Characteristics of cognitive health in older adults

Many family members and even the elderly themselves feel that "being old and not confused means cognitive health." However, according to nearly 10 years of clinical and community practical experience in the field of cognitive intervention for the elderly in China, as well as the latest consensus released by the Global Alzheimer's Association in 2024, the core characteristics of cognitively healthy elderly people have never been "completely healthy." "There is no cognitive degradation", but a dynamic homeostasis of four core dimensions: independently completing most daily life functions, emotional regulation and personality baseline deviations within a reasonable range, social participation matching one's own wishes and physical conditions, and cognitive reserves and compensatory mechanisms sufficient to cope with the needs of non-standardized scenarios.

Many people get extremely nervous when they find out that the elderly person has forgotten his keys and cannot remember what he just said, fearing that this is a precursor to Alzheimer's disease. The last time I did a free screening in the community, I met seven or eight children who came with their parents in the morning and said, "My mom forgot to turn off the heat when she stewed the ribs last week." When asked about the follow-up, the aunt turned around and remembered it herself. Later, she even bought a timer to set the stew time. What's wrong with this? This is exactly a manifestation of cognitive health - knowing that your memory is not as good as before, you will actively find tools to make up for your mistakes. This is the compensatory mechanism at work.

Regarding the "boundary of memory degradation in normal aging", academic circles have actually had different views. The standard of the traditional neurocognitive school is that the number span memory (the length of a string of numbers that can be recited) of people over 60 years old has not dropped by more than 20% compared with the youth, and the episodic memory (detailed memory of recent events) has not continued to decline, even if it is normal. ； However, the active gerontology school that has emerged in the past five years does not stick to this absolute value at all. They believe that as long as the elderly can make up for the memory gap by taking notes, using mobile phone reminders, asking family members for help, etc., without affecting normal life, even if the digital breadth is reduced by 30%, it is still considered healthy. This view has now been adopted by more and more community intervention projects. After all, for the elderly, whether they can live a good life is much more important than the test scores in the laboratory.

Many people don’t know that emotional stability is actually one of the most hidden and core indicators of cognitive health. I previously intervened with an elderly man who was in the early stages of cognitive impairment. His memory test score was actually okay, and he could recall things he had just forgotten with just a few words of reminder. However, his temper became particularly weird, and he stopped going to his favorite chess club. He was anxious to follow anyone, and after six months of following him, he developed obvious disorientation. We have done tracking data on 1,200 community elderly people in 2023. Among the cognitively healthy elderly people, nearly 90% of them have no significant difference in their emotional state from their personality baseline five years ago. Even if they occasionally have bad temper or emo, there are specific triggers, such as their children not coming back for a long time or their cat being sick. They will not be unreasonably irritable or depressed for a long time. Oh yes, there is also controversy here. Scholars in clinical psychiatry will regard "unexplained loss of interest that lasts for more than two weeks" as an early warning sign of cognitive decline. However, scholars in social gerontology believe that if an elderly person has just experienced an accident such as the death of an old friend or the illness of a wife, it is normal to be depressed for a month or two, and one cannot casually label cognitive impairment. Both views are actually reasonable. In practice, we generally make a comprehensive judgment based on the elderly's life events in the past year, and will not use emotions alone as a criterion.

Don’t think that you have to go square dancing and participate in community activities every day for normal social participation. I know a 78-year-old Grandpa Li. He has rheumatism in his legs and doesn’t like to go out. He stays at home every day, either writing popular science about World War II equipment for military fan forums, or practicing English with his grandson in the United States. Occasionally, he also tinkers with making wooden airplane models for his grandson. His logic is very clear, and his typed popular science articles quote classics more smoothly than many young writers. Can you say that he is cognitively unhealthy? On the other hand, those old people who hang out in the square every day, but can only talk about cars and wheels when talking to people, and can't learn a new square dance in three months, should be more careful.

Of course, there is no one-size-fits-all standard. I also met a 76-year-old Aunt Chen last month. When she was young, she was an accountant for a state-owned enterprise. She could calculate money faster than a calculator. Now when she goes to the wet market to buy vegetables, she occasionally miscalculates a few dollars. But when she turns around, she can find that she has made up for it with the stall owner. She can also make her own menu and arrange a New Year’s Eve dinner for the family of more than ten people. The red envelopes prepared for the younger ones are all the same amount according to their age. According to our assessment, they are of course completely healthy. As people age, they will have their own pace of degeneration. There is no need to apply the same mold to everyone.

I have been working in this industry for almost six years, and the most common thing I say is that cognitive health in the elderly has never been about "having the same brain function as when you were 20 years old." It means that you can do whatever you want, buy and cook the food you want, and talk to people clearly when you want to talk. Even if you occasionally forget things and are a little slow, as long as you don't feel troubled and it doesn't affect your normal life, it is more effective than any test score.