What We Can Say about Cognition in Aging: Arguments for and against Cognitive Health Promotion Pubblico
Vandenberg, Ann Elisabeth (2012)
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 a pressing 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 question, What is adequate evidence for issuing public health recommendations? or When do we know enough to act? Using a grounded theory framework, it examines discourse by cognitive health experts and published documents in three areas of cognitive health activity: research, industry, and policy. Altogether, 17 experts were interviewed and a sequence of policy arguments traced from the Cognitive and Emotional Health Project, to the Alzheimer's Association's Maintain Your BrainTM campaign, to the CDC-based Healthy Brain Initiative, to the NIH State-of-the-Science Conference on Preventing Alzheimer's Disease and Cognitive Decline, to the National Alzheimer's Project Act. After evaluating epidemiology and randomized controlled trials (RCTs) on lifestyle behaviors for cognitive health, it 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 RCTs showing that a behavior is effective in preventing a risk factor for a certain disease to endorse the same behavior to prevent a common cognitive sequela of that disease. This project ultimately endorses the Logically Derived Policy Argument in support of heart-healthy behaviors for cognitive health.
Table of Contents
Introduction ……………………………………………………………………………………………….....1
Chapter 1: The Emergence of the Healthy Older Brain …………………………………26
Chapter 2: Researching Cognitive Health ……………………………………………………..68
Chapter 3: The Cognitive Health Marketplace …………………………………………….127
Chapter 4: The Evolution of Cognitive Health Policy …………………………………..163
Conclusion …...................................................................................229Appendix: Profiles of Cognitive Health Experts Interviewed ………………………..247
Bibliography ……………………………………………………………………………………………......250
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