Comorbidities and Consequences
Addictive and Co-Occurring Disorders in Late Life
David W. Oslin, M.D.
The impact of late-life addictive disorders is a growing public health concern. Epidemiological studies have demonstrated that the abuse of addictive substances is common among older adults. Moreover, substance abuse in early adulthood can have lasting effects, including an increase in the likelihood of developing late-life mental health problems. Thus, in measuring the impact of addictions on older adults, one must consider the lifetime use and abuse of these substances. Dr. David Oslinís presentation focused on the intersection between use and abuse of addictive substances and the presence and course of other mental health disorders. He emphasized mainly those substances that are most commonly abused by older adults (alcohol, cigarettes, and benzodiazepines), but discussed other abused drugs as well.
Cognitive and Brain Aging in the Baltimore Longitudinal Study of Aging
Susan M. Resnick, Ph.D.
The Baltimore Longitudinal Study of Aging (BLSA), conducted by the National Institute on Aging (NIA), is Americaís longest running scientific study of human aging. Adult men and women have been enrolled and followed since 1958 and 1978, respectively. An investigation of age-related changes in memory and other cognitive functions in BLSA participants was initiated in the early 1960s. It focused on longitudinal age changes, especially cognitive tasks
(e.g., visual memory, problem solving skills, and reaction time). The cognitive testing program was expanded in 1986 to include prospective diagnoses of dementia and cognitive impairment. In 1993, a separate test battery was introduced to tap a broad range of cognitive functions as predictors of cognitive decline. Since 1994, we also have assessed longitudinal changes in brain structure and function to identify early biomarkers of the development of cognitive impairment and dementia. We have performed annual MRI and PET scans to measure age changes in brain
structure and regional cerebral blood flow, respectively, in approximately 150 BLSA participants aged 55 years and older. Results of these studies show that there are longitudinal declines in brain volume, degenerative changes in white matter tissue characteristics, and longitudinal changes in patterns of functional brain activation during cognitive challenge even in the nondemented elderly. Thus, effects of drug abuse on cognition and brain structure and function in the elderly will be superimposed upon a changing brain.
Long-Term Consequences of Heroin and Cocaine Addiction
Yih-Ing Hser, Ph.D.
Dr. Yih-Ing Hser discussed findings from two long-term followup studies. The 33-Year Followup Study of Narcotics Addicts followed a sample of 581 male narcotics addicts admitted to the California Civil Addict Program (CAP) from 1962 through 1964.
The CAP was a compulsory drug treatment program for opiate-dependent criminal offenders committed under court order. The program consisted of an inpatient period followed by supervised community aftercare. The sample was interviewed in 1974/75, 1985/86, and 1996/97. In 1998, medical examinations were performed among a subset of these subjects. Results empirically demonstrated poor health conditions and high morbidity among surviving narcotics addicts. The Cocaine Followup Study is a 12-year followup study of 321 cocaine-dependent men originally admitted in 1988/89 to their first treatment for cocaine dependence at the West Los Angeles Veterans Affairs Medical Center. Respondents were interviewed at intake and in 1990/91 and 1991/92, and the latest followup was in 2002/03. Results showed that cocaine abstinence was associated with less criminality, morbidity, psychological distress, and higher employment.