First Ever Brain Health 'Road Map' Released

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Road Map

The Centers for Disease Control and Prevention and the Alzheimer's Association released the first-ever National Public Health Road Map to Maintaining Cognitive Health.

The Road Map highlights the importance of maintaining and improving cognitive health to the overall health of the nation. The Road Map is both a call to action and a guide for implementing a coordinated approach to raising the public's awareness about cognitive health and increasing the nation's commitment to understanding both the risks for cognitive decline and ways of maintaining brain health.

"Public health has a key role to play in ensuring that added years for older Americans are quality years, including both physical health and cognitive health," said CDC Director, Dr. Julie L. Gerberding. "The National Public Health Road Map to Maintaining Cognitive Health represents a reason for optimism coupled with a clear need for action. The Road Map provides critical action steps that organizations and agencies can take to move cognitive health into the public health arena in a strategic, coordinated manner."

The components of healthy cognitive functioning include language, thought, memory, judgment, perception and the ability to carry out the activities of daily living.

Public health efforts to date have largely focused on physical health. It is clear, however, that the loss of cognitive function carries life-altering implications for individuals and families, high costs for healthcare systems, and a tremendous burden on society. As Americans age, there is increased risk of cognitive decline, including a dramatic rise in Alzheimer's disease and other dementias. This in turn contributes to caregiver burden, spiraling health care costs and economic hardship.

Drawing on the most recent developments in science, the Road Map highlights physical activity and reducing cardiovascular risk as key factors for understanding and contributing to cognitive health. In May 2006, CDC and the Alzheimer's Association invited national experts to review public health prevention research related to cognitive health, and to identify specific recommendations for addressing risk factors that promote and protect cognitive health. They concluded that the following factors may be associated with the maintenance of cognitive health: 1) the prevention or control of high blood pressure, cholesterol, diabetes, overweight, and obesity; 2) smoking prevention or cessation; and 3) being physically active. Other factors that may be associated with maintaining cognitive function include social engagement, a "heart-healthy" diet, and emotional supports, though these have much more limited research evidence.

While there is yet no conclusive evidence that brain-healthy behavior can prevent or alter the course of Alzheimer's, it has been suggested that maintaining or improving the public's cognitive health could have enormous social and economic value.

"Efforts to maintain and improve public health have focused mostly 'below the neck,' addressing diseases and conditions affecting the heart and other bodily organs," said Harry Johns, Alzheimer's Association President and CEO. "The National Public Health Road Map to Maintaining Cognitive Health shifts the focus 'above the neck' to draw attention to maintaining the health of our brains, which arguably is the most important organ in our bodies. At the Alzheimer's Association, we understand the devastation caused by cognitive impairment, Alzheimer's disease and other dementias. We sincerely believe that efforts such as this that contribute to maintaining cognitive function will save the nation billions of dollars and prevent unnecessary heartache and hardship for millions of families."

The Road Map provides 44 recommendations for action. In addition to strategies for assessing public perceptions and educating the public about myths and realities of cognitive health, the document calls for more research to better understand the risks for cognitive decline and design interventions to prevent it.

Congress recognized the importance of brain health in 2005 when it appropriated funds to the CDC to address "educating the general public and health professionals on ways to reduce the risks of developing Alzheimer's disease by maintaining a healthy lifestyle." In response, the CDC formed a partnership with the Alzheimer's Association and convened a diverse group of advisors, including representatives from the National Institute on Aging, the Administration on Aging, AARP, American Society on Aging, state public health departments and other public and private sector organizations to begin to explore this uncharted territory. The Road Map released today is the culmination of an 18-month endeavor that included the thoughtful input from dozens of scientists, public health experts and community advocates.

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Cognitive decline can range from memory loss and mild cognitive impairment to Alzheimer's disease and other dementias. In the United States, the societal weight of cognitive impairment has primarily manifested itself in the high prevalence of Alzheimer's disease, the seventh leading cause of death among all adults. With more than 5 million Americans with Alzheimer's disease and other dementias and 78 million baby boomers causing the most dramatic population shift in the country's history, there is growing concern and fear among adults about the loss of mental capacity.

The Road Map serves a dual role in identifying the critical need for the American public to have accurate information about cognitive health and to provide mechanisms that will eventually lead to prescriptions for behavior and community responses that would help maintain and improve brain health. It also offers the public solid, evidence-based research to dispel myths about cognitive issues. This includes the myth that as one ages one should automatically expect an irreversible mental decline, or that dementia is universal and inevitable. The Road Map provides clear steps to help move brain health and cognitive fitness into the mainstream of public health efforts, just as has been done with efforts to reduce heart disease, prevent cancer, and maintain physical fitness.

The Road Map's recommendations are firmly grounded in science. Among the most important are:

-- Conducting reviews of current literature to determine the physical activity prescriptions (type, frequency, duration and activity) that are effective in enhancing cognitive function in order to provide the public with specific recommendations targeted to improving brain health.

-- Supporting basic and public health research, including controlled clinical trials on physical activity and cardiovascular risk, which will help determine the specific role these elements play in cognitive health and the amounts of each that are most beneficial.

-- Establishing and maintaining a web-based cognitive health clearinghouse that offers a "one stop shop" for valid and tested information that provides consumers and healthcare professionals with cognitive health information and tools.

-- Developing a population-based surveillance system that looks at the burden of cognitive health at the community level and determines targeted strategies that are customized to assist those in specific communities.

-- Including cognitive health in Healthy People 2020, a set of health objectives for the nation that also serves as the foundation for state and community public health plans.

Effective implementation of the recommendations outlined in the Road Map require a commitment from the public health community; policymakers at the federal, state and local levels; and a public informed about cognitive health issues.

"Cognitive health is gaining increasing attention and it represents a growing area for research and action," Gerberding said. "By embracing cognitive health as a priority issue, legislators and the public health community would be mobilized to study, identify, and implement effective interventions that preserve it. Our challenge is to offer a coordinated and unified national effort. The Road Map meets that challenge by laying out a shared vision that builds on the foundation of the work done to date and shapes the work of the future."

"We have to take what we know, build on it and share the knowledge, resources, and tools with the public and health community. It will take a coordinated effort, but the Road Map provides a solid platform to make this happen," Johns said. "We look forward to building on the partnership between the CDC and Alzheimer's Association to continue to bring cognitive health to the forefront as a national priority."

Concepts included in the Road Map are already helping guide community-based brain health programs. One such effort is a demonstration program sponsored by the Alzheimer's Association, with support from the CDC, targeting brain health promotion among African-American Baby Boomers. The program is being implemented in Atlanta and Los Angeles; it addresses a critical public health problem that is especially challenging among African Americans, i.e. higher rates of cardiovascular disease, diabetes, obesity and high blood pressure, all of which increase the risk of cognitive decline, Alzheimer's disease and other dementias. This multi-year demonstration, which is in the early stages, will begin reporting initial results next year.

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