An NCI-designated Comprehensive Cancer Center
By Rachel Morrison | February 26, 2018
William Dale, M.D. Ph.D. William Dale, M.D., Ph.D.
The population of older adults in the U.S. is growing: By 2050, it is expected to nearly double from its 2012 numbers. This includes the “oldest old” — people aged 80 or older — a population that is expected to triple by 2050. People are potentially living longer, fuller lives. However, this longevity also puts them at risk for developing the diseases and conditions most associated with aging.
Cognitive function is a general term used to describe the various ways in which a person processes information, including memory, language, visual processing and abstract thought. “Cognitive decline” is a decrease in any of these functions, and is often viewed as an expected outcome of normal aging. But other than processing speed, significant decreases are not normal. 
With the number of older adults expected to surge, and the average lifespan extending to 94 by 2050, the need to understand risk factors for cognitive decline is of critical importance to both public health and individual well-being.
From a public health perspective, understanding the risk factors for cognitive decline allows us to project the future needs of an aging population,” said William Dale, M.D., Ph.D., Arthur M. Coppola Family Chair of Supportive Care Medicine at City of Hope.
“For health care providers, understanding who might be at risk for cognitive decline can help patients and families get support earlier in the course of disease.”
That’s why, in 2010, Dale, whose research focuses on improving the comprehensive health for older adults, especially those with cancer, along with colleagues from the University of Chicago, embarked on a large-scale, national study of risk factors for cognitive decline among older adults. The results, recently published in the journal Alzheimer’s Disease & Associated Disorders, paint a representative portrait of how age and other demographic and socioeconomic variables (such as education, health and lifestyle) are associated with cognitive function.
A nationally representative sample of over 3,000 adults aged 62 to 90 answered survey questions aimed at assessing cognition, based on an adaptation of a common test for a national survey. The lower the score, the greater the degree of cognitive impairment. Based on the survey results using standard cut-off scores, 72 percent of U.S. older adults would be classified as having some degree of cognitive impairment, and cognition scores decreased with increasing age.
“Incidentally, cognition loss is an even greater concern for older adults with cancer,” said Dale.
Just as cognitive decline is more common as one ages, the risk of cancer also rises with increasing age, and cancer treatments can lead to accelerated cognitive loss — the term ‘chemobrain’ captures this idea.”
Additionally, the researchers found other surprising associations between cognitive decline and socioeconomic factors. Those with at least a high school degree or more had slower rates of decline than those who did not complete high school, and individuals with at least a bachelor’s degree did not begin to exhibit any decline until age 70. Though women exhibited higher average cognition scores, their scores declined at a faster rate, essentially eliminating any sex difference by age 90.
Further, the study revealed health-related risk factors associated with cognitive decline. Depressive symptoms; individuals in “fair” or “poor” health (versus “good,” “very good,” or “excellent health”); and individuals needing assistance with activities of daily living (such as managing money and preparing meals) all had lower levels of cognitive function.
Knowing these risk factors not only helps researchers and policymakers prepare the infrastructure for an aging population — such as supportive housing — but will help anticipate the impact on another rapidly growing population: Those who care for older adults with cognitive decline.
The vast majority of caregiving is done by informal arrangements, such as a spouse or a child, as formal caregiving options are scant and expensive. This has vast implications for social structure: For example, a child who has to travel for work may now be required to stay near to a parent, which changes everyone’s lives significantly,” said Dale.
If one is experiencing memory loss or confusion, the idea of having testing that may confirm a diagnosis of Alzheimer’s or dementia may be daunting. However, a growing body of research is showing that people may be able to build up defenses against future cognitive losses through lifestyle choices, such as increased physical activity, and the best defense against further decline is early intervention.
To that end, Dale is spearheading a new Specialized Oncology Care and Research in the Elderly (SOCARE) clinic at City of Hope, which will be offering cognitive assessments and supportive services to patients.
“I’ve long been fascinated by a holistic account of health and aging — how the mind, body and soul intersect to make us who we are,” said Dale, “so it was natural for me to gravitate towards research and patient care aimed at preserving memory and cognitive function, things that are vitally important to individuals’ health, social lives and independence.”
For more information on the SOCARE clinic, please call 626-218-8799. Learn more about City of Hope's Department of Supportive Care Medicine.

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