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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
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COGNITIVE
AGING

Progress in Understanding and Opportunities for Action

Committee on the Public Health Dimensions
of Cognitive Aging

Board on Health Sciences Policy

Dan G. Blazer, Kristine Yaffe, and Catharyn T. Liverman, Editors

INSTITUTE OF MEDICINE
          OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This project was supported by the McKnight Brain Research Foundation; by Contract No. HHSN26300034 between the National Academy of Sciences and the National Institutes of Health (National Institute of Neurological Disorders and Stroke, National Institute on Aging); by Contract No. 200-2011-38807 between the National Academy of Sciences and the Centers for Disease Control and Prevention; by The Retirement Research Foundation; and by AARP. The views presented in this publication are those of the editors and attributing authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee on the Public Health Dimensions of Cognitive Aging, author.

  Cognitive aging : progress in understanding and opportunities for action / Committee on the Public Health Dimensions of Cognitive Aging, Board on Health Sciences Policy, Institute of Medicine of the National Academies ; Dan G. Blazer, Kristine Yaffe, and Catharyn T. Liverman, editors.

  p. ; cm.

Includes bibliographical references.

ISBN 978-0-309-36862-9 (hardcover) — ISBN 978-0-309-36863-6 (pdf)

I. Blazer, Dan G., II (Dan German), 1944- , editor. II. Yaffe, Kristine, editor. III. Liverman, Catharyn T., editor. IV. Title.

  [DNLM: 1. Aging—physiology. 2. Cognition—physiology. 3. Cognition Disorders—prevention & control. 4. Health Policy. 5. Policy Making. 6. Risk Factors. WT 145]

  QP356

  612.8'233—dc23

2015020490

Additional copies of this report available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2015 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2015. Cognitive aging: Progress in understanding and opportunities for action. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”       

                                              —Goethe

img

INSTITUTE OF MEDICINE
           OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

COMMITTEE ON THE PUBLIC HEALTH DIMENSIONS OF COGNITIVE AGING

DAN G. BLAZER (Chair), J. P. Gibbons Professor of Psychiatry Emeritus, Duke University Medical Center

KRISTINE YAFFE (Vice Chair), Scola Endowed Chair, Professor of Psychiatry, Neurology and Epidemiology, University of California, San Francisco

MARILYN ALBERT, Professor of Neurology, Director of the Division of Cognitive Neuroscience, Johns Hopkins University School of Medicine

SARA J. CZAJA, Leonard M. Miller Professor of Psychiatry and Behavioral Sciences, Scientific Director, Center on Aging, University of Miami Miller School of Medicine

DONNA FICK, Distinguished Professor of Nursing, Co-Director, Hartford Center of Geriatric Nursing Excellence, Pennsylvania State University

LISA P. GWYTHER, Director, Family Support Program, Center for Aging, Duke University

FELICIA HILL-BRIGGS, Professor of Medicine, Departments of Physical Medicine and Rehabilitation, and Health Behavior and Society, Johns Hopkins University

SHARON K. INOUYE, Professor of Medicine, Harvard Medical School; Milton and Shirley F. Levy Family Chair; and Director, Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife

JASON KARLAWISH, Professor of Medicine, Medical Ethics and Health Policy, University of Pennsylvania

ARTHUR F. KRAMER, Professor and Director, Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign

ANDREA Z. LACROIX, Professor and Chief of Epidemiology and Director, Women’s Health Center of Excellence, University of California, San Diego

JOHN H. MORRISON, Dean of Basic Sciences and the Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai

TIA POWELL, Director, Montefiore Einstein Center for Bioethics, Professor of Clinical Epidemiology and Clinical Psychiatry, Albert Einstein College of Medicine

DAVID REUBEN, Director, Multicampus Program in Geriatric Medicine and Gerontology, Chief, Division of Geriatrics, University of California, Los Angeles

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

LESLIE SNYDER, Professor, Department of Communication Sciences, University of Connecticut

ROBERT B. WALLACE, Irene Ensminger Stecher Professor of Epidemiogy and Internal Medicine, Center on Aging, University of Iowa College of Public Health

IOM Staff

CATHY LIVERMAN, Study Director

SARAH DOMNITZ, Program Officer

CLAIRE GIAMMARIA, Research Associate

JUDY ESTEP, Program Associate

JEANETTE GAIDA, Senior Program Assistant

ANDREW M. POPE, Director, Board on Health Sciences Policy

IOM Scholar-in-Residence

KATIE MASLOW

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Julie Bynum, The Geisel School of Medicine at Dartmouth

Laura Carstensen, Stanford University

Mark E. Frisse, Vanderbilt University

Fred Gage, The Salk Institute for Biological Studies

Adam Gazzaley, University of California, San Francisco

Charlene Harrington, University of California, San Francisco

Dilip V. Jeste, University of California, San Diego

K. Ranga Krishnan, Duke-National University of Singapore Graduate Medical School

Nancy E. Lane, University of California, Davis, Health System

Kenneth M. Langa, University of Michigan, Ann Arbor

Eric B. Larson, Group Health Research Institute

Sally C. Morton, University of Pittsburgh

Ruth M. Parker, Emory University

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

Ronald C. Petersen, Mayo Clinic

Brenda Plassman, Duke University School of Medicine

Thomas R. Prohaska, George Mason University

George Rebok, Johns Hopkins University

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Nancy Fugate Woods, Dean Emeritus, University of Washington School of Nursing, and Bradford H. Gray, Editor Emeritus, The Urban Institute. Appointed by the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

Preface

Of the abilities people hope will remain intact as they get older, perhaps the most treasured is to “stay sharp”—to think clearly, remember accurately, and make decisions with careful thought. Yet the brain ages. Cognitive functioning in older adults can improve in some areas, such as those related to wisdom and experience, and can decline in others, such as memory, attention, and speed of processing. Individuals vary widely in the specific cognitive changes that occur with age, in the nature and extent of cognitive aging, as well as in the ways these changes affect daily life.

This Institute of Medicine (IOM) study focused on the public health dimensions of cognitive aging as separate from neurodegenerative diseases, such as Alzheimer’s disease and other dementias. To accomplish its task, the IOM committee looked at cognitive aging through a broad lens and explored its implications for individuals, for their families, and for society. Its report comes at a time ripe for change in how society responds to cognitive aging. The population of older Americans is rapidly growing, and this frontier of science and health is achieving a marked increase in understanding of the brain, cognition, and aging.

The report greatly benefited from the efforts of many individuals and organizations. We thank the study sponsors for their support and for their work in bringing the topic of cognitive aging to the forefront of discussion: the McKnight Brain Research Foundation, the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, the Centers for Disease Control and Prevention, The Retirement Research Foundation, and AARP. Further, we thank each of the workshop speakers

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
×

for their presentations and for the time and expertise that they and others shared with the committee. We are grateful to the reviewers whose insights strengthened this report.

The committee is especially indebted to the IOM staff who worked with us tirelessly and most competently. Cathy Liverman led the effort with her usual quiet and effective guidance. She was assisted by Sarah Domnitz, Claire Giammaria, Judy Estep, and Jeanette Gaida. Katie Maslow, IOM Scholar-in-Residence, provided a wealth of insights into this complex topic. As is usually the case, staff were full colleagues in the process of producing this report while retaining their specific duties in support of the committee. We also thank Andrew Pope, Director of the Board on Health Sciences Policy, who shepherded the report from its inception to completion.

The report’s findings and recommendations result from the deliberations of a dedicated and hardworking committee. It was our pleasure and privilege to have the opportunity to work with these colleagues—each of whom brought energy, commitment, and intellectual curiosity and rigor to this endeavor. This committee was intrigued and engaged by this most challenging of public health issues encountered by older adults, and such engagement was crucial in our deliberations.

We and our colleagues on the committee hope this report focuses attention and action on cognitive aging. Much can be done by older adults and their families and a wide range of stakeholders—at every level of society, from the local community to national policy and research priorities—to address the opportunities and challenges of cognitive aging and to ensure that older adults live the full and independent lives they desire.

Dan G. Blazer, Chair

Kristine Yaffe, Vice-Chair

Committee on the Public Health Dimensions of Cognitive Aging

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Cognitive Aging: Progress in Understanding and Opportunities for Action. Washington, DC: The National Academies Press. doi: 10.17226/21693.
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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.

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