Declining mental sharpness “just comes with age,” right? Not so fast, say geriatrics researchers and clinicians gathered at a prestigious 2018 conference hosted by the American Geriatrics Society (AGS) with support from the National Institute on Aging (NIA). In a report published in the Journal of the American Geriatrics Society (JAGS), attendees at a conference for the NIA’s Grants for Early Medical/Surgical Specialists Transition into Aging Research (GEMSSTAR) program describe how increasing evidence shows age-related diseases—rather than age itself—may be the key cause of cognitive decline.
“We’ve long been taught that cognitive issues are ‘just part of aging,’” explains Christopher R Carpenter, MD, MSc, who helped coordinate the conference. “But contemporary medical research shows how bodily changes that lead to diseases like dementia appear long before the symptoms we associate with “old age.” This begs the question: Is it really age that causes cognitive decline, or is it ultimately the diseases we now associate with age—in large part because we see them with increasing frequency now that we live longer? That’s what we wanted to tackle coming together for this meeting.”
Hosted by the AGS and NIA in 2018 as the third conference in a three-part series for GEMSSTAR scholars, the NIA “U13” conference brought together NIA experts and more than 100 scholars, researchers, and leaders representing 13 medical specialties to explore experiences with cognitive impairment across health care. Conference findings, published in JAGS (doi:10.1111/jgs.16093), detail early thinking on the two-way relationship between cognitive health and the health of other organ systems, as well as opportunities for moving science and practice forward.
According to attendees, several themes emerged:
Researchers and clinicians from across health care noted the critical relationship between two of their top concerns: Dementia and delirium. Research now suggests delirium and dementia are mutually inclusive risk factors, with cases of one prompting risks for the other. Thus, prevention of delirium may offer the unprecedented opportunity to prevent or lessen future cognitive decline.
Still, as one of the conference attendees noted, “[T]he brain is not an island.” Because the conference focused on the impact of cognitive impairment across specialties, a critical focal point for scholars was the complex, bi-directional relationship between cognition and the rest of the body. For example, cognitive impairment is perhaps “the strongest independent predictor” of hospital readmission and mortality for older people living with heart failure.
As the field progresses, however, a major barrier remains: A dearth of research owing to the exclusion of potential study participants who are cognitively impaired. Though obtaining informed consent remains challenging, researchers pointed to data that willingness to participate remains high. Suggestions for tailoring consent safeguards to the types of studies and potential participants hold promise for protecting against exploitation while continuing to move cutting-edge care principles forward.
As the GEMSSTAR conference attendees concluded, “The aging of the US population and the growing burden of dementia make this an area of critical research focus…[U]nderstanding and addressing cognitive health and its relationship with the health of other organ systems will require multidisciplinary team science…[and new] study designs…”
The NIA’s GEMSSTAR program awards support to early-career physicians trained in medical and surgical sub-specialties to conduct aging research across other disciplines. The AGS serves as a central coordinating body for applicants in particular specialties interested in applying for professional development support and connects these awardees with their specialty societies. Additional funds support a Professional Development Plan to complement research projects.