Memory, Cognitive Loss Decreasing in Older
Americans: Great News for Seniors, Boomers
Better education, finances and cardiovascular care
may be boosting brain health for elderly
Feb. 20, 2008 - Although it’s too soon to sound the
death knell for the “senior moment,” it appears that memory loss and
thinking problems are becoming less common among older Americans,
according to researchers at the University of Michigan. The new
nationally representative study shows a downward trend in the rate of
“cognitive impairment” - the umbrella term for everything from
significant memory loss to dementia and Alzheimer’s disease - among
people aged 70 and older.
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Read the latest news
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Alzheimer's, Dementia & Mental Health |
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The prevalence of cognitive impairment in this age
group went down by 3.5 percentage points between 1993 and 2002 — from
12.2 percent to 8.7 percent, representing a difference of hundreds of
thousands of people.
And while the reasons for this decline aren’t yet
fully known, the authors say today’s older people are much likelier to
have had more formal education, higher economic status, and better care
for risk factors such as high blood pressure, high cholesterol and
smoking that can jeopardize their brains.
In fact, among the 11,000 people in the study,
those with more formal education and personal wealth were less likely to
have cognitive problems.
Interestingly, the more-educated seniors who had
cognitive impairment were more likely to die within two years. But the
researchers say this may actually result from a protective effect of
better education on a person’s “cognitive reserve” — their ability to
sustain more insults to their brain before significant thinking problems
arise.
The study is published today online in the journal
Alzheimer’s and Dementia by a team led by two University of Michigan
Medical School physicians and their colleagues. The study is based on
data from the Health and Retirement Study (HRS), a national survey of
older Americans funded by the National Institute on Aging and based at
the U-M Institute for Social Research (ISR).
Lead author Kenneth Langa, M.D., Ph.D., calls the
findings good news for today’s seniors, noting that the new data support
recent theories of how brains can be protected and preserved.
“From these results, we can say that brain health
among older Americans seems to have improved in the decade studied, and
that education and wealth may be a big piece of the puzzle,” says Langa,
an associate professor of internal medicine who also holds appointments
in ISR and the VA Ann Arbor Healthcare System.
“We know mental stimulation has an impact on the
way a person’s brain is ‘wired,’ and that education early in life likely
helps build up a person’s cognitive reserve. We also know cardiovascular
health has a close link with brain health,” he continues. “So what we
may be seeing here is the accumulated effects of better education and
better cardiovascular prevention among the people who were over age 70
in 2002, compared with those who were over age 70 in 1993.”
The research team’s analysis, in fact, suggests
that about 40 percent of the decrease in cognitive impairment over the
decade was likely due to the increase in education levels and personal
wealth between the two groups of seniors studied at the two time points.
Langa notes that school attendance requirements,
high school graduation rates and college or technical school enrollment
rates all increased during the years when the adults in the study were
children and young adults. In 1990, 53 percent of people over age 65 had
a high school diploma, but by 2003 that proportion had increased to 72
percent. The rates of college-educated older people also rose, from 11
percent to 17 percent. In recent years, research has suggested that the
more education a person receives early in life, the more his or her
brain will be able to stay sharp later.
At the same time, the use of cholesterol-lowering
drugs, blood pressure medications and other preventive cardiovascular
medications and strategies increased dramatically in the 1990s. These
factors may have helped protect seniors’ brain function by decreasing
the incidence of vascular dementia — cognitive problems brought on by
mini-strokes, strokes and decreased blood flow to and within the brain
due to “hardened” or clogged arteries.
Improved cardiovascular health, combined with more
education and wealth, may also help explain why death rates within two
years were highest for those with CI who were highly educated. A good
cognitive reserve can protect brains from minor insults, keeping them
intact longer for thinking and memory by finding a way around a damaged
area. But then when a major crisis, such as a stroke, occurs, that
remaining reserve may be depleted quickly and death can come more
quickly.
Richard Suzman, Ph.D., director of the Social and
Behavioral Research Program at the NIA, which partially funded the
study, notes that “the trend toward improved cognitive status is
consistent with a dramatic decline in chronic disability among older
Americans over the past two decades, especially in the areas of everyday
function that depend on cognition. It will be important to pinpoint the
influence of factors such as increased education, exercise, medications,
cardiovascular health, and lifestyle to discover which ones contributed
to this trend and to also replicate the findings in other studies.”
The study divides individuals into four categories
— no cognitive impairment, and mild, moderate and severe CI — based on
their performance on a standardized cognitive test.
But the authors caution that they could not tell
which patients had true dementia, which requires additional clinical
information, or Alzheimer’s disease, which can be positively identified
only on autopsy. However, the cutoff points for the different categories
of CI were based on prior studies and on data from a new sub-study of
the HRS designed to identify dementia specifically.
While the new study shows a decline in CI
prevalence over time, the researchers note that the gains made in the
1990s and early 2000s might be offset by the damage that could result if
the current epidemic of type 2 diabetes keeps growing among the elderly
and if current middle-aged and younger people stick with unhealthy
eating and exercise habits that lead to unhealthy weights and blood
pressures.
Even if the proportion of older adults with CI
keeps declining, the total number of older adults with CI and dementia
will likely increase significantly due to the huge increase in the size
of the over-65 population as the Baby Boom generation enters older age
in the coming decades.
“This demographic reality will continue to make
combating Alzheimer’s disease and other types of dementia a top public
health priority,” said Allison Rosen, M.D., Sc.D., assistant professor
of internal medicine at U-M and the Ann Arbor VA, and co-author of the
study.
Meanwhile, they say, today’s older Americans should
not rest on their laurels — but instead should be pursuing activities
that can keep their minds sharp and their cardiovascular risk low. From
crossword puzzles and volunteer activities to blood pressure
medications, today’s seniors can work to boost their brain health now
and prevent decline later.
“More and more studies suggest that walking and
other types of physical activity are important for preventing cognitive
and memory decline,” says co-author Eric Larson, M.D., M.P.H., executive
director of the Group Health Center for Health Studies in Seattle, where
he has led many studies of the relationship between physical activity
and brain health.
“The evidence seems to be showing that staying
mentally engaged with the world in any fashion — reading, talking with
friends, going to church, going to movies — is also likely to help
reduce your risk down the road,” says Langa.
Editor’s Notes:
In addition to Langa, Rosen and Larson, the study’s
authors are Jason Karlawish, M.D., of the University of Pennsylvania,
David Cutler, Ph.D., of Harvard University, Mohammed Kabeto, M.S., of
U-M General Medicine, and Scott Kim, M.D., Ph.D., of the U-M Department
of Psychiatry, Bioethics Program and Center for Behavioral and Decision
Sciences in Medicine. Additional support for the study came from the
Harvard Interfaculty Program for Health Systems Improvement, and from
grants to individual authors from the Greenwall Faculty Scholar in
Ethics and the Paul Beeson Physician Faculty Scholars in Aging Research
programs.
