[32]
- best indicator of pathologic neurologic decline
- executive dysfunction contributory[32]
- getting lost in familiar places is pathological & consistent with dementia[32]
- difficulty following conversations & understanding instructions is pathological in the absence of hearing impairment[32]
- difficulty remembering names is common, a cue may be helpful in normal aging but not with pathologic cognitive impairment[32]
- ability to learn & remember a list of words may be diminished in normal aging[32]
- taking longer to complete routine tasks may be a decline in the speed of processing that may occur with normal aging[32]**
- anxiety can be a prodromal manifestation of cognitive impairment & dementia[32]
- subtle declines in various activities of daily living are associated with cognitive impairment in the elderly[45]
- stages of objective memory impairment predict mild cognitive impairment[60]
* distinguishes abnormal cogntition from normal age-related cognitive decline[32] ** seems more like a pathololgic effect of myelination changes
Laboratory
Diagnostic procedures
- assess for hearing impairment[27]
- audiology as needed
- vision assessment
- CSF analysis not part of routine evaluation
- indications:
- rapidly progressive dementia
- age < 60 years
- malignancy or paraneoplastic syndrome
- suspicion of acute or subacute infection
- immunosuppresion
- positive syphilis serology or Lyme serology
- autoimmune disease or suspected CNS inflammation[27]
- indications:
- electroencephalography (EEG)
- subacute decline in cognitive function with new onset incontinence[32]
- actigraphy demonstrate changes in circadian rhythms, decreased & delayed activity associated with increased risk of cognitive impairment
- University of Pennsylvania Smell Identification Test (UPSIT)
- olfactory impairment is an independent risk factor for cognitive impairment in the elderly[21]
Radiology
- neuroimaging (all patients)[27]
- PET scan for uncertain diagnosis or atypical presentation in consultation with neurologist[27]
Complications
- cognitive impairment in the elderly predicts mortality[2]
- increased risk of stroke (RR=1.4), & fatal stroke, especially ischemic stroke[13]
- may be increased risk of parkinsonism & Parkinson's disease[39]
- vulnerability to scams in older patients is associated with cognitive impairment & Alzheimer dementia[44]
- memory problems & problems with executive function that interfere with activities of daily living such as making mistakes in finances, forgetting to pay bills is best indicator of pathologic neurologic decline[32]
Management
- Institute of Medicine guidelines include:[20]
- conduct a formal cognitive assessment at primary care visit
- consider screening for:
- encourage patients to
- get regular physical activity
- reduce their cardiovascular risk factors
- maintain social engagement & learning
- get sufficient sleep.
- minimize use of psychoactive medications & inappropriate medications, including anticholinergic drugs
- identify patients who could be at high risk for delirium before or at the time of hospital admission
- caution patients about the use of so-called "brain games" & nutraceuticals, which have little proven benefit[20]
- multicomponent strategy may help slow cognitive decline in elderly[14][36]
- higher cognitive activity associated with better cognitive performance[54]
- exercise improves cognition in the elderly[4]
- moderate-intensity exercise of no benefit for cognition in sedentary elderly[24]
- insufficient evidence to assess benefit of physical activity[35]
- exercise may reduce beta-amyloid burden in men[54]
- an intensive program of exercise & functional activity training did not improve activities of daily living, physical activity, or quality of life; reduce falls; or improve any other secondary health outcomes in elderly (80 years) with mild cognitive impairment or early dementia, despite good compliance[64]
- adequate sleep & good sleep hygiene may improve cognition in the elderly[19]
- cognitive training (Tai-chi) improves iADL* in the elderly[9]
- cognitive training with benefits in domain of training
- midlife & late-life social & cognitive activities diminish likelihood of late-life cognitive decline[16]
- intellectual engagement helps to maintain cognitive function in the elderly but does not change the downward trajectory[42]
- treat depression
- see prevention of cognitive impairment
- see prevention of Alzheimer's disease
- USPSTF recommends against routine screening
- no evidence of improved outcomes[6]
- no benefit of antihypertensive treatment vs placebo or intensive vs standard treatment[35]
- intensive blood pressure control & intensive lowering of lipids with combination of simvastatin plus fenofibrate does not slow the rate of cognitive decline in elderly with diabetes mellitus type 2[10]
- rosuvastatin (10 mg) &/or candesartan/hydrochlorothiazide (16 mg/12.5 mg) ineffective in slowing cognitive decline in the elderly (> 70 years)[43]
- intensive glycemic control in elderly with type 2 diabetes of no benefit[35]
- no evidence of benefit for statins[35]
- no benefit of cholinesterase inhibitors in minimal cognitive impairment[35]
- neither omega-3 fatty acids, lutein/zeaxanthin or both improves cognition in elderly with macular degeneration[24]
- no benefit in omega-3 fatty acids or gingko biloba in reducing incidence of Alzheimer's disease or improving cognition in normal elderly[35]
- DHA-rich fish oil does not improve age-related cognitive decline in the elderly[41]
- no strong evidence supports benefit of any vitamin[35]
- multivitamin for 3 years is associated with a 60% slowing of cognitive aging in older adults[49]
- no benefit for NSAIDs or aspirin[35]
* instrumental activities of daily living
Comparative biology
- plasma beta2 microglobulin (B2M) negatively regulates age-associated cognitive function in hippocampus of mice[22]
- increased plasma eotaxin may inhibit learning, memory, & neurogenesis during aging in mice[23]
- blocking FSH in ovariectomized mice protects against cognitive decline[50]
Notes
- Affordable Care Act requires a cognitive assessment for Medicare recipients during their annual wellness visit[29]
- cognitive assessment by general practitioners is more specific than sensitive[53]
- false negatives more likely in elderly with less severe impairment
- false positives may occur in those with depression[53]
More general terms
Additional terms
- Alzheimer's disease (ADD)
- cognitive resilience
- dementia; Alzheimer's disease & related dementias (ADRD)
- depression in the elderly
- mild cognitive impairment (MCI); benign senile forgetfulness; age-associated memory impairment (AAMI)
- pre-mild cognitive impairment (preMCI)
- prevention of Alzheimer's disease/dementia
- prevention of cognitive impairment
- psychosis, agitation & difficult behavior in the elderly
- subjective memory problems in the elderly
- SuperAger (exceptional cognition in the elderly)
References
- ↑ Tranah GJ et al. Circadian activity rhythms and risk of incident dementia and MCI in older women. Ann Neurol 2011 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22162057
- ↑ 2.0 2.1 Sachs GA et al. Cognitive impairment: An independent predictor of excess mortality. A cohort study. Ann Intern Med 2011 Sep 6; 155:300 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21893623
- ↑ 3.0 3.1 Wilson RS et al Cognitive decline after hospitalization in a community population of older persons Neurology March 21, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22442434 <Internet> http://www.neurology.org/content/early/2012/03/21/WNL.0b013e31824d5894.abstract
- ↑ 4.0 4.1 Jackson AS, Sui X, Hebert JR, et al. Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Arch Intern Med 2009; 169(19):1781-1787 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19858436
- ↑ 5.0 5.1 Chowdhury R et al. Dopamine restores reward prediction errors in old age. Nat Neurosci 2013 Mar 24 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23525044 <Internet> http://www.nature.com/neuro/journal/v16/n5/full/nn.3364.html
- ↑ 6.0 6.1 6.2 Lin JS et al Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 22 October 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24145578 <Internet> http://annals.org/article.aspx?articleid=1760977
Moyer VA et al Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 25 March 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24663815 <Internet> http://annals.org/article.aspx?articleid=1850963 - ↑ Centers for Disease Control and Prevention Self-Reported Increased Confusion or Memory Loss and Associated Functional Difficulties Among Adults Aged >= 60 Years - 21 States, 2011 MMWR. May 10, 2013 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a1.htm
- ↑ 8.0 8.1 Boyle PA et al. Much of late life cognitive decline is not due to common neurodegenerative pathologies. Ann Neurol 2013 Sep; 74:478 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23798485
- ↑ 9.0 9.1 Rebok GW et al Ten-Year Effects of the Advanced Cognitive Training for Independent and Vital Elderly Cognitive Training Trial on Cognition and Everyday Functioning in Older Adults. Journal of the American Geriatrics Society. Jan 13, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24417410 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/jgs.12607/abstract
Wayne PM et al. Effect of tai chi on cognitive performance in older adults: Systematic review and meta-analysis. J Am Geriatr Soc 2014 Jan; 62:25 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24383523 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/jgs.12611/abstract - ↑ 10.0 10.1 Williamson JD et al Cognitive Function and Brain Structure in Persons With Type 2 Diabetes Mellitus After Intensive Lowering of Blood Pressure and Lipid LevelsA Randomized Clinical Trial. JAMA Intern Med. Published online February 03, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24493100 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1819574
- ↑ 11.0 11.1 11.2 Kohler S et al. Temporal evolution of cognitive changes in incident hypertension: Prospective cohort study across the adult age span. Hypertension 2014 Feb; 63:245 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24296281 <Internet> http://hyper.ahajournals.org/content/63/2/245
Gottesman RF et al Midlife Hypertension and 20-Year Cognitive Change: The Atherosclerosis Risk in Communities Neurocognitive Study. JAMA Neurol. 2014;71(10):1218-1227 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25090106 - ↑ 12.0 12.1 12.2 Rajan KB et al. Gene-behavior interaction of depressive symptoms and the apolipoprotein E epsilon4 allele on cognitive decline. Psychosom Med 2014 Feb; 76:101 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24434953 <Internet> http://journals.lww.com/psychosomaticmedicine/pages/default.aspx
- ↑ 13.0 13.1 Lee M, Saver JL, Hong KS et al Cognitive impairment and risk of future stroke: a systematic review and meta-analysis. CMAJ August 25, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25157064 <Internet> http://www.cmaj.ca/content/early/2014/08/25/cmaj.140147.full.pdf+html
- ↑ 14.0 14.1 Ngandu T et al A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. March 11, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25771249 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960461-5/abstract
- ↑ Brown CH IV et al. Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort. Neurology 2015 Mar 11 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25762715 <Internet> http://www.neurology.org/content/early/2015/03/11/WNL.0000000000001439
- ↑ 16.0 16.1 Roberts RO et al Risk and protective factors for cognitive impairment in persons aged 85 years and older. Neurology. April 8, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25854867 <Internet> http://www.neurology.org/content/early/2015/04/08/WNL.0000000000001537
Galvin JE Too much of a good thing may still be good for your brain. Neurology. April 8, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25854870 <Internet> http://www.neurology.org/content/early/2015/04/08/WNL.0000000000001547 - ↑ 17.0 17.1 Mossello E et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med 2015 Apr; 175:578 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25730775 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=2173093
- ↑ 18.0 18.1 Sabayan B et al. High blood pressure and resilience to physical and cognitive decline in the oldest old: The Leiden 85-Plus Study. J Am Geriatr Soc 2012 Nov; 60:2014. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23126669
- ↑ 19.0 19.1 19.2 19.3 Blazer DG, Yaffe K, Karlawish J Cognitive Aging. A Report From the Institute of Medicine. JAMA. 2015;313(21):2121-2122 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25875498 <Internet> http://jama.jamanetwork.com/article.aspx?articleID=2276710
Blazer DG, Yaffe K, Liverman CT (eds) Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington DC. National Academies Press. 2015 http://www.iom.edu/cognitiveaging - ↑ 20.0 20.1 20.2 Institute of Medicine. April 14, 2015 Cognitive Aging: Progress in Understanding and Opportunities for Action. http://www.iom.edu/Reports/2015/Cognitive-Aging.aspx
Inouye SK Enhancing Cognitive Aging: Clinical Highlights of a Report From the Institute of Medicine. Ann Intern Med. Published online 23 June 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26099073 <Internet> http://annals.org/article.aspx?articleid=2337280 - ↑ 21.0 21.1 21.2 Growdon ME et al. Odor identification and Alzheimer disease biomarkers in clinically normal elderly. Neurology 2015 May 26; 84:2153. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25934852
Devanand DP et al. Olfactory identification deficits and increased mortality in the community. Ann Neurol 2015 Jun 1; PMID: https://www.ncbi.nlm.nih.gov/pubmed/26031760 - ↑ 22.0 22.1 22.2 Smith LK, He Y, Park JS et al beta2-microglobulin is a systemic pro-aging factor that impairs cognitive function and neurogenesis. Nat Med. 2015 Jul 6. doi:http://dx.doi.org/ 10.1038/nm.3898. [Epub ahead of print] PMID: https://www.ncbi.nlm.nih.gov/pubmed/26147761
- ↑ 23.0 23.1 23.2 Villeda SA et al. The ageing systemic milieu negatively regulates neurogenesis and cognitive function. Nature 2011 Sep; 477:90 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21886162
- ↑ 24.0 24.1 24.2 Sink KM et al Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults. The LIFE Randomized Trial. JAMA. 2015;314(8):781-790. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26305648 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2429712
Chew EW et al Effect of Omega-3 Fatty Acids, Lutein/Zeaxanthin, or Other Nutrient Supplementation on Cognitive Function. The AREDS2 Randomized Clinical Trial. JAMA. 2015;314(8):791-801 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26305649 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2429713
Gill SS, Seitz DP Lifestyles and Cognitive Health. What Older Individuals Can Do to Optimize Cognitive Outcomes. JAMA. 2015;314(8):774-775 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26305645 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2429694 - ↑ 25.0 25.1 Ogliari G et al. Age- and functional status-dependent association between blood pressure and cognition: The Milan Geriatrics 75+ Cohort Study. J Am Geriatr Soc 2015 Sep; 63:1741 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26280562
- ↑ 26.0 26.1 Hayakawa T et al. Orthostatic blood pressure behavior in people with mild cognitive impairment predicts conversion to dementia. J Am Geriatr Soc 2015 Sep; 63:1868 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26313614
- ↑ 27.0 27.1 27.2 27.3 27.4 27.5 27.6 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
- ↑ 28.0 28.1 Pellegrino LD, Peters ME, Lyketsos CG, Marano CM. Depression in cognitive impairment. Curr Psychiatry Rep. 2013 Sep;15(9):384 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23933974
- ↑ 29.0 29.1 Centers for Disease Control & Prevention (CDC) Preventing Chronic Disease. Routine Check-Ups and Other Factors Affecting Discussions With a Health Care Provider About Subjective Memory Complaints, Behavioral Risk Factor Surveillance System, 21 States, 2011. CME ACTIVITY - Volume 13 - January 28, 2016 http://www.cdc.gov/pcd/issues/2016/15_0471.htm
- ↑ 30.0 30.1 Willey JZ, Gardener H, Caunca MR et al. Leisure-time physical activity associates with cognitive decline: The Northern Manhattan Study. Neurology 2016 Mar 23 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27009261
- ↑ 31.0 31.1 Qin B, Viera AJ, Muntner P Visit-to-Visit Variability in Blood Pressure Is Related to Late-Life Cognitive Decline. Hypertension. 2016;68:00-00. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27217401 <Internet> http://hyper.ahajournals.org/content/early/2016/05/23/HYPERTENSIONAHA.116.07494.full.pdf+html
- ↑ 32.00 32.01 32.02 32.03 32.04 32.05 32.06 32.07 32.08 32.09 32.10 32.11 32.12 32.13 32.14 32.15 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Hoogendam YY, Hofman A, van der Geest JN Patterns of cognitive function in aging: the Rotterdam Study. Eur J Epidemiol. 2014 Feb;29(2):133-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24553905
- ↑ 34.0 34.1 Haba-Rubio J, Marti-Soler H, Tobback N et al. Sleep characteristics and cognitive impairment in the general population: The HypnoLaus study. Neurology 2017 Jan 31; 88:463. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28039311 <Internet> http://www.neurology.org/content/88/5/463
- ↑ 35.0 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 Agency for Healthcare Research and Quality (AHRQ) Executive Summary - March 24, 2017 Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia. https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2456
- ↑ 36.0 36.1 Bassett M Lifestyle Program May Slow Cognitive Decline - At-risk seniors seem to benefit from nutritional guidance, vigorous exercise. MedPage Today. April 25, 2017 https://www.medpagetoday.com/MeetingCoverage/AAN/64800
Kivipelto M, et al A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A Randomized Control Trial American Academy of Neurology (AAN) 2017 Annual Meeting - ↑ 37.0 37.1 Terracciano A, Stephan Y, Luchetti M, Albanese E, Sutin AR. Personality traits and risk of cognitive impairment and dementia. J Psychiatr Res 2017 Jun; 89:22. Epub 2017 Jan 22. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28153642 <Internet> http://www.journalofpsychiatricresearch.com/article/S0022-3956(16)30635-5/fulltext
- ↑ 38.0 38.1 Dearborn JL, Zhang Y, Qiao Y et al. Intracranial atherosclerosis and dementia: The Atherosclerosis Risk in Communities (ARIC) Study. Neurology 2017 Apr 18; 88:1556. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28330958 <Internet> http://www.neurology.org/content/88/16/1556
- ↑ 39.0 39.1 Darweesh SKL, Wolters FJ, Postuma RB et al. Association between poor cognitive functioning and risk of incident parkinsonism: The Rotterdam Study. JAMA Neurol 2017 Dec 1; 74:1431 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28973176
- ↑ 40.0 40.1 Deal JA, Sharrett AR, Rawlings AM et al. Retinal signs and 20-year cognitive decline in the Atherosclerosis Risk in Communities study. Neurology. 2018 Mar 27;90(13):e1158-e1166 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29490915
- ↑ 41.0 41.1 Danthiir V, Hosking DE, Nettlelbeck T et al An 18-mo randomized, double-blind, placebo-controlled trial of DHA-rich fish oil to prevent age-related cognitive decline in cognitively normal older adults. Am J Clin Nutr. 2018 May 1;107(5):754-762 PMID: https://www.ncbi.nlm.nih.gov/pubmed/297228
- ↑ 42.0 42.1 George J Can Intellectual Engagement Stem Cognitive Decline? It may boost mental ability in old age, but won't affect the trajectory of decline, study suggests. MedPage Today. Dec 10, 2018 https://www.medpagetoday.com/neurology/dementia/76833
Staff RT, Hogan MJ, Williams DS, Whalley LJ Intellectual engagement and cognitive ability in later life (the 'use it or lose it' conjecture): longitudinal, prospective study. BMJ 2018;363:k4925 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30530522 Free full text https://www.bmj.com/content/363/bmj.k4925 - ↑ 43.0 43.1 Bosch J, O'Donnell M, Swaminathan B Effects of blood pressure and lipid lowering on cognition. Results from the HOPE-3 study Neurology, February 27, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30814321 https://n.neurology.org/content/early/2019/02/27/WNL.0000000000007174
- ↑ 44.0 44.1 Boyle PA, Yu L, Schneider JA, Wilson RS, Bennett DA. Scam awareness related to incident Alzheimer dementia and mild cognitive impairment: A prospective cohort study. Ann Intern Med 2019 Apr 16; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30986826 https://annals.org/aim/article-abstract/2731121/scam-awareness-related-incident-alzheimer-dementia-mild-cognitive-impairment-prospective
- ↑ 45.0 45.1 Lee MT, Jang Y, Chang WY How do impairments in cognitive functions affect activities of daily living functions in older adults? PLoS One 2019 Jun 7; 14:e0218112. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31173607 Free PMC Article
- ↑ 46.0 46.1 Meglio M Health-Deficit Accumulation Affects Risk for Mild Cognitive Impairment, Dementia. NeurologyLive. 2020. Nov 17. https://www.neurologylive.com/view/health-deficit-accumulation-affects-chance-of-mild-cognitive-impairment-dementia
- ↑ 47.0 47.1 Levine DA, Gross AL, Briceno EM et al Sex Differences in Cognitive Decline Among US Adults JAMA Netw Open. 2021;4(2):e210169 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33630089 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776902
- ↑ 48.0 48.1 George J Anxiety May Amplify Risk of Cognitive Impairment. Amyloid-anxiety interaction appears additive. MedPage Today December 15, 2021 https://www.medpagetoday.com/neurology/alzheimersdisease/96223
- ↑ 49.0 49.1 Manson JE Multivitamins Slow Cognitive Aging in Older Adults. Medscape. December 10, 2021 https://www.medscape.com/viewarticle/963748
Anderson P Multivitamins, but Not Cocoa, Tied to Slowed Brain Aging. Medscape. November 11, 2021. https://www.medscape.com/viewarticle/962772
ClinicalTrials.gov COcoa Supplement and Multivitamin Outcomes Study for the Mind (COSMOS-Mind). https://clinicaltrials.gov/ct2/show/NCT03035201 - ↑ 50.0 50.1 Xiong J et al. FSH blockade improves cognition in mice with Alzheimer's disease. Nature 2022 Mar; 603:470-476 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35236988 https://www.nature.com/PMID: 35236988articles/s41586-022-04463-0
- ↑ 51.0 51.1 Donovan NJ, Wu Q, Rentz DM et al. Loneliness, depression and cognitive function in older U.S. adults. Int J Geriatr Psychiatry. 2017;32(5):564-573 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27162047 PMCID: PMC5102822 Free PMC article https://onlinelibrary.wiley.com/doi/10.1002/gps.4495
- ↑ 52.0 52.1 Ehrlich JR, Goldstein J, Swenor BK et al Addition of Vision Impairment to a Life-Course Model of Potentially Modifiable Dementia Risk Factors in the US. JAMA Neurol. Published online April 25, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35467745 https://jamanetwork.com/journals/jamaneurology/fullarticle/2791268
Deal J, Rohas JC Visual Impairment as a Modifiable Risk Factor in Dementia Prevention and Management. JAMA Neurol. Published online April 25, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35467705 https://jamanetwork.com/journals/jamaneurology/fullarticle/2791267 - ↑ 53.0 53.1 53.2 Creavin ST et al Clinical judgement by primary care physicians for the diagnosis of all- cause dementia or cognitive impairment in symptomatic people. Cochrane Library. 2022. June 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35709018 PMCID: PMC9202995 Free PMC article https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012558.pub2/full
- ↑ 54.0 54.1 54.2 Bachmann D et al. Lifestyle affects amyloid burden and cognition differently in men and women. Ann Neurol. 2022 Sep;92(3):451-463. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35598071 https://onlinelibrary.wiley.com/doi/10.1002/ana.26417
- ↑ 55.0 55.1 Brooks M Not Just a Bad Dream: Nightmares May Predict Dementia. Medscape. Sept 26, 2022 https://www.medscape.com/viewarticle/981468
- ↑ 56.0 56.1 George J Cognitive Function at Older Ages Linked to Childhood Lead Exposure. Consequences of early lead exposure may be felt most in the decades ahead. MedPage Today November 10, 2022 https://www.medpagetoday.com/neurology/dementia/101689
Lee H, Lee MW, Warren JR et al Childhood lead exposure is associated with lower cognitive functioning at older ages. Science Advances. 2022 8(55):eabn5164. Nov 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36351011 https://www.science.org/doi/10.1126/sciadv.abn5164 - ↑ 57.0 57.1 Yeo BSY, Song HJJMD, Toh EMS et al Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia. A Systematic Review and Meta-analysis. JAMA Neurol. Published online December 5, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36469314 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799139
Denham MW, Weitzman RE, Golub JS Hearing Aids and Cochlear Implants in the Prevention of Cognitive Decline and Dementia - Breaking Through the Silence. JAMA Neurol. Published online December 5, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36469311 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799142 - ↑ 58.0 58.1 Zheng H, Cagney K, Choi Y Predictors of cognitive functioning trajectories among older Americans: A new investigation covering 20 years of age- and non-age-related cognitive change. PLOS One. 2023. Feb 8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36753483 PMCID: PMC9907834 Free PMC article https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281139
- ↑ 59.0 59.1 George J Incident Cognitive Impairment Tied to Stress. More than one in five older adults report high levels of perceived stress. MedPage Today March 7, 2023 https://www.medpagetoday.com/neurology/dementia/103420
Kulshreshtha A, Alonso A, McClure LA et al Association of Stress With Cognitive Function Among Older Black and White US Adults. JAMA Netw Open. 2023;6(3):e231860. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36881411 PMCID: PMC9993177 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802090 - ↑ 60.0 60.1 Grober E, Petersen KK, Lipton RB et al Association of Stages of Objective Memory Impairment With Incident Symptomatic Cognitive Impairment in Cognitively Normal Individuals. Neurology. 2023. April 19 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37076305 https://n.neurology.org/content/early/2023/04/19/WNL.0000000000207276
- ↑ 61.0 61.1 Rosano C, Newman A, Santanasto A et al Increase in skeletal muscular adiposity and cognitive decline in a biracial cohort of older men and women. J Am Geriatr Soc 2023. Jun 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37282843 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18419
- ↑ 62.0 62.1 Velkers C et al Association Between Exposure to General Versus Regional Anesthesia and Risk of Dementia in Older Adults. J Am Geriatrics Soc, 2020 Oct 6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33025584 https://onlinelibrary.wiley.com/doi/10.1111/jgs.16834
- ↑ 63.0 63.1 Li W, Jiang J, Zhang S et al Prospective association of general anesthesia with risk of cognitive decline in a Chinese elderly community population. Sci Rep. 2023 Aug 18;13(1):13458 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37596302 PMCID: PMC10439205 Free PMC article https://www.nature.com/articles/s41598-023-39300-5
- ↑ 64.0 64.1 Harwood RH, Goldberg SE, Brand A et al. Promoting Activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED): randomised controlled trial. BMJ. 2023 Aug 29;382:e074787. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37643788 PMCID: PMC10463053 Free PMC article. https://www.bmj.com/content/382/bmj-2023-074787