Cognitive decline

See Memory loss

Age associated decline occurs in cognition.

Cognitive changes in older adults includes a spectrum of normal cognitive aging, subjective cognitive decline, mild cognitive impairment, and dementia.
Normal cognitive aging is associated with a continuous decline in processing speed, modest declines in memory and aspects of executive function, with these latter abilities declining more rapidly after age 65 years.
Subjective cognitive decline relates to the self perceived concern about cognitive decline among individuals who perform normally on neuro psychological tests.
Subjective decline is associated with the risk of pre-clinical Alzheimer’s disease, particularly among adults over age 60 who are concerned about memory decline, rather than other aspects of cognition.

Subjective cognitive decline is not specific to Alzheimer’s disease and can be associated with depression, anxiety, and personality traits such as neuroticism.

Declines in episodic memory and executive function parallel volume losses in brain structures, such as the hippocampus and dorsolateral prefrontal cortex.

There is the influence of the 24 hour circadian rhythm on cognition.

Cognitive performance generally peaks in late evening.

Cognition peaks in late summer and early fall and diminishes in late winter and early spring.

A leading cause of functional impairment worldwide.

Cognitive aging is a lifelong process of gradual onset of changes in cognitive function that occur as people age.

Cognitive function declines may decrease predictably such as memory and reaction time.

Cognitive decline often associated with advancing age, and even mild levels of reduction are associated with incident mortality in the elderly.

Cognitive impairment is associated with decreased quality-of-life, increased disability, and dependence on others, increased health care costs, and early mortality.

((Mild cognitive impairment)) is a heterogeneous condition, defined most recently as a modest decline in cognition, based on clinical and neuropsychological data, that does not significantly impact daily functioning.

Associated with increased admission to ICUs.

An estimated 5.4 million individuals 71 years or older in the US have cognitive impairment without dementia.

Some kind of cognitive functions can be maintained or increase, such as wisdom or knowledge.

Occurs in all individuals regardless of initial cognitive function.

A dynamic process with variability among and between individuals.

Episodic memory, the recall of experience and events begins to decline early in the 20’s.

Spontaneous recall, working memory, selective attention, speed of processing and ability to multitask decline normally with aging.

Factual and conceptual knowledge, procedural memory, and language abilities can be maintained until late in life.

At least 10% of persons older than 65 years and 50% of those older than 85 years have some form of cognitive impairment, ranging from mild deficits to dementia.

Potential for older adults to strengthen some cognitive abilities.

Involves structural and functional brain changes.

Not a defined neurological or psychiatric disorder and does not inevitably lead to neuronal death and neurodegenerative dementia.

Risk of CD increases with age and is enhanced with hospitalization for critical illness and surgery and can result in long-term morbidity and reduced quality of life.

Associated with stroke, cardiovascular disease, peripheral vascular disease, hypertension, and diabetes mellitus.

Associated with modifiable and non-modifiable factors that include genetics, medical comorbidities, acute illness, exercise, cultural, education, and other health behaviors.

Higher levels of hemoglobin A1c associated with lower cognitive function in men with type 2 diabetes and metabolic syndrome.

Visual impairment is a significant comorbidity that increases the risk of disability in cognitive impairment.

Vascular dementia may contribute to cognitive decline in patients with CAD and DM.

Older individuals with cardiovascular disease or coronary risk factors have increased risks of cognitive impairment.

Incidence of cognitive decline in patients undergoing coronary bypass surgery is 53% at discharge, 36% at six weeks, 23% at six months and 42% at five years.

Up to one drink per day in women may decrease the risk of cognitive decline.

Women’s Antioxidant Cardiovascular Study showed regular physical activity associated with a better preservation of cognitive decline in older women with vascular disease or risk (Vercambre MN et al).

Physical activity in midlife and late life is associated with lower rates of dementia and cognitive impairment in late life.

People who participate in higher levels of physical activity have slower rate of cognitive decline compared with individuals who are less active.I is

During a median followup of 56 months patient’s with albuminuria at a 21% increase odds of cognitive decline compared with those with no albuminuria, and participants who developed new onset albuminuria during followup at a 30-77% increased odds of developing cognitive decline compared with those who remained without albuminuria (Barzilav JI et al).

Lower plasma β amyloid 42/40 is associated with greater cognitive decline among elderly persons without dementia over nine years, and this is associated with those with low measures of cognitive reserve (Yaffe K et al).

There is a rising prevalence of cognitive impairment such as mild cognitive impairment (MCI) and dementia, including Alzheimer disease.



Comparing random assigned cognitive screening with no screening among 4004 older primary care patients with no indication of cognitive impairment, and those who screened positive on the instruments were referred for a voluntary diagnostic assessment. 


Nonpharmacologic interventions, as physical exercise and cognitive activities, have shown small clinical effects. 


Meta-analysis does not support an advantage suggesting that psychoeducation vs other caregiver or caregiver-patient interventions was associated with better outcomes relative to another.


The harms of interventions in individuals with some degree of cognitive impairment include adverse effects of pharmacologic interventions.

Among cognitively unimpaired individuals with a family, history of dementia, changes in cognition, and brain MRI outcomes did not differ significantly between those who followed a Mediterranean/Dash diet intervention with those who followed a controlled diet with mild caloric restriction.






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