Since Steve Prince retired from dentistry 18 months ago, he hasn’t slowed down. The 68-year-old Fallbrook, California, man fills his days with activities, both mental and physical. He socializes. He swims and golfs and tackles chess puzzles and word games. And he takes regular long walks with his wife, Meredith.
Though he’s never seen the report just released by the Institutes of Medicine, Prince could star on its pages, living the IOM’s recipe for maintaining brain health. The IOM says families and individuals can do a lot to prevent mental decline related to aging. Brain health is as influenced by lifestyle choices like exercise and diet as heart health is.
“The brain ages just like the rest of the body,” said Dr. Kristine Yaffe, vice chair of the IOM committee that this week issued “Cognitive Aging: Progress in Understanding the Opportunities for Action.” She is a professor of psychiatry, neurology and epidemiology at University of California San Francisco. “This report is trying to understand what (aging of the brain) is all about, what it means from a public health perspective and what steps one can take to make sure you are aging as well as possible and maybe prevent decline.”
The report is packed full of “actions for families, actions for society and actions for healthcare professionals,” she said. “The things we suggest are the things you’d want to do anyway, even for heart health or for body health. We think they are good for brain health, too.”
The report defines cognition as “the mental functions involved in attention, thinking, understanding, learning, remembering, solving problems and making decisions.” It calls cognition the “fundamental aspect of an individual’s ability to engage in activities, accomplish goals and successfully negotiate the world. Although cognition is sometimes equated with memory, cognition is multidimensional because it involves a number of interrelated abilities that depend on brain anatomy and physiology.”
Cognitive aging is what happens to the brain over time, absent disease like Alzheimer’s. Aging’s toll on the brain is influenced by protective and risk factors, genetics and more. The changes should not lead to clinical diagnosis, like dementia, although memory may be less sharp and speed may slow. Yaffe sees positives to the aging brain, too: sounder judgment, better vocabulary, more positive feelings.
But cognitive aging’s effects can be difficult for older adults and their kin. “They can manifest themselves as decreased judgment regarding when to make a left turn while in a busy intersection, uncertainty whether a new financial investment is a wise choice or a fraudulent scam or declining ability to take care of one’s overall health.”
A 2012 AARP survey found degenerative brain disorders are a major worry people have about growing old. But while a disease like Alzheimer’s is “a very terrible disease, it affects only 10 percent of the aging population,” said Marilyn Albert, Ph.D., an IOM report co-author and director of the Division of Cognitive Neuroscience at Johns Hopkins University School of Medicine. “Cognitive aging affects the rest. … And although people completely understand that their kidneys or lungs might age, they don’t particularly understand that’s also true for the brain. There can be age-related changes in the brain that affect mental abilities that aren’t disease.”
Although at 84 her dad’s still quite healthy, slowed reaction time and somewhat questionable judgment have worried Sylvia Penn and her siblings.
The Pittsburgh, Pennsylvania, woman and her two brothers recently convinced their father to give up his car keys. It won’t stun them if at some point he cannot live alone although she checks in daily, she said. In the meantime, she actively seeks ways to slow aging-related decline. She encourages him to be involved with her family and his church and they often go for walks, although he’s more sedentary than she would like because of arthritis.
The report emphasizes the brain is susceptible to the same things that hurt the heart, like diabetes or high blood pressure or smoking. Just as strategies like adequate exercise and an attentive physician help heart health, they can aid brain health, too. Recognizing it provides guidance for adult children of elderly people, for caretakers and for the individuals themselves.
People can promote cognitive health with physical activity, the report says. Reducing heart disease risk factors reduces the cognitive-woe quotient. The report says to control blood pressure and blood sugar levels and don’t smoke. It recommends collaborating with a doctor and recognizing that some medications — including over-the-counter drugs — can hurt mental status.
The report lists other strategies believed to help: Be socially and intellectually active, get plenty of sleep, monitor medications.
Prince, the retired dentist, touts sleep as vital throughout life and certainly if one hopes to age well mentally. Even before you’re old, he said, not sleeping enough causes problems. And it makes people grumpy to boot. He’s an early-to-bed, early-to-rise kind of guy who says he doesn’t sit around much. Parking in front of a television has little appeal.
While Albert said most people probably experience age-related changes, it’s well-known that some people in their 80s perform as well as people in their 30s at some tasks. “That’s what we would like for everybody,” she said. “We’re trying to say, ‘What are the basic things that happen with age and what can people do to maximize their function as they get older?’”
Albert said the concept of cognitive reserve suggests the brain has mechanisms that can help overcome pathology, so people function at a high level. It may result from having a “flexible and efficient” brain. More study is needed, the report says.
The report tells doctors to work with families to address concerns about mental function, to watch for changes that are not complained about and to be proactive in heading off preventable decline.
In the face of change, doctors have a lot to look at, including kidney and lung function or the possibility of vitamin deficiencies, among other things that impact cognition. They should also observe when there are no complaints, she added.”Anybody knows if they are dealing with old people how variable it can be,” Albert said. “Some people are doing remarkably well, and that’s what we would like for everybody.”