Cognitive health in old age is characterized by

The core characteristic of cognitive health in the elderly has never been "not forgetful at all", but the ability to maintain the function of independent living, maintain a sense of active control over life, and have long-term stable emotional and social connections. This is the most intuitive conclusion I have come to after doing cognitive screening work in the community for five years and meeting nearly a thousand elderly people.

Don't tell me, many people have misunderstandings about cognitive health in the elderly. They always think that as long as they forget things, they will suffer from Alzheimer's disease. Last week, I met a girl at a community free clinic. She dragged her 76-year-old mother to have a full set of cognitive tests. She said that the old man forgot where to put his bankbook yesterday, which scared her so much that she couldn't sleep all night. I asked for a long time and found out that the old lady, except for occasionally forgetting where to put things, usually does her own grocery shopping and pays the bills. She also goes to the community choir to arrange programs every afternoon. Last time she went to perform with a group out of town, she packed her luggage and brought more things than the young people in the same industry. This is not a cognitive problem, it is just ordinary benign aging.

The academic community has actually been arguing about the criteria for determining cognitive health for almost two decades. In the past, the mainstream Western medicine system used to use scale card thresholds, such as the commonly used Mini-Mental State Examination (MMSE). A score below 27 points was judged to be cognitively impaired. However, in recent years, more and more clinicians and elderly social workers do not recognize this single standard. What particularly impressed me was when I went to a suburban county for screening last year and met a 74-year-old Uncle Zhang. He had never gone to school and could not even write his own name. He only scored 24 on the scale. According to previous standards, he was already mildly cognitively impaired. However, he grew two acres of vegetable gardens and sold them at the market every day. He settled accounts faster than the young man who helped. When he returned home, he could cook and clean his paralyzed wife, and kept the house in order. Are you saying he is cognitively unhealthy? This is much better than the state of many urban elderly people who are bored at home every day, score 28 on the scale but can’t even cook. The "function priority" criterion proposed by many scholars now means that as long as it can meet the needs of independent life, even if the score is lower on the scale, it is considered cognitively healthy.

The elderly people I have come into contact with who are in good cognitive status have another very interesting thing in common: they all have a strong sense of control over their lives. It does not mean that you should have the power to control the whole family, but that you know what you have to do every day and be willing to take the initiative to find things for yourself. There used to be a 68-year-old Uncle Li. When he first retired, he would sit at home every day. He would be scared to death if he forgot his keys. He always thought he was going to suffer from Alzheimer's disease. Later, he was dragged by his old colleagues to learn how to shoot short videos. Now he leads old men and women in the community to make funny jokes every day. He can memorize lines better than many young people. The last time I saw him, he was still studying how to add subtitles and cut transitions. He said he wanted to increase his followers to 10,000 and give out eggs to everyone. Do you think he will forget things now? Yes, sometimes he forgets a line while filming, but he can turn around and take out a small book he wrote to read, which does not affect his pace of life at all.

Of course, that doesn’t mean you don’t need to worry about forgetfulness at all. There is a very important distinction here: benign forgetfulness means forgetting details. For example, if you can’t remember what you ate yesterday, you can remember it with a few reminders, and it will not affect subsequent actions.； But if there is a sudden emotional abnormality or memory lapse, for example, you have just finished lunch and you insist that you haven't eaten, you always suspect that your family members stole your things, or you can't find your home when you go out, even if it only happens once in a while, you have to go to the hospital for examination as soon as possible. This is likely to be an early sign of cognitive impairment. I met an aunt the year before last. She was usually fine, but she always said that the nanny stole her money. Her children thought she was an old man being stingy at first, but later she was taken for a checkup and found out that she had temporal lobe atrophy, which was already early-stage Alzheimer's disease. Fortunately, she was discovered early, and her condition is now very stable after intervention.

Speaking of which, I sometimes feel that cognitive health for the elderly is like an old mobile phone that has been used for more than ten years. There is no need to compare the benchmark speed with a new mobile phone. As long as it can make calls normally, scan QR codes to pay bills, save frequently used contacts, and occasionally restart the phone, it will be fine. It is completely sufficient. The previous 2023 survey data released by the Chinese Center for Disease Control and Prevention also said that the proportion of benign forgetfulness among people over 60 years old is close to 42%, but only about 6% actually develop cognitive impairment. Many people's anxiety is actually unnecessary.

If I really want to talk about the most reliable judgment standard, I don’t think you need to rely on a scale. You can know it if you go home and visit your parents twice more: if he can still remember what you like to eat, and can prepare a table of food for you, and is willing to chat with you about the problems of Zhang’s parents and Li’s family in the community, and can also arrange his own time for walking, playing chess, and square dancing every day, then there will basically be no problem. Don't get nervous whenever you see an old man forgetting something small. Aging is a normal life process. Being able to live your life comfortably is better than anything else.