Is your Cognitive Ability declining with Age?

Cognitive abilities are the mental skills that we need to carry out any task from the simplest to the most complex.

Mental skills include

• Awareness

• Information handling

• Memory and reasoning

Our cognitive abilities start deteriorating as we age!!

• Cognitive decline is a normal part of ageing process.
• Few people will also feel a severe deterioration in cognitive skills, leading to various disorders.

• Cognitive ageing dissolves  the fact that there are more or less successful trajectories of cognitive change as people grow older.
•  Identifying the risk factors responsible, and mechanisms of, individual differences in age-related cognitive decline is amongst the greatest challenges to improving the health of older people.

Definition

• Cognitive aging is a process of ongoing, gradual, yet highly variable changes in cognitive functions that occur as people get older.
• Cognitive aging is a lifelong process and it is not a disease or a quantifiable level of function.

In the context of aging,

• cognitive health is exemplified by an individual who maintains his or her optimal cognitive function with age.
• Cognitive ageing is complex
• There is little age-related decline in some mental functions—such as vocabulary, some numerical skills, and general knowledge but other mental capabilities decline from middle age onwards, or even earlier.

• The latter include aspects of memory, executive functions, processing speed, reasoning, and multitasking.
• All of these mental functions are critical for carrying out everyday activities, living independently, and for general health and wellbeing.

There are three more findings that are striking.

• Firstly, different aspects of age-related decline occur together.

• Secondly, slow the speed of information processing accounts for a large proportion of age-related decline in all cognitive domains.
•  This slowing of the speed of brain processing begins from young adulthood.

• Third, the ability to schedule and undertake multiple everyday activities appears to be sensitive to ageing, and particularly striking impairments in dual-tasking or multitasking appear to signal the onset of dementia.

Symptoms

• Our brain changes as we grow older.
• People may notice slowly increasing memory loss as they age.
• It also take longer to think of a word .
• Increasing concern about our mental performance suggest mild cognitive impairment (MCI).
• Cognitive issues may also give us symptoms like
• We start to have trouble finding our way around familiar environments.
• Also, we become more impulsive or show increasingly poor judgment.
• Forgetfulness.
• Also, our train of thought or the thread of conversations, books or movies.
• We feel overwhelmed by making decisions, understanding instructions, planning steps to accomplish a task.
• Some changes are easily noticeable like
• Anxiety
• Apathy
• Depression
• Irritability and aggression

Diseases and Disorders linked with cognitive ageing

• Our size  of the brain decreases with age. Not all brain areas develop atrophy equally with aging, but both gray and white matter regions are affected with aging.

•  Gray matter volume loss is most prominent in the prefrontal cortex.

• A class of psychological disorders characterized by impairment in cognitive abilities .Cognitive disorders are not psychologically based

• They are either caused by physical or medical conditions, including drug use or withdrawals, which affect the functioning of the brain

• Degenerative dementias are the most common cause of significant late-life cognitive decline.

• Alzheimer’s disease is the most common cause of cognitive decline in older adults.

• The prevalence of clinically diagnosed AD increases with age. At age 65, less than 5% of the population has a clinical diagnosis of AD, but this number increases to more than 40% beyond age 84

• Cellular mechanisms of neurodegeneration and neuroplasticity have been proposed and are being actively investigated.
• Microvascular ischemia, apoptosis, inflammation, oxidative stress, excitotoxicity, are a common mechanism of neurodegeneration.

Agnosia

•  A disturbance of sensory perception which  affects  visual perception.
• People suffering from  cognitive disorders may become completely dependent on others to meet basic needs in feeding, toileting etc

Dementia Senile dementias

• Forms of dementia that begin after age 65.

• Presenile dementias: Dementia that begin at or before age 65.
• Although the risk of dementia is greater in later life,it  is not a consequence of normal aging rather a sign of a degenerative brain disease, such as Alzheimer’s disease.

Delirium  

• A state of mental disorientation, , confusion, and inability to focus attention.

Amnestic Disorders

• It is characterized by disturbances of memory linked with inability to learn new material or recall past events.
• Amnestic disorders follow a traumatic event, like a  blow to the head or an operation, , an electric shock.

Korsakoff’s syndrome

• Its a syndrome linked with chronic alcoholism that is characterized by memory loss and disorientation .
• People suffering from  Korsakoff ’s syndrome have major spaces/gaps  in their memory of past experiences. Memory deficits are said to be a  result from the loss of brain tissue due to bleeding in the brain.

Anxiety Disorders and Aging

•  Anxiety disorders occur at any point in life.
• Anxiety disorders are the  psychological disorders among older adults which are very common .
• Around  1 out of  10 adults over the age of 55 years  suffering from a diagnosable anxiety disorder

Ideologies

• Various factors have been stated to influence cognition .

Examples include lifestyle, endocrine, and genetic factors, and medical and surgical treatments for disease systemic diseases, neurotoxic exposures.

• Variety of lifestyle factors affect cognitive function.

Such factors may effect cognition by exerting biological influence on the brain or by promoting various systemic diseases (e.g., cardiovascular, pulmonary) that indirectly affect the brain.

• Less healthy lifestyles tend to aggregate among individuals with lower levels of education .

Examples of such include smoking, dietary factors, and physical inactivity, excessive alcohol consumption, illicit drug use etc.

Common causes of cognitive disorders or impairment in older adults

• Many medicines may interfere with proper brain functioning . Like sedatives, tranquilizers, and anticholinergic medications are the most common medicines.

• Metabolic imbalances refer to abnormalities in one’s blood chemistry.Examples include abnormal levels of blood sodium, calcium etc.Kidney or liver dysfunction can also cause certain types of imbalances, and these affect brain function.
• Problems with thyroid hormones.Imbalances in estrogen ,other sex hormones also affect cognitive function.
• Deficiencies in vitamins ,core  nutrients.Brain function is affected by low levels of vitamin B12 and folate.

Important factors that cant be ignored

• Genetic factors  predispose individuals to systemic diseases and influence numerous biological variables that can affect cognitive performance.
• One of those factors that  has received much attention is apolipoprotein E (APOE) polymorphism.
• Although most commonly examined in relation to dementias, the presence of one or two APOE-ε4 alleles has linked with poorer cognitive function.

Neurotoxicity

• Environmental and  occupational exposure to chemicalslike  solvents and lead, exerts direct neurotoxic effects on the brain and is linked  with poor  cognitive functioning
• Both high  exposures and chronic  low-level exposures are of concern.
• Individuals of lower socioeconomic status are  likely to experience neurotoxic exposures.

• Systemic Diseases have been linked with poorer cognitive functioning. Examples like cardiovascular diseases, such ass high BP and myocardial infarction, pulmonary diseases  such as chronic obstructive pulmonary disease .
• Also variety  of medical and surgical treatments for disease have been shown to impact cognitive performance.

Cardiovascular diseases are  the leading causes of death in the United States as its  affecting one in every five individuals (AHA)and also conferring substantially elevated risk for stroke and vascular dementia.

• However, before the development of cerebrovascular complications, even early manifestations of cardiovascular disease like  hypertension, are linked  with diminished cognitive function.
• The relation of hypertension with  cognitive function has been studied for over 40 years
• Results of numerous case-control and cross-sectional, population-based studies conclude  that hypertensives generally perform poorly  than normal bp people  across various areas  of cognitive function,like  learning and memory, attention, abstract reasoning and other executive functions, visuospatial, visuoconstructional etc

Assessment

Cognitive aging is not easily defined by clear thresholds on cognitive tests since many factors like culture, occupation, education, environmental context, and health variables (e.g., medications, delirium) influence test performance .

For an individual, cognitive performance is best assessed at  various points in time.

For assessing we can include the following pointers:

1. First we need to ask about and document the patient’s concerns about his  memory and  thinking.

2. Then we must obtain or request information on memory or thinking difficulties from family members.

It’s necessary for the health provider to be diplomatic about requesting and getting information from family members, especially if the older person finds it upsetting.

Family members can facilitate this process by bringing in a written summary of what difficulties they’ve observed. Be sure to include information on when the problems started and whether they seem to be getting worse.

3. then we need to ask  about difficulties in  managing instrumental activities of daily living (IADLs) .

Instrumental activities of daily living (IADLs)  are often affected by cognitive impairment.

So it’s important to ask if the older person is having difficulty with problems with works  such as:

• Managing the telephone, the mail, and other forms of communication
• Medication management
• Driving and other forms of transportation
• Management of finances
• Grocery shopping and meal preparation
• Home maintenance

We  should also ask about ADLs, which are the more fundamental self-care tasks like  walking around, feeding oneself, getting dressed, managing continence.

Difficulties with IADLs and ADLs (which geriatricians refer to as “functional impairment”) are important to document.

Then we need to check for the presence of other behavioural, mood, and thinking symptoms that are related to certain causes of cognitive impairment.

These include:

• Personality changes
• Apathy (losing motivation)
• Depression symptoms
• Hallucinations
• Delusions
• Anxiety symptoms
• Getting lost
• Confusion about visual-spatial tasks (e.g. having difficulty figuring out how to put on one’s shirt)

5. We need to ask about any new symptoms or changes in physical health.

It’s especially important to ask about symptoms related to neurological function, such as new difficulties with walking, balance, speech, and coordination

6. We need to ask about substance use and consider the possibility of substance abuse.

Excessive use of alcohol, certain prescription drugs (such as tranquilizers), or of illicit drugs can affect cognitive function. Health providers should inquire about an older person’s use of these substances.

7. it is needed to review all the medications, with a focus on identifying those known to worsen cognitive function.

Certain kinds of medications tend to impair  brain function  and may cause a noticeable worsening in cognitive abilities.

8. Perform a physical examination.

The health provider should check vitals (blood pressure and pulse) ,should also complete a basic neurological evaluation, including an observation of the person’s gait, balance, and coordination.

Impact on our daily lives:

• Daily functions like   driving, making financial , health care decisions, and understanding instructions given by health professionals, may be affected.
• Experience, expertise, and environmental support can help to compensate for declines in cognition.

• The obstacles of cognitive aging may be more apparent in environments that require individuals to engage in highly technical and fast-paced tasks, in situations that involve new learning, and in stressful situations.

Prevention or how we can manage ?

• Individuals of all ages including their families should take  appropriate actions to maintain and sustain their cognitive health.
• Specifically, individuals should be physically active,reduce and manage cardiovascular disease risk factors (like  hypertension, diabetes, smoking).
• Also we need to regularly discuss and review health conditions and medications that might influence cognitive health with a health provider.

In addition, we must take additional actions that may promote cognitive health, including

• Being socially and intellectually engaged.
• Getting adequate sleep and receiving treatment for sleep disorders if needed.
• Taking steps to avoid the risk of cognitive changes ,
• Carefully evaluation of products advertised to consumers to improve cognitive health, such as medications,  cognitive training etc.

• Also by conducting the multicomponent clinical trials of various  interventions to promote cognitive health and also to  prevent cognitive decline.
• Assessing of cognitive outcomes in clinical trials that target the reduction of cardiovascular and other risk factors linked with  cognitive health.
• Explore older adults’ likes and dislikes  and values regarding cognitive health and aging.
• Identify effective methods  to sustain the behavioural  changes that promote healthy cognition across the life .

Also, there are natural remedies that we can start doing:

• Scientists like Stough and Pase’s laboratory has  stated  the effects of multivitamins on cognitive performance, and found improvements in one kind of verbal memory — but no other forms of cognitive enhancement.
• Another study found moderate improvements in recall over six years, while yet another found no effect on cognitive decline over 12 years.
• The B vitamins are also important  because these  lower vitamins  levels of homocysteine, an amino acid linked to dementia.
• 1 study showed that B vitamins slowed the rate of brain atrophy by 27 percent and also slowed cognitive decline in adults with little impairment.

• But a large study found no effects in adults without cognitive impairment.
• Polyphenols  are compounds found in many foods, including cocoa, tea and coffee, onions, apples, berries.
• Many are considered healthy because they appear to scavenge for harmful free radicals, and to improve vascular health .

• In a study  which shows that polyphenol which is extracted from bark of pine which  found improvement in working memory and also  a decrease in oxidative stress.

• Some studies have also stated that dark chocolate improves our  cognition .
• Fish  like mackerel and salmon  are rich  in certain Omega-3 fatty acids, which play an important role in regulating the cell function and inflammation.
• Few studies have also shown that Omega-3 can slow down the rate of cognitive decline.

It is very  important to understand how cognition changes with age, given our growing elderly population and the importance of cognition in maintaining functional independence and effective communication with others.

• Measurable changes in cognition occur with the normal aging.
• The most  noticing  changes are declines in cognitive tasks that require one to quickly process information to make a decision, including measures of speed of processing, working memory, and executive cognitive function.

• Healthy  lifestyle factors may include physical activity, mental stimulation, avoiding excessive exposure to neurotoxins (e.g., alcohol), treating depression and managing stress, and controlling common medical conditions such as diabetes, and obstructive sleep apnoea, hypertension.
• Thus, we may already hold the keys to driving a successful campaign to minimize the detrimental impact of age on cognition and to delay the onset of dementia in the elderly.