136 Age-related Cognitive Decline (780.93)

DSM-IV-TR criteria

• Individuals with age-related cognitive decline disorder may report problems remembering names or appointments or may experience difficulty in solving complex problems. This category should be considered only after it has been determined that the cognitive impairment is not attributable to a specific mental disorder or neurological condition.
• Age-related cognitive decline (ARCD) resembles dementia because memory loss is a major indication of the cognitive dysfunction, but in order for the condition to be considered dementia, the DSM says that memory loss must be present along with a cognitive disturbance such as aphasia, apraxia, agnosia, or a disturbance in executive functioning. It is coded under “Additional Conditions That May Be a Focus of Clinical Attention,” because at this time it is only considered a condition, rather than a disease.

Associated features

Individuals with ARCD are typically around the age of 65 begin to show declining rates of cognitive memory. Individuals with this disorder, experience deterioration in memory, learning, attention, concentration, thinking, use of language, and other mental functions. Even though research has shown that cognition naturally declines with age progression, those with ARCD present with more of a neurological loss than normal age related cognitive loss; however, it is not as severe or as rapidly progressive as those with Alzheimer’s disease or dementia. Individuals with ARCD may also show difficulties in new tasks, complex problem solving and use of language.

Child vs. adult presentation

ARCD is commonly seen in adults around the age of 65. Research has shown that severe brain damage affecting functional cognition can mimic ARCD at any age, but individuals suffering from brain damage would not be considered candidates for ARCD classification. Cognitive skills will peak by age 22 and then show natural regression by around 27, however, the average age for memory decline is around 37 (Salthouse, 2009).

Gender and cultural differences in presentation

• Females are much more likely than males to develop age-related cognitive decline, it could have a strong correlation to the general finding that women outlive men. One study has also suggested that it might be due to the decline of estrogenic milieu after menopause (Markowska, 1999).
• A 2004 Gerontology study performed by Aartsen, Martin, and Zimprich concludes that there is not a gender difference in cognitive function decline, despite more evidence for stronger age-related atrophy of the brain structure in men.
• Overall culturally, there has not been enough research to show findings of any major cultural differences, although there has been a few studies done in specific areas of the world such as Mexico, Italy, and Israel. Each study showed that educational, cultural, and environmental influences, such as dietary or activity levels, had a significant effect on the development of ARCD.
• ARCD is the result of a natural process because of an inability to live forever. Just as the skin will lose its firmness, the brain will not perform as it did in its early 20’s. The natural aging process is not culturally valued in the United States, or seen as something to be desired. As the brain ages, memory fades, and as a result, bad decisions and socially unacceptable behavior may occur. Our culture offers retirement/nursing homes as an option to those families who do not have the capabilities to cope with their aging family members. Other cultures, do not offer such remedies, nor do they view aging as undesirable. Many cultures practice family blending as a means of support to family members both young and old.

Epidemiology

• Of the older adults who are diagnosed with ARCD, about 30% of them are diagnosed between the ages of 70 to 74, and only about 20% are diagnosed after the age of 75.
• In a study done about cardiovascular disease and disease related cognitive decline, even healthy older people show a decline in global cognition and memory function with aging. On a conceptual basis and non-sociological status it still remains controversial.

Etiology

• Age-related cognitive decline is a condition that is developed over a long period of time, and studies have shown that it is more based on environmental effects than genetic development. Studies have shown that poor dietary and decreased mobility issues can increase risks of developing ARCD. High intake of saturated fatty acids has negative effects on cognition and is linked to contributing to ARCD. Vitamin B6 and B12 deficiencies in older adults have also been thought to lead to ARCD.
• Other types of individuals have been found to have high risks of developing ARCD. Lower education or lower cognition might also be a cause of ARCD. Individuals with Down syndrome are at an increasingly high risk of developing ARCD, and possibly Alzheimer’s disease, because of their lower than normal cognition and continued decline with age. Studies have also shown that those with a history of depression or mood disorders are at more risk for age-related cognitive decline and later manifest into dementia (Gualtieri & Johnson, 2008).
• Much research has found that an individual’s socioeconomic status can greatly contribute to functional cognitive decline. In a 2003 Maatrich Brain and Behavior Institute study, it concludes that individuals coming from lower socioeconomic statuses receive substandard education, and therefore, will be more likely to perform jobs that do not require a great amount of cognition. This results in the under-stimulation of cognition, which greatly enhances the risk of getting ARCD earlier in life.

Empirically supported treatments

• There is no drugs currently used to treat ARCD, but there are many experimental drugs, herbal remedies, and dietary changes that have been shown to dramatically reduce or reverse the effects of ARCD, or improve cognitive functioning drastically. Experimental drugs such as Hydergine, Gerimal, and Oxiracetam are among the top medical treatments being studied as possible treatments for ARCD, but none have shown more results than the others. Acetyl-L-carnitine has been repeatedly studied in mild cases of ARCD and has shown significantly improved cognitive functioning in a very short time with effects lasting about a month after the studies were stopped. Vitamin B6 and B12 supplements could improve cognition and long-term memory in adults who suffer from those deficiencies.
• Herbal remedies have been studied with repeated conclusions that ginkgo is the most effective supplement for ARCD. Ginkgo has ingredients in it that enhances memory and concentration, which show moderate improvements in people being treated for ARCD. Mild memory loss has also been shown to be improved by Huperzine A more than some experimental drugs on the market.
• A healthy diet and exercise has also been shown to be extremely important measure used to prevent and or reduce the effects associated with age-related cognitive decline. Antioxidants that can be found in fruits and vegetables help minimize the risk for ARCD. Also, it has been found that an increase in monounsaturated and polyunsaturated fatty acids will improve cognitive functioning and help prevent against the development of dementia (Solfrizzi, 2008). Staying active and exercising can improve blood flow to the brain and help memory, cognition, and other aspects of the body to prevent, or reduce, the risk of ARCD, or other cognitive disorders.
• A six year study of more than 3,000 participants suggested that eating fish at least once per week slowed the progression of ARCD by 3-4 years. The Rush University Medical Center study was not able to distinguish what substance from fish caused the actual slow-down in cognitive decline. They did rule-out Omega-3 fatty acids as being associated with their results.
• There is intense interest in the studies related to the potential of phytochemical-rich foods to prevent age-related neurodegeneration and cognitive decline. Recent evidence has indicated that a group of plant-derived compounds known as flavonoids may exert particularly powerful actions on mammalian cognition and may reverse age-related declines in memory and learning. In particular, evidence suggests that foods rich in three specific flavonoid sub-groups, the flavanols, anthocyanins and/or flavanones, possess the greatest potential to act on the cognitive processes (Spencer, 2010).