Promoting Cognitive Health in the 21st Century: A new IOM report recognizes the public health importance of cognitive aging

2015 Institute of Medicine (IOM) Report on Cognitive Aging

The Institute of Medicine has release Cognitive Aging: Progress in Understanding and Opportunities for Action, a report on the public health dimensions of cognitive aging.

The report, released on April 14, 2015, is timely. The U.S. population is rapidly aging and individuals are becoming more concerned about their cognitive health. Older adults view “staying sharp” as perhaps one of their most important health care goals.

Prepared by the Committee on the Public Health Dimensions of Cognitive Aging, the report assesses examined definitions and terminology, epidemiology and surveillance, prevention and intervention, education of health professionals, and public awareness and education.

Jason Karlawish, MD, associate director of the Penn Memory Center and director of the Penn Prevention Research Center’s Healthy Brain Research Center — a member of the CDC supported Healthy Brain Network dedicated to surveillance, education, awareness and empowerment the promotes brain health — was a member of the report committee.

“This report is a beginning,” Dr. Karlawish explained. “Over the last 30 years we have made a substantial progress in understanding the causes of neurodegeneration. Alzheimer’s disease has gone from a hidden disorder, to a front and center national concern. Now, we need to pay the same attention to cognitive aging.”

Cognitive aging is a process of gradual, ongoing, yet highly variable, changes in cognitive functions that occur as people get older. Age-related changes in cognition can affect not only memory but also decision-making, judgement, processing speed, and learning.

“Among our key findings was that both human and animal models show how in cognitive aging, neurons are not working as well, but they’re not dying.” Dr. Karlawish noted that this is important because “Synapses may be sick, but there’s a chance they can get well again.”

The report’s findings and recommendations address steps individuals, health care professionals, communities and society can take to promote cognitive health:

  • Increasing research and tools to improve the measurement of cognitive aging.
  • Promoting physical activity; reducing and managing cardiovascular disease risk factors, including high blood pressure, diabetes, and smoking; and regularly discussing and reviewing with a health care professional the medications that might influence cognitive health.
  • Expanding public communications efforts around cognitive aging with clear messages that the brain ages, just like other parts of the body; cognitive aging is not a disease; cognitive aging is different for every individual (there is wide variability across persons of similar age); some cognitive functions improve with age, and neurons are not dying as in Alzheimer’s disease (hence, realistic hope is inherent in cognitive aging); and finally, there are steps that patients can take to protect their cognitive health.
  • Developing and improving financial programs and services used by older adults to help them avoid financial exploitation, optimize independence, and make sound financial decisions.
  • Health care systems and health care professionals should implement interventions to insure optimal cognitive health across the life cycle including programs to avoid delirium associated with medications or hospitalizations.
  • Determining the appropriate regulatory review, policies and guidelines for products advertised to consumers to improve cognitive health, particularly medications, nutritional supplements, and cognitive training.

The report, a slide set, and a four-page key point summary, are free and available for download at: www.iom.edu/cognitiveaging.

Published by: Barbara Overholser, Administrative Coordinator, Communication and Dissemination, Penn Memory Center

 

IOA’s 2015 Sylvan M. Cohen Annual Retreat

Retreat2015SaveTheDateforScreens“Aging with Financial Security: Addressing the Challenges of Cognitive  Aging & Impairment”

This year’s Institute on Aging Sylvan M. Cohen Annual Retreat will focus on some of the challenges of cognitive aging that are addressed in this new IOM report. Co-sponsored by the Department of Medical Ethics and Health Policy among others, the retreat will offer a line-up of lectures on a variety of topics related to cognitive aging and financial security for seniors.

For additional details on registration, poster submission, and the event’s full agenda, click here.

Is Cardiovascular Disease a Human Inevitability? Insights from the Bolivian Amazon ft. Michael Gurven, PhD

This week the IOA welcomed Visiting Scholar, Michael Gurven, PhD, professor of Anthropology at the University of California, Santa Barbara, where he focuses his research in human social behavior and life history evolution. Dr. Gurven’s talk, titled “Is Cardiovascular Disease a Human Inevitability? Insights from the Bolivian Amazon,” is a result of his professional background in anthropology and personal interest in human health, particularly aging.

Holding the number one spot on the list of causes of death for men and women across the United States and in Europe as well, one of the most common aging-related health concerns is cardiovascular disease. This includes angina, hypertension, atrial fibrillation, and atherosclerosis. Dr. Gurven’s presentation focused primarily on whether the small, horticultural populations that he studies, such as the Tsimane of Bolivia, suffer form the same risk factors and aspects of heart disease as individuals in other areas such as the U.S. and Europe.

Get an overview of of Dr. Gurven’s findings here:

For more information on Dr. Gurven and his research, click here.

What is PD? Help spread the word during Parkinson’s Awareness Month

 Parkinson’s Awareness Month

PDAwarenessThroughout the month of April, the IOA will be celebrating Parkinson’s Awareness Month. As close collaborators of the Penn Udall Center for Parkinson’s Research and the Penn Parkinson’s Disease and Movement Disorders Center (PDMDC), it is our goal to help facilitate and support the groundbreaking research and care for Parkinson’s disease (PD) patients and their loved ones here at Penn.

 

 

So, what is Parkinson’s disease?

SubstantiaNigraParkinson’s disease is a “chronic and progressive disorder of the nervous system that primarily affects movement.” It develops when a group of cells in an area of the brain called the substantia nigra begin to malfunction and die. These cells are responsible for the production of dopamine, a neurotransmitter that sends information to the parts of the brain that control movement and coordination. As the dopamine-producing cells die and the level of dopamine in the brain decreases, messages from the brain telling the body how and when to move are slowed more and more, rendering the person unable to initiate and control movement normally.

Other symptoms of PD can include problems with thinking and changes in mood and/or sleep, as well as involuntary movements like tremors or muscle stiffness. While there is currently no cure for PD, there are ways to treat the symptoms. Treatment options include deep brain stimulation, drug treatment, occupational therapy, physical therapy, psychiatric and neuropsychology services, and speech therapy among others.

Parkinson’s Disease Facts
Courtesy of PDMDC and michaeljfox.org

  • Parkinson’s disease affects one in 100 people over the age of 60.
  • The exact cause of PD is unknown, but both genetic and environment are causes.
  • There is no single test to diagnose PD. Neurologists make diagnoses based on assessment of symptoms, medical history, and neurological and physical examinations. In some cases, advanced imaging techniques like MRI scans or dopamine imaging scans can help make the diagnosis by ruling out other disorders.

Celebrate Parkinson’s Awareness Month with the IOA

#FaceTheFactsFriday: This year, the IOA will celebrate Parkinson’s Awareness month in a few different ways. Each Friday this month, the IOA will participate in ‘Face the Facts Friday.’ Like us on Facebook and Follow us on Twitter for a new Parkinson’s disease fact each week. Share our posts and use the hashtags #FacetheFactsFriday and #ParkinsonsAwarenessMonth to join in on the conversation and help spread the word!

Penn Udall Center for Parkinson’s Research Virtual Tour

Towards the end of the month, be sure to keep an eye out for the official premiere of the Penn Udall Center for Parkinson’s Research Virtual Tour video! The video will highlight the talented team of researchers, scientists, and Udall collaborators and the groundbreaking work being done here at Penn. You will get a look into both the clinical and basic research that is at the foundation of our projects and how these investigators are working to improve and increase the levels of education and research on this neurodegenerative disease.

All things Alzheimer’s: This week’s news on the most common form of dementia

While the start of Spring may not have brought on the warmer weather that we were all hoping for, it certainly brought in a wave of attention for Alzheimer’s disease (AD). There seemed to be no shortage of exciting and thought-provoking AD news this week so the IOA decided to highlight some of the top stories here.

| 2015 Alzheimer’s Disease Facts and Figures Report

First up, the Alzheimer’s Association recently released their official 2015 Screen Shot 2015-03-26 at 11.58.48 AMAlzheimer’s Disease Facts and Figures Report, a statistical resource for the most current knowledge on all aspects of Alzheimer’s disease. This report includes information on Alzheimer’s prevalence, mortality and morbidity, caregiving, and costs. In addition, this year’s report includes special coverage on disclosing the diagnosis of AD to patients and their family members, which is an issue that has sparked quite a bit of conversation this week as well.

| Disclosing the Diagnosis of Alzheimer’s Disease

According to new findings from research conducted by the Alzheimer’s Association, an estimated 55% of Alzheimer’s patients do not know their diagnosis. They are typically treated without being told their condition until the disease has progressed to a much more advanced stage. Representatives from the Alzheimer’s Association explain that the biggest problem with this, other than overriding a patient’s general right to be in-the-know, is that it is taking away the patient’s ability to make certain life decisions and plan for their future or to choose to participate in potentially beneficial clinical trials while they still can.

“Doctors commonly cite fear of causing emotional distress as one of the main reason they fail to disclose an Alzheimer’s diagnosis,” quoted the recent CBS News article covering the story, which also listed “uncertainty about their diagnosis, insufficient time to fully discuss treatment options and support services, a lack of support services, and the general stigma that surrounds Alzheimer’s,” as the other reasons given by doctors for not disclosing the diagnosis.

For the full CBS News article, click here.

| New clinical trial raises hope for possible treatment of Alzheimer’s Disease

Recent news of a “game changing” clinical trial for Alzheimer’s treatment highlights the ongoing A4 Study that is testing whether the drug Solanezumab can slow the progression or even prevent Alzheimer’s disease.

Screen Shot 2015-03-26 at 2.53.24 PMThe clinical trial, which is being offered at several different sites across the country including the University of Pennsylvania, is targeting patients who have not yet experienced symptoms related to AD, but whose brain scans indicate they will likely develop the disease in the future. The scans reveal that these patients have a buildup of amyloid plaque, which is one of the proteins believed to cause Alzheimer’s disease, in addition to tau tangles. The hope is that this drug will kill the amyloid before the amyloid can kill the brain cells, resulting in the disease.

For the full CBS News article, click here.

For more information on the A4 Study, click here.

| In other news…

While not directly related to Alzheimer’s disease, the coverage on the A4 Study also brings up the conversation about another recent breakthrough in the realm of neurodegenerative diseases right here at the University of Pennsylvania. Penn Medicine researcher, Corey McMillan, research assistant professor of Neurology in the Penn Frontotemporal Degeneration Center, and his colleagues, have identified a new potential drug target to protect against Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Degeneration (FTD). They have found that hypermethylation, the epigenetic ability to turn down or turn off a bad gene implicated in 10 to 30 percent of all patients with ALS and FTD, can serve as a protective barrier preventing the development of these diseases.

For the full Penn Medicine News Release, click here.

Geriatrics: From Bedside to Bench to Policy – Singing a Single Song in Separate Keys ft. Neil Resnick, MD

NeilResnickPicEarlier this week, the IOA welcomed Visiting Scholar, Neil Resnick, MD to discuss Geriatrics: From Bedside to Bench to Policy – Singing a Single Song in Separate Keys. Dr. Resnick, Thomas Detre Professor of Medicine; Chief, Division of Geriatric Medicine; Associate Director, Aging Institute of University of Pittsburgh Medical Center (UPMC) Senior Services and University of Pittsburg; and Director, Hartford Center of Excellence in Geriatrics, focused his talk mainly around his research on urinary incontinence in older adults and the myths surrounding this geriatric syndrome.

Myth #1: Urinary incontinence is a normal consequence of aging.

Myth #2: Urinary incontinence is inevitable in the demented, frail, and elderly.

Myth #3: Urinary incontinence is less treatable in the elderly.

During a brief interview, Dr. Resnick addressed these myths and explains how he and his colleagues work to treat, and ultimately cure, the burden of urinary incontinence in older adults.

Dr. Resnick explains that, according to his years of research, incontinence is never normal, regardless of age, even in those with conditions such as Alzheimer’s disease and other dementias. Aging does not cause the symptoms, but merely predisposes the individual and makes them more vulnerable to this syndrome. Therefore, it is not untreatable, as long as you can determine what is setting the stage for the development of incontinence. In younger people, the cause of incontinence is almost always due to the diseased organ, however, in older people this is rarely the case. Instead, the reason can be as simple as a medication or an injury or issue unrelated to the urinary tract.

Another important facet of his research is the realization that this treatment approach can be applied to a variety of other areas in geriatrics such as memory impairment, syncope, fall risks, and depression among others. The idea behind this unified approach is that, regardless of the condition, to properly treat or cure it you must detect any and all outside issues or factors such as medication, other diseased organs, or functional and sensory impairment, rule them out as the cause, and then proceed by addressing the organ-specific issues if still necessary.

 

Still Alice and the Hidden Tolls of Early-Onset Alzheimer’s Disease

still_aliceIn Still Alice, Julianne Moore plays a college professor struggling with her diagnosis of a genetic form of early-onset Alzheimer’s disease. Moore has already won two awards, a Golden Globe and a SAG Award, and is now nominated for an Oscar for Best Actress in a Leading Role.

While her performance is clearly nothing short of noteworthy, the biggest takeaway from this film in the increase in awareness of Alzheimer’s disease, particularly early-onset. Still Alice has gained a reputation as an outlet for highlighting the “hidden tolls” and its “shockingly accurate” depiction of this neurodegenerative condition.

With this in mind, Penn Medicine’s Steven E. Arnold, MD, director of the Penn Memory Center, sat down with us to weigh in on the topic with his expert opinion.

Spoiler Alert: This video may contain spoilers for Still Alice.

The Penn Memory Center is a National Institute on Aging-designated Alzheimer’s Disease Center (ADC). Their team consists of board-certified, experienced physicians specializing in cognitive neurology, geriatric psychiatry, and geriatric medicine, and clinical professionals from disciplines including neuropsychology, psychometrics, nursing, psychotherapy, social work, and research management. They provide clinical care including evaluation, diagnosis, treatment, and research opportunities for patients experiencing symptoms related to Alzheimer’s disease and mild cognitive impairment and related disorders, as well as providing support and resources to caregivers and family members.

For more information on the Penn Memory Center, visit: pennadc.org

Find more facts on the hidden tolls of Alzheimer’s disease that are highlighted in Still Alice, in the related NY Daily News article here.

Debunking the Common Myths of Aging ft. Sarah H. Kagan, PhD, RN

DrKaganBlogPicAccording to Sarah H. Kagan, PhD, RN, the idea of aging is not simply to live longer, but to live happier and healthier as well. As a Lucy Walker Honorary Term Professor of Gerontological Nursing at the University of Pennsylvania’s School of Nursing, her goal is to help the aging community to do just that.

During her recent presentation on “Debunking the Common Myths of Aging” at a lunchtime workshop offered to Penn faculty and staff, Dr. Kagan explained that one way to live longer, happier, and healthier lives is to change the way that we think about aging. We must discredit the stigma that our age defines who we are, how we act, and what we are capable of. There is a common misconception that “the older you get the more invisible you get,” however, this notion is quickly taking a positive turn for older Americans in this recent longevity revolution. With the still-evolving science around what is “normal aging,” we are finding that many conditions and behaviors that we associate with getting older may actually be epigenetic diseases rather than aging-related diseases.

Epigenetic diseases are those that are influenced by a variety of non-genetic factors such as geographic location, personal habits, and other environmental factors. For example, an individual does not necessarily lose their ability to hear simply because of their age, but rather due to a variety or combination of other factors in their life such as frequent attendance at rock concerts or years of working around heavy machinery. Aging also often takes all of the stereotypical blame for wrinkles and grey hair when the true culprits such as UV exposure and a variety of genetic factors actually play major roles in these physical changes.

Dr. Kagan also explained how ageism, the stereotyping of individuals based on their age, is the same as any other form of discrimination. Not every senior becomes frail, experiences memory loss or needs a caregiver but society often forgets that. However, it is not only the younger generations that are guilty of this. Self-stereotyping is a huge issue as well. Older individuals need to stray away from the “I’m too old for that” mindset. After all, an individual’s aging experience is significantly influenced by how they think about it.

ageism

With that said, Dr. Kagam shared that for the most part, the aging community is actually a generally happy on despite the “old and grumpy” stereotype. She explained it as a “U-shaped curve.” Our level of happiness is very high at a young age, decreases around midlife, and increases again as we enter the “last half” of our lives. This level of happiness tends to be higher in those who maintain healthy social relationships, and at a population level, those with closer relationships tend to live longer.

Find more information on Dr. Kagan here.

Follow Dr. Kagan on Twitter here.