Behavior Modification for Cognitive Health in Aging: A Justifiable Public Health Agenda? Open Access
Vandenberg, Ann Elisabeth (2012)
Published
Abstract
Rising life expectancies and reductions in
chronic disease mortality have resulted in an increasing prevalence
of cognitive impairment in the United States, with high societal
and personal costs, widespread fear, and a thriving marketplace of
cognitive solutions that have not received official sanction.
Cognitive health in aging has therefore emerged as an urgent public
health issue. However, the intersection of gerontology, cognition,
and public health has received little academic attention to date.
This qualitative research project examines the question, Why
have no public health recommendations been issued nationally for
older Americans to maintain or promote their cognitive health?
and the deeper epistemological questions, What is adequate
evidence for issuing public health recommendations? and When
do we know enough to act? Using a grounded theory framework, it
examines spoken discourse of seven cognitive health researchers.
The project first evaluates epidemiological and randomized
controlled trial (RCT) evidence associating cognitive engagement,
vascular factors, physical activity, and social engagement with
cognitive health outcomes. It then examines arguments made for or
against issuing public health recommendations, using the Toulmin
model of analyzing arguments. The analysis revealed four
epistemological arguments for or against recommending public health
recommendations for cognitive health: 1) the Evidence-Based
Policy Argument, which uses RCTs alone to warrant issuing
recommendations, 2) the Epidemiologically Informed Policy
Argument, which proposes that epidemiology and RCTs together
constitute adequate evidence, 3) the Triangulated Evidence
Policy Argument, built around a cumulative weight of multiple
forms of evidence to support recommendations, and 4)
the Logically Derived Policy Argument, which uses RCT
evidence that supports behavioral risk factor prevention to endorse
the same behavior to prevent a common cognitive sequela of the
disease risk factor. This project ultimately endorses the
Logically Derived Policy Argument in support of
heart-healthy behaviors for cognitive health.
Table of Contents
Chapter 1: Introduction ………………………………………………………………………………1
Chapter 2: Literature Review …………………………………………………………………….10
Chapter 3: Methods ……………………………………………………………………………………46
Chapter 4: Results ……………………………………………………………………………………..50
Chapter 5: Discussion …………………………………………………………………………………83
Appendix: Profiles of Cognitive Health Researchers Interviewed ……………….89
Bibliography ………………………………………………………………………………………………...91
About this Master's Thesis
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