Article

Systematic Review: Factors Associated With Risk for and Possible Prevention of Cognitive Decline in Later Life

Duke University Medical Center, Durham, North Carolina 27701, USA.
Annals of internal medicine (Impact Factor: 17.81). 08/2010; 153(3):182-93. DOI: 10.1059/0003-4819-153-3-201008030-00258
Source: PubMed

ABSTRACT

Many biological, behavioral, social, and environmental factors may contribute to the delay or prevention of cognitive decline.
To summarize evidence about putative risk and protective factors for cognitive decline in older adults and the effects of interventions for preserving cognition.
English-language publications in MEDLINE, HuGEpedia, AlzGene, and the Cochrane Database of Systematic Reviews from 1984 through 27 October 2009.
Observational studies with 300 or more participants and randomized, controlled trials (RCTs) with 50 or more adult participants who were 50 years or older, drawn from general populations, and followed for at least 1 year were included. Relevant, good-quality systematic reviews were also eligible.
Information on study design, outcomes, and quality were extracted by one researcher and verified by another. An overall rating of the quality of evidence was assigned by using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria.
127 observational studies, 22 RCTs, and 16 systematic reviews were reviewed in the areas of nutritional factors; medical factors and medications; social, economic, or behavioral factors; toxic environmental exposures; and genetics. Few of the factors had sufficient evidence to support an association with cognitive decline. On the basis of observational studies, evidence that supported the benefits of selected nutritional factors or cognitive, physical, or other leisure activities was limited. Current tobacco use, the apolipoprotein E epsilon4 genotype, and certain medical conditions were associated with increased risk. One RCT found a small, sustained benefit from cognitive training (high quality of evidence) and a small RCT reported that physical exercise helps to maintain cognitive function.
The categorization and definition of exposures were heterogeneous. Few studies were designed a priori to assess associations between specific exposures and cognitive decline. The review included only English-language studies, prioritized categorical outcomes, and excluded small studies.
Few potentially beneficial factors were identified from the evidence on risk or protective factors associated with cognitive decline, but the overall quality of the evidence was low.
Agency for Healthcare Research and Quality and the National Institute on Aging, through the Office of Medical Applications of Research, National Institutes of Health.

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    • "Factors in adult life that are known to influence blood pressure, such as body mass, alcohol consumption and intake of salt, account for only a small part of the differences in pressure between individual people and populations (Barker et al., 1990). This is also true for other adverse health outcomes, such as cognitive decline (Plassman et al., 2010). Hence, in searching for new ways to tackle adverse health outcomes later in life, researchers have started to look beyond behavioural risk factors to examine the effect of shocks to health in utero and in childhood on health in old age. "
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    ABSTRACT: There is much interest in the causes of several adverse health outcomes in middle and old age. In searching for new explanations for adverse health outcomes later in life, researchers have started to look beyond behavioural risk factors to examine the effect of shocks to health in utero and in childhood on health in old age. In this paper we extend this literature to examine the long-term health effects of mass political violence experienced in utero and in childhood using China’s Cultural Revolution as a natural experiment. We find that individuals who were in utero in the Cultural Revolution have reduced lung capacity later in life, but we find no evidence that being in utero has adverse effects on other health indicators later in life. We find more evidence that being an adolescent in the Cultural Revolution has an adverse effect on health later in life. Specifically, we find that individuals who were adolescents in the Cultural Revolution have higher blood pressure and reduced ability to engage in activities of daily living later in life. We also find that males who were adolescents in the Cultural Revolution have reduced cognitive skills later in life, while females who were adolescents in the Cultural Revolution have reduced lung capacity in middle and old age. specific recommendations for the Canadian context.
    Full-text · Article · Jul 2015 · Social Indicators Research
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    • "Reductions in hearing sensitivity have also been independently associated with social isolation and depression, which are each also associated with cognitive decline (Plassmanet et al., 2010; Gates & Mills, 2005; Strawbridgeet et al., 2000; Barnes et al., 2004; Steffens et al., 2006; Dawes et al., 2015). Taken together, these findings suggest links between hearing ability and cognitive status; however, hearing­aid use has not yet been directly evidenced as slowing cognitive decline. "
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    ABSTRACT: Since the early years of audiology, researchers and clinicians have been aware of underlying connections between audition and cognition. This awareness has increased greatly in recent years, as is evidenced by the growing amount of literature on these topics. The number of published articles on topics related to hearing and cognition had reached 4,000 by the year 2000, in the past 15 years that number has quickly climbed to 15,000. A changing patient demographic and a growing body of literature is giving audiology a new sense of purpose, as it is becoming increasing likely that measures of cognition will one day, affect how audiologists counsel their patients, prescribe hearing-aid technology and assess treatment outcomes.
    Full-text · Article · Jul 2015
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    • "Factors in adult life that are known to influence blood pressure, such as body mass, alcohol consumption and intake of salt, account for only a small part of the differences in blood pressure between individual people and populations (Barker 1990). This is also true for other adverse health outcomes, such as cognitive decline (Plassman et al. 2010). Hence, in searching for new ways to tackle adverse health outcomes later in life, researchers have started to look beyond behavioural risk factors to examine the effect of shocks to health in utero and in childhood on health in old age. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We examine the long-term health effects of mass political violence experienced in utero and in adolescence using China’s Cultural Revolution as a natural experiment. We find that individuals who were in utero in the Cultural Revolution have reduced lung capacity later in life. We also find that individuals who were adolescents in the Cultural Revolution have higher blood pressure and reduced ability to engage in activities of daily living later in life. Females who were adolescents in the Cultural Revolution have reduced lung capacity later in life, while males who were adolescents in the Cultural Revolution have reduced cognitive function later in life. We find that these effects are channelled through childhood health and education as well as height, which itself is a marker of childhood health.
    Full-text · Article · Jan 2015 · Social Indicators Research
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