Opportunities for enhancing brain health across the lifespan
Published online by Cambridge University Press: 22 March 2021
As we age, there are characteristic changes in our thinking, reasoning and memory skills (referred to as cognitive ageing). However, variation between people in the timing and degree of change experienced suggests that a range of factors determine individual cognitive ageing trajectories. This narrative review considers some of the lifestyle factors that might promote (or harm) cognitive health. The focus on lifestyle factors is because these are potentially modifiable by individuals or may be the targets of behavioural or societal interventions. To support that, the review briefly considers people’s beliefs and attitudes about cognitive ageing; the nature and timing of cognitive changes across the lifespan; and the genetic contributions to cognitive ability level and change. In introducing potentially modifiable determinants, a framing that draws evidence derived from epidemiological studies of dementia is provided, before an overview of lifestyle and behavioural predictors of cognitive health, including education and occupation, diet and activity.
Even limited hearing loss might be associated with cognitive decline. If true, early intervention with hearing aids might help people have better cognitive performance.
Michael Johns III, MD, online editor for JAMA Otolaryngology, speaks with Justin Golub, MD, MS, assistant professor of otolaryngology at Columbia University, whose research has shown that very mild hearing loss can be associated with cognitive disability.
From a MedPage Today online article (April 2, 2020):
This relationship between higher glucose levels and poorer cognitive functioning extended beyond just CASI z-score, as well, Cukierman-Yaffe noted. Higher HbA1c levels were also tied to significantly poorer performance in other psychological tests, including the clock making test of executive functioning, test of discriminative ability, and for the test of verbal fluency.
Poorer glycemic control was tied to cognitive decline following a lacunar stroke in a prospective cohort study.
Among 942 individuals with type 2 diabetes who had a lacunar stroke, every 1% higher HbA1c was tied to a 0.06 drop in cognitive function at baseline measured by Cognitive Assessment Screening Instrument (CASI) z-score (95% CI -0.101 to -0.018), reported Tali Cukierman-Yaffe, MD, MSc, of Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University in Israel.
From a National Institute on Aging online release:
First place prize awarded to MapHabit: This mobile software provides behavior prompts with customizable picture and keyword visual maps to assist memory-impaired people with accomplishing activities of daily living. The care management platform employs different interfaces depending on whether the user is a person with impaired memory, caregiver or long-term care community manager. Caregivers can monitor adherence to medication schedules or track other activities.
The team found 85% of people first diagnosed with dementia were diagnosed by a non-dementia specialist physician, usually a primary care doctor, and an “unspecified dementia” diagnosis was common.
One year after diagnosis, less than a quarter of patients had seen a dementia specialist. After five years, the percent of patients had only increased to 36%.
In the first large study to examine the diagnosis of dementia in older Americans over time, researchers found the vast majority never meet with a dementia specialist and are instead overwhelmingly diagnosed and cared for by non-specialists.
From a Journal of the American Geriatrics Society release:
In our study, we found significant associations between baseline teeth symptoms and change in episodic memory. Deficits in episodic memory (ie, ability to retain new information) are most common in older adults with mild cognitive impairment making them more likely to progress to Alzheimer’s disease dementia.30 Furthermore, changes in episodic memory are often reported in older adults several years before the onset of dementia.
Our findings point to the importance of assessing oral health symptoms in this population. Developing policy measures aimed at ameliorating health and improving cognition in this high‐risk fast‐growing population in the United States would need to include oral health preventive and dental care services. Medical and dental care providers can identify problematic oral health symptoms as risk factors of cognitive decline. Outreach programs that target older adults to improve the awareness of these problems can then be developed. Dental care community outreach programs should focus their information on practical ways to prevent oral health problems and provide information on accessible treatment options.