Characteristics of cognitive health in the elderly

The core characteristic of cognitive health in the elderly is by no means “linear decline with age”; Physiological decline and functional compensation coexist, individual differences are much greater than the group mean, and the influence of social support far exceeds genetic factors. dynamic equilibrium state.

I have been doing cognitive screening for the elderly in the community for almost 4 years, and the most contrasting pair of cases I have come across are two 72-year-old aunts in the same community: one is a retired elementary school Chinese teacher, who memorizes ancient poems with his grandson every day, and plays Sudoku on his tablet in his spare time. When I took the digit span test last year, I could recite 7 digits forward and 5 digits backward. This level is similar to the average of middle-aged people around 50 years old.； Another aunt has lived alone for almost 10 years, and her children are out of town. She hardly goes out except for going downstairs to buy groceries. During the screening, she even thought about what she had eaten for lunch yesterday for three to five minutes. She had to ask her again about the screening precautions she had just finished talking about. You see, at the same age, the gap in cognitive status can even be as long as 20 years. This is why the academic community has long stopped using "poor memory as you get older" as a unified standard for normal aging.

The traditional view of neuroscience once believed that after the age of 60, the rate of apoptosis of brain neurons will reach about 1% per year, and fluid intelligence, which is responsible for temporarily recording new information and processing unfamiliar tasks, will definitely decline.； However, the active gerontology school that has emerged in the past decade has produced completely opposite tracking data: the crystallized intelligence of the elderly, which is formed by a lifetime of experience and knowledge accumulation, will not only not decline, but will even rise steadily, which can completely compensate for the lack of fluid intelligence. I once met an 81-year-old retired electrical engineer who is still working as a technical consultant for his old company. It takes ten minutes to look for reading glasses every time. Sometimes he forgets what he wants when he enters the room. But when he picks up the circuit diagram and glances at it, he can immediately point out where the wrong parameters are calculated. Even if the young man calculated the results for a long time with a calculator, he can give an approximate value with just a few words, and he is absolutely accurate.

Oh, by the way, many people think that cognitive degeneration is innate. After all, the high-risk gene apolipoprotein E4 does increase the risk of Alzheimer's disease by 3 to 5 times. However, the national survey data on cognitive impairment in the elderly released by Peking Union Medical College in 2023 is very Meaning: If an elderly person who carries this high-risk gene can have more than three social activities per week and has a hobby that persists for more than one year, the risk of cognitive impairment is 37% lower than that of an elderly person who does not carry the high-risk gene but lives alone for a long time and has almost no social interaction. I have been tracking the elderly choir in our community for almost 2 years. The average age of the 32 elderly people in the group is 76. The cognitive screening score last year was 2.3 points higher on average than in 2021. Not to mention a decrease, it has actually increased. This is because they rehearse twice a week and go out to perform during holidays. Their brains are moving and people are chatting, so their status naturally improves.

Nowadays, many people have misunderstandings and believe that "exerting their brains can prevent dementia." They even enroll the elderly in a bunch of mental training classes, forcing them to memorize vocabulary words and do Mathematical Olympiad questions every day. In fact, there have been different opinions in clinical practice: If you deliberately train your brain with the pressure of "must get better", it will actually cause anxiety in the elderly. Long-term sleep problems and emotional stress will accelerate cognitive degradation. I met an old man last year. His children heard that playing mahjong can prevent dementia, so they forced him to go to the mahjong parlor and sit for four hours every day. The old man didn’t like playing cards, and it was like sitting on pins and needles. Three months later, when he went for a screening test, his score dropped by 4 points. Later, the old man changed back to going to the park every day to play Tai Chi and talk about current affairs with his old friends. After half a year, his score went back up.

There is another hidden feature that many family members fail to notice: Signs of cognitive decline in old age are particularly easy to confuse with normal aging. Many people think that it is normal for the elderly to be unable to remember recent events, but clearly remember events decades ago. In fact, this is often an early sign of mild cognitive impairment (MCI) - the poor memory of normal aging is "all-dimensional". For example, you cannot remember what you ate yesterday, and you will also be confused about the specific years when you were an educated youth in your youth. However, if your long-term memory is unusually clear and your recent memory has declined off a cliff, it is best to go to the hospital for a special screening and do not take it seriously.

In fact, after having been in this field for a long time, I feel that there is no unified "standard of excellence" for cognitive health in the elderly. It does not mean that you have to memorize the last hundred digits of pi at the age of 80 to be considered healthy. As long as the elderly can take care of their own lives, have things they are willing to do, have companions they can talk to, and live a solid and happy life every day, this is the best cognitive state. After all, our original intention of doing cognitive screening and early intervention is not to make the elderly "reverse growth", but to help them live their lives comfortably.