Sep 4, 2019
In this masterclass, Philip
D. Harvey, PhD, professor of psychiatry and behavioral sciences
at the University of Miami, discusses the relationships between
aging, neurocognition, and functional outcomes.
And in a new segment from MDedge, called This Week in
Psychiatry, we’d like to share a Current Psychiatry evidence-based
review on using
antidepressants for pediatric patients (PDF)
by Jennifer B.
Dwyer, MD, PhD, and Michael
H. Bloch, MD, MS.
Show Notes by Jacqueline Posada, MD, consultation-liaison
psychiatry fellow with the Inova Fairfax Hospital/George Washington
University program in Falls Church, Va.
Introduction to normal aging
- Changes in cognitive abilities are part of normal aging.
- Crystalized intelligence, the storage of information learned
throughout life, does not change over time in normal, healthy
- Fluid intelligence, the ability to learn new information, solve
problems, concentrate, and rapidly process information, starts
changing at age 65 or so.
- Episodic memory performance, the ability to learn new verbal
information, declines 30% between ages 65 to 80, followed by
another equivalent decline from ages 80 to 90.
- Alzheimer’s disease and amnestic mild cognitive impairment are
characterized by signature memory loss called rapid forgetting,
which occurs in cases in which a person is unable to remember
information right after being told.
- Older people who are self-aware and sensitive to their
age-related cognitive changes have a better prognosis.
Technology and aging
- Individuals in their 80s to 90s might have retired before the
advent of technological advances such as ATMs, cell phones, the
Internet, smartphones, and other touch screen devices.
- For these individuals, vital aspects of daily living, such as
accessing finances online, requires using Internet navigation
skills, and those skills were not acquired at a younger age.
- A direct connection exists between cognitive abilities and
learning how to use technology for the first time.
- Healthy older people will be challenged by new technology the
first time because of their lack of exposure. Yet, their ability to
learn how to use technology is comparable to that of younger
Embracing technology to prevent normative cognitive
ACTIVE study, sponsored by the National Institute on Aging,
enrolled 2,800 older healthy adults, with a mean age of 75, to
evaluate the effectiveness of cognitive interventions in
maintaining cognitive health and functional independence in older
- Participants were randomized to either computerized speed
training, memory training, problem solving training, or
- The computerized speed training produced the most significant
benefit in cognitive functioning. Participants randomized to
computerized speed training sustained their functioning of
instrumental daily activities of living and had a 50% lower rate of
at-fault motor vehicle collisions, compared with controls, over a
6-year follow-up period.
- The ACTIVE study results suggest that age-related changes might
be reversible with 14 1-hour sessions of brain training. Normative
age-related cognitive decline can be attenuated through the use of
affordable, accessible technology.
In summary, not all age-related cognitive complaints are
- Clinicians must ask specifically about memory loss and rapid
forgetting of information to differentiate normative age-related
changes from Alzheimer’s dementia.
- Patients should be empowered to use technology to intervene for
- Both brain and physical fitness are paramount to preventing
- Physical fitness is essential to prevention, because chronic
illnesses such as type 2 diabetes are primary risk factors for
dementia, and being overweight in middle age is a major predictor
for developing type 2 diabetes.
- Physical exercise, brain exercise, and embracing technology are
essential to preventing social isolation and subsequent
Antidepressants for pediatric patients
by Jennifer B. Dwyer, MD,
PhD; Michael H Bloch, MD,
An evidence-based review from Current Psychiatry: 2019
Tennstedt SL and FW Unverzagt. The ACTIVE study: Study overview
and major findings. J Aging Health. 2013 Dec;25(8 0):3S-20S.
Rebok GW et al. Ten-year effects of the ACTIVE cognitive
training trial on cognition and everyday functioning of older
adults. J Am
Geriatr Soc. 2014 Jan;62(1):16-24.
Harvey PD and MT Strassnig. Cognition and disability in
schizophrenia: Cognition-related skills deficits and
decision-making challenges add to morbidity. World
Psychiatry. 2019 Jun;18(2):165-7.
Brem AK and SL Sensi. Towards combinational approaches for
preserving cognitive function in aging. Trends
Neurosci. 2018 Dec;41(2):885-97.