Take Action to Promote Brain Health: IOM Report

Megan Brooks

April 14, 2015

Older adults can take action to combat the gradual decline in cognitive function that occurs naturally with age, the Institute of Medicine (IOM) says in a new report released today.

In the report, "Cognitive Aging: Progress in Understanding and Opportunities for Action," the IOM Committee on the Public Health Dimensions of Cognitive Aging advises that outside of the effects of neurologic disease, such as Alzheimer's disease, individuals of all ages should take three steps to help promote cognitive health:

  • Be physically active.

  • Reduce and manage cardiovascular disease risk factors, including high blood pressure, diabetes, and smoking.

  • Regularly discuss and review with a healthcare professional health conditions and medications that might have a negative effect on cognitive function.

These three actions have the "best evidence" for promoting cognitive health in individuals of all ages, Kristin Yaffe, MD, committee vice chair, and professor of psychiatry, neurology, and epidemiology, University of California, San Francisco, said during a media briefing. Other actions the IOM says may promote cognitive health include the following:

  • Being socially and intellectually active and continually seeking opportunities to learn.

  • Getting adequate sleep and seeking professional treatment for sleep disorders, if needed.

  • Taking steps to avoid a sudden acute decline in cognitive function (delirium) associated with medications or hospitalizations.

  • Carefully evaluating products advertised to consumers to improve cognitive health, such as medications, nutritional supplements, and cognitive training.

"The brain ages in all of us, [but] there is a message of hope in this report. Actions can be taken" to promote brain health, said committee chair Daniel G. Blazer, MD, PhD, emeritus professor of psychiatry, Duke University Medical Center in Durham, North Carolina.

Jury Out on Brain Games

The report notes that it remains largely unclear whether cognitive stimulation, either through formal training or everyday activities, such as doing crossword puzzles, reading, or learning to play a musical instrument, can help maintain or boost brain function enough to have an impact on daily life.

"The scientific literature on cognitive stimulation and cognitive training has shown that older adults can improve on trained abilities, albeit often at a slower pace than younger adults, and that improvements on the tasks can be maintained over time," the IOM says in a news release. "However, studies examining whether cognitive stimulation and training could transfer to real-world activities and tasks have had mixed results. Claims regarding the effectiveness of cognitive aging related products require careful evaluation by consumers and in regulatory review."

There is also only limited evidence on the benefits of vitamins and supplements to enhance cognition or prevent decline. The medical literature "does not convincingly support any vitamin supplement intervention to prevent cognitive decline," the report says.

The report recommends that federal agencies expand research on risk and protective factors for cognitive aging and on interventions aimed at preventing or reducing cognitive decline and maintaining cognitive health.

Prepared for the Silver Tsunami?

"We are only really beginning to understand how the brain changes with age," said IOM President Victor Dzau, MD. "As the population of older Americans grows, so will the effects of cognitive aging on society. By calling attention to this issue, we can learn more about the risk and protective factors and needed research so older adults can better maintain their cognitive health to the fullest extent possible," he added.

The report also calls on the Department of Health and Human Services, the Department of Veterans Affairs, and educational and professional organizations involved in the healthcare of older adults to develop and disseminate core competencies, curricula, and continuing education opportunities, including for primary care providers, that focus on cognitive aging as distinct from clinical cognitive syndromes and diseases, such as dementia.

The report notes that cognitive aging has significant effects and widespread consequences on society, including financial losses, with older adults losing an estimated $2.9 billion annually, directly and indirectly, to financial fraud.

The report calls for relevant private sector companies and consumer organizations to develop, expand, implement, and evaluate programs and services used by older adults relevant to cognitive aging ,with the goal of helping older adults avoid exploitation, optimize their independence, improve their function in daily life, and aid their decision making.

With the graying of the US population, cognitive aging will affect an ever-increasing number and proportion of Americans, the report notes. "I don't think as a society we are prepared for the silver tsunami, but we are getting there," Dr Yaffe said. "We need to bring cognitive aging to the forefront."

The IOM report was sponsored by the McKnight Brain Research Foundation, National Institutes of Health (National Institute of Neurological Disorders and Stroke and National Institute on Aging), Centers for Disease Control and Prevention, Retirement Research Foundation, and the AARP.

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