Characteristics of cognitive health in the elderly are

The core characteristics of cognitive health in the elderly are extremely heterogeneous, the rate of decline is highly bound to lifestyle, the boundaries between physiological aging and pathological changes are highly blurred, and there is no unified "normal standard."

I was deeply impressed by the fact that when I was doing cognitive screening on the street last year, I met two elderly people from the same community. The 78-year-old Aunt Zhang carried the registration form for the meticulous painting of the senior college that she had just applied for. By the way, she also volunteered for us to help register the information. She could count the number of people in line faster than we could use a calculator.； Another 69-year-old Li Shu has just retired for three years. He even asked his wife three times whether he had taken antihypertensive medicine in the morning. Neither of them has underlying diseases, and no one in their family has suffered from cognitive-related diseases. Their cognitive status has been worse than it has been for nearly twenty years - this is the most intuitive manifestation of the heterogeneity of cognitive health. Survey data from the Chinese Center for Disease Control and Prevention in 2023 also confirms this: among people over 60 years old with normal cognition, 32% have cognitive reserves that are even higher than the average level of people aged 50 years old. In turn, there are nearly 15% of people aged 60-65 whose cognitive performance is close to the average level of 75 years old.

When I went to the National Elderly Cognition Forum before, this point even caused a heated argument between the two groups of scholars. The traditional clinical school believes that cognitive decline is the inevitable result of aging, and intervention can only delay it for one or two years at most, and there is no need to spend too much energy on popular science. ； Young scholars engaged in public health and cognitive neuroscience directly ignored the cohort data that had been tracked for 12 years. They said that at the age of 70, an elderly person who started exercising three times a week and actively using his brain for half an hour a day would suffer less than one-third of the cognitive decline of an elderly person who was sedentary and watched TV every day at the age of 85. 80% of early-onset cognitive decline could have been avoided. To be honest, we who are involved in front-line intervention think that both sides are reasonable. Cognitive reserves are actually like the pensions saved when they were young. Some people love reading, socializing, and doing new things when they are young. If they save enough "cognitive pensions", even if there is a little natural wear and tear when they are old, it will be enough. ； If you didn't like to use your brain when you were young, and if you retire, you will completely lie down, then your cognitive function will naturally decline quickly.

What makes people most confused is actually the blurred boundary between physiological aging and pathological changes. Last week, a family member anxiously dragged 72-year-old Uncle Wang to our studio, saying that he had been forgetting to turn off the gas and forget to take his keys when he went out in the past half month. He must have Alzheimer's disease. After a screening, all indicators were normal. After questioning for a long time, I found out that the uncle has recently been addicted to watching the World Cup. He stayed up until two or three o'clock every day, which was a temporary loss of concentration caused by lack of sleep. After going back to sleep for a week, everything was normal. Many people always think that "it's normal to be confused when you get old," or conversely, "forgetting things means dementia." In fact, this is not true: normal aging amnesia, at most, can't remember the names of people you just said, or where you put old things, but you may be able to remember them later, and you won't forget how to eat or how to get home. ； If you can't remember what you just ate, can't find your way home, or can't even recognize your closest relatives, that's a sign of pathology and you need to go to the hospital quickly.

There is still a controversial point in the academic circles that has been quarreling for five or six years: Is "subjective cognitive decline" a precursor to cognitive impairment? One group believes that as long as the elderly feel that their memory is not as good as before, even if the objective screening is normal, it is a high-risk signal and requires early intervention. ； The other group believes that often this "feeling of poor memory" is caused by anxiety. On the contrary, the more worried you are, the easier it is to forget things. There is no need to panic. After working on the front line for a long time, we actually prefer the middle view: if you just forget things occasionally and it doesn't affect your life, you don't need to take it to heart at all. You should just play and eat. ； If the frequency of forgetting things becomes higher and higher, and you feel that it has affected your normal life, then don't hesitate and go for a screening as soon as possible, there is no harm in it.

In fact, after working in this industry for a long time, I discovered that there are no unified standards for cognitive health in the elderly. Uncle Zhao, who runs a shoe repair shop downstairs, is 82 years old this year. He repairs shoes for customers every day, settles accounts, and notes various customization needs. He is smarter than a young man in his twenties. ； Aunt Chen, who is across the street, is 70 years old. She loves to bask in the sun every day and go for a walk. She cannot remember complicated things, but she can clearly remember that she loves to eat candy cakes and remembers to pick up her grandson from school every day. She lives a comfortable life. Both of these are healthy states. There is really no need to apply other people’s standards to your own elderly people. If you are really unsure, it is much better to go to the community for a free cognitive screening every year than to ponder at home at home.