The brain changes as we get older. The hippocampus takes information into short-term memory and communicates it to other brain areas for processing and long-term storage. Brain lesions often develop in the elderly causing cognitive changes as short term memory loss.

A large number of microscopic lesions in the brain are found in the elderly with memory difficulties. These memory difficulties are also evident in elderly peoples’ neuropsychological tests results.

Brain deterioration occurs in normal healthy elderly, especially in the total brain volume, loss of synaptic contacts and death of neuron cells. This physiological brain deterioration due to age can be monitored on serial MRI scans. However studies discovering this phenomenon conclude that this degeneration can rarely predict cognitive deterioration.

The cognitive changes as we get older

Since physiological brain deterioration is normal in the elderly, it is expected to be apparent as a decline of sensory processing, motor performance, and cognitive functions. The cognitive changes in the elderly are mainly attention and concentration difficulties; slower rate processing information; memory function difficulties as remembering past events but not recognizing or being familiar with recent changes in their daily life or not being able to learn, retain and use new information; and executive functioning difficulties in goal directed thought and behavior.

Some studies have found that this decline in functional cognitive brain activity in the healthy elderly includes less daydreaming while they are concentrating on performing other tasks; while other studies found the elderly show a decline in their ability to hold back from recollecting irrelevant or no longer relevant information.
Many older adults remember an event but have memory difficulties remembering the order in which things happened.

What are NOT normal cognitive changes as we age?

Mild cognitive impairment (MCI) is the phase between normal aging and early deterioration toward dementia. MCI patients often complain about memory difficulties and when tested they are found to have objective evidence of memory difficulties compared to other elderly people at the same age and level of education. Generally their cognitive function is fine and only small changes in daily living activities can be seen, they definitely are not yet suffering from the symptoms of dementia. 1%-2% of healthy elderly people will progress to dementia per year compared to 10% to 15% elderly with MCI a condition that is different from normal aging.

Dementia is a mental disorder with a severe and progressive loss of intellectual abilities to the degree they interfere with the person’s social or occupational functioning. Cognitive changes are apparent in memory, behavior (irritability, depression and abnormal appetite); personality (lack of inhibition, apathy, and lack of insight); judgment, attention (difficulties focusing and concentrating); language and communication (anomia- the inability to name people and objects; aphasia- difficulties understanding and in fluency of speech, apraxia of speech-inability to speak a previously learned language); abstract thought and other difficulties in goal directed thought and behavior. Dementia is often the first sign of Alzheimer disease.

Simple tips to keep the mind sharp

For healthy elderly who wish for a productive everyday life with full emotional and intellectual capabilities, mental stimulation and physical activity have been proven to promote preserving brain activity.

For family members who wish to help the elderly in their family keep a sharp mind, communication is essential! This communication should allow for reminiscing about the past, they have stories to tell and a need to be listened to, patiently. They should be encouraged to express their ideas and opinions rather than expected to remember the facts.

Any kind of cognitive stimulation to preserve language are useful, as reading, listening to others read to them, and communicating thoughts with a free flow of associations. The elderly still need to be treated and respected as unique individuals with their own personality preferences, and habits, and encouraged to be socially active in volunteer work or taking courses, learning for personal satisfaction.

Concerns…contact a neuropsychologist

You can contact a neuropsychologist if you or your elderly loved ones appear to have changes in the ability to concentrate; appear to take longer processing new information or have signs of memory difficulties. The neuropsychologist can assess whether these are normal age related changes. If you have concerns you would like to consult with a clinical neuropsychologist, referrals can be made from your physician, neurologist or psychiatrist.
If you observe changes in personality and behavior the neuropsychologist can assess whether these symptoms are caused by a psychiatric disorder or an age related disease.

Neuropsychologists routinely make assessments in the elderly, to determine whether or not an individual is suffering from cognitive difficulties which can cause everyday functioning problems.
These assessments are based on information from psychometric tests, the patient’s medical state and history, as well as subjective descriptions of changes in personality and behavior from family members and all these are discussed with the patient.

Neuropsychological therapies as ‘Cognitive Stimulation Therapy’ and ‘Reality Orientation’ are effective for the treatment of mild dementia, together with other rehabilitative methods can contribute to the healing process and may improve the quality of your life.

1) Markesbery WR. Neuropathologic substrate of mild cognitive impairment Arch Neurol. 2006 Jan;63(1):38-46.
2) Rossini PM. Clinical neurophysiology of aging brain: from normal aging to neurodegeneration. Prog Neurobiol. 2007 Dec;83(6):375-400.
3) Daselaar SM et al. Effects of healthy aging on hippocampal and rhinal memory functions: an event-related fMRI study. Cereb Cortex (2006) 16:1771–1782
4) Davidson PS, Glisky EL. Neuropsychological correlates of recollection and familiarity in normal aging Cognitive, Affective, & Behavioral Neuroscience 2002, 2 (2), 174-186
5) Rohrer JD, Warren JD. Phenomenology and anatomy of abnormal behaviours in primary progressive aphasia. J Neurol Sci. 2010 Jun 15;293(1-2):35-8