|NIH Seeks Strategies to Preserve Brain Health
New Report Suggests Promising Areas for Intervention
With the rapid aging
of the population, the National Institutes of Health (NIH) is intensifying the
search for strategies to preserve brain health as people grow older. The effort
moved an important step forward today with a report by an expert panel to the NIH,
suggesting a number of promising avenues for maintaining or enhancing cognitive
and emotional function. Specifically, the group said, education, cardiovascular
health, physical activity, psychosocial factors and genetics appear to be associated
with brain health with age, and research aimed at directly testing the effectiveness
of interventions in several of these areas deserves further attention.
The report is published online today in Alzheimer’s and Dementia: The Journal
of the Alzheimer’s Association. It is a product of the Critical Evaluation
Study Committee, a panel of experts appointed by NIH and led by Hugh Hendrie,
M.B., Ch.B., D.Sc., of Indiana University, Indianapolis. The committee evaluated
several large on-going studies of older adults for current scientific knowledge
on brain health.
“Three NIH institutes — the National Institute on Aging (NIA), the National Institute
of Mental Health (NIMH) and the National Institute of Neurological Disorders
and Stroke (NINDS) — established the NIH Cognitive and Emotional Health Project
to coordinate and accelerate research leading to interventions for neurological
health,” says NIH Director Elias A. Zerhouni, M.D. “This report suggests a future
direction of research and is a terrific example of what we can learn when scientists
of diverse specialties work together on a complex health issue.”
Hendrie and colleagues cited demographic pressures to find ways to maintain
cognitive and emotional health with age. Approximately 4.5 million Americans
have Alzheimer’s disease, and additional numbers of older people experience less
severe, but still problematic cognitive impairment with the risk of such cognitive
decline increasing with age. In one area of emotional health — depression — the
everyday function of an estimated two million older adults is also threatened,
according to NIMH.
“With more Americans living well into their 70s, 80s and 90s, developing strategies
to preserve cognitive and emotional health as we grow older is a major public
health goal,” says Richard J. Hodes, M.D., director of the National Institute
on Aging. “This report analyzes research identifying factors that are associated
with cognitive and emotional health and most importantly describes several directions
for testing interventions to determine their effectiveness in improving cognition
and emotional health.”
The panel broadly discussed a change in the focus of brain research. In addition
to studying specific causes of brain disease and dysfunction, research also should
approach cognition and emotion from the opposite direction — looking at what works
to preserve brain health. “We set up the Cognitive and Emotional Health Project
in recognition of changed thinking. In this report, the committee specifically
articulates a new paradigm for research focused on health rather than dysfunction,” says
NINDS Director Story C. Landis, Ph.D.
Another major theme emphasized the interconnectedness between cognitive and
emotional health. Cognitive health and emotional well-being are “inextricably
linked,” the report concludes, and efforts should be made to examine them simultaneously.
“Cognitive decline and emotional stress in older people involve a number of
physiological and psychological processes going on at the same time,” says Thomas
Insel, M.D., Director of NIMH. “This report highlights the need to better understand
this interrelatedness if we are going to devise effective ways to maintain brain
The evaluation committee reviewed scientific data from 36 large, ongoing studies
of aging and identified more than 40 separate factors that may play a role in
cognitive and emotional health. Those highlighted in the report are summarized
below, including those in which possible interventions might be explored:
- Education — Higher levels of education correlate with both good cognitive
and emotional function in the scientific literature. But there is no consensus
as to why this may be so. Researchers continue to explore such explanations
as education providing cognitive “reserve” or the socioeconomic factors such
as quality of education that may affect the relationship between higher education
and better cognition.
- Cardiovascular — A growing body of observational research links cognitive
decline with several traditional risk factors for cardiovascular disease, including
hypertension, greater body mass index, heart disease, diabetes and smoking.
Understanding the impact of these influences is critically important because
they can be modified though lifestyle and medical interventions. NIH currently
funds clinical trials to test whether interventions for high blood pressure,
diabetes and high cholesterol reduce the risk of cognitive decline.
- Psychosocial — A number of psychosocial factors — emotional and social support
networks, high socio-economic status and low stress levels — correlate with cognitive
and emotional health later in life. Stress, for example, has been linked to
cognitive decline, while social engagement, social support and higher socio-economic
status are associated with better cognitive and emotional health.
- Depression and anxiety — Some studies associate a history of depression or
anxiety with poor cognitive and emotional health later in life. Researchers
only recently have recognized a possible connection between mood disorders
and future cognitive decline. This could be an important area for testing interventions.
- Physical activity — Finding out if physical activity can protect against cognitive
deterioration “would be of great public health importance because physical
activity is relatively inexpensive, has few negative consequences, and is accessible,” the
report says. A number of studies suggest a protective effect, and clinical
trials are underway to test exercise as an intervention against cognitive decline.
The panel said a large clinical trial should be considered.
- Chronic illness — Chronic illnesses, such as arthritis, cancer, lung disease,
heart disease and diabetes, are linked to poor emotional outcomes, specifically
depression, in older people. Further study could examine the important questions
of cause and effect, whether illness causes depression or whether depression
can make people more vulnerable to illness.
- Genetics — There is a poor understanding of genetic influences on cognitive
and emotional health. While risk for late-onset Alzheimer’s disease increases
with inheriting one form of the apolipoproteinE (APOE) gene, little is known
about its specific role in Alzheimer’s or its effects on emotional health.
Genetic factors cannot be modified, but greater knowledge of the genetics of
cognitive and emotional health could help identify people at higher risk.
Details of the research papers evaluated by the panel are available online at
http://www.biostat.iupui.edu/~sgao/healthybrain/hblogin.asp. The Cognitive and
Emotional Health Project’s searchable database of a large number of studies on
age and cognitive and emotional function can be found on the NIH website at http://trans.nih.gov/CEHP.
The National Institute on Aging (NIA) leads the federal government effort conducting and supporting research on the biomedical and social and behavioral aspects of aging and the problems of older people. For more information on aging-related research and the NIA, please visit the NIA website at www.nia.nih.gov.
The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website, www.nimh.nih.gov.
The National Institute of Neurological Disorders and Stroke (NINDS) is the nation’s primary supporter of biomedical research on the brain and nervous system and provides information to the public and patients. More information is available at the NINDS website, www.ninds.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.