In this masterclass, Philip D. Harvey, PhD, professor of psychiatry and behavioral sciences at the University of Miami, discusses the relationships between aging, neurocognition, and functional outcomes.
And in a new segment from MDedge, called This Week in Psychiatry, we'd like to share a Current Psychiatry evidence-based review on using antidepressants for pediatric patients (PDF) by Jennifer B. Dwyer, MD, PhD, and Michael H. Bloch, MD, MS.
Show Notes by Jacqueline Posada, MD, consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va.
Introduction to normal aging
- Changes in cognitive abilities are part of normal aging.
- Crystalized intelligence, the storage of information learned throughout life, does not change over time in normal, healthy aging.
- Fluid intelligence, the ability to learn new information, solve problems, concentrate, and rapidly process information, starts changing at age 65 or so.
- Episodic memory performance, the ability to learn new verbal information, declines 30% between ages 65 to 80, followed by another equivalent decline from ages 80 to 90.
- Alzheimer's disease and amnestic mild cognitive impairment are characterized by signature memory loss called rapid forgetting, which occurs in cases in which a person is unable to remember information right after being told.
- Older people who are self-aware and sensitive to their age-related cognitive changes have a better prognosis.
Technology and aging
- Individuals in their 80s to 90s might have retired before the advent of technological advances such as ATMs, cell phones, the Internet, smartphones, and other touch screen devices.
- For these individuals, vital aspects of daily living, such as accessing finances online, requires using Internet navigation skills, and those skills were not acquired at a younger age.
- A direct connection exists between cognitive abilities and learning how to use technology for the first time.
- Healthy older people will be challenged by new technology the first time because of their lack of exposure. Yet, their ability to learn how to use technology is comparable to that of younger people.
Embracing technology to prevent normative cognitive decline
- The ACTIVE study, sponsored by the National Institute on Aging, enrolled 2,800 older healthy adults, with a mean age of 75, to evaluate the effectiveness of cognitive interventions in maintaining cognitive health and functional independence in older adults.
- Participants were randomized to either computerized speed training, memory training, problem solving training, or psychosocial intervention.
- The computerized speed training produced the most significant benefit in cognitive functioning. Participants randomized to computerized speed training sustained their functioning of instrumental daily activities of living and had a 50% lower rate of at-fault motor vehicle collisions, compared with controls, over a 6-year follow-up period.
- The ACTIVE study results suggest that age-related changes might be reversible with 14 1-hour sessions of brain training. Normative age-related cognitive decline can be attenuated through the use of affordable, accessible technology.
In summary, not all age-related cognitive complaints are pathological
- Clinicians must ask specifically about memory loss and rapid forgetting of information to differentiate normative age-related changes from Alzheimer's dementia.
- Patients should be empowered to use technology to intervene for their cognition.
- Both brain and physical fitness are paramount to preventing dementia.
- Physical fitness is essential to prevention, because chronic illnesses such as type 2 diabetes are primary risk factors for dementia, and being overweight in middle age is a major predictor for developing type 2 diabetes.
- Physical exercise, brain exercise, and embracing technology are essential to preventing social isolation and subsequent dementia.
References
Antidepressants for pediatric patients
by Jennifer B. Dwyer, MD, PhD; Michael H Bloch, MD, MD
An evidence-based review from Current Psychiatry: 2019 September:18(9):26-30,32-36,41-42,42A-42F
Tennstedt SL and FW Unverzagt. The ACTIVE study: Study overview and major findings. J Aging Health. 2013 Dec;25(8 0):3S-20S. doi: 10.1177/0898264313118133.
Rebok GW et al. Ten-year effects of the ACTIVE cognitive training trial on cognition and everyday functioning of older adults. J Am Geriatr Soc. 2014 Jan;62(1):16-24.
Harvey PD and MT Strassnig. Cognition and disability in schizophrenia: Cognition-related skills deficits and decision-making challenges add to morbidity. World Psychiatry. 2019 Jun;18(2):165-7.
Brem AK and SL Sensi. Towards combinational approaches for preserving cognitive function in aging. Trends Neurosci. 2018 Dec;41(2):885-97.
