Characteristics of cognitive health in older adults include

The core characteristics of healthy elderly cognitive status are concentrated in three dimensions - "functional adaptability", "fluctuation controllability" and "reserve compensability". There is no absolute health criterion that "completely benchmarks the cognitive level of young and middle-aged people".

Last month, I met 72-year-old Aunt Zhang while doing a cognitive screening on the street. When she filled out the standardized memory scale, she couldn’t even remember the address of the community convenience sampling point that she had just changed last week. She was so anxious that she said she was “confused”, but she turned around and could tell Tang poetry to the children in the community summer care class for two hours straight. She even remembered the creative background of each poem and the little joke about the students who secretly corrected their homework when she was teaching. Regarding the determination of this situation, there have been different voices in the academic community: the traditional school of thought that insists on neuropsychological measurement scores believes that as long as the test scores of short-term memory and executive function are lower than the norm threshold for the same age, it is considered cognitive abnormality. ； The functional school that has emerged in recent years advocates that all assessments should be anchored in the real life scenarios of the elderly. People like Aunt Zhang, who can take care of their own lives and stably output social value, but cannot remember information that is useless to them, are completely within the normal scope of healthy aging - this is what we call "functional adaptability". The cognitive level does not need to be high, as long as it can match their own life needs.

You can think of the cognition of an elderly person as an old mobile phone that has been used for decades. It does not have to run the latest large-scale games. As long as the common functions such as watching videos, making phone calls, and paying bills can be smooth, even if it occasionally loads slowly, it will not affect its use at all.

In addition to whether it can adapt to one's own life, there is another point that is easily overlooked by everyone, which is whether the fluctuations in cognitive status are controllable. Last year, a 68-year-old Uncle Li was brought to the screening by his children. He said that he had often forgotten to turn off the fire in the past two months, and even threw away his wallet when he went out to throw garbage bags. He was suspected to be a precursor to Alzheimer's disease. After I asked a few questions, I found out that his wife had just undergone breast cancer surgery a while ago. He stayed with her in bed during the day in the hospital, and made soup for her when he came home at night. He worked continuously for almost a month and slept less than 4 hours a day. Later, my wife was discharged from the hospital to recuperate for half a month. Uncle Li came to see me again, still clutching the Xinjiang self-driving tour guide he had just made. He knew the route planning and budget for food and accommodation better than the young people. How could he show any signs of cognitive abnormality?

A different clinical point of view should also be mentioned here: some institutions that focus on early screening will advocate that intervention should be carried out immediately as long as transient forgetfulness and inattention occur to avoid progression to irreversible cognitive impairment.； However, most of our front-line clinical interventionists will recommend that we first investigate the triggers. Fluctuations like this, which have clear stressors and can return to normal after such stress events, are actually signs of health. On the contrary, excessive intervention and labeling the elderly as "dementia precursors" can easily lead to sustained cognitive decline.

Another very interesting feature is that healthy old age cognition often comes with a "filling buff", which is what academic circles call compensatory reserve. I have met 78-year-old Grandpa Wang before. After a stroke, his left temporal lobe was slightly damaged. His speech was often stuck and he couldn't remember the words he wanted to say. At first, his children were afraid that he was suffering from cognitive decline. However, after observing him for half a year, they found that when he couldn't remember how to say "soy sauce", he would point directly in the direction of the kitchen, or The reporter took out the small cards he drew and showed them to his wife. He did not miss out on grocery shopping, settling accounts, or playing chess with his old comrades. In order to make up for his language shortcomings, he even learned simple drawings. When he played with his grandson, he could also draw small animals for his children. His life as a child was more fulfilling than before the stroke. The traditional view is that the nerves of the elderly are not plastic, and cognitive degradation can never be repaired. However, research in recent years has long proven that as long as the elderly are willing to actively mobilize other functional areas of the brain, they can completely make up for the lack of a certain function, which is also a core sign of cognitive health.

I have been doing community cognitive intervention for almost 6 years, and I have seen too many children use the online "10-question self-assessment for Alzheimer's disease" to score the elderly. If they make two mistakes, they will be scared to death. They insist on taking the elderly to undergo various expensive examinations, which in turn causes great psychological pressure on the elderly. In fact, there has never been a standardized answer to the cognitive health of the elderly. When people get older, their hair will turn gray, their legs and feet will become weak, and it is normal for the brain to occasionally have problems such as "not being able to move" and "cannot remember". As long as life goes smoothly, you can do whatever you want. Occasionally forgetting keys or being unable to remember new mobile phone operations is really not a big problem.