The Institute of Medicine today released a groundbreaking new report that spells out what older Americans can do to keep their brains healthy into very old age, while offering insight into the lifestyle habits and medications that can lead to cognitive decline.
The report, cosponsored by AARP and authored by some of the leading neuroscientists, psychiatrists and brain-health experts in the country, offers the first multidisciplinary look at how aging affects the brain. It creates a new term — “cognitive aging” — to define a natural, ongoing, yet highly variable process that affects memory, thinking and decision-making in all human brains but is not a disease such as Alzheimer’s or another form of dementia.
The good news is that cognitive decline is not inevitable and that some aspects of brain health can actually improve with age. Specifically, the report recognizes that advancing years provide an increase in both knowledge and wisdom, expanding expertise in insight, judgment and life planning.
The report identifies key actions — including exercising regularly, staying intellectually engaged and getting enough sleep — that people can take to stay mentally sharp as they age. And it offers a review of medications, health issues and behaviors that may harm the brain. It also warns against false claims made about brain-training tools, nutritional supplements and other products touted by companies to improve brain health.
How fast your brain ages varies widely from person to person, and your actions can make a real difference, said Dan Blazer, M.D., emeritus professor of psychiatry at Duke University and lead author of the Institute of Medicine report. “There are interventions that seem to be important,” he said.
Ronald Petersen, M.D., director of the Mayo Clinic Alzheimer’s Disease Research Center and a member of an expert panel that reviewed the document, agreed with Blazer that the report should help the public understand that aging need not be a passive process. “We don’t have to just sit by and let time do ravages on us,” he said. “We can do something about cognitive aging, and we can have an impact on the rate at which we might experience these changes, perhaps postponing those ravages for extended periods of time.”
“This report confirms that there is much you can do over the course of your life to improve your brain health. That’s an empowering message for older Americans,” said Sarah Lock, senior vice president for policy with AARP. She added that although more than 90 percent of older Americans cite good brain health as a top concern, according to a recent AARP survey, many aren’t sure how to maintain or improve it.
Here’s what the report says helps, hurts, and may not be effective.
- Exercising: Aerobic exercise is especially beneficial to brain health, and even better when combined with strength training.
- Staying socially and intellectually active: Activities that challenge your brain — including reading books, writing letters and learning a new language — all help preserve brain function, as do social activities such as volunteering, playing cards, attending worship services and talking to friends.
- Keeping your heart healthy: What’s good for your heart is also good for your brain. High blood pressure, high cholesterol and diabetes — especially in midlife — are linked to poor brain health later in life. Lowering blood pressure with medications seems to help prevent brain problems, but it’s unclear whether lowering cholesterol with drugs improves brain function.
- Eating a healthy diet: Although no specific diet has been proven to maintain or improve brain health, studies of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets justify eating less meat and consuming more nuts and beans, whole grains, vegetables and olive oil. Omega-3 fatty acids, found in fatty fish such as salmon, have been shown to help cognition in some studies, yet not in others. Light to moderate alcohol use — fewer than two drinks per day — may be protective, but excessive alcohol is clearly bad for the brain.
- Getting good sleep: Studies show that poor sleep quality is linked to cognitive impairment and Alzheimer’s. Breathing disorders, such as sleep apnea, also put older people at higher risk for memory problems and dementia. The authors say that improving sleep may prove helpful for brain health later in life.
- Certain medications: Medications listed in the American Geriatrics Society’s Beers Criteria are linked to problems with cognitive decline and delirium in older adults. Adults between ages 65 and 69 use an average of 14 different prescription drugs per year, often leading to serious complications. The report singles out strong anticholinergic drugs (including antihistamines such as Benadryl and some antidepressants) as well as benzodiazepines (such as Valium and Xanax, used to treat anxiety and sleeplessness) as being linked to delirium, cognitive impairment and dementia. “We aren’t saying don’t take them ever,” Blazer said. “But you need to watch out and be aware of the side effects.”
- Depression: Depression in midlife and later life are strongly linked to dementia. The authors say preventing and treating depression are important goals toward improving the quality of life for older adults.
- Hearing and vision loss: Problems hearing and seeing are both linked to trouble with cognitive performance and should be corrected, if possible.
- Stress: Not only can daily stress cause memory problems; long-term stress is connected with faster rates of decline in brain health, too. Methods to reduce stress, such as meditation and mindfulness, may help but require further study, the report found.
- Delirium and hospitalization: Delirium, which is preventable in 30 to 50 percent of cases, is strongly connected to problems with brain health later in life. Hospitalization, often a major stressor for older adults, is also linked to mental decline. Strategies such as helping patients get good sleep, control pain and stay hydrated have all been found to reduce delirium and the negative consequences of hospitalization.
- Brain games and other cognitive training: Although research shows that brain training on computers and video games can improve attention and memory as they relate to the games, few studies show that those skills transfer to real life. The report recommends that consumers carefully evaluate claims of companies selling brain games. “People may fall prey to using products that have not been proven to be effective and think they will help them in all areas of their lives,” Blazer said.
- Supplements: Americans spend more than $30 billion a year on dietary supplements, yet “there just is no good, consistent evidence that vitamins provide value in improving brain health,” Blazer said.
- Vitamin E does not seem to help brain health and has been linked to a higher risk of death in large doses.
- Vitamins B6 and B12 provide no benefit to older adults who are not folate deficient.
- Vitamin D deficiency has been linked to a decline in brain health, but taking vitamin D supplements has not been shown to improve memory, motor speed or other aspects of brain health. Moreover, says the report, high levels of vitamin D are linked to attention problems and cognitive impairment.
- Ginkgo biloba “is not considered effective in preventing cognitive decline,” the report found.
In addition to AARP, the report was sponsored by the National Institute on Aging, the Centers for Disease Control and Prevention, and a number of other government and nonprofit organizations.
Infographic: Courtesy Institute of Medicine; photo: Getty Images
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