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Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK;
Department of Psychology, University of Edinburgh, Edinburgh, UK; Medical Genetics Section,
University of Edinburgh, Edinburgh, UK; }Centre for Population Health Sciences, University of
Edinburgh, Edinburgh, UK, and #Royal Victoria Hospital, Edinburgh, UK
Emerging areas for developing research: Genome-wide scans are a likely source
to establish genetic contributions. The role of vascular factors in cognitive
ageing is increasingly studied and understood. The same applies to diet,
biomarkers such as inflammation and lifestyle factors such as exercise. There are
marked advances in brain imaging, affording better in vivo studies of brain
correlates of cognitive changes. There is growing appreciation that factors
affecting general bodily ageing also influence cognitive functions in old age.
Keywords: ageing/cognition/intelligence/memory/genetics/inflammation/
cardiovascular
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I. J. Deary et al.
Introduction
136
The impact of age itself on cognitionnot dementia, and not mild cognitive impairment, nor the other specific cognitive decline syndromes
is such a large, immediate problem for current science, and so ignored
by current scientists, that Brayne1 called it, the elephant in the room.
With an increasingly aged population, both in the UK and internationally, cognitive impairment is a major health and social issue.
Cognitive decline is among the most feared aspects of growing old. It is
also the most costly, in terms of the financial, personal and societal
burdens. It is important, because cognitive decline heralds dementia,
illness and death. In the UK, cognitive failure is the cause for 40% of
admissions to institutional care. It is widely agreed that more research
is needed to understand the mechanisms of cognitive ageing and the
factors that contribute to its individual differences.1 Committees have
been formed, and book-length calls have gone out from national organizations, enumerating the problems of the ageing brain and the necessary research agenda: from the Scottish National Health Service,2 from
the UKs House of Lords,3 from the USAs National Academies4 and
the USAs National Institutes of Health.5 The latter stated that, identifying the demographic, biological, and psychosocial factors that can
help people maintain or enhance their cognitive and emotional health
as they grow older becomes a major public health goal for this
country ( p. 13). The present summary of some aspects of nonpathological cognitive ageing focuses on studies that have examined
older people. However, the state of the brain in old age is the summary
of effects across the lifecourse, from conception. This long view is
well represented in the UK Government Office for Sciences
Foresight Report, Mental Capital and Wellbeing,6 and it is highly
recommended.
The above-mentioned sources1 6 on cognitive ageing and its causes
make it clearto a greater or lesser extentthat it is far from straightforward to separate non-pathological from pathological cognitive
decline. Often, in the studies that are summarized below, this is done
by brief tests such as the Mini-Mental State Examination and/or by the
absence of a clinical diagnosis, and sometimes by exclusion using a
standardized psychiatric interview. However, it is recognized and must
be remembered that: peoples differences in age-related cognitive
decline form a continuum, not entirely discrete groups (of course,
defining into groups is needed for treatment decisions); diagnostic criteria for Mild Cognitive Impairment (and its alternative terms) and
dementia change, and so the points on the continuum that are deemed
pathological or not can change; peoples cognitive level in old age
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I. J. Deary et al.
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I. J. Deary et al.
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Example results
Future
Heritability
studies
Genetic influences on
cognitive ability studied
using twin, adoption and
family designs
Determine source
of heritability by
searching for
molecular genetic
influences
14,48
Candidate gene
studies
Genetic
contributions to
intelligence
variation are: 41%
childhood; 55%
adolescence; 66% in
young adulthood;
about 60% in old
age
Variants in the
following genes
reported as
associated with
differences in
cognitive ageing:
APOE, BDNF, COMT,
DISC1, PRNP
APOE is well
established; other
genes have
largely failed to
replicate
15 17
Replication in
larger samples;
improved
genome
coverage;
detailed cognitive
testing
49
Whole-genome
association
LRP1B haplotypes
associated with
successful ageing
without cognitive
decline
References
The gene names are as follows: APOE, apolipoprotein E; BDNF, brain-derived neurotrophic factor;
COMT, catechol-O-methyltransferase; DISC1, disrupted in schizophrenia 1; PRNP, prion protein; LRP1B,
low-density lipoprotein-related protein 1B.
141
Targets
I. J. Deary et al.
142
143
There is strong evidence linking markers of inflammation with atherosclerosis and cardiovascular disease, but its relationship with cognition
is less well defined. Current prospective and cross-sectional studies
provide conflicting views with positive and null findings being reported
between late-life biomarker levels and cognitive ability.28,29 Of these
studies, few have assessed a large cohort of subjects over a long-term
follow-up using an extensive battery of cognitive tests.
In terms of the inflammatory biomarkers studied, there is a reasonably large body of work on the downstream acute-phase protein
C-reactive protein (CRP), and the upstream cytokines tumour necrosis
factor alpha and interleukin-6. The magnitude of the effect sizes
between these markers and cognition is typically small, with the biomarkers explaining 1% of the variance of the cognitive test scores. In
addition to inflammatory biomarkers, some studies have also integrated
rheological and thrombotic factors, such as plasma viscosity and fibrinogen into their analyses. Initial findings for these markers are again
mixed, although a causal rheology-cognition association is certainly
plausible via a sticky blood hypothesis. Explicitly, some suggest that
increased blood viscosity has an effect on cerebral blood flow at a
microvascular level.30
One study showed associations between both CRP and fibrinogen
with cognitive ability at age 70 years.31 However, upon adjustment for
a measure of IQ at age 11, the associations were markedly attenuated.
Further, the age-11 IQ scores also predicted age-70 CRP levels. This
again raises the possibility of a reverse causation argument, in which
lower childhood IQ leads to more inflammation in later life.
Longitudinal data such as these are clearly a desirable study feature,
although investigators might also consider the inclusion of a
vocabulary-based test to estimate peak prior cognitive function.
Measures such as the National Adult Reading Test are fairly robust
estimates with scores on vocabulary-based tests showing little evidence
of change over time.32
Given the high variability and acute nature of some inflammatory
biomarker levels in old age, especially CRP, it may be relevant to use
genetic variants as predictors of lifetime exposure to inflammation.
Such an approach treats the intermediate phenotype (the biomarker
level, such as CRP) as a biased measure. Instead, it models directly a
gene-cognition association using genetic information, such as single
nucleotide polymorphisms. Because genetic variants are determined at
conception, they are less likely to be affected by confounding.
Therefore, the use of such variants as predictors may be an approach
I. J. Deary et al.
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I. J. Deary et al.
Physiological markers of
health status
truly a protective effect, more studies are needed which are able to
control for an early measure of premorbid cognitive function.
The reason such activities are of particular interest derives from the
fact that they may suggest simple, cost-effective lifestyle interventions
148
Details
Conclusion
The interest in cognitive ageing is as understandable as it is compelling,
for personal, scientific and practical interest. Personally, as we become
aware of cognitive processes deteriorating, we witness the diminishing
of something at the core of our rational self. Scientifically, it is a fascinating problem, namely to construct the multivariate recipe for successful cognitive ageing (a summary of the current review is provided in
Table 2). Practically, demographic changes mean that our care services
and economies will be better placed to cope with the increasing burden
of cognitive ageing if there are clues to amelioration and prevention.
Some contributions to cognitive ageing are clearly more open to intervention than others: smoking, exercise, and diet can be changed following advice. Mechanistically, even the contributions from genetics and
from childhood intelligence should not be looked on too pessimistically; even these factors have mechanisms which might afford
interventions.
Acknowledgements
The work was undertaken by the University of Edinburgh Centre for
Cognitive Ageing and Cognitive Epidemiology, part of the cross
council Lifelong Health and Wellbeing Initiative.
British Medical Bulletin 2009;92
149
I. J. Deary et al.
Funding
Funding from the BBSRC, EPSRC, ESRC and MRC is gratefully
acknowledged.
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