1. Cognitive Functioning as we Age Meryl A. Butters, Ph.D. Department of Psychiatry University of Pittsburgh School of Medicine Advanced Center for Intervention and Services Research for Late-Life Depression Prevention Alzheimer’s Disease Research Center

2. In times past, when a rare event occurred, an older person was asked for advice because she may have experienced it before. Now, although there are still some fields where age and wisdom are highly valued (politics, justice system, religion, literature), problems and techniques for solutions are constantly changing, making it more challenging for some older adults to compete.

3. General view: Aging occurs as time passes. Most complex organs, including the brain, tend to slowly break down over time (entropy). “Cognitive aging” reflects these changes occurring in the brain.

4. Normal Brain Changes as we Age Fjell & Walhovd, 2010

5. Recent research findings: It doesn’t have to be all downhill, there is hope… The aging brain retains much ability to “rebuild and repair” itself, which means that… …we can compensate for brain shrinkage by using alternative, unaffected brain circuits to maintain cognitive performance * Rebuilding and repairing can be influenced by some behaviors under our control! (more, later)

6. Cognitive Assessment

7. Digit Span 394862……..268493 Story Recall “Four adults were not at home when…”

8. 1.Perimenopause was associated with a decline in learning ability compared with premenopause. But…learning ability rebounded, suggesting that menopause transition-related cognitive difficulties may be time-limited. 2.Hormone initiation prior to the final menstrual period had a beneficial effect whereas initiation after the final menstrual period had a detrimental effect on cognitive performance. Cognitive Results Greendale et al., 2009

9. 1.Depressive and anxiety symptoms had a small, negative effect on cognitive processing speed. 2.However, depressive, anxiety, sleep disturbance, and hot flashes did not account for the temporary decline in learning observed during the late perimenopause. Cognitive Results Greendale et al., 2010

10. When our 80 year-old grandmother spends 20 minutes looking for the eyeglasses perched on top of her head, we chuckle and chalk it up to “normal aging”. However, at what point should we start to be concerned about age- related cognitive changes? Drag & Bieliauskas, 2010

11. Most common description of Cognitive Aging Fluid abilities are vulnerable to decline (as early as the 20’s): Fluid abilities are reflected in how efficiently we process information, including mentally manipulating or transforming material. Also relating and integrating information especially to use in a new way. Example: Thinking outside the box

12. Most common description of Cognitive Aging Crystallized abilities usually stay stable (and can increase) throughout life Crystallized abilities represent the accumulation of knowledge and skills from education and life experience. Examples: Vocabulary, Wisdom

13. Cognitive Changes in Normal Aging

14. Other than aging-associated physical limitations, our cognitive abilities perhaps play the largest role in determining the limits of our activities and accomplishments. In this spirit: Knowledge is power

15. Risk Factors for Cognitive Decline Age Genes Family history of cognitive decline Female gender Low or poor education History of head trauma History of depression Diabetes Untreated hypertension Untreated sleep apnea Sedentary Lifestyle High-fat diet Hormone Replacement Therapy (?)

16. Protective Factors Under study: NSAIDs, statins, resveratrol, fish oil, anti-oxidants Greater education Cognitively stimulating occupational experience Regular low-to-moderate alcohol consumption (1-3 drinks/day) Healthy diet (especially Mediterranean) Mentally stimulating activities Active social life (connections) Regular physical exercise Many of these are under our control!

17. Thanks for your attention!

18. Characterizing cognitive aging has been challenging for researchers Because some decline is normal (result of brain aging), it can be difficult to distinguish from early brain diseases. The differences in cognitive ability between people (some decline a lot and others very little) and within people (probably due to increasing fluctuations in attention) increases dramatically as people age. Another complication is that as people age they both have more life experiences that put their brain at risk and become more vulnerable to diseases (and their treatments) that affect brain function. So, this leads to a complicated question for aging researchers with implications for the public at large: is “normal cognitive aging” what occurs under ideal circumstances (e.g., no health problems) or is it what occurs in the “average” person?