February 21, 2006
Posted online March 15, 2006
How to preserve brain health as you age
By Linda Joy, firstname.lastname@example.org
With the rapid aging of the population, the National Institutes of
Health (NIH) is intensifying the search for strategies to preserve brain
health as people grow older. The effort moved an important step forward
today with a report by an expert panel to the NIH, suggesting a number
of promising avenues for maintaining or enhancing cognitive and
emotional function. Specifically, the group said, education,
cardiovascular health, physical activity, psychosocial factors and
genetics appear to be associated with brain health with age, and
research aimed at directly testing the effectiveness of interventions in
several of these areas deserves further attention.
The report is published online today in "Alzheimer's and Dementia: The
Journal of the Alzheimer's Association". It is a product of the Critical
Evaluation Study Committee, a panel of experts appointed by NIH and led
by Hugh Hendrie, M.B., Ch.B., D.Sc., of Indiana University,
Indianapolis. The committee evaluated several large on-going studies of
older adults for current scientific knowledge on brain health.
"Three NIH institutes -- the National Institute on Aging (NIA), the
National Institute of Mental Health (NIMH) and the National Institute of
Neurological Disorders and Stroke (NINDS) -- established the NIH
Cognitive and Emotional Health Project to coordinate and accelerate
research leading to interventions for neurological health," says NIH
Director Elias A. Zerhouni, M.D. "This report suggests a future
direction of research and is a terrific example of what we can learn
when scientists of diverse specialties work together on a complex health
Hendrie and colleagues cited demographic pressures to find ways to
maintain cognitive and emotional health with age. Approximately 4.5
million Americans have Alzheimer's disease, and additional numbers of
older people experience less severe, but still problematic cognitive
impairment with the risk of such cognitive decline increasing with age.
In one area of emotional health -- depression -- the everyday function
of an estimated two million older adults is also threatened, according
"With more Americans living well into their 70s, 80s and 90s, developing
strategies to preserve cognitive and emotional health as we grow older
is a major public health goal," says Richard J. Hodes, M.D., director of
the National Institute on Aging. "This report analyzes research
identifying factors that are associated with cognitive and emotional
health and most importantly describes several directions for testing
interventions to determine their effectiveness in improving cognition
and emotional health."
The panel broadly discussed a change in the focus of brain research. In
addition to studying specific causes of brain disease and dysfunction,
research also should approach cognition and emotion from the opposite
direction -- looking at what works to preserve brain health. "We set up
the Cognitive and Emotional Health Project in recognition of changed
thinking. In this report, the committee specifically articulates a new
paradigm for research focused on health rather than dysfunction," says
NINDS Director Story C. Landis, Ph.D.
Another major theme emphasized the interconnectedness between cognitive
and emotional health. Cognitive health and emotional well-being are
"inextricably linked," the report concludes, and efforts should be made
to examine them simultaneously.
"Cognitive decline and emotional stress in older people involve a number
of physiological and psychological processes going on at the same time,"
says Thomas Insel, M.D., Director of NIMH. "This report highlights the
need to better understand this interrelatedness if we are going to
devise effective ways to maintain brain health."
The evaluation committee reviewed scientific data from 36 large, ongoing
studies of aging and identified more than 40 separate factors that may
play a role in cognitive and emotional health. Those highlighted in the
report are summarized below, including those in which possible
interventions might be explored:
-- Education - Higher levels of education correlate with both good
cognitive and emotional function in the scientific literature. But there
is no consensus as to why this may be so. Researchers continue to
explore such explanations as education providing cognitive "reserve" or
the socioeconomic factors such as quality of education that may affect
the relationship between higher education and better cognition.
-- Cardiovascular - A growing body of observational research links
cognitive decline with several traditional risk factors for
cardiovascular disease, including hypertension, greater body mass index,
heart disease, diabetes and smoking. Understanding the impact of these
influences is critically important because they can be modified though
lifestyle and medical interventions. NIH currently funds clinical trials
to test whether interventions for high blood pressure, diabetes and high
cholesterol reduce the risk of cognitive decline.
-- Psychosocial - A number of psychosocial factors -- emotional and
social support networks, high socio-economic status and low stress
levels -- correlate with cognitive and emotional health later in life.
Stress, for example, has been linked to cognitive decline, while social
engagement, social support and higher socio-economic status are
associated with better cognitive and emotional health.
-- Depression and anxiety - Some studies associate a history of
depression or anxiety with poor cognitive and emotional health later in
life. Researchers only recently have recognized a possible connection
between mood disorders and future cognitive decline. This could be an
important area for testing interventions.
-- Physical activity - Finding out if physical activity can protect
against cognitive deterioration "would be of great public health
importance because physical activity is relatively inexpensive, has few
negative consequences, and is accessible," the report says. A number of
studies suggest a protective effect, and clinical trials are underway to
test exercise as an intervention against cognitive decline. The panel
said a large clinical trial should be considered.
-- Chronic illness - Chronic illnesses, such as arthritis, cancer, lung
disease, heart disease and diabetes, are linked to poor emotional
outcomes, specifically depression, in older people. Further study could
examine the important questions of cause and effect, whether illness
causes depression or whether depression can make people more vulnerable
-- Genetics - There is a poor understanding of genetic influences on
cognitive and emotional health. While risk for late-onset Alzheimer's
disease increases with inheriting one form of the apolipoproteinE (APOE)
gene, little is known about its specific role in Alzheimer's or its
effects on emotional health. Genetic factors cannot be modified, but
greater knowledge of the genetics of cognitive and emotional health
could help identify people at higher risk.
The National Institute of Mental Health (NIMH) mission is to reduce the
burden of mental and behavioral disorders through research on mind,
brain, and behavior. More information is available at the NIMH website,
The National Institute of Neurological Disorders and Stroke (NINDS) is
the nation's primary supporter of biomedical research on the brain and
nervous system and provides information to the public and patients. More
information is available at the NINDS website, www.ninds.nih.gov.