The term “cognitive” has been on the lips of many of us recently after the presidential debate, in which President Biden had an episode of losing his train of thought. 

The concept of cognition is very complex, even for health care professionals who study the brain. For the layperson, a simpler definition of “cognitive” is “of, or relating to conscious intellectual activity, such as thinking, reasoning, communicating, or remembering.” (Webster’s Dictionary)

Our U.S. population profile is changing rapidly among adults aged 65 and older. This group will double in the next 40 years, increasing from 40.5 million in 2010 to 88.5 million by 2050. (U.S. Census Bureau). 

This will profoundly affect our society. There will be more older adults around us, and they could have subtle to more profound cognitive changes. Some older adults will be able to manage their daily functions regardless of age, while others will require intervention by family, friends or society with protective housing.

Cognition

Our cognition is made up of many functions. Here are just a few. The information comes from Caroline Harada’s article “Normal Cognitive Aging,” published in Clinics in Geriatric Medicine, 2013. 

Memory has several parts that allow us to spontaneously pull up information with and without a clue, such as recalling names or remembering where we left something. In more severe cases the person may not recognize family members, could get lost or lose the ability to care for themselves.

Acquisition is the ability to file new information into our memory. Retention of information is usually not lost in cognitively healthy older adults. 

Our language usually remains intact. 

The ability to see and name objects remains the same until about age 70, then begins to decline. 

Executive functioning has several important parts that we need to live and function independently, plan, organize and remain flexible in our problem-solving. Motor speed testing and performance on math tests is susceptible to aging effects starting around 45 years of age.

The impaired older adult might have problems in more than one part of cognition.

Structural changes of the brain

Our grey and white matter decreases with aging. Starting at about age 20, our grey matter begins to atrophy in the prefrontal cortex. (Terry, D. and Katzman, R. in Neurobiology.) Later in life, the hippocampus and temporal lobes decrease in size. Alzheimer’s disease (AD) affects this part of the brain in the early years, and there will be beta amyloid deposits which aren’t seen in the brains of the normal elderly. 

The relationships of the rate of brain cell death, the amount of atrophy and cognitive functioning will vary widely.

What can affect cognitive changes?

A number of factors can affect our cognitive functioning either acutely or long-term. Depending on the stress to the nervous system, the person can appear to be functioning normally or exhibit transient impairment. 

Physical illnesses and chronic diseases will affect our cognition if the diseases are not controlled. Cognition usually returns when treated. Some of these conditions include diabetes, smoking, depression, obesity and obstructive sleep apnea. More short-term effects can come from excessive fatigue, respiratory infection and medication side effects. 

What can we do to maintain our cognition?

Mild cognitive changes are unavoidable and might be not recognized initially by the person. 

Various medical sites list the following preventative practices in their patient education on preserving cognitive functioning:

Limit alcohol. 

Reduce the risk of head injury.

Stop smoking and avoid air pollution. 

Manage chronic health conditions.

Practice good sleep hygiene.

Follow a good diet.

Stay social.

Get moderate exercise on most days of the week.

If you have hearing loss, wear a hearing aid when you’re out and around.

Play games that challenge your mind; try memory training.

 What can be done if there is cognitive loss?

The most important thing to do, as a family member, is to bring your concern to the family doctor caring for that individual. There are standard written tests, labs and X-rays that can be run. 

We all can have mild lapses of memory as we age. We can lose threads of a conversation or have problems with recalling information. The good news is that most of us will not experience significant losses as we age, or if we get Alzheimer’s, we can still manage our lives. At some point, performing daily tasks could be harder, but help is available at that point too.