Normal Cognitive Changes in the Elderly

Normal Cognitive Changes in the Elderly

By Alexander Slesarenko

Aging is an inevitable process of human life and should not scare us. Normal aging is natural and starts from birth, giving us a lot of opportunities to live a happy and healthy life to prevent early physical and mental illnesses. That is a goal. The longer we are staying healthy despite of aging, the more we can enjoy this pretty good thing called life.

Nevertheless, we can notice some cognitive changes even during normal aging and we should know about them to differentiate normal processes from pathology, to recognize some warning signs and symptoms and to be ready to prevent/alleviate them.

Despite the inevitability of the changes while aging, they should not significantly impair daily functioning of the person, such as self-care, everyday activities, managing finances, medication, and self-management. However cognitive changes do.

Cognitive symptoms are explained by anatomic and physiologic changes in the brain, which influence our health and behaviour

What are those anatomic and physiologic processes, that we are talking about?

First, there is a progressive decline in brain volume. The volume of fluids in brain cells decreases, the protective myelin shells of the neurons become thinner, and cells move closer to each other, leading to shrinking of the brain tissue. The greatest changes usually affect the Frontal and Temporal Lobes of the Cerebrum and white matter is affected more than grey matter.

Second, the blood flow to the brain is decreased. The cause of this is the narrowing of blood vessels due to deposition of cholesterol plaques inside the lumen and loosening of the elasticity of the vessels with aging. Chronic hypertension, anaemia, and metabolic disorders, like diabetes could significantly complicate the process of blood supplying the brain. This is called “ischemia” – the deprivation of cells from the lack of oxygen and nutrients which leads to the decline of their functioning.

And the last, levels of main chemical substances in the brain, called neurotransmitters, are also decreasing. Those neurotransmitters (Dopamine, Serotonin, etc) are responsible for quick impulse transmission between nerve cells and between nerve cells and other cells in different parts of the body. For example: our gait is regulated from the brain and most problems with the gait relate to slow or impaired neuro-muscular transmission.

Keeping this information in mind, let’s consider how it will influence the neurocognitive functions:

There is no doubt that the above can affect the person’s reaction time and psychomotor skills. The older person will slow down in moving, and the normal voluntary and unvoluntary reactions will slow and more time will be required for performing even routine tasks.

It will also affect the person’s memory and we will notice decline in semantic memory (difficulty with language, understanding of the meaning of some words), and episodic memory (forgetfulness of some past events). However, it is very important to know, that the nondeclarative memory, what is the previously learned skills, does not significantly decline with aging and if this happens it could be the sign of disease-free cognitive aging.

Unfortunately, even normal aging can be followed by loss of attention and concentration. It is usually expressed in the decline of multitasking abilities, ability to plan and solve problems. Decline in verbal fluency and naming objects, as well as problems with recognition of some visual objects, are also common.

All the described symptoms makes the aged person more vulnerable and dependent, however, in contrast with the symptoms of brain disorders such as dementia, do not limit them from participating in a broad spectrum of activities and continue to have a fulfilling and enjoyable life.

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