Penn Medicine News Blog

April 18, 2015 // By Lee-Ann Donegan // Comments

Thinking More about Cognitive Aging

The subject of aging is something I’ve thought about a great deal this week, having just celebrated a milestone birthday. But the thing that gets me upset much more than my own aging, is the aging of my parents and older relatives.
This week, the Institute of Medicine (IOM), an independent organization that advises the government and the public on health decisions, published a report on a relatively new concept known as “cognitive aging.”
Cognitive aging refers to the lifelong process of gradual, ongoing, yet highly variable changes in cognitive function that occur as people get older. Scientifically speaking, it refers to the aging process that occurs in the neurons of the brain. It is distinct from diseases like Alzheimer’s and Parkinson’s, where the neurons die.  
Medical researchers have spent a lot of time trying to understand Alzheimer’s and the diseases of neurodegeneration, but not quite as much on understanding what the processes of optimal brain aging looks like.
“The report differentiates the processes of cognitive aging from those of neurodegeneration,” says Jason Karlawish, MD, professor of Medicine, Medical Ethics and Health Policy and acting co-director of the Penn Memory Center and director of Penn’s Healthy Brain Aging Research Network Center, and one of 16 authors of the report, all of whom are national leaders in aging research and practice.
In addition to explaining cognitive aging, the report also provides actionable steps supported by research that people can take to maintain cognitive health as they age. These include:  
·    Control high blood pressure and diabetes, and don't smoke: what's bad for your heart is bad for your brain.
·     Monitor medications closely: certain anxiety or sleep drugs, antihistamines, incontinence drugs and older antidepressants — can fog the brain.
·     Keep socially and intellectually active.
·     Get enough sleep.
·     Be wary of products that claim to improve cognitive functioning. There's no evidence that vitamins and dietary supplements help. And the jury's still out on whether computer-based brain-training games do any good, he said.
Karlawish, a geriatrician, sees patients at the Penn Memory Center and has observed the effects of cognitive decline, whether from a neurodegenerative disease or cognitive aging. As a result he has become an advocate for seniors and is involved in efforts to improve the diagnosis of these diseases, and educating patients and families as to the best ways to plan for cognitive decline.
“Finances are often the first place people’s cognitive abilities show impairment,” says Karlawish. He advises that older adults have someone available to monitor their finances and intervene as help is needed.
Karlawish and the Penn Memory Center are involved in efforts to protect older adults through advocacy groups, such as National Adult Protective Services Association, on the national, city and state levels to promote justice for elder Americans. The Center participates in events throughout the city to educate older adults to protect them against financial fraud and those that prey on this population.
The IOM also urged more research into cognitive aging and more education of doctors about their patients' risks. For example, hospitalized seniors are at an increased risk for delirium — sudden confusion and agitation — that can cause lingering cognitive decline long after hospital discharge. But there are ways to prevent delirium. The IOM also said government agencies and communities should consider cognitive aging as they set policies and programs.
I hope to be there to step in, should cognitive aging, or worse, begin to develop in my family. But, with these tips, a healthy lifestyle and a solid support system, my family and many others will be able to stay sharp and enjoy their older years.

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