This article is more than 5 years old. Information may no longer be current.

ACP releases key points guide for cognitive health of seniors

The ACP has highlighted the most important takeaway messages from a new report by the Institute of Medicine on the cognitive health of the aging population and various prevention and intervention opportunities that health care providers may be able to supply.

“Cognitive aging is not a disease or a level of impairment — it is a lifelong process that affects everyone. Given the sizable number of adults approaching older age, understanding the impact of cognitive aging has become a significant health concern,” Sharon K. Inouye, MD, MPH, of Harvard Medical School, said in a press release.

Cognitive aging is defined in the report as “a process of gradual yet highly variable changes in cognitive functions that occur as persons age.”

Cognition Screenings in Primary Care

Formal screenings for cognitive impairment are vital since early warning signs can often go unnoticed. Both primary care visits and Medicare Annual Wellness visits pose optimal opportunities for these screenings to be performed.

While the report did not recommend one specific screening test, they noted that the General Practitioner Assessment of Cognition, Memory Impairment Screen and the Mini-Cog Test were rated the most appropriate for use in primary care.

In addition to screening for cognitive function, the report recommends that screening be done for cardiovascular risks, alcohol use, smoking history, diet, exercise, depression and chronic conditions, which are all risk factors for cognitive impairment.

Interventions that optimize cognition

Informing patients about interventions that can maintain cognitive health is an important step for health care providers to take. Regular exercise, reducing cardiovascular risk factors, and avoidance of psychoactive medications are all vital recommendations that physicians should be endorsing to their patients. Maintaining healthy sleep habits and social interactions are also important to cognitive health.

Additionally, health care providers should pay close attention to the medications older adults are taking to minimize the likelihood of adverse events. Certain medications, such as anticholinergics, have been shown to cause both short- and long-term adverse cognitive events, and patients may not be aware of these risk factors. Health care providers should be educating patients about these possible risks.

Delirium has been found to be among the most common causes of short- and long-term cognitive decline after hospitalization, according to the report. Health care professionals play an important role in the prevention of delirium during hospital stays that occur in nearly 50% of older patients each year. Identifying those who are at higher risk, as well as establishing preventative approaches, such as early mobility, nutrition and fluid replenishment and pain management, can aid in the prevention of many delirium cases.

Physical and Financial Safety

Factors that are associated with good driving skills, such as reaction time and decision making, can be severely compromised due to cognitive decline. However, the loss of driving privileges may lead older adults to become depressed due to their perceived “loss of independence.” Physicians may consider recommending driver-training courses that can improve the safety of older drivers. The report noted that several resources on assessing and intervening with older adults on driving safety are available to health care providers.

In addition to driving safety courses, consumer financial education programs are available, which may help older adults avoid financial fraud or exploitation. Issues related to financial planning may be early warning signs of cognitive decline and should be evaluated, according to the report.

Lastly, the report advises health care providers to warn patients about products that are marketed as “cognitive enhancements,” such as nootropics, nutritional supplements and cognitive training tools. Many of these consumer-directed products have not been thoroughly evaluated, and little evidence exists supporting their efficacy for improving cognitive function. Rather, physicians should recommend proven strategies for the improvement of cognitive health, such as exercise and reduction of cardiovascular risks.

“Maintaining cognitive health is a major concern. Although much remains to be learned about the basic biological mechanisms and more effective interventions to enhance cognitive aging, the Institute of Medicine report highlights that much can and should be done now. Health care professionals will play an increasingly vital role in ensuring their patients’ cognitive health,” Inouye concluded. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.