What are the characteristics of cognitive health in the elderly?

The core feature of cognitive health in the elderly is that it does not decline simultaneously in all dimensions, but that there is obvious differentiation of abilities. At the same time, individual differences are huge and performance fluctuations are high. It is completely different from the popular stereotype that "old people must be confused".

I have been doing elderly health services in the community for almost five years. I have seen too many elderly people in their 70s who forget their keys and forget other people’s names when they turn around. They gather at the mahjong table to count numbers and memorize cards faster than a social worker in their 20s. This is actually the most intuitive manifestation of cognitive differentiation. Those "crystalline intelligences" accumulated through a lifetime of experience, such as judgments about worldly situations, application of experience in familiar fields, vocabulary reserves, etc., as long as there is no pathological damage, can be maintained at a good level until the age of 80, and will even gradually improve with increasing experience. ； What will really cause physiological decline is the "liquid intelligence" that requires rapid processing of unfamiliar information and short-term memory. For example, forgetting the verification code you just received, or being unable to remember the functions of a new mobile phone after learning it several times. These are normal manifestations of aging, and there is no need to be overly anxious.

In addition to the differentiation of ability dimensions, individual differences in cognitive health in the elderly often exceed our expectations. The academic community has yet to reach a unified conclusion on the weight of the impact of cognitive aging. Some molecular biology studies believe that genetic factors can explain about 40% of the speed of cognitive aging. There are also 20-year follow-up cohort studies that show that acquired social frequency, brain use habits, and exercise habits have a much higher impact than genetics. Last time I met two 82-year-old men at a community free clinic, one was a retired middle school geography teacher. Every day when he went out for a walk, he brought a small notebook to record observations of plants and birds along the way. When he took the MoCA (Montreal Cognitive Assessment), he scored 28 points, which is higher than many 50-year-old middle-aged people. ； Another old man doesn't like to go out. He sits at home and watches TV every day. He can't even remember clearly when his grandson came to the house for dinner last week. His scale score is just above the borderline of cognitive impairment. It’s actually not difficult to understand. Cognitive reserve is like a “brain deposit” that we have saved for a lifetime. We use it regularly and replenish it consciously. Even if it is depleted slowly as we get older, it is still enough to cope with daily life. If you don’t like to use your brain and don’t have much social contact, and your savings are depleted quickly, you are prone to cognitive decline.

Another feature that is easily overlooked by family members is that the cognitive performance of the elderly fluctuates much more than that of the young. Last month, an aunt's daughter hurriedly asked her to come for a screening. She said that her mother had a very bad memory in the past week. She often didn't pick up the groceries after shopping. She also forgot to pick up her great-granddaughter from school, fearing that she might have Alzheimer's disease. As a result, we found out after we asked that her aunt's old sister had passed away the week before, and she had been in a very low mood. After half a month, the aunt's mood calmed down and we took the test again. The score returned to the normal range. It was just that her emotions had affected her cognitive performance. Of course, if this kind of memory decline lasts for more than half a month, and there are even problems with orientation, such as being unable to find your home or not knowing where you are at, then you should go to the hospital to check for pathological problems in time.

In fact, the cognitive health of the elderly is much more flexible than we imagine. Don’t just label the elderly as “old fools”. Instead, spend more time chatting with the elderly and encourage them to go out and participate in activities. Many elderly people can maintain very good cognitive status even in their eighties or nineties.