Behavior Modification for Cognitive Health in Aging: A Justifiable Public Health Agenda? 公开

Vandenberg, Ann Elisabeth (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/0g354f50j?locale=zh
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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

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