Characteristics of cognitive health in the elderly are

The core characteristic of cognitive health in the elderly has never been “not confused at all and their memory is as good as that of young people”; The speed of cognitive decline matches biological age, the preservation of daily functions is sufficient to support independent life, and the state of emotional and social connection is stable. . This is the most intuitive conclusion after I have done five years of health follow-up in the cognitive impairment clinic of a tertiary hospital and seen the cognitive status of nearly a thousand elderly people.

The 72-year-old Aunt Zhang, who just completed the follow-up visit last week, has recently been complained by her daughter that her "memory is getting worse and worse": when she goes out to buy soy sauce, she will occasionally bring back a bottle of vinegar. She can't remember the names of the dishes at last week's family dinner. Sometimes she even boils water to water the flowers on the balcony, only to remember that the stove is still on after ten minutes. My daughter was afraid that she was a precursor to Alzheimer's disease, so she forced her to have a check-up. After a full set of cognitive tests, all indicators were within the normal range for the same age group.

Many family members have this misunderstanding, thinking that as long as the elderly forget things, there is a "brain problem." In fact, according to clinical standards, as long as this kind of "forgetting" does not really cause danger and does not affect normal life, it is completely healthy. For example, although Aunt Zhang occasionally forgets to boil water, she always checks the stove before going out. She cannot remember the dishes for the dinner, but she remembers to bring steamed buns to her old colleague who lives alone downstairs. This situation is completely fine.

Judging from the conclusions of neurobiological research, after the age of 60, the hippocampus, which is responsible for storing short-term memory, will naturally shrink by about 1% every year. The decline of episodic memory such as names and specific events is a normal physiological process, just like the skin will loosen as you get older, and the legs and feet will get sore when going upstairs. It is normal. The current academic consensus on normal cognitive aging is that as long as the rate of decline does not suddenly accelerate, for example, if you can go to the bank to do business on your own in the first half of the year, but cannot even remember the bank card password in the second half of the year, there is no need to be overly nervous.

However, if you attribute all factors affecting cognitive health to physiological aging, scholars who study the sociology of aging will be the first to disagree. I have seen too many elderly people with so-called "poor memory". It is not brain degeneration at all, but "use it or lose it" caused by no one communicating for a long time and too little information input. There was a 76-year-old Uncle Li who stayed at home for half a year after his wife left. He couldn’t even remember the names of his neighbors. When his family brought him for a checkup, they thought he had early-stage dementia. However, the community later persuaded him to join the choir. He had always loved singing. After half a month of joining, he could recite the entire lyrics of "Song of the Yangtze River" better than a twenty-year-old boy. After three months of follow-up, his cognitive assessment scores continued to rise. The sociological school's view is very practical: in many cases, it's not that the old man's cognition is failing, it's that there are no things in his life that require him to use his cognition. Sitting at home and watching TV every day, his brain will naturally "rust" quickly.

By the way, here is a point that is still debated in academic circles: Should we give excessive mental training to healthy elderly people? There is a group of cognitive neuroscientists who believe that doing more arithmetic problems and memorizing words can exercise brain function and delay decline. ； However, doctors from another school of geriatric medicine believe that this kind of "brain training for the sake of brain training" behavior will cause psychological stress to the elderly and is not conducive to cognitive health. I have encountered such an example. The 74-year-old Uncle Wang was enrolled in three online brain training classes by his son. He had to do 20 logic questions and memorize 10 English words every day. Within two months, Uncle Wang suffered from insomnia and anxiety. To be honest, for the elderly, doing what they like is the best mental exercise. When playing chess, you need to remember the steps, when fishing, you need to observe the fish float, and when chatting with the old friend, you need to pick up the lines. Which one does not require using your brain?

I sometimes compare the cognitive system of the elderly to an old mobile phone that has been used for more than ten years. You cannot ask it to open all the apps in seconds like a new mobile phone, and have more than a dozen programs running in the background without being stuck. As long as it can answer calls normally, scan the health code, pay for groceries, and occasionally open a large software and be stuck for a few seconds, then exit and restart it, then it is a useful mobile phone. There is no need to forcefully install the latest system and clear the background every day, which will easily crash.

After doing follow-up visits for so many years, what annoys me the most is that family members use the standard of 20 or 30 years old to ask the elderly to improve their memory, and they have to force the elderly to have "smart brains" to be considered healthy. In fact, for the elderly, it is not a big problem to be able to buy and cook their own food, chat with their old friends, and remember the things they love to do. Occasionally they forget something or make a mistake. To be honest, it's not that my memory is poor, it's that I've lived a lifetime and know which trivial things are not worth keeping in my mind.