How much does aging affect mental acuity? It’s debatable
By Donald Jurivich, University of North Dakota,
2024-09-05
I cringed recently while driving to the clinic where I specialize in geriatric medicine when I heard a young radio announcer refer to old people as “wiggy,” a pejorative for wacky.
The tension between age and function certainly have played out on a world stage in the 2024 U.S. presidential campaign . Prior to President Joe Biden’s withdrawal from the election process in July 2024, a writer for a national magazine asked my expert opinion as to whether either or both presidential candidates exhibited signs of dementia.
The reporter then asked whether older people can be more susceptible to the effects of fatigue, stress and other psychological pressures that might be reflected in altered verbal performance .
My answer was yes, and I cited examples of how an aging brain under duress may lose a train of thought or engage in excessively long pauses or disconnected topics.
The results are often surprising. One 2021 study suggests nearly half of the 38-year-old participants were up to five years older in biological age than their actual age , while the other half were as many as five years younger.
But even most of those changes are subtle and really do not limit learning and executive function – that is, the ability to set and achieve goals, solve problems, regulate emotions and function normally overall.
Still, researchers are beginning to recognize a “no man’s land ” between normal brain aging and late-life diseases of the brain. For example, periodic memory lapses may be recognized as mild cognitive impairment, which can represent a fork in the road, with half of these situations progressing to dementia and the other half either getting better or not worsening . Through adequate blood pressure control, regular exercise and cognitive engagement, many people show improvement.
Cognitive frailty
Physical frailty is characterized primarily by slowness, weakness and fatigue. But what’s now called “cognitive frailty ” relates to increased sensitivity to stressors and less ability to bounce back from physical or mental stress.
This is an area that many clinicians, even those working in the field every day, do not fully understand. Many of them don’t dig deeply enough into those subtle changes expressed by older patients. Indeed, one study found that rural primary care doctors underrecognized dementia among their patients .
Primary care is lacking in sufficient screening for cognitive disorders . Furthermore, Medicare does not yet have a diagnostic code for cognitive frailty. That is why advocates for optimizing health care in older adults are promoting the routine use of the geriatric 4Ms in clinical practice for everyone 65 and older: medication, mentation, mobility and what matters. Mentation refers to the mind, while what matters has to do with what matters most to older adults.
Perhaps the most important question: What can all of us do to protect our brains and bodies from the negative effects of aging and disease as we get older?
The national discussion around President Biden and former president and presidential nominee Donald Trump’s mental acuity may be a catalyst to promote a larger conversation about aging, cognitive dysfunction and dementia, as well as what each of us can do to reduce our likelihood of developing cognitive problems late in life.
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