It’s annoying but unfortunately true: most parts of the body work less well as one gets older and older.
This is even true of the brain, which is part of why it becomes more common to experience a “tip of the tongue” moment as one gets older.
Such age-related changes in how the brain manages memory, thinking, and other mental processes are called “cognitive aging.”
Understanding how aging changes cognition is important. It can help you understand what to anticipate when it comes to your own aging. It can also help families better understand the changes they’re noticing in an older person, and whether those are out of the ordinary or not.
Since I’ve often written about changes in thinking that are abnormal and concerning in older adults, I thought it might be helpful for me to write an article outlining what is normal and to be expected.
Specifically, I’ll cover:
- How cognitive aging differs from other diseases and conditions that affect memory and thinking
- 6 ways that memory and thinking change with aging
- The difference between crystallized and fluid intelligence
- How to tell cognitive aging apart from more worrisome changes
- Practical takeaways and what you can do
Now, I’ll be frank. As you’ll see, most mental processes become less nimble with time. Just as your 75-year-old self can’t run as fast as your 30-year old self, your 75-year-old brain will, for the most part, not think as quickly either.
This can be discouraging news to many people. Which means they might feel reluctant to learn more about this.
But the news is not all bad. Yes, things tend to work a little slower and less well, but on the other hand older adults can often compensate by drawing on their experience. Cognitive aging also helps older adults become more optimistic and emotionally resilient, as I explain later in the article.
By better understanding cognitive aging, you’ll be better equipped to understand the older adults in your life, whether that is yourself or an older loved one.
How does cognitive aging differ from a disease or more concerning changes in mental function?
People sometimes have trouble understanding how cognitive aging is different from something more concerning, such as mild cognitive impairment, early Alzheimer’s disease, or other memory-related conditions they may have heard about.
A good explanation of the difference is available here, in the Cognitive Aging Action Guide published by the National Academy of Medicine (formerly the Institute of Medicine), which issued a fantastic report on cognitive aging in 2015.
Basically, cognitive aging is the brain’s version of your body parts working less efficiently due to age, rather than due to disease or serious damage.
This loss of efficiency is gradual. And like many other age-associated changes in the body, cognitive aging tends to happen a little differently for every person, in part due to things like genetics, lifestyle and environmental factors.
But it’s not a disease. Very importantly: cognitive aging doesn’t involve neurodegeneration or significant damage to the brain’s neurons.
So whereas Alzheimer’s disease and other conditions cause neurons to become badly damaged and eventually die, in a normal older person with cognitive aging, the brain’s neurons are basically ok, they’re just working less quickly and less well than earlier in life.
Although cognitive aging does cause certain mental processes to happen less quickly, normal cognitive aging should not impair an older person’s abilities to the point that they are visibly struggling with life tasks or no longer able to live independently.
6 Ways that Memory and Thinking Change With Aging
People often think of memory when they think of cognition or “brain function.” But there’s actually much more to thinking and the brain’s work.
Here are six key ways that cognition changes with aging.
Processing speed
What it is: This refers to how quickly the brain can process information and then provide a response, such as making a movement or providing an answer. Processing speed affects just about every function in the brain. Processing speed in of itself is not a specific mental task, it’s about how quickly you can manage a mental task.
How it changes with aging:
- Processing speed decreases with age, with one expert describing it as a nearly linear decline.
- This decrease starts in early adulthood, so by the time people are in their 70s or 80s, processing speed is significantly down compared to the speed one had in one’s 20s.
Practical implications:
- Older adults need more time to take in information and to formulate an appropriate response, compared to their younger selves.
- Some older adults may struggle with complex tasks that require a lot of quick information processing.
- Driving, in particular, can be affected by slower processing, because driving requires the brain to keep noticing and processing a lot of information while quickly formulating appropriate responses.
Memory
What it is: This is a broad category covering the ability to remember information. Key sub-types include:
- Working memory
- This refers to the ability to temporarily hold information in mind and manipulate it mentally, like remembering a new phone number and then dialing it.
- Working memory is involved in a variety of mental tasks, including problem-solving, making decisions, and processing language.
- Semantic long-term memory
- This refers to factual information that you acquire over time, such as the name of a state capital.
- Episodic memory
- This refers to one’s memory for personally experienced events that have happened at a particular place or time.
- Prospective memory
- This refers to the ability to remember to do things in the future.
- Procedural memory
- This is also known as skill learning. It refers to the learning and remembering how to do certain activities.
- It usually requires time and practice to build up.
Memory is actually a complicated topic, one can identify many other subtypes and experts are also still debating just how to categorize and explain the many different ways that people remember information or how to do things.
It’s also technically a different task for the brain to create a memory (this is sometimes called encoding) versus to retrieve it. So a person may have trouble remembering something either because they had difficulty encoding it in the first place, or because they are having difficulty promptly retrieving it.
How memory changes with aging: Many aspects of memory do decline with age, but not all:
- Types of memory that decline:
- Working memory
- Episodic memory (especially for more recent events)
- Prospective memory
- Types of memory that stay stable
- Procedural memory
- Semantic long-term memory (may decline after the seventh decade)
Practical implications:
- Normal older adults are generally good at retaining information and memories that they’ve previously acquired, but they can take longer to retrieve them.
- The ability to perform well-learned procedures (e.g. typing) remains stable. However, older adults often need more time and practice to learn a new procedure and create the procedural memory.
- Declines in working memory mean that older adults may take longer or have more difficulty solving complex problems or weighing complicated decisions.
- Declines in episodic memory may cause older adults to be a little more forgetful, especially for recent events.
- Declines in prospective memory can make older adults more likely to forget something they were supposed to do.
- It can help to give older adults more time and support to actually encode information into their memories. This requires processing time and also adequate attention (see below).
Attention
What it is: Attention is the ability to concentrate and focus on something specific, so that the related information can be processed. Key sub-types include:
- Selective attention
- This is the ability to focus on something specific despite the presence of other distracting and “irrelevant” information or stimuli.
- Examples: spotting the relevant information on a cluttered website, following a conversation despite being in a busy environment.
- Divided attention
- Also known as “multi-tasking,” this is the ability to manage multiple tasks or streams of information at the same time.
- Examples: reading a recipe while listening to music, driving while talking to someone.
- Sustained attention
- This is the ability to remain concentrated on something for an extended period of time.
How it changes with aging: Some aspects of attention do get worse with aging. Specifically:
- Selective attention gets worse with aging.
- Divided attention gets worse with aging.
- Sustained attention does not tend to get worse with aging.
Practical implications:
- As people get older, they are more easily distracted by noise, visual clutter, or a busy situation. It requires more effort for them to pay attention, especially when other things are going on.
- People will also get worse at multi-tasking or switching between tasks, as they get older.
Language Skills
What they are: Language skills cover a variety of abilities related to understanding and producing both verbal language and written language.
How they change with aging:
- Vocabulary tends to remain stable with aging.
- The comprehension of written language tends to remain stable.
- Speech comprehension can decline with age, especially if the older person has any hearing difficulties or if the speech is rapid or distorted (because such speech requires more mental processing).
- Language production does decline with age. Examples include:
- More time is needed to find a word, and it becomes more common to pause in the middle of a sentence.
- Spelling familiar words may become more difficult.
- The ability to name a common object tends to decline after age 70.
Practical implications:
- Normal older adults retain their vocabulary and ability to comprehend written language.
- They may struggle with understanding rapid speech or distorted speech (such as that broadcast by a loudspeaker or synthetic voice).
- Retrieving words often takes longer.
Executive Functioning
What it is: This refers to the mental skills that are needed for activities related to planning, organizing, problem-solving, abstract thinking, mental flexibility, and appropriate behavior. Executive function allows people to do things such as:
- Solve new problems
- Organize information and plan activities
- Think abstractly
- Use reason (especially when it comes to reasoning with unfamiliar material)
- Adapt to new situations
- Behave in socially appropriate ways
- Make complex decisions
How it changes with aging: Executive function generally declines with age, especially after age 70.
Practical implications:
- Normal older adults generally can perform the executive functioning tasks listed above, but they will not do them as well as when they were younger.
- Older adults may struggle or take more time for more demanding executive functioning tasks, especially if they are tired or otherwise cognitively feeling taxed.
Emotional Processing
What it is: This refers to the ways one processes and regulates emotions, especially the negative ones. Examples include:
- How quickly one moves out of a negative emotional state
- How physically or emotionally reactive one is to interpersonal stressors
- Mental strategies for minimizing negative stimuli, such as paying less attention to them
How it changes with aging: Older adults experience several changes that generally make them more positive and optimistic. These include:
- Paying less attention to or withdrawing from negatively-simulating situations.
- Paying more attention to positive things.
- Becoming better at remembering positive things.
Practical implications:
- Normal older adults develop a positivity bias, and will tend to pay more attention to situations that are emotionally positive.
- Older adults have more difficulty remembering or paying attention to situations or problems that generate negative emotions.
- This may be part of why it’s difficult for them to engage in planning for unpleasant future eventualities.
- People tend to get happier and recover from negative emotions more quickly as they age.
- Older adults may seem to avoid or deny certain issues that they find unpleasant.
Crystallized versus fluid intelligence in aging
When experts discuss normal cognitive changes in aging, they sometimes refer to crystallized intelligence versus fluid intelligence.
Basically, crystallized intelligence refers to everything one has learned over time: skills, abilities, knowledge. This increases as people get older, because crystallized intelligence is a function of experience, practice, and familiarity. This can lead to what we might refer to as “wisdom.”
Crystallized intelligence gets better or stays stable as people get older. This experience and wisdom does enable older adults to compensate for some of the decline in processing speed and other ability. It also means that older adults may perform better than younger people at those mental tasks that require depth of experience or knowledge.
Fluid intelligence, on the other hand, refers to abilities related to processing power, taking in new information, problem-solving with new or less familiar information, and reacting quickly.
Fluid intelligence is at its peak when we are younger adults, and then declines over time.
How to tell cognitive aging apart from more worrisome changes
It’s true that some very common brain problems, such as very early Alzheimer’s disease, can be very hard to tell apart from changes due to cognitive aging.
If you’re concerned that certain symptoms might be early Alzheimer’s, I recommend taking a look at the Alzheimer’s Association’s handy list of “10 Early Signs and Symptoms of Alzheimer’s.”
What is nice about the Alzheimer’s Association’s resource is that for every early sign, they give an example of a normal change due to cognitive aging.
If you are wondering whether certain changes might qualify as “mild cognitive impairment” (MCI), then you’ll probably need to ask your health provider for more assistance in assessing memory and other cognitive domains.
In general, the diagnosis of MCI requires objective evidence of cognitive difficulties that is beyond what would be considered normal, but not bad enough to qualify as dementia. In other words, in MCI, cognitive testing should reveal that a person does worse than expected for his/her age and level of education. But the person should still be able to manage daily life tasks.
Otherwise, there are some signs and symptoms that are very unlikely to be due to cognitive aging alone. These include:
- Delusions
- Hallucinations
- Paranoia
- Personality changes
- Becoming irritable very easily, or emotionally much more volatile than before
- Depression
- Lack of interest in activities, and/or inability to enjoy activities one used to enjoy.
If you notice any such symptoms, it’s important to not assume this is “normal aging.” Instead, I recommend learning more about these symptoms and then bringing them up to your usual health providers. Such changes in behavior can be caused by a variety of different health conditions, none of which should be ignored.
You can learn more about what can cause paranoia and other forms of “late-life psychosis” here: 6 Causes of Paranoia in Aging & What to Do.
I also explain what should be done during a primary care evaluation for cognitive impairment here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
Last but not least, if you’ve gotten worried about an aging parent’s memory: my new book was written for you, and will walk you through what to do. You can learn more here.
Practical Takeaways & What You Can Do
In short, cognitive aging means that as we get older, our mental functions become less nimble and flexible, and many aspects of our memory get a little worse.
We also become more easily distracted by busy environments, and it takes more effort to work through complex problems and decisions.
Aging also tends to make people more positive, optimistic, trusting, emotionally resilient, and focused on good things. This often helps people feel happier as they get older.
But, this can make it harder for older adults to plan ahead to avoid problems, or to think through decisions that generate negative emotions. These changes to the aging brain can also make older adults more susceptible to deception and financial exploitation.
(This NYTimes story about an older man’s misread of a younger woman’s intentions seems to illustrate how optimism in late-life can be problematic.)
Can anything be done about cognitive aging?
It’s not really possible to prevent all cognitive aging. But there certainly are things that you can do! I would categorize them into two key categories:
1.Take steps to optimize and maintain your brain function.
These include a variety of sensible “brain-healthy” actions such as making sure to get enough sleep, exercising, not smoking, being careful about medications that affect brain function, and more. Here are some useful resources that provide a more detailed list of suggested actions:
- Cognitive Aging Action Guide for Individuals and Families (National Academy of Medicine)
- How to Promote Brain Health
2. Take sensible steps and precautions to compensate for cognitive aging changes.
There’s no need to seriously limit oneself in later life, just because the brain isn’t quite as quick and nimble as it used to be.
That said, it’s probably a good idea to consider making a few sensible accommodations to the aging brain. These might include:
- Allow older adults more time to think through complicated decisions.
- Writing down key points to consider can also help, as this reduces the need to use mental working memory.
- For more mentally demanding conversations and decisions, avoid noisy, busy, stimulating, or otherwise tiring environments.
- An example of a mentally demanding conversation would be one in which adult children ask their aging parent to consider whether to move to a new living situation.
- It’s also probably a good idea to avoid doing these late in the day, or when a person’s brain and body might be tired.
- Use hearing aids or otherwise minimize hearing difficulties, for those many older adults who have some hearing loss. A good short-term solution can be to use a “PocketTalker“*, which is a simple hearing amplification device we often use in geriatrics.
- Remember that “negative” possibilities become harder for older adults to keep in mind. So it may take extra persistence and patience to discuss these.
- Such “negative” possibilities include the possibility that one’s new romantic interest is after one’s money, that one might fall and break a hip at home, etc.
- Simplify finances and take steps to reduce the risk of financial exploitation in later life.
I must say that after researching this article, I found myself thinking that we should all consider making an effort to deal with big complicated mental tasks (e.g. estate planning, advance care planning) sooner rather than later.
Because the longer one waits, the harder it becomes for the brain to think through complicated decisions.
For more on cognitive aging
Here are some of the resources that I found especially helpful, in researching this article:
- Cognitive Aging: Progress in Understanding and Opportunities for Action (National Academy of Medicine Report)
- Normal Cognitive Aging (PubMed Central)
- Selective review of cognitive aging (PubMed Central)
- Cognitive Skills and the Aging Brain: What to Expect
- The emotion paradox in the aging brain
Any questions or comments on cognitive aging? Post them below!
*Note: Links to products on Amazon are affiliate links. We are now participating in the Amazon Associates affiliate program, so if you buy through links on our site, Better Health While Aging will earn a small commission, at no additional cost to you. Thank you for your support!
One of the most comprehensive and easy-to-understand article I have read. And I really appreciate the sensible suggestions and helpful links provided. Thank you.
Thank you!
Thank you for the best article
You’re very welcome!
It would be very helpful if you would publish a printable version. Most times I can’t sit at the computer long enough to thoroughly read the wonderful information you provide. I would like to be able to print your articles to read when convenient for me and to also keep on hand for future reference. Since I am caregiving for my husband who has Parkinson’s, your articles are extremely informative and helpful.
I do have your book on aging parents. Extremely helpful. I will give to my daughter,
Hi Norma and thank you so much for your feedback! I’m so happy to hear that you find the articles informative and useful, and thanks for checking out Dr. Kernisan’s new book. I’ve read it too and recommended it to many patients and friends.
If you scroll down to the very bottom of the article, there’s a little picture of a printer (with a little green swirl on the top) on the left hand side. If you click on this icon it will take you to the printable version. Let us know if you have any difficulties with getting the article to print.
thank you, great info Michael, 72
You’re most welcome and thanks for taking the time to let us know you liked it!
Timely and informative.
Excellent overview Dr. Kernisan! This will help many people who are concerned about the changes in their word-finding and memory skills. Lots of great info on the aging brain. Thank you!
Thank you, glad you found this useful.
I agree, excellent information. Please keep it coming!
Dear Dr. Leslie Kernisan:
Your article was most informative, clearly written, and truly valuable. I have read the ‘terms and conditions’ of the Better Health While Aging Website, and I fully recognize that one-time use only for the ‘user’ is expected. However, I also noted written permission could be requested. If allowed, I would like to ask how I might post a link on the website of the UMass Lowell, Center for Gerontology Research and Partnerships, of which I serve as the Director. Thank you.
Thank you for this feedback, it would be an honor to be linked to from your gerontology website.
It’s true that the information is my original work and belongs to me and the site. However, if all you want to do is link to it, no permission is required…the law and Internet etiquette allow anyone to link to publicly available online information, permission is only required to do things like repost to another site, reprint and distribute, etc.
I’m always especially happy to be of service to other educators, so delighted to connect with you!
Fantastic Dr K
I am 72 year old and had a mom and grandmother with Alzheimers. This is a wonderful article full of sooo much information. This should be a must read for all older individuals. Thank you so much
Yes, I’m hoping this will help older people — and their families — worry a little less. Glad you found it helpful!
Thank you for your continued work in educating us on the aging process in a thorough, grounded and understandable way! I have been truly blessed by your work.
So kind of you to post this feedback. Glad to have you as part of our community!
Thank you for this extremely comprehensive overview on the subject. It is a valuable resource for helping to allay unnecessary fears and inaccurate conclusions a healthy patient may have or develop about their mental processing ability.
Yes, I’m hoping this will reduce unnecessary worrying. thanks!
I find the article very relevant at this stage of my life. I like the ” practicalities ” to be part of my system since I want to sustain my “optimism ” as I move on to the last lap of my life’s journey.
I am all for sustaining optimism in later life! Glad you did not find this too discouraging.
Thank you so much. This will be great to show my daughter when she’s telling to hurry up and make a decision about something she’s just mentioned and that she’s given me no time to think about!
Yes! I would love for this type of information to foster a little more understanding — and better communication — between older adults and their adult children.
This is a little long, unfortunately…but once I find the time, I’m hoping to create some kind of cheatsheet to go with. Maybe that will be easy for older adults to share with their families.
That would be a wonderful article to be handed to adult children. Thank you for all the helpful information you provide. I have been following you while caring for my 90 + year old mother, and now it is time to pass your name, web information, and book titles on to my son.
I agree Cheryl and I’m so glad that you find this article share-worthy! Please feel free to print and pass on, or share the link.
I hope your son enjoys Dr. Kernsian’s new book as well: When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more. the book is a very practical step-by-step guide to starting to help your older parent, which I’ve found valuable in my own life and practice!
Thanks for taking the time t leave a comment.
Wow! I have learning disabilities , mainly around “memory”- and could never get anywhere in school , or the work field, it always surfaced and caused me not just poor production, but severe embarrassment .. and of course I couldn’t explain why or what , mainly because I didn’t know which made it even worse..
Now with the internet and google I can get snap shots of “AHA!!” Moments- and look for help.. That’s how I found you!!
I’m 50 years old, one child 16 with different issues unexplained or defined yet, a younger sister that has some rare something , not Lupas, Not Parkinson’s, but parts.. she is only 45 and her brain is deteriorating so badly her physical body is nothing but a skeleton and just had to be admitted for pneumonia and now has a feeding tube in her tummy.. everyone is at a loss…..
even with all that’s known about the brain, there are still huge deficits in understanding and treatment for far to much..
I appreciate your web sight and your writings!!
I do wish you were a local physician and wanted to take on our family’s “weirdness’ “ – I can’t help but to keep looking and keep putting the word out there in hopes someone will know something and be able to connect with us , even if it’s for just long distance research!! After all if it would help those that may follow, its important for knowledge to be acquired!!
Kindest of regards!!
T-Lynn
Thanks for this comment and for sharing your story. I’m afraid that you and your sister are quite young compared to my usual patients and so I’m not really sure what might explain the cognitive issues in your family. It’s true that there is still so much that is poorly understood about the brain, although a lot of exciting research is underway.
For help figuring things out, you might want to see if you can connect online with other patients who have similar health challenges. SmartPatients and PatientsLikeMe are two site that help people connect for this purpose. Such online communities can share research, provide moral support, and more. Good luck!
Much wisdom here. Thank you!
Thank you, Dr. Leslie!
As usual with your articles, very helpful and informative.
I read everything you write and always learn something, but this article wins the top award. I am 81 with a still very good memory but I am going to keep this one forever.
Thank you for all your caring information.
Yay! always fun to hear that something was a particular favorite for a reader. Thank you for letting me know and glad to have you as part of our community.
Dr K: once again you have written an article that “hits home” directly. My mother’s cognitive deterioration has yet to be diagnosed by a neurologist but her memory and behavioral changes strongly indicate Alzheimer’s. I am 65 and am concerned about certain declines in my memory and problem solving and I’ll read the links that you have posted. I also play brain games with web app called Lumosity daily to measure speed, memory, problem solving. It’s challenging and fun! Thank you for sharing your knowledge with us. Please keep it coming!
So glad to know you found this helpful. Seeing an older parent decline cognitively can certainly be a wake-up call. I’m glad that you are taking action and being proactive about this in your mid-60s. Research suggests that making changes at this age can make a difference later on. Take care!
Dr. Kernisan: Your clear presentation of normal cognitive changes in aging is quite reassuring to my friends and I in our mid-60s. The specifics help to “normalize” our experience of occasional difficulties retrieving proper names, forgetting how to spell a word, or finding it difficult to pay attention in noisy restaurants. (Still, there is variability among older adults in these changes, as you’ve noted.)
If someone appears to have mild cognitive impairment or dementia based on a primary care physician’s eval and cognitive screening exam, where might you refer for further examination, that is, what kinds of health care settings or disciplines?
Thanks!
Glad you found this article helpful.
So, whether and where to refer someone who seems to have MCI or dementia depends on a few things. Memory centers based at academic medical institutions are probably the best equipped to evaluate cognitive issues. I think they are especially valuable for people who are younger, such as in their 60s or early 70s, and for people who have more unusual signs and symptoms. A comprehensive evaluation at such a center will include neuropsychological testing, which basically means more involved and detailed testing of cognitive functions. It is also possible to get neuropsychological testing on its own, but if one is going that route, I think it helps to have the more comprehensive and detailed evaluation of the memory center, to help interpret the neuropsych testing results.
In principle, a PCP can also simply refer to a neurologist for cognitive impairment. In practice, I’ve found that the quality of their evaluation and assistance is variable, but it’s certainly an option to consider, especially if there is no memory center easily available.
A geriatrician is another option, but there tend to be few of us available.
I do think the more detailed testing and evaluation done by memory centers and neuropsychologists tends to get less helpful as people get older (e.g. into their 80s and older)…as people get older they are more likely to have a mixed dementia, and doing all this detailed evaluation tends to have little impact on how we ultimately manage them and try to help them optimize their function and well-being. (What does help is detailed evaluation of behaviors and coming up with behavior management strategies, and family caregiver coaching.) It is also less likely to help when the person’s cognitive symptoms are fairly substantial, or if there are other reasons to be fairly sure this is dementia (e.g. slowly progressive symptoms for years & typical symptoms in someone aged 85+).
This is THE only website older adults and caregivers or future caregivers need. I wish everyone would read such adviuce soioner rather than later. I am paying attention to the “signs” and healthy lifestyle changes recommended. Thank you Doctor K.
Thank for you this lovely feedback. I’m so glad you are finding the site helpful.
Thanks so much for this comprehensive post. This level of detail with links to more information is extremely helpful and manageable.
Thank you, glad you find it useful.
Loved your article it was very informative. My father has Alzheimer’s so it was very useful, I even read it to my mom. How old is this article?
Glad you found it helpful. This article was first published in August 2018. Most of what I write about on this site is “fundamentals” of aging health and family caregiving, and so it doesn’t change much over a few years.
Dr. Kernisan articles are always the very best from a MD. Wish you were my health provider.
Thank you!
Well, I’ve often wondered how I’m doing in my head. I am 72. I was just accepted into one of the senior communities that has advanced long term care, should you need it. Yea! But entrance required passing a medical evaluation. Part of that was a cognitive test. It has 30 tasks, a well-known one is drawing a clock set at 10 after eleven. Hooray, I passed 29. I only missed that 1 task. I was told at the beginning 5 words and she said I’d be asked to repeat them back to her at the end of the testing. I got all words except 1 … and I will never forget “daisy”. See, I remember NOW. Too bad not then for that coveted perfect score. Such a perfectionist.
Sounds like you did very well, congrats!
Thank you, Dr. Leslie. You perform an extremely valuable public service with the articles you share.
Thank you!
Wow. Outstanding, to say the least. I always read your posts thoroughly but haven’t had the nerve to leave a comment before. Thanks for your great efforts.
Aw…well I appreciate you letting me know you are reading the posts. Hearing from readers helps me keep going 🙂 Thank you!
Dr. Leslie.
this all seems very interesting
Dr. Kernisan,
I have a 94 year old mother in assisted living with dementia, but who mostly is fine physically. You articles help me stay on top of geriatrics, aging, dementia, normals/abnormals. I also look at them as guidelines for my husband and me, as we are now 70. Thanks for being sincere, helpful, and caring. You do a great service with this website, and I will continue to subscribe to it.
Thank you so much for this comment, I’m so glad the site is helpful to you and your family!
Thank you for this wonderfully detailed yet readable article. I’ve sent the link to so many friends helping their parents age in place. My 84-year old mom also really loved it! It’s a great reminder that people of all ages are interested in reliable information about what’s going on with their bodies. And – they feel empowered when its respectfully presented so they can understand it!
Thank you!
Thank you for an excellent article.
Thanks for the enlightening article. At least I can safely say that at this age , I am experiencing COGNITIVE AGING. I will really consider the take away suggested to maintain a good enough working brain.
” I was told at the beginning 5 words and she said I’d be asked to repeat them back to her at the end of the testing. I got all words except 1 … and I will never forget “daisy”. See, I remember NOW. Too bad not then for that coveted perfect score. Such a perfectionist.”
Maybe we should practice this exercise with word flashcards.
I play Klondike solitaire online every night. Have not tried Lumosity because some of these brain exercise websites did not get good reviews.
Sounds like you are doing very well on the recall 🙂
Glad you are being proactive about your health and your aging.
Hi Dr K, I am a year 11 student currently completing Research Project. I have read your article and found it extremely useful towards answering my question on “How does the brain change with age”. I was hoping you could give me some insights specifically on the physical and mental changes of the brain as age increase.
All my insights are in the article 🙂
i’m so happy I found you. Where would I find information regarding the % of chance to have dementia when a parent had it.
I’m 77 now and still work from home and have no problems at this time.
Warm Regards,
Barbara Gene
Hi Barbara. In general, having a first degree blood relative (mother, father, sibling) who develops dementia later in life (after age 60), doubles the lifetime risk for getting dementia. So, the general population has about a 10% lifetime risk, and if you have a first degree relative with dementia, you have a 20% lifetime risk. If the relative developed dementia at an earlier age, the risk is about four times that of normal.
I’m saying “dementia”, and it’s important to point out that there are many causes of dementia, including Alzheimer’s disease, frontotemporal dementia, vascular dementia, and others, each of which is part related to heredity and part to other factors. The biggest risk factor for dementia is older age, which most of us do hope to achieve! Glad to hear you are still working and thanks for your question!
Hi – I have recently posted on another of your articles but im desperate for info and your site is superb. Please can you clear something up for me Im confused, My mum is showing terrible short term memory loss – the last 3 years it hasnt massivley declined but she was given sertraline 5mg a couple of years ago and this helped with her outlook on life .
She is unaware of the level of repetition and keeps saying im totally fine I dont know why I am having these tests(memory clinic assesments) we do discuss it as a family but she is really unaware that she is asking the same thing over and over. I have looked through the other things mentioned and she seems fine with processing speed etc (awaiting memory clinic assesment results) She has been told that from her recent MRI that she has SVD. I have read on your site about SVD and now im reading about mild cognitive impairment – are the 2 different ?
If she has SVD is it inevitable that this will eventually develop into a dementia ? is Sertraline a known drug to hinder memory ? sorry for all the questions but im panicking in case we just get discharged and are left in limbo again. Dad needs some undertsanding and reassurance (they both nursed my mums mum and my mums older sister through alzheimers – hence my dads concern) thank you
Hi Elaine. Let me go through your questions.
1. Small vessel disease is covered by Dr. K here, and in this podcast.
2. Mild cognitive impairment is on the spectrum of brain changes with aging. I describe it as when brain performance is worse than it should be for age (and usually results in an impaired score on a screening test, like the MoCA), but does not interfere with day to day function. That is, the person can still do everything they need to do to manage life (cook, pay bills, drive, manage medications, etc.). Mild cognitive impairment can be caused by SVD, and we would refer to that as Vascular MCI.
3. MCI does not inevitably lead to dementia. Five years after diagnosis with MCI, about 30-40% of people will meet criteria for dementia, whereby there IS a functional decline (that is, a person will have difficulty with day to day life related to their brain changes).
4. Sertraline is a selective serotonin re-uptake inhibitor (SSRI), used to treat anxiety and depression. It has some anticholinergic properties, but is not known to be as potentially harmful to brain function as some older antidepressants. If your mom was depressed, the sertraline may actually appear to sharpen her thinking.
5. You mention that your mom is repetitive, and seems to have changes in her insight into her behaviour, which is a characteristic that is often seen in dementia, particularly Alzheimer’s disease. Anxiety can also lead someone to be repetitive. For my patients with Alzheimer’s, or MCI I usually recommend contacting the Alzheimer Society for tips on how to best respond to the repetition behaviour.
I am an almost 68 year old man and stopped working a year and a half ago. I stopped a year before my contract ended because I was diagnosed with mild amnestic cognitive impairment by an academic institution in Beirut, Lebanon.
I worked in humanitarian interventions and the last years before retirement this was in the Middle East with Syrian refugees as the national director of a humanitarian NGO. You can imagine how busy and how much pressure there was with a caseload of 100.000 refugees we were taking care of with around 400 staff. I always needed to get up and use the toilet at night and often had difficulty falling asleep again. My local pharmacist advised me to take dosage stillnox/diazepam. So I started doing that. Initially 10mg a night for a few weeks and later reduced it to 2.5 mg a night (half way the night after using the toilet). I did this for a total of around 6 years, not realizing there could be serious side effects.
I did another round of tests in a local institution a couple of weeks ago where we live and the diagnosis was beginning Alzheimer.
My question is whether this can be linked to my use of stillnox over this period and, if so, if there is anything I can now do about it? I try to live healthy, go jogging several times a week, take some extra vitamins….. The idea that I may be having progressive Alzheimers is scary of course……..
I can understand feeling scared about the possibility of Alzheimer’s, and I’m glad to hear that you have an active, healthy lifestyle now.
The connection between benzodiaepines (like diazepam) and sedative-hypnotics (like zolpidem or stillnox) and Alzheimer’s or other types of dementia has been reviewed recently. From what I read, most studies were retrospective, looking back at data from several years, often comparing those who had been given a prescription for one of those medications versus those who hadn’t, and seeing which group had a higher incidence of dementia. These studies suggest a connection between sleeping pills and dementia, but it’s not the strongest form of scientific evidence for a causal relationship.
It may be that poor sleep itself is a risk factor for dementia, or that the studies that have been done don’t capture the full story. When I see a person who might have an increased risk for dementia, I definitely advise them to avoid sleeping pills currently and in the future. Stay well.
Very comprehensive information.
Hits things squarely on the head.
Mother passes all of the mental health screenings at her general practitioner, she knew all the correct answers after the first time they every gave her the screening. Seems like if the family is alerting the doctor there should be some second line more intensive questioning to get the aging parent the care they so desperately need.
Very difficult.
Mom is in complete denial of her depression a and anxiety, and paranoia, delusions.
Doctor won’t/can’t treat it if she won’t own it.
Any discussion of anything that would help is met with a blow up.
Am visiting with mom now and have put myself in another room til she cools off, only so much verbal abuse I can stand.
She is no longer allowed to say anything to the folks who live upstairs because of a delusional verbally abusive episode.
Only trying to get her some assistance so that she can stay where she is for as long as she can.
Hi Bonnie and thanks for sharing your experience. It can be frustrating to notice changes with an aging parent and seem not to be able to get help! As a Geriatrician, I always try to get the story from a family ember as well as the patient themselves, because it is very common with conditions like depression and dementia, that the older person’s insight into the situation is impaired. If you can get a referral to a Geriatrician or Geriatric team, it might help to move things forward.
I also think the strategy of stepping away from the situation and “cooling off” is a very good one.
You might also be interested in the Helping Older Parents Membership. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here if you’re interested.
As someone in their late 50’s, I’m starting to notice the gradual changes in my daily brain life. Your article goes a very long way in helping me categorize and identify these changes, since i may need to properly communicate them to healthcare professionals in the future.
Hello Jeff and I’m so glad that you found the article to be helpful! You’re right that communicating effectively with your care team is such a vital part of staying healthy. Thanks for reading!
I really enjoy your articles – well written and researched. Easy to read and very informative. Sometimes it is overwhelming but I can always read it again. Keep up the good work.
Thanks for the feedback and I’m so happy to hear that you’re enjoying the articles! They are full of information, so please feel free to read them in smaller sessions!
I’m taking a course on the Great Courses called “The Aging Brain”. Your information is much more thorough and understandable than what I’m finding in the course. Thank you for being such a great resource on aging!
I’m so happy to hear that you’re interested in learning more about brain health! You might also want to visit my website, The Wrinkle. Like Dr. Kernisan, I have a lot of information about aging well and brain health (I use video as a teaching tool as well). Thanks so much for reading and for leaving your comment!
Hey you said you are studying a course called “The aging Brain .” Could you please help me with it. I was wondering if I could get any information regarding how the memory of an individual changes with.
Need to write a paper.
Dr. K., I have been receiving your newsletters for about 2 years. You are my go to resource when it comes to caregiving for my now 97 year old father. I must say he was doing quite well until he suffered a compression fracture a year ago and had to be hospitalized for surgery. Then he became housebound due to Covid. Up until then he went to the gym 3 times a week. Of course, this year has been especially hard on all of us, especially him. I think some of the signs of cognitive decline are very normal for someone of his age and I’m not particularly worried about anything out of the ordinary. I just can’t thank you enough for being there for us and the clarity with which you present the information. I’ve purchased your book and am in the book group., I look forward to continuing my relationship with you as a wonderful resource!
Hello Kris and thanks for your very kind words on behalf of Dr. Kernisan! I know you’re going to find the book to be a wonderful resource (I’ve read it cover to cover). I hope your father gets back to the gym when he can and thanks again for sharing your thoughts! Keep in touch.
I am a 75 year old man, take the usual meds most of my friends take, BP medicine, and cholesterol meds. Never had heart problems or a stroke.
About a year ago, I took the annual test I always take during my once a year physical check up. This year however, I was given the “three words” in a virtual session, due to the COVID situation.
When asked to repeat the “3 words”, my mind was completely blank. I told the nurse, “I have no idea what the three words are that you just asked me to remember just minutes earlier. I was quite shocked and it really bothered me a lot. As a result of this, my physician sent to me, a written test to complete. I was able to answer all of the 20 some questions and solve the little puzzles with ease. No problems at all.
My physician’s secretary contacted me after I submitted the test to the office by mail. She let me know that I had gotten all questions 100% correct.
What surprised me was this.
She told me that my doctor wanted to know if I would like to have an MRI done. I declined and wondered, “why would I do that if I completed the written test with no mistakes?”
Now, I am always watching and judging myself, to see if I forget things, and I do forget names at times. Names I should remember. At the same time, I notice that when I am in conversation with others, or watching a movie or even reading a book, I catch myself “thinking of other things” and don’t even know what I just read or how the movie ended. As a youngster, I had this problem in school which caused me to struggle academically. I have wondered if what may have been ADD, (though I was never officially diagnosed with it) might be part of my problem.
I am terrified that I might be on the path to Dementia.
Wondering if this sounds concerning ?
Hi Mike
I see a lot of individuals like you in my practice as a Geriatrician. I rarely do a cognitive screening test unless there is some complaint about memory from the patient or their family members. The US Preventive Screening Task Force found that there’s no good evidence to recommend or advise against screening in adults who don’t have symptoms of cognitive decline.
As in the situation you describe, an abnormal screening test can lead to more investigation that may or may not be necessary, anxiety, and may even lead to false labelling. In my experience, many individuals get worried that they’re “on the path to dementia” because of screening test results, and become anxious about cognitive performance, which in itself can, ironically, worsen cognitive performance.
Individuals who have been living with an undiagnosed learning disability or neurodevelopmental difference, like ADD for example, may have results on testing that could be abnormal due to those factors, or a number of other issues that are not related to a dementia (like depression, anxiety, medications, hearing impairment, etc.).
So, it’s up to you and your doctor whether more testing is needed but in a situation like the one you describe, I would advise considering the role of attention and anxiety when interpreting cognitive screening results.
Thank you for your comments back to me. You touched on something else that I noticed and failed to mention. When I have to remember something, like a name quickly on request, sometimes I sort of panic if it doesn’t come to me immediately which makes it much worse. Two minutes later, while relaxed, I have no problem. I think I’ll just have to relax more :-). Thanks very much.
Mike
Interesting observation! Hope you can find some time to relax and be compassionate to yourself.
My dear Dr. K.
A clear and encouraging message for those of us who are experiencing this.
Thank you!
I’m happy to hear that you found the article reassuring. Thanks for taking the time to comment and for your kind words.
Your article mentions medications that effect brain function.
Many seniors, like myself, have difficulty sleeping. I understand that taking Tylenol PM will cause decline in brain function. Please comment. What over the counter sleeping aid can you recommend.
Your articles are very informative. Thank you for providing information that seniors need.
Tylenol PM does contain diphenhydramine (brand name Benadryl) which is quite anticholinergic and tends to make thinking worse in older people, so we usually recommend older adults avoid such drugs, especially if they are having memory problems. There isn’t really an over the counter sleep mediation that we recommend, but for many older adults, melatonin, which is an herbal supplement that wsa first used for jet lag and is somewhat helpful for falling asleep with no anticholinergic side effects.
I’m so glad you enjoy the articles! Thanks for taking the time to comment!
Gosh… timely article. Hope I can find the time and energy to digest it. I’ve been the sole caregiver for elderly parents for eight years now. Dad, age 91, had severe cognitive impairment at the end, which was diagnosed as mixed dementia in his brain autopsy. Mom is becoming more erratic in her 90s. My out-of-state sibling, who offers me no assistance, says, “old people are exhausting” to the rest of us. I’m pushing 70 years old now and I’m feeling the brain drain from the strain of years of trying to adapt to others cognitive decline. It’s like I’ve been living in an alternative universe. Now, I’m sensing decline in myself. It’s upsetting. Hope this article will enlighten me on my own situation.
I’m happy that the article was helpful and it sounds like you can relate to many of the symptoms described.
The stress of caregiving can definitely affect cognitive performance, and feel like a “brain drain” as you put it. It wounds trite but looking after yourself is the only way to ensure that you’ll be there for your mom. I made a video about this on my YouTube channel The Wrinkle, which you can watch here: https://www.youtube.com/watch?v=_SYE4b7aw-s
You might also want to read Dr. Kernisan’s new book and the associated tools. You can find out more about the book, here: When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more. This book contains step by step information about how to help your parent. Now it’s mostly geared towards those who are starting the helping journey but would be valuable for someone in your situation too.
I hope these resources are helpful, and thanks for taking the time to share your experience.
On January 7, 2021, my wife passed away from Alzheimer,s disease, after eight years with the battle. She was 84 years old. Her situation became progressively worse as brain cells died.
Your article on the normal decline of brain function was interesting, because it showed the difference with Alzheimer’s patients.
Hi Robert and I’m so sorry about the loss of your wife and it sounds like it was a long journey with dementia.
Thanks for letting us know that you liked the article and for taking the time to share your experience.
Thank you Leslie. I was very glad I came upon this link, it has been very enlightening. A number of “lightbulbs” have gone off in regards to my elderly father (who lives alone) and also in changes in the last year, with my partner who is 13 years my senior and approaching 70. It has certainly alleviated some of my frustrations and worries in understanding cognitive changes better.
I’m so happy that you found the article helpful and that those “lightbulbs” got turned on! You might also be interested in my YouTube channel and website The Wrinkle (www.TheWrinkle.ca), where I have many articles and videos about cognition and the the aging brain.