Annals of Long Term Care

A substantial number of older adults in long-term care have cognitive impairment, mood disturbances, movement disorders, or a combination of these. A 2006 study of nearly 200 elderly residents of assisted living facilities in Maryland, for example, found that 68% met criteria for dementia and 24% for depression.¹ Cognitive, mood, and movement disorders often coexist in older adults in both institutional and community settings. Whether these disorders share an underlying biological basis was the subject of a recent conference initiated by the American Geriatrics Society and funded by grants from the National Institute on Aging (NIA) and the John A. Hartford Foundation.

The two-and-a-half-day conference “Thinking, Moving, and Feeling: Common Underlying Mechanisms?” was the first in a new series of AGS/NIA “Bedside to Bench” research conferences. The conferences focus on important but poorly understood problems of aging that have been identified by clinicians “at bedside.”

“Older adults have coexisting problems with thinking, moving, and mood more often than is recognized, and this triad of problems can have greater impact on disability and survival than any of them alone,” says Joe Verghese, MD, Associate Professor in the Department of Neurology at Albert Einstein College of Medicine, and a member of the AGS and the committee that planned the September conference on thought, affect, and movement disorders. “While not yet well understood, the simultaneous occurrence of these problems could be due to shared underlying mechanisms which may interact.”

Potential underlying contributors include disorders of nutrient and energy metabolism, anemia, inflammation, hormonal effects, problems with circulation or nerve cell growth and repair, or altered sleep patterns, according to the researchers attending the September conference.

“These underlying factors may even interact to cause injury to distinct parts of the brain and the rest of the aging body that contribute to this triad of problems,” says Stephanie Studenski, MD, who is heading the new three-session “Bedside to Bench” series. Past chair of the AGS Research Committee, Dr. Studenski is a professor of geriatric medicine at the University of Pittsburgh.

Treating hypertension may help prevent the onset of all three disorders, and exercises or activities, particularly those with an element of social interaction, may also be helpful, researchers at the conference noted. Other possible interventions include treatments to address low-level inflammation, and new interventions aimed at stimulating nerve cell communication and repair.

Greater awareness of the co-occurrence of cognitive, affect, and movement disorders—not only among researchers and clinicians but also among older adults and their family members—is critical to progress with the recognition, treatment, and prevention of this triad, says Dr. Studenski.

In addition, all clinical and basic scientists who study conditions and disorders related to the triad should investigate aspects of all three disorders, those at the conference agreed. Better animal models must also be developed to facilitate study of the underlying biology of these disorders, and clinical trials of potential preventive and therapeutic interventions should assess all three.

A conference report on “Thinking, Moving, and Feeling” will be published on the AGS website, at www.americangeriatrics.org, with a shorter summary of the proceedings submitted to the Journal of the American Geriatrics Society. Conference findings will also be presented during AGS’ 2008 Annual Scientific Meeting in Washington, DC. The May session on the findings is slated for 12:30-2:00 pm.