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Review ArticleReview Article

Cognitive Impairment in Older Adults and Therapeutic Strategies

Thomas J. Montine, Syed A. Bukhari and Lon R. White
VIVIAN HOOK, ASSOCIATE EDITOR
Pharmacological Reviews January 2021, 73 (1) 152-162; DOI: https://doi.org/10.1124/pharmrev.120.000031
Thomas J. Montine
Department of Pathology, Stanford University, Stanford, California (T.J.M., S.A.B.) and Pacific Health Research and Education Institute, Honolulu, Hawaii (L.R.W.)
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Syed A. Bukhari
Department of Pathology, Stanford University, Stanford, California (T.J.M., S.A.B.) and Pacific Health Research and Education Institute, Honolulu, Hawaii (L.R.W.)
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Lon R. White
Department of Pathology, Stanford University, Stanford, California (T.J.M., S.A.B.) and Pacific Health Research and Education Institute, Honolulu, Hawaii (L.R.W.)
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VIVIAN HOOK
Roles: ASSOCIATE EDITOR
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Abstract

Cognitive impairment and its severe form dementia are increasingly prevalent in older adults and loom as a public health disaster unless effective interventions are developed. Cognitive impairment is a convergent trait caused by damage from an idiosyncratic mix of four prevalent diseases (Alzheimer disease; vascular brain injury; Lewy body diseases, such as Parkinson disease and dementia with Lewy bodies; and limbic-predominant age-related transactive response DNA-binding protein 43 encephalopathy) that is counterbalanced by individually varying resilience, which is comprised of reserve and compensation. Brain regional damage from each of these four prevalent diseases is generated by the net effect of injury and (mal)adaptive response and is accompanied by characteristic lesions. Existing therapeutics enhance resilience, whereas most agents under development target mechanisms of damage with only suppression of vascular brain injury yet to show therapeutic promise. We hope to anticipate future tailored interventions that target mechanisms of damage and thereby avert the oncoming surge of cognitive impairment and dementia in older adults.

Significance Statement Brain regional damage is generated by the net effect of injury and (mal)adaptive response. The extent to which signs and symptoms of such damage occur is influenced by an underlying resilience comprising reserve and compensation. Finding tailored interventions that target specific mechanisms of damage likely yields the most effective therapies.

Footnotes

    • Received April 19, 2020.
    • Accepted October 12, 2020.
  • This work was supported by National Institutes of Health National Institute on Aging [Grant R01 AG021055], [Grant P50 AG016573], [Grant UF1 AG053983], [Grant P50 AG047366], and [Grant UF1 AG057707] and National Institute of Neurological Disorders and Stroke [Grant P50 NS062684].

  • https://doi.org/10.1124/pharmrev.120.000031.

  • Copyright © 2020 by The American Society for Pharmacology and Experimental Therapeutics
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Pharmacological Reviews: 73 (1)
Pharmacological Reviews
Vol. 73, Issue 1
1 Jan 2021
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Review ArticleReview Article

Cognitive Impairment in Older Adults

Thomas J. Montine, Syed A. Bukhari and Lon R. White
Pharmacological Reviews January 1, 2021, 73 (1) 152-162; DOI: https://doi.org/10.1124/pharmrev.120.000031

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Review ArticleReview Article

Cognitive Impairment in Older Adults

Thomas J. Montine, Syed A. Bukhari and Lon R. White
Pharmacological Reviews January 1, 2021, 73 (1) 152-162; DOI: https://doi.org/10.1124/pharmrev.120.000031
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  • Article
    • Abstract
    • I. Introduction
    • II. Cognitive Impairment
    • III. Pathologic Lesions Versus Biomarkers
    • IV. Diseases Versus Resilience
    • V. Damage Versus Resistance
    • VI. Time
    • VII. Interventions
    • VIII. Concluding Remarks
    • Acknowledgments
    • Authorship Contributions
    • Footnotes
    • Abbreviations
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