What are cognitive changes in late adulthood?

There are numerous stereotypes regarding older adults as being forgetful and confused, but what does the research on memory and cognition in late adulthood actually reveal? In this section, we will focus upon the impact of aging on memory, how age impacts cognitive functioning, and abnormal memory loss due to Alzheimer’s disease, delirium, and dementia.

Cognitive Development and Memory in Late Adulthood

How does aging affect memory?

The Sensory Register

Aging may create small decrements in the sensitivity of the senses. And, to the extent that a person has a more difficult time hearing or seeing, that information will not be stored in memory. This is an important point, because many older people assume that if they cannot remember something, it is because their memory is poor. In fact, it may be that the information was never seen or heard.

The Working Memory

Older people have more difficulty using memory strategies to recall details (Berk, 2007). Working memory is a cognitive system with a limited capacity responsible for temporarily holding information available for processing. As we age, the working memory loses some of its capacity. This makes it more difficult to concentrate on more than one thing at a time or to remember details of an event.  However, people often compensate for this by writing down information and avoiding situations where there is too much going on at once to focus on a particular cognitive task.

When an elderly person demonstrates difficulty with multi-step verbal information presented quickly, the person is exhibiting problems with working memory. Working memory is among the cognitive functions most sensitive to decline in old age. Several explanations have been offered for this decline in memory functioning; one is the processing speed theory of cognitive aging by Tim Salthouse. Drawing on the findings of the general slowing of cognitive processes as people grow older, Salthouse (1996) argues that slower processing causes working-memory contents to decay, thus reducing effective capacity. For example, if an elderly person is watching a complicated action movie, they may not process the events quickly enough before the scene changes, or they may processing the events of the second scene, which causes them to forget the first scene. The decline of working-memory capacity cannot be entirely attributed to cognitive slowing, however, because capacity declines more in old age than speed.

Another proposal is the inhibition hypothesis advanced by Lynn Hasher and Rose Zacks. This theory assumes a general deficit in old age in the ability to inhibit irrelevant information. Therefore, working memory tends to be cluttered with irrelevant content which reduces the effective capacity for relevant content. The assumption of an inhibition deficit in old age has received much empirical support but, so far, it is not clear whether the decline in inhibitory ability fully explains the decline of working-memory capacity.

An explanation on the neural level of the decline of working memory and other cognitive functions in old age was been proposed by Robert West (1996). Age-related decline in working memory can be briefly reversed using low intensity transcranial stimulation, synchronizing rhythms in bilateral frontal, and left temporal lobe areas.

The Long-Term Memory

Long-term memory involves the storage of information for long periods of time. Retrieving such information depends on how well it was learned in the first place rather than how long it has been stored. If information is stored effectively, an older person may remember facts, events, names and other types of information stored in long-term memory throughout life. The memory of adults of all ages seems to be similar when they are asked to recall names of teachers or classmates. And older adults remember more about their early adulthood and adolescence than about middle adulthood (Berk, 2007). Older adults retain semantic memory or the ability to remember vocabulary.

Younger adults rely more on mental rehearsal strategies to store and retrieve information. Older adults focus rely more on external cues such as familiarity and context to recall information (Berk, 2007). And they are more likely to report the main idea of a story rather than all of the details (Jepson & Labouvie-Vief, in Berk, 2007).

A positive attitude about being able to learn and remember plays an important role in memory. When people are under stress (perhaps feeling stressed about memory loss), they have a more difficult time taking in information because they are preoccupied with anxieties. Many of the laboratory memory tests require comparing the performance of older and younger adults on timed computerized memory tests in which older adults do not perform as well. These results are criticized for lacking ecological validity, or real-world relevance. Few real-life situations require speedy responses to memory tasks on a computer. Older adults rely on more meaningful cues to remember facts and events without any impairment to everyday living.

Changes in Attention in Late Adulthood

Divided attention has usually been associated with significant age-related declines in performing complex tasks. For example, older adults show significant impairments on attentional tasks such as looking at a visual cue at the same time as listening to an auditory cue because it requires dividing or switching of attention among multiple inputs. Deficits found in many tasks, such as the Stroop task which measures selective attention, can be largely attributed to a general slowing of information processing in older adults rather than to selective attention deficits per se. They also are able to maintain concentration for an extended period of time. In general, older adults are not impaired on tasks that test sustained attention, such as watching a screen for an infrequent beep or symbol.

The tasks on which older adults show impairments tend to be those that require flexible control of attention, a cognitive function associated with the frontal lobes. Importantly, these types of tasks appear to improve with training and can be strengthened.

An important conclusion from research on changes in cognitive function as we age is that attentional deficits can have a significant impact on an older person’s ability to function adequately and independently in everyday life. One important aspect of daily functioning impacted by attentional problems is driving. This is an activity that, for many older people, is essential to independence. Driving requires a constant switching of attention in response to environmental contingencies. Attention must be divided between driving, monitoring the environment, and sorting out relevant from irrelevant stimuli in a cluttered visual array. Research has shown that divided attention impairments are significantly associated with increased automobile accidents in older adults. Therefore, practice and extended training on driving simulators under divided attention conditions may be an important remedial activity for older people.

Problem Solving

Problem-solving tasks that require processing non-meaningful information quickly (a kind of task which might be part of a laboratory experiment on mental processes) declines with age. However, real-life challenges facing older adults do not rely on the speed of processing or making choices on one’s own. Older adults are able to resolve everyday problems by relying on input from others such as family and friends. They are also less likely than younger adults to delay making decisions on important matters such as medical care (Strough et al., 2003; Meegan & Berg, 2002).

New Research on Aging and Cognition

Can the brain be trained in order to build a cognitive reserve to reduce the effects of normal aging? ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), a study conducted between 1999 and 2001 in which 2,802 individuals age 65 to 94, suggests that the answer is “yes.” These participants received 10 group training sessions and 4 follow up sessions to work on tasks of memory, reasoning, and speed of processing. These mental workouts improved cognitive functioning even 5 years later. Many of the participants believed that this improvement could be seen in everyday tasks as well (Tennstedt et al., 2006). Consistent practice and scaffolded lessons can build skills at any age. Learning new things, engaging in activities that are considered challenging, and being physically active at any age may build a reserve to minimize the effects of primary aging of the brain.

Wisdom

Wisdom is the ability to use common sense and good judgment in making decisions. A wise person is insightful and has knowledge that can be used to overcome the obstacles they encounter in their daily lives. Does aging bring wisdom? While living longer brings experience, it does not always bring wisdom. Those who have had experience helping others resolve problems in living and those who have served in leadership positions seem to have more wisdom. So it is age combined with a certain type of experience that brings wisdom. However, older adults generally have greater emotional wisdom or the ability to empathize with and understand others. Wisdom is challenging to study because the definitions of what is “wise” vary between cultures.

Cognitive Function in Late Adulthood

Abnormal Loss of Cognitive Functioning During Late Adulthood

Dementia was the umbrella category used to describe the general long-term and the often gradual decrease in the ability to think and remember that affects a person’s daily functioning. The manual used to help classify and diagnose mental disorders, the Diagnostic and Statistical Manual of Mental Disorders, or DSM-V, reclassified dementia as “neurocognitive disorder”. It is further specified as a mild or major neurocognitive disorder. Even though this change was made in 2013, the term dementia is still often used by laypersons.

Common symptoms of neurocognitive disorders include emotional problems, difficulties with language, and a decrease in motivation. A person’s consciousness is usually not affected. Globally, neurocognitive disorders affected about 46 million people in 2015. About 10% of people develop the disorder at some point in their lives, and it becomes more common with age. About 3% of people between the ages of 65–74 have dementia, 19% between 75 and 84, and nearly half of those over 85 years of age. In 2015, dementia resulted in about 1.9 million deaths, up from 0.8 million in 1990. As more people are living longer, dementia is becoming more common in the population as a whole.

Dementia generally refers to severely impaired judgment, memory, or problem-solving ability. It can occur before old age and is not an inevitable development even among the very old. Dementia can be caused by numerous diseases and circumstances, all of which result in similar general symptoms of impaired judgment, etc. Alzheimer’s disease is the most common form of dementia and is incurable, but there are also nonorganic causes of dementia that can be prevented. Having strong social supports is a buffer against cognitive decline. Malnutrition, alcoholism, depression, and mixing medications can also result in symptoms of dementia. If these causes are properly identified, they can be treated. Cerebral vascular disease, due to insufficient blood reaching the brain, can also reduce cognitive functioning.

Delirium, also known as acute confusional state, is an organically caused decline from a previous baseline level of mental function that develops over a short period of time, typically hours to days. It is more common in older adults, but can easily be confused with a number of psychiatric disorders or chronic organic brain syndromes because of many overlapping signs and symptoms in common with dementia, depression, psychosis, etc. Delirium may manifest from a baseline of existing mental illness, baseline intellectual disability, or dementia, without being due to any of these problems.

Delirium is a syndrome encompassing disturbances in attention, consciousness, and cognition. It may also involve other neurological deficits, such as psychomotor disturbances (e.g. hyperactive, hypoactive, or mixed), impaired sleep-wake cycle, emotional disturbances, and perceptual disturbances (e.g. hallucinations and delusions), although these features are not required for diagnosis. Among older adults, delirium occurs in 15-53% of post-surgical patients, 70-87% of those in the ICU, and up to 60% of those in nursing homes or post-acute care settings. Among those requiring critical care, delirium is a risk for death within the next year.

Alzheimer’s Disease

Alzheimer’s disease (AD), also referred to simply as Alzheimer’s, is the most common cause of dementia, accounting for 60-70% of its cases. Alzheimer’s is a progressive disease causing problems with memory, thinking, and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, not managing self-care, and behavioral issues. In the early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment.

Alzheimer’s is the sixth-leading cause of death in the United States. On average, a person with Alzheimer’s lives four to eight years after diagnosis but can live as long as 20 years, depending on other factors. Alzheimer’s is not a normal part of aging. The greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. But Alzheimer’s is not just a disease of old age. Approximately 200,000 Americans under the age of 65 have younger-onset Alzheimer’s disease (also known as early-onset Alzheimer’s).

The cause of Alzheimer’s disease is poorly understood. About 70% of the risk is believed to be inherited from a person’s parents with many genes usually involved. Other risk factors include a history of head injuries, depression, and hypertension. The disease process is associated with plaques and neurofibrillary tangles in the brain. A probable diagnosis is based on the history of the illness and cognitive testing with medical imaging and blood tests to rule out other possible causes. Initial symptoms are often mistaken for normal aging, but an examination of brain tissue, specifically of structures called plaques and tangles, is needed for a definite diagnosis. Though qualified physicians can be up to 90% certain of a correct diagnosis of Alzheimer’s, currently, the only way to make a 100% definitive diagnosis is by performing an autopsy of the person and examining the brain tissue. In 2015, there were approximately 29.8 million people worldwide with AD. In developed countries, AD is one of the most financially costly diseases.