Characteristics of cognitive health in older adults

Cognitively healthy elderly people have three core manifestations - daily decision-making ability is not impaired, cognitive function fluctuations are in line with the physiological aging range of people of the same age, and there is no pathological decline in social function. There are obvious individual differences in other accompanying manifestations, and there is no unified standardized judgment template.

Last week I was on duty at a community geriatric cognitive screening site, and I met 72-year-old Aunt Zhang who came for a free screening. As soon as I walked in, she complained to me that she had spent ten minutes looking for reading glasses in the morning. Then she turned around and said that she had just learned a new fan dance with the dance team the day before. I still remembered that last week I made an appointment with an old colleague to go to the botanical garden next week to see the chrysanthemums. I even remembered who prepared the picnic mat. A full set of scale assessments were performed on her on site, and all indicators were within the normal range, making her a typical cognitively healthy elderly person.

Many family members always think that "the elderly have good memory and are cognitively healthy", but this is not true. There was a time when the academic community did regard "no significant memory decline" as the core criterion, but research in the past five years has generally overturned this conclusion - think about it, when a person reaches the age of 70, the activity of brain neurons will have dropped by 20% to 30% compared to when he was 20 years old. Forgetting irrelevant information is a normal manifestation of physiological aging. As long as you don't forget who you are, forget the way home, forget about the meal you just had and want to eat again and again, there is no need to be nervous. If you really have amnestic symptoms that affect your daily life, it is most likely a precursor to mild cognitive impairment. You must go to the hospital for treatment in time without delay.

Interestingly, the academic community has yet to come up with a conclusion as to whether emotional stability is a core feature of cognitive health. One group believes that emotional regulation itself is part of the cognitive function of the prefrontal lobe. If the elderly are often suspicious, anxious, and angry for no reason, it is most likely a precursor to cognitive impairment. ； The other group believes that some elderly people are naturally short-tempered and that emotions should not be used as a criterion, but rather should be considered based on past personality baselines. When we do first-line screening, we usually choose a mid-range value: If the old man's personality suddenly changes within half a year, and he used to be cheerful and now always suspects his family members of stealing his money, then no matter what the result of the scale is, it is recommended to go to the hospital for further examination.

Speaking of which, we have a little judgment method that is not included in the guide. This is to talk to the old man about his life in the past half month. If he can tell three specific happy things, including time, place and relevant people, then there will be no big problem with basic understanding. There used to be an 81-year-old man who was very hard of hearing and had to shout in his ear to talk to him. But when he talked about his great-grandson coming to celebrate his birthday last week, he could even describe the details of the little guy eating three pieces of braised pork and smearing cream on his face. The scale was indeed up to standard in all aspects.

There is also a survey conclusion that is quite counter-intuitive. Previously, the academic community has always believed that "high cognitive reserve" means that the elderly who have a high degree of education and often use their brains when they are young have a higher probability of cognitive health. However, a survey conducted by a domestic team last year on the elderly in rural areas in the central and western regions showed that many elderly people who have never read a book and have been doing farm work all their lives, as long as they have close contact with their neighbors all year round and can manage the food and drink of the whole family by themselves, have better cognitive functions than many highly educated elderly people who live alone in cities. To put it bluntly, the brain is meant to be used or lost. Whether you use your brain to read or calculate the food money at home, the difference in maintaining cognitive function is not that big.

Oh, by the way, there is another common misunderstanding. Many people think that the elderly must go out and socialize every day to be healthy, but this is not the case. We met 76-year-old Grandpa Li before. He never liked to go out. After retirement, he practiced calligraphy and played Sudoku at home. He made video calls with his old comrades twice a week. He didn’t even go to the square dance downstairs. During the screening, his cognitive function was better than that of many elderly people who run out every day. The key to determining whether it is pathological withdrawal is not the inability to go out, but "whether you suddenly don't want to do the things you liked before" - if you used to go square dancing every day and suddenly you can't even leave the house, then you have to be vigilant. If you are a homebody, then it's good to be happy as a homebody.

In fact, after all, there is no perfect template for cognitive health in the elderly. Just like the health of young people does not mean that they will never catch a cold. The elderly occasionally forget their keys or turn around and forget what they were doing. As long as it does not affect their normal life and can live according to their own wishes, it is better than anything else. If you are really unsure, go to a cognitive screening point in the community for a free assessment. Don’t just find a self-assessment form online and label the elderly as “dementia”. It is unnecessary and unscientific.