What are the characteristics of cognitive health in the elderly?

Cognitive health in the elderly is not the "all-dimensional decline with age" that the public has in mind. The core feature is the coexistence of selective function preservation and compensatory ability improvement. The cognitive level of the vast majority of healthy elderly people can fully adapt to all the needs of daily socialization and life. Only in a few specific scenarios will there be minor symptoms that do not affect life.

I have been doing cognitive screening for the elderly in the community for almost 4 years, and I have encountered more than a hundred times when family members dragged the elderly to the clinic for consultation. Most of the time it was because the elderly had forgotten where to put the groceries they had just bought, or turned around and forgot to call their children. The family members were so panicked that they thought it was a precursor to Alzheimer's disease. As a result, after completing a set of scales, all cognitive scores were within the healthy range. This is the case for the 72-year-old Aunt Zhang who came here a while ago. She went out to buy groceries the day before and forgot to take change. Her daughter forced her to come. I talked to her about the first batch of students she taught when she was a primary school teacher. She couldn't even tell which child she loved most secretly. She clearly remembers the candies in her textbooks, and which class of students raised money to give her a thermos cup when they graduated. When calculating the pension money for her children, she can calculate the accounts faster than young people. The only thing she can't remember is the name of the new community social worker she just met last week. In fact, this is the normal cognitive state of healthy elderly people: the instantaneous memory of recent trivial events will decline slightly, which is often called "forgetfulness", but the semantic memory and logical judgment ability accumulated for decades will continue to improve with the increase of experience. To put it bluntly, it is like the running memory of an old mobile phone is small, and opening a new application is half a beat slower, but the hard drive data that has been stored for a lifetime is smoother than a new mobile phone.

Speaking of which, there is still a lot of controversy in the academic community about the speed of cognitive decline in healthy elderly people. An 82-year-old retired professor did a screening before, and all the indicators were very good. As a result, Alzheimer's disease was diagnosed six months later, and the disease deteriorated much faster than the average elderly person. One group of scholars believes that this is because his cognitive reserve was thick enough when he was young, which delayed the onset of disease by nearly 10 years. The rate of cognitive decline in a healthy state is much slower than that of an elderly person with low cognitive reserve. ； The other group believes that cognitive reserve can only cover up the symptoms of decline, but cannot change the speed of decline. The old professor has actually experienced hidden decline before, but his strong reserves have helped him maintain normal functions on the surface. Each of the two groups has data to support it, and there is no unified conclusion yet.

However, no matter how much the academic circles argue, the most intuitive feeling from our front-line service providers is that the cognitive plasticity of healthy elderly people is much stronger than everyone thinks. Last year, we held a smartphone usage class in our community. At first, no one dared to let elderly people over 80 come. Later, a few old men and women insisted on signing up, so we tried to accept it. As a result, after two months, several elderly people in their 80s were able to shoot short videos, cut music and make Douyin, and use navigation to take the subway to go to the park. They learned faster than many elderly people in their early 60s who always said that they "can't learn it when they are old." To put it bluntly, as long as there is no pathological damage, the cognitive health of the elderly is particularly flexible. It is not at all a state of "nothing good as we age" as everyone thinks.