There are two main pathways for cognition as we age: normal aging and cognitive decline (abnormal aging). It is important to understand that aging is not a disease, Alzheimer’s is. It seems clear that there are things we can do to protect and enhance cognition during normal aging. What is not clear is whether there are things that we can do to protect against abnormal aging.

Staying sharp cognitively is a goal for many seniors as evidenced by the popularity of “brain fitness” programs such as Lumosity. Lumosity alone has some 70 million members from 180 different counties. It’s marketing ads boast that it is “scientifically” developed. There is no clear evidence that mastering their 40 games makes any real world improvement in everyday cognitive functioning let alone protects against abnormal aging.

A recent report from the Institute of Medicine makes several cogent points. Clearly there is great variability in cognitive abilities in the aged. Many stay very sharp as they age. Two cognitive changes are associated with advancing age. First, as we age we process information more slowly than we did when we were younger. Second, as we age we multitask more poorly. Most of us actually do a good job of compensating for these changes in such skills as driving. For example, we slow down, leave more following distance, and limit night driving in unfamiliar places.

Even subtle changes in cognitive skills increase vulnerability for some. We may become more susceptible to scams so we become more suspicious. We may become less able to make complex financial decisions so we involve family and advisors. We may have difficulty in an increasingly complex technological society so we solicit guidance from our children and grandchildren. Long-term memory stays intact as evidenced by knowledge, skills, and routines despite decline in working memory. Hence we use more external memory supports.

The report makes several recommendations based on accepted evidence for helping maintain cognitive skills as we age. These suggestions include:

1. Stay physically active.
2. Control high blood pressure and diabetes. So goes the heart, so goes the brain.
3. Don’t smoke. Limit consumption of alcohol.
4. Some medications can be especially problematic for cognition as we age. These include antihistamines, sleep aids, anti-anxiety medications, older antidepressants, bladder medications, pain medications, and anti-seizure medications.
5. Stay socially and intellectually active.
6. Get enough sleep. Indeed, “power” naps can help memory and improve alertness.
7. Be wary of products that promise to improve cognition. This includes supplements as well as brain fitness games. The “MIND” diet has not been adequately tested.

Of course, these are the recommendations that we read about often and we have known for a long time. We can better manage cognitive changes that arise from normal aging. The suggestions for preventing abnormal aging remain elusive at his time.