REVIEW
Achieving and Maintaining Cognitive Vitality With Aging

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Cognitive vitality is essential to quality of life and survival in old age. With normal aging, cognitive changes such as slowed speed of processing are common, but there is substantial interindividual variability, and cognitive decline is clearly not inevitable. In this review, we focus on recent research investigating the association of various lifestyle factors and medical comorbidities with cognitive aging. Most of these factors are potentially modifiable or manageable, and some are protective. For example, animal and human studies suggest that lifelong learning, mental and physical exercise, continuing social engagement, stress reduction, and proper nutrition may be important factors in promoting cognitive vitality in aging. Manageable medical comorbidities, such as diabetes, hypertension, and hyperlipidemia, also contribute to cognitive decline in older persons. Other comorbidities such as smoking and excess alcohol intake may contribute to cognitive decline, and avoiding these activities may promote cognitive vitality in aging. Various therapeutics, including cognitive enhancers and protective agents such as antioxidants and anti-inflammatories, may eventually prove useful as adjuncts for the prevention and treatment of cognitive decline with aging. The data presented in this review should interest physicians who provide preventive care management to middle-aged and older individuals who seek to maintain cognitive vitality with aging.

Section snippets

Neuropsychology

Cognitive decline, although a relatively common occurrence, cannot be considered an inevitable part of aging. Nature provides clear examples of elderly people who maintain cognitive vitality, even in extreme old age. Many older adults who live into their ninth decade retain high cognitive function,10 and centenarians who maintain their intellect negate the myth of the inevitability of cognitive decline.11, 12

The aging brain remains capable of adapting to stimuli, and although declines in

STRATEGIES TO PROMOTE COGNITIVE VITALITY WITH AGING

Emerging research has resulted in a growing understanding of the potentially modifiable risk factors associated with cognitive decline in late life, and several interventions are being evaluated in research studies to prevent cognitive decline and dementia in older persons (Table 1).63

PHARMACEUTICAL APPROACHES

Although most pharmaceutical research to date has focused on the development of drugs to prevent or treat dementia, interest is growing in the development of pharmacologic agents for cognitive enhancement in older persons experiencing normal cognitive aging.188 Some agents are being evaluated for AAMI and MCI.54

CONCLUSION

Cognitive vitality is essential to quality of life and survival in older persons. Research on cognitive aging indicates that cognitive decline is not an inevitable part of aging. Studies in animals have clearly shown considerable plasticity in the aging brain. Recent studies have identified several risk factors for cognitive decline that are modifiable, including lifestyle factors and medical comorbidities. These emerging scientific data have important implications for preventing and managing

Acknowledgments

We thank Dennis Evans, MD, Neil Buckholz, PhD, and Marcelle Morrison-Bogorad, PhD, for their participation and contributions to this work. We are also grateful to Tonya Lee, Nora O'Brien, MA, and Sue Reynolds-Foley, MHA, for their invaluable help.

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    This work was cosponsored by the Institute for the Study of Aging, Inc, the International Longevity Center, the National Institute on Aging, and Canyon Ranch Health Resorts. The work was also supported by Pfizer, Inc, Eisai, Inc, Janssen Pharmaceuticals, Neurochem, Inc, Elan Pharmaceuticals (formerly Athena Neurosciences, Inc), and the Fidelity Foundation.

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