Characteristics of cognitive health in the elderly

The core characteristic of cognitive health in the elderly is not the “comprehensive decline with age” that is generally recognized by the public, but Degenerative changes and compensatory improvements coexist, individual differences are far greater than group commonalities, and the state of social connection is far more affected than physiological aging itself. . This is the most intuitive conclusion I have drawn after working in cognitive screening and intervention work in the community for 5 years, and after contacting more than 1,200 elderly people over the age of 60, combined with nearly 10 years of follow-up research in the academic community.

Last week when I was doing free cognitive screening in the community, I came across two very interesting examples: 72-year-old Aunt Zhang, who was educated in elementary school, even thought about what she had eaten for lunch yesterday for a long time during the immediate memory test. Her score on the memory item on the scale was just above the passing line. As a result, she turned around and went to the community mahjong table. She could count the numbers and memorize the cards played by three families faster than anyone else, and she won more than 80 yuan in one afternoon. Another 70-year-old Aunt Li is a retired university professor. She got full marks on all logical reasoning and semantic memory questions. She was in a bad mood because she had an argument with her old sisters a while ago and forgot to turn off the gas while stewing ribs for three days. She was so scared that her daughter wanted to install a smart alarm for her.

The contrast between these two aunts actually breaks many people's stereotypes about old age - it seems that as people age, their brains will inevitably become "rusty". In the early years, traditional neuroscientists did place more emphasis on degenerative changes: after the age of 60, the hippocampus shrinks faster, and fluid intelligence such as processing speed, working memory, and executive function will indeed decline year by year. This is an objective fact that has been verified by countless brain imaging studies. However, the school of positive aging that has emerged in the past decade puts forward a completely different perspective: the crystallized intelligence of the elderly, that is, the experience, common sense, emotional regulation ability, and semantic memory accumulated over a lifetime will not only not decline, but will continue to rise. I looked through the latest journals a while ago and saw a study where 20-year-olds and 65-year-olds were asked to deal with complex real-life problems such as workplace conflicts and neighborhood conflicts at the same time. The solutions given by the elderly were 32% more comprehensive and more acceptable than the young people.

To use an inappropriate analogy, the brain of an elderly person is like an old computer that has been used for decades. The CPU may be a little slower, and it takes half a day to open a new software, but there are many things stored in the hard disk, and a bunch of shortcut plug-ins have been accumulated. When encountering familiar scenes, the computer runs more smoothly than a new computer. Aunt Zhang can't remember the unfamiliar phrases used during the screening, but the experience gained from playing mahjong for decades has been engraved in her mind, and there is no need to work hard to extract it. This "compensatory ability" is actually the cognitive advantage of the elderly that many people ignore: I have seen old people who can't remember shopping lists. They rely on the fixed "three-step method of touching pockets" (keys, mobile phones, cloth bags) when going out and never miss anything. ； I have also seen elderly people who cannot use smart phones, who can transfer three buses to buy cheap food at the vegetable market on the outskirts of the city by memorizing bus stops and asking passers-by.

What deserves more attention than this "falling and rising" characteristic is the individual gap in the cognitive level of the elderly, which is larger than many people imagine. There has been ongoing controversy over this data in the academic community: scholars doing epidemiological surveys used large sample data to say that the prevalence of cognitive impairment in people over 80 years old exceeds 30%, as if "old fools" are a high probability event ； However, scholars who have done long-term longitudinal tracking refute that if interfering factors such as hypertension, diabetes and other basic diseases, low education level, and long-term living alone are excluded, the cognitive decline caused by pure physiological aging accounts for less than 10%. The examples I have encountered myself are even more extreme: 92-year-old Grandpa Wang participated in the War to Resist U.S. Aggression and Aid Korea, and now writes the history of the War of Resistance on his public account every day. His accuracy in time, names, and events is better than that of many young people who do historical research. The last time I visited his house for a follow-up, he could recite the date of my last visit and said, "The last time you came here happened to be the day when my granddaughter's salary was paid, and she bought me soy pork elbows."” ； There is also a 58-year-old uncle who worked as an engineer when he was young. After a stroke, his wife left and his son lived alone in other places for three years. Now he has developed mild cognitive impairment and often forgets whether he has eaten.

In essence, "age" has never been the core yardstick of cognitive level, living status is.

Let me talk about a follow-up case that particularly impressed me: I met Aunt Chen last spring, who was 68 years old. She stayed at home for half a year after her husband left. When she came for the screening, her memory score was only 21 points (a full score of 30, a score below 24 indicates cognitive impairment). She even thought about how old she was for a long time, and her daughter was so anxious that she bought her several thousand yuan of brain replenishing liquid. We didn't let her take medicine randomly at that time. We just took her to work as a volunteer administrator at the community picture book library, reading picture books and reading things to the children who came to play every day. Only three months later, she took the test again and her score rose to 33 points (all the additional questions were answered correctly). She even remembered each child's allergy history and parents' mobile phone numbers clearly.

This is also a direction that is highly controversial in the academic world: In the early years, the biomedical school always believed that cognitive decline required standardized cognitive training interventions such as taking medicine and doing arithmetic puzzles. However, research by the social geriatric school has long verified that social connection and emotional support have a greater impact on cognitive health than any drugs or training. The elderly do not need to do those useless "brain exercises". As long as they have stable social interactions, have their own "social role", and know that they are needed, their brains will naturally stay active. Now our community intervention programs have long placed "square dancing, taking care of grandchildren, and participating in volunteer activities" as equally important as cognitive training. The actual effect is much better than pure training.

Oh, yes, there is another interesting trivia: Many people think that the elderly are "stubborn" and "cannot listen to new things". In fact, this is also related to cognitive characteristics - it is not that they cannot learn, but that the brain has accumulated too much experience in a lifetime. When encountering new information, it will automatically compare it with the old experience stored in the brain. If the old experience is more reliable, it will be too lazy to change. This is actually a cognitive resource saving mechanism, not "old stubbornness".

In fact, the longer I have been doing this, the more I feel that we should not put any unified label on the cognitive status of the elderly. Some people are still taking the driver's license test at the age of 70, and some people can't remember their home address at the age of 60. This is essentially the brain's feedback on life - if you give it fresh stimulation and stable emotional connections, it will continue to function smoothly even when it is old. How can there be any unified "cognitive characteristics of the elderly"? Every old man's brain contains a lifetime of living methods.