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.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE PUBLIC HEALTH DIMENSIONS OF COGNITIVE AGING
• Reviewers
• Preface
• Summary
  • WHAT IS COGNITIVE AGING?
  • CHARACTERIZING AND ASSESSING COGNITIVE AGING
  • UNDERSTANDING THE POPULATION IMPACT
  • REDUCING RISKS AND DEVELOPING INTERVENTIONS
  • IMPROVE HEALTH CARE PROFESSIONAL EDUCATION AND USE OF WELLNESS VISITS
  • COMMUNITY ACTIONS: HEALTH, FINANCES, DRIVING, TECHNOLOGY, AND CONSUMER DECISIONS
  • EXPAND PUBLIC EDUCATION AND ENGAGEMENT
  • OPPORTUNITIES FOR ACTION
• 1. Introduction
  • WHAT IS COGNITION
  • THE INTERSECTION OF COGNITION AND AGING
  • CHANGING DEMOGRAPHICS
  • CROSS-CUTTING THEMES
  • OVERVIEW OF THE REPORT
  • REFERENCES
• 2. Characterizing and Assessing Cognitive Aging
  • AGE-RELATED CHANGES IN HUMAN COGNITION
  • VARIABILITY IN COGNITIVE CHANGES
  • BOUNDARY CONDITIONS
  • AGE-RELATED CHANGES IN COGNITION—INSIGHTS FROM ANIMAL MODELS
  • NEURAL MECHANISMS THAT CONTRIBUTE TO AGE-RELATED CHANGE IN COGNITIVE FUNCTION
  • COGNITIVE RESERVE AND PLASTICITY
  • CHALLENGES AND OPPORTUNITIES IN DEFINING AND ASSESSING COGNITIVE AGING
  • RECOMMENDATION
  • REFERENCES
• 3. Population-Based Information About Cognitive Aging
  • LIFE-COURSE PERSPECTIVE
  • NATURE AND EXTENT OF COGNITIVE AGING IN THE UNITED STATES
  • CHALLENGES TO INCREASING POPULATION-BASED INFORMATION ABOUT COGNITIVE AGING
  • NEXT STEPS AND RECOMMENDATION
  • RECOMMENDATION
  • REFERENCES
• 4A. Risk and Protective Factors and Interventions: Lifestyle and Physical Environment
  • ISSUES IN STUDYING RISK AND PROTECTIVE FACTORS AND INTERVENTIONS
  • PHYSICAL ACTIVITY AND EXERCISE
  • EDUCATION AND INTELLECTUAL ENGAGEMENT
  • SOCIAL ISOLATION, LONELINESS, AND SOCIAL ENGAGEMENT
  • DIET
  • VITAMINS
  • ALCOHOL
  • SMOKING
  • SUBSTANCE ABUSE
  • PHYSICAL ENVIRONMENT
  • STRESS
  • REFERENCES
• 4B. Risk and Protective Factors and Interventions: Health and Medical Factors
  • MEDICATIONS
  • MEDICAL CONDITIONS
  • OTHER MEDICAL CONDITIONS
  • TRAUMATIC BRAIN INJURY
  • HEARING AND VISION LOSS
  • SLEEP
  • GENETIC FACTORS: APOE STATUS
  • REFERENCES
• 4C. Risk and Protective Factors and Interventions: General Cognitive Aging Interventions and Next Steps
  • COGNITIVE STIMULATION AND TRAINING
  • ARTS
  • PHARMACOLOGICS, NOOTROPICS, AND SUPPLEMENTS
  • TRANSCRANIAL DIRECT CURRENT STIMULATION (tDCS)
  • MULTI-DOMAIN TRIALS
  • NEXT STEPS AND RECOMMENDATIONS
  • REFERENCES
• 5. Health Care Response to Cognitive Aging
  • ATTITUDES AND PRACTICES OF HEALTH PROFESSIONALS AND THE HEALTH SYSTEM
  • IMPROVING THE HEALTH CARE RESPONSE
  • USING MEDICAL VISITS TO ADDRESS COGNITIVE AGING
  • RECOMMENDATIONS
  • REFERENCES
• 6. Community Action: Health, Financial Management, Driving, Technology, and Consumer Decisions
  • SUPPORTING AND MAINTAINING THE PUBLIC'S COGNITIVE HEALTH
  • FINANCIAL DECISION MAKING
  • DRIVING
  • CONSUMER DECISIONS
  • TECHNOLOGY
  • SUMMARY
  • RECOMMENDATIONS
  • REFERENCES
• 7. Public Education and Key Messages
  • PUBLIC PERCEPTIONS AND BELIEFS ABOUT COGNITIVE AGING
  • INFORMATION ENVIRONMENT
  • RELEVANT COMMUNICATIONS STRATEGIES AND MESSAGES
  • CHALLENGES FOR PUBLIC EDUCATION CAMPAIGNS
  • DESIGNING PUBLIC EDUCATION CAMPAIGNS AND COMMUNICATION PROGRAMS
  • KEY MESSAGES AND RECOMMENDATION
  • REFERENCES
• 8. Opportunities for Action
• APPENDIXES
  • A Meeting Agendas
  • B U.S. Surveys and Studies That Include One or More Items to Measure Cognition
  • C Committee Biographies

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.

Suggested citation:

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

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.