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Today there are 24.3 million people worldwide suffering from dementia, with 4.6 million new cases of dementia occurring every year (one new case every 7 seconds). As demographics shift and people live longer, the prevalence of Alzheimer's disease is expected to quadruple by 2047. Alzheimer's disease and related dementias were the third most expensive health conditions in the United States in 2000.
Everyday life involves many activities that younger adults take for granted. We make grocery lists, prepare meals, balance checkbooks and schedule appointments. These tasks require skills as simple as dialing a phone or reading instructions, as well as more complex operations such as driving a car or negotiating public transportation.
When memory starts to fade or thinking becomes muddled, these mundane, but important tasks become challenging. If individuals are unable to handle these responsibilities, it signals the end of independence. The mission of the newly established Aging Brain Center is to bring together investigators across disciplines in the Greater Boston area and beyond to better understand the mechanisms involved with cognitive decline and to develop and test treatment and prevention strategies.
Focusing on Cognitive Decline in Old Age
Institute for Aging Research studies have always examined the problem of cognitive decline in seniors from a variety of perspectives and across multiple disciplines. Finding underlying causes and ways to improve patient care, support caregivers, and improve early detection have all been, and continue to be, investigated. The Aging Brain Center will greatly enrich faculty efforts by complementing existing programs and developing new initiatives.
Under Dr. Inouye's direction, researchers in the Aging Brain Center will focus on the detection, prevention and amelioration of cognitive impairment. The initial themes to explore will include the interrelationship of delirium and dementia/Alzheimer's disease; the evaluation of vulnerability to cognitive dysfunction and elucidation of cognitive reserve capacity; and post-operative cognitive dysfunction. Studies will focus on biological, medical, social and psychological factors influencing cognitive function as people age. Dr. Inouye's short-term goals are to build collaborations to address the core themes of the center, establish pilot grants, and host a scientific symposium. Collaborators will span the disciplines of geriatrics, gerontology, epidemiology, neurology, neuroscience, neuroimaging, neuropsychology, psychology, psychiatry, anesthesiology, sociology, behavioral sciences, health economics and health policy. In the long-term, Dr. Inouye hopes that the center will emerge as a leader in clinical research on aging and the brain.
Unlocking the Mystery of Delirium
Dr. Inouye is well known for her groundbreaking work on a prevalent and vexing condition known as delirium. Delirium is described as an acute decline in cognitive function and attention, and is a significant problem for hospitalized seniors. The hospital mortality rates in patients with delirium range from 22-76 percent, which are as high as the rates associated with acute heart attack and sepsis, an overwhelming bacterial infection in the blood. The one-year mortality rate associated with delirium is 35-40 percent. In addition, the dollar costs associated with delirium are substantial. According to several reports, inpatient costs alone are estimated at $4 billion in the United States; add on post-acute care in rehabilitation hospitals, nursing homes and home health care and the financial burden rises.
Through her research, Dr. Inouye has made progress toward finding ways to predict, treat or prevent delirium. Her accomplishments include development of a new instrument for identifying delirium-the Confusion Assessment Method-that is now a widely used standard in the field. She also helped develop a model for predicting delirium that takes into consideration multiple factors that promote the syndrome. This model allowed her to develop an intervention strategy that reduced the incidence of delirium by 40 percent in her study population, demonstrating for the first time that the condition, in many instances, is preventable. Her recent work has included a study indicating the cost-effectiveness of the delirium prevention model, and studies examining the pathophysiology and long-term outcomes of delirium.
Despite Dr. Inouye's considerable progress, there is still more work to be done. She lists several issues on which her continuing research on delirium and dementia within the Aging Brain Center will focus, including clarifying the relationship between delirium and dementia; addressing the problem of under-recognition of the condition; developing better treatment; and finding ways to decrease caregiver burden.
Dr. Inouye brought two grants with her when she joined the Institute for Aging Research. One will allow her to continue her work in delirium research and the other funds a mentoring program. The latter promotes aging research by providing opportunities for those interested in pursuing research careers in this area to work with accomplished mentors. Mentees receive the guidance, training and experience necessary to launch independent careers.
Finding HELP for Reducing Delirium in Hospitalized Seniors
The Aging Brain Center also serves as the administrative headquarters for the Hospital Elder Life Program (HELP). Based on effective interventions identified by Dr. Inouye's research, this program is available as a resource to hospitals to combat delirium among their older patients.
HELP reduces the incidence of delirium by keeping hospitalized older people oriented to their surroundings; meeting their needs for nutrition; fluids; and sleep; and keeping them mobile within the limitations of their physical condition. More information on the HELP program can be found at www.hospitalelderlifeprogram.org.
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