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The cognitive spectrum between normal aging and dementia is broad. Many terms including mild cognitive impairment (MCI) have been developed to identify a group of people at the transitional phase for early detection of Alzheimer disease (AD). The lack of biomarker based criteria and the dependence on the sociocultural context result in great variability in case definition. Cerebrospinal fluid (CSF), positron emission tomography (PET) and magnetic resonance imaging (MRI) serve as three important tools to track biological changes in AD. The Alzheimer's Disease Neuroimaging Initiative (ADNI) provides the infrastructure for investigators to examine the longitudinal patterns of CSF, PET and MRI biomarkers at different cognitive stages. The dissertation first delineated the biomarker changes over time in relation to cognitive decline in ADNI and found that the trajectories support a hypothetical sequence of AD pathology, suggesting that biomarker prediction for cognitive change is stage dependent. Missingness is common but often overlooked in longitudinal studies of AD. The mechanism of missing data is often assumed to be missing completely at random. The second aim of the dissertation is to test this assumption. The missing biomarker data in ADNI were found not completely at random but rather conditional on certain clinical features. Understanding the missing data structure may help in the design of future longitudinal studies and clinical trials in AD. Cognitive reserve has been proposed to account for the discordance between cognitive performance and AD pathology. The long held viewpoint is that cognitive reserve affects the clinical expression but has no direct effect on AD pathology. This viewpoint was re-examined in the dissertation. The results showed that higher cognitive reserve indexed by education and other proxies was associated with slower rates of AD pathological deterioration, particularly among cognitively normal elderly people. These findings suggest that the pathological course of AD can be modified by cognitive reserve. Many cardiovascular risk factors increase the risk of AD. Vascular dysfunction reduces brain reserve or threshold of cognitive impairment. Whether the underlying mechanism also involves impairment of cerebral amyloid clearance remains controversial. Vascular burden, indexed by cardiovascular risk profile and MRI white matter hyperintensities, was not significantly associated with rates of AD biomarker changes, suggesting that typical AD pathology, presumably reflective of amyloid accumulation, appears to be independent of vascular burden. In conclusion, CSF and imaging markers change over time at different rates in aging and dementia and the missing data are conditional on certain clinical features during follow-ups. Education and other cognitive reserve surrogates may have direct effects on AD pathological progression while vascular burden may influence cognitive function via its own pathway independent of amyloid deposition. Considering the longitudinal effect of cognitive reserve and the potential to control vascular risks, AD can be a preventable disease.
Almost 25 years have passed since the Demography of Aging (1994) was published by the National Research Council. Future Directions for the Demography of Aging is, in many ways, the successor to that original volume. The Division of Behavioral and Social Research at the National Institute on Aging (NIA) asked the National Academies of Sciences, Engineering, and Medicine to produce an authoritative guide to new directions in demography of aging. The papers published in this report were originally presented and discussed at a public workshop held in Washington, D.C., August 17-18, 2017. The workshop discussion made evident that major new advances had been made in the last two decades, but also that new trends and research directions have emerged that call for innovative conceptual, design, and measurement approaches. The report reviews these recent trends and also discusses future directions for research on a range of topics that are central to current research in the demography of aging. Looking back over the past two decades of demography of aging research shows remarkable advances in our understanding of the health and well-being of the older population. Equally exciting is that this report sets the stage for the next two decades of innovative researchâ€"a period of rapid growth in the older American population.
For most Americans, staying "mentally sharp" as they age is a very high priority. Declines in memory and decision-making abilities may trigger fears of Alzheimer's disease or other neurodegenerative diseases. However, cognitive aging is a natural process that can have both positive and negative effects on cognitive function in older adults - effects that vary widely among individuals. At this point in time, when the older population is rapidly growing in the United States and across the globe, it is important to examine what is known about cognitive aging and to identify and promote actions that individuals, organizations, communities, and society can take to help older adults maintain and improve their cognitive health. Cognitive Aging assesses the public health dimensions of cognitive aging with an emphasis on definitions and terminology, epidemiology and surveillance, prevention and intervention, education of health professionals, and public awareness and education. This report makes specific recommendations for individuals to reduce the risks of cognitive decline with aging. Aging is inevitable, but there are actions that can be taken by individuals, families, communities, and society that may help to prevent or ameliorate the impact of aging on the brain, understand more about its impact, and help older adults live more fully and independent lives. Cognitive aging is not just an individual or a family or a health care system challenge. It is an issue that affects the fabric of society and requires actions by many and varied stakeholders. Cognitive Aging offers clear steps that individuals, families, communities, health care providers and systems, financial organizations, community groups, public health agencies, and others can take to promote cognitive health and to help older adults live fuller and more independent lives. Ultimately, this report calls for a societal commitment to cognitive aging as a public health issue that requires prompt action across many sectors.
Decades of research have demonstrated that normal aging is accompanied by cognitive change. Much of this change has been conceptualized as a decline in function. However, age-related changes are not universal, and decrements in older adult performance may be moderated by experience, genetics, and environmental factors. Cognitive aging research to date has also largely emphasized biological changes in the brain, with less evaluation of the range of external contributors to behavioral manifestations of age-related decrements in performance. This handbook provides a comprehensive overview of cutting-edge cognitive aging research through the lens of a life course perspective that takes into account both behavioral and neural changes. Focusing on the fundamental principles that characterize a life course approach - genetics, early life experiences, motivation, emotion, social contexts, and lifestyle interventions - this handbook is an essential resource for researchers in cognition, aging, and gerontology.
In recent years, the aim of research on aging has shifted from prolonging life to fostering healthy and cognitively robust old age. In order to improve the quality of life of older people, we need to better understand cognitive aging as well as bodily aging. Health and Cognition in Old Age assembles the cream of research across varied medical, mental health, and social disciplines, and demonstrates how this knowledge can lead to improved outcomes for older people. The first half of this expert volume discusses biomedical and life course factors in aging, particularly as they affect cognition and well-being in later life. From there, effective solutions are the focus: interventions and care programs to improve mental functioning and general quality of life, and current policy and practice ideas in promoting healthy, active, and cognitively robust aging. Together, these diverse chapters offer a multi-faceted approach to understanding and modifying what was formerly the inevitable course of growing old. A sampling of the coverage: How the aging process affects the immune system. Occupational gerontology – work-related determinants of old age health and functioning. Social, behavioral, and contextual influences on cognitive function and decline. Lifestyle factors in the prevention of dementia. Understanding long-term care outcomes: conventional and behavioral economics. Social capital, mental well-being, and loneliness in older people. For gerontologists, sociologists, social workers, health psychologists, and others working to improve older people’s lives, Health and Cognition in Old Age brings expertise, versatility, and confidence to the table.
New Developments in Dementia Prevention Research addresses a dearth of knowledge about dementia prevention and shows the importance of considering the broader social impact of certain risk factors, including the role we each play in our own cognitive health throughout the lifespan. The book draws on primary and secondary research in order to investigate the relationship between modifiable factors, including vascular and psychosocial risks, that may affect the incidence of dementia. Bringing together world-leading expertise from applied science, medicine, psychology, health promotion, epidemiology, health economics, social policy and primary care, the book compares and contrasts scientific and service developments across a range of settings. Each chapter presents these themes in a way that will ensure best practice and further research in the field of dementia prevention is disseminated successfully throughout the world. Perhaps most importantly, chapters also question what type of social responsibility we are prepared to embrace in order to address the challenges inherent in dementia prevalence. New Developments in Dementia Prevention Research includes contributions from leading authorities in brain health and dementia prevention and provides an essential contribution to the discourse on dementia prevention. It will be of great interest to academics, researchers and postgraduate students engaged in the study of the psychological and social aspects of aging and dementia.
Cognitive reserve has emerged as a powerful concept for interpreting individual differences in susceptibility to, and recovery from, brain injury or pathology. Underlying cognitive reserve is the idea that individual differences in how cognitive tasks are mediated in the brain allow some people to cope with pathology to a greater degree than others. Cognitive Reserve: Theory and Applications describes in depth the source of these individual differences. This volume provides a comprehensive review of theory, research and clinical application of the cognitive reserve. Chapters explore the theoretical underpinnings of cognitive reserve, and evidence for its existence. Various approaches for studying this concept are addressed, including epidemiologic, cognitive experimental, and neuroimaging. Possible genetic and physiologic underpinnings of cognitive reserve are presented. Application of this concept to a wide range of situations, including child development, aging, Alzheimer’s disease, stroke, HIV, and head injury is discussed. The result is an up-to-date, global treatment of cognitive reserve that will be of interest to someone new to the concept or the experienced investigator.
Societies around the world are concerned about dementia and the other forms of cognitive impairment that affect many older adults. We now know that brain changes typically begin years before people show symptoms, which suggests a window of opportunity to prevent or delay the onset of these conditions. Emerging evidence that the prevalence of dementia is declining in high-income countries offers hope that public health interventions will be effective in preventing or delaying cognitive impairments. Until recently, the research and clinical communities have focused primarily on understanding and treating these conditions after they have developed. Thus, the evidence base on how to prevent or delay these conditions has been limited at best, despite the many claims of success made in popular media and advertising. Today, however, a growing body of prevention research is emerging. Preventing Cognitive Decline and Dementia: A Way Forward assesses the current state of knowledge on interventions to prevent cognitive decline and dementia, and informs future research in this area. This report provides recommendations of appropriate content for inclusion in public health messages from the National Institute on Aging.
The phenomenon of age-related cognitive decline has long been controversial, both in terms of mere existence, and with respect to how it is explained. Some researchers have dismissed it as an artifact of declining health or lower levels of education, and others have attributed it to general changes occurring in the external environment. Still other interpretations have been based on the "use it or lose it" principle -- known as the Disuse Hypothesis -- or on the idea that there are qualitative differences in either the structure or the process of cognition across the adult years. Perhaps the most popular approach at present relies on the information-processing perspective and attempts to identify the critical processing component most responsible for age-related differences in cognition. The primary purposes of this book are first to review the evidence of age-related differences in cognitive functioning and then to evaluate the major explanations proposed to account for the negative relations between age and cognition that have been established. Included is a discussion of theoretical dimensions and levels of scientific theorizing assumed to be helpful in understanding and evaluating alternative perspectives on cognitive aging. The various perspectives are then covered in detail and analyzed. The text concludes with observations about the progress that has been made in explaining cognitive aging phenomena, plus recommendations for research practices that might contribute to greater progress in the future.