Cognitive Functioning in Older Adults

Multidimensionality and Multidirectionality

• Cognitive Mechanics and Cognitive Pragmatics

  • cognitive mechanics

    • hardwire of the mind

    • reflect the neurophysiological architecture of the brain that was developed through evolution

    • consist of the speed and accuracy of the processes involved in

      • sensory input

      • attention

      • visual and motor memory

      • discrimination

      • comparison

      • categorization

    • likely to decline with age

    • decline in cognitive mechanics may begin as soon as early midlife

    • like fluid intelligence

  • cognitive pragmatics

    • culture-based software programs of the mind

    • include

      • reading and writing skills

      • language comprehension

      • educational qualifications

      • professional skills

      • self-understanding and life skills that help us to master or cope with challenges

    • possible for them to continue improving into old age

    • may actually improve, at least until individuals become very old

    • like crystallized intelligence

• Speed of Processing

  • declines in late adulthood

  • considerable individual variation

    • correlated with physical aspects of aging

  • slowing of processing speed is linked to the emergence of dementia over the next six years

  • processing speed and health status are among the best predictors of living longer

  • decline in processing speed in older adults is likely due to a decline in functioning of the brain and central nervous system

  • processing speed is an important indicator of the ability of older adults to continue to safely drive a vehicle

  • exercise interventions can improve older adults’ processing speed

    • high-intensity aerobic training

• Attention

  • in many contexts older adults may not be able to focus on relevant information as effectively as younger adults can

  • less effective attention and processing speed were linked to declining memory in older adults

  • older adults are less able to ignore distracting info than younger adults

    • becomes more pronounced as attentional demands increase

    • greater distractibility of older adults is associated with less effective functioning in neural networks in the frontal and parietal lobes (cognitive control)

  • **==selective attention: ==**focusing on a specific, relevant aspect of experience while ignoring the irrelevant aspects

    • older adults are less adept at selective attention

    • training in speed of processing improves selective attention

  • **@@divided attention: @@**concentrating on more than one activity at the same time

    • the more difficult the competing tasks are, the less effectively older adults divide attention compared with younger adults

  • **$sustained attention:$**focused and extended engagement with an object, task, event, etc. aka vigilance

    • with simple vigilance: older adults perform as well as younger adults

    • complex: older adults performance usually drops

    • the greater the variability in their sustained attention, the more likely they were to experience falls

    • older adults’ wisdom and experience might offset some of their declines in vigilance

  • executive attention: planning actions, allocating attention to goals, detecting and compensating for errors, etc etc

    • older adults have deficiencies in executive attention

    • executive attention training improved the selection attention and divided attention of older adults

• Memory

  • Explicit and Implicit Memory

    • aging is linked with a decline in explicit memory

    • **^^explicit / declarative memory: ^^**memory of facts and experiences that individuals consciously know and can state

    • **^^implicit memory: ^^**memory without conscious recollection

    • implicit memory is less likely to be adversely affected by aging

  • Episodic Memory and Semantic Memory

    • forms of explicit memory

    • episodic memory: retention of info about the details of life’s happenings

    • younger adults have better episodic memory than older adults have for both real and imagined events

    • in older adults, the older the memory is, the less accurate it is

    • autobiographical memories are stored as episodic memories

    • reminiscence bump: adults remember more events from the second and third decades of their lives than from other decades

      • found more for positive than negative life events

    • semantic memory: a person’s knowledge about the world

      • independent of an individual’s personal identity with the past

    • ability to retrieve very specific info usually declines in older adults

    • episodic memory declines more than semantic memory

    • tip-of-the-tongue phenomenon: individuals can’t quite retrieve familiar info but have the feeling that they should be able to retrieve it

      • older adults are more likely to experience TOT states

  • Working Memory

    • closely linked to short-term memory but places more emphasis on memory as a place for mental work

    • declines during late adulthood

    • continues to decline from 65-89

    • older adults’ working memory can be improved through training

    • aerobic endurance was linked to better working memory in older adults

  • Source Memory

    • ability to remember where one learned something

    • failures of source memory increase with age in the adult years

    • self-referenced encoding improves the source memory of older adults

    • older adults with better source memory were characterized by healthy cardiovascular markers and psychological traits

    • older adults with good retrieval strategies had no deficits in source memory

  • Prospective Memory

    • remembering to do something in the future

    • remembering to remember

    • decline in prospective memory with age

      • depends on the nature of the task, what is being assessed, and the context of the assessment

      • age-related deficits occur more often in prospective memory tasks that are time-based rather than those that are event-based

    • impaired in those with mild alzheimers

    • declines in prospective memory occur more often in labs than in real-life settings

  • Conclusions About Memory and Aging

    • most, but not all, aspects of memory decline during late adulthood

    • decline in perceptual speed is associated with memory decline

• Executive Function

  • managing one’s thoughts to engage in goal-directed behavior and to exercise self-control

  • prefrontal cortex shrinks with aging

    • linked with a decrease in working memory and other cognitive activities

  • execute function skills decline in older adults

  • aspects of working memory that especially decline

    • updating memory representations that are relevant for the task at hand

    • replacing old, no longer relevant info

  • older adults are less effective at engaging in cognitive control

    • switching back and forth between tasks or mental sets

    • inhibiting dominant or automatic responses

  • variability in executive function among older adults

    • highly educated older adults have better executive function

      • associated with slower age-related reduction in executive function

    • aerobic exercise improves executive function in older adults

  • deficits in executive function but not memory predicted a higher risk of coronary heart disease and stroke three years later

  • executive function in older adults increased their sense of control, which is associated with higher life satisfaction and positive affect

• Metacognition

  • when older adults engage in metacognitive monitoring of their performance, their visual short-term memory benefits

  • older adults perform worse on metacognition tasks

    • deterioration in metacognition is linked to older adults’ life satisfaction

  • theory of mind abilities decline in older adults

    • due to declines in cognitive skills and declines in prefrontal cortex functioning

• Mindfulness

  • being alert, mentally present, and cognitively flexible

  • some, but not all, studies have shown that mindfulness training improves older adult’s cognitive functioning

• Wisdom

  • expert knowledge about the practical aspects of life that permits excellent judgment about important matters

  • high levels of wisdom are rare

  • time frame of late adolescence and early adulthood is the main age window for wisdom to emerge

  • factors other than age are critical for wisdom to develop to a high level

    • certain life experiences

    • values that are more likely to consider the welfare of others

    • personality-related factors

    • education

  • wisdom peaks in midlife

Education, Work, and Health

• Education

  • successive generations in america are better educated

  • today’s older adults were more likely to go to college than their parents

  • more older adults are returning to college to further their education

  • higher educational attainment is strongly associated with older adults’ working memory

  • older adults with less education had lower cognitive abilities

  • for older adults with less education, frequently engaging in cognitive activities improved their episodic memory

• Work

  • successive generations have had work experiences that include a stronger emphasis on cognitively oriented labor

  • younger generations will have more experience in jobs that require considerable cognitive investment

  • when older adults engage in complex working tasks and challenging daily work activities, their cognitive functioning shows less age-related decrease

• Health

  • successive generations have been healthier in late adulthood as better treatments for a variety of illnesses have developed

  • cardiovascular disease is associated with cognitive decline in older adults

  • depression is linked to lower executive attention, memory, and language performance

  • some of the decline in intellectual performance found in older adults is likely due to health-related factors rather than to age

  • exercise is linked to improved cognitive functioning in older adults

  • dietary patterns are linked to cognitive functioning in older adults

  • terminal decline: changes in cognitive functioning may be linked more to distance from death or cognition-related pathology than to distance from birth

Use It or Lose It

• changes in cognitive activity patterns might result in disuse and consequent atrophy of cognitive skills

• mental activities that likely benefit the maintenance of cognitive skills in older adults

  • reading books

  • doing crossword puzzles

  • going to lectures and concerts

Training Cognitive Skills

• training can improve the cognitive skills of many older adults

• there is some loss in plasticity in late adulthood, especially in those 85+

• sustained engagement in cognitively demanding, novel activities improved the older adults’ episodic memory

• improving the physical fitness of older adults can enhance their cognitive functioning

• engaging in mild or moderate exercise was linked to improved cognitive functioning in older adults with chronic disease

• engagement in physical activity in late adulthood was linked to less cognitive decline

• an in-home exergame training program improved their executive function

• changes in cognitive activity predicted cognitive outcomes as long as two decades later

• when older adults continued to increase their engagement in cognitive and physical activities, they were better able to maintain their cognitive functioning in late adulthood

• nutritional supplements, brain games, and software products have unrealistic claims

  • most research has not provided consistent plausible evidence that dietary supplements can accomplish major cognitive goals in aging adults over a number of years

  • some software-based cognitive training games have been found to improve older adults’ cognitive functioning, but the gains typically occur only for the specific cognitive task assessed

  • effectiveness of brain games is often exaggerated

  • little evidence that playing brain games in late adulthood improves underlying broad cognitive abilities or that the games help older adults to function more competently in everyday life

Cognitive Neuroscience and Aging

• explores the links between brain activity and cognitive functioning

• changes in the brain can influence cognitive functioning, and changes in cognitive functioning can influence the brain

• aging of the brain’s prefrontal cortex may produce a decline in working memory

• cognitive interventions that activate older adults’ working memory may increase these neural connections

• older adults are more likely than younger adults to use both hemispheres of the brain to compensate for declines in attention, memory, executive function, and language that occur with age

• functioning of the hippocampus declines to a lesser degree than the functioning of the frontal lobe

• patterns of neural decline with aging are more dramatic for retrieval than for encoding

• cortical thickness in the frontoparietal network products executive function in older adults

• younger adults have better connectivity between brain regions than older adults do

Language Development

• in late adulthood, some decrements in language skills may appear

• difficulty in retrieving words to use in conversation and problems understanding spoken language in certain contexts

• in less than ideal listening conditions older adults can have difficulty understanding speech

  • may be due to hearing loss as well as cognitive impairment

• most language skills decline little among older adults if they’re healthy

• older adults’ speech is typically lower in volume, slower, less precisely articulated, and less fluent

• conflicting info about changes in discourse

• non language factors may be responsible for some of the declines in language skills that do occur in older adults

  • slower information processing speed

  • decline in working memory

• language skills decline among individuals with alzheimers

  • difficulties in finding and generating words are one of the earliest symptoms of alzheimers

  • difficulty on tests of semantic verbal fluency

  • make more grammatical errors

  • less likely to use synaptic components

  • bilingualism may delay the onset of alzheimers

Work and Retirement

Work

• older workers who continued working beyond retirement age were motivated by factors involving financial status, health, knowledge, and purpose in life

• lower-income older adults are more likely to work in more physically demanding jobs, making it more difficult for them to continue working when they get old

• us workers are reasonably satisfied with their jobs

  • older us workers are the most satisfied of all age groups

  • significant individuals in worker satisfaction

• older workers take fewer sick days and demonstrate stronger problem-solving sets

• cognitive ability is one of the best predictors of job performance in older adults

• changes in federal law now allow individuals over 65 to continue working

• working in an occupation with a high level of mental demands is linked to higher levels of cognitive functioning before retirement and a slower rate of cognitive decline after retirement

  • a cognitively stimulating work context promotes successful aging

• older adults who work have better physical and cognitive profiles than those who retire

  • physical functioning declined faster in retirement than in full-time work for individuals 65+

  • retirement increased the risk of having a heart attack in older adults

  • individuals who retired for health reasons had lower verbal memory and verbal fluency than their counterparts who retired voluntarily or for family reasons

Retirement in the United States and in Other Countries

• Retirement in the United States

  • on average, today’s workers will spend 10 to 15 percent of their lives in retirement

  • the average number of years spent in retirement is 18 yrs

  • 37% of americans retire earlier than they planned

  • about 7 million retired americans return to work after they retired about 4 yrs after retirement

    • jobs pay less than pre-retirement jobs

    • about ⅔ are happy to do so

    • ⅓ needed to go back to work to meet financial needs

• Work and Retirement in Other Countries

  • France has the earliest average retirement age

  • Korea had the oldest average retirement age

  • a substantial percentage of individuals expect to continue working as long as possible before retiring

  • Japanese retirees missed the work slightly more than expected and the money considerably less than expected

  • US retirees missed the work and the money slightly less than expected

  • workplace organizational pressures, financial security, and poor physical and mental health were antecedents of early retirement

  • an increasing number of adults are beginning to reject the early retirement option as they hear about people who retired and then regretted it

Adjustment to Retirement

• older adults who adjust best to retirement are healthy, have adequate income, are active, are better educated, have an extended social network, and usually were satisfied with their lives before they retired

• the US retirement system is in transition

• main worries of individuals approaching retirement

  • having to draw retirement income from savings

  • paying for health care expenses

• flexibility is a key factor

• cultivating interests and friends unrelated to work improves adaptation to retirement

• planning ahead and then successfully carrying out the plan are important aspects of adjusting well in retirement

Mental Health

Depression

• major depression: mood disorder in which the individual is deeply unhappy, demoralized, self-derogatory, and bored

• symptoms: doesn’t feel well, loses stamina easily, has a poor appetite, is listlessness and unmotivated

• not more common in older adults than in younger adults

• not more often caused by psychological factors in older adults

• compared with middle-aged adults, depression in older adults is more likely to be chronic

• lower frequency of depressive symptoms in older adults compared with middle-aged adults was linked to

  • fewer economic hardships

  • fewer negative social interchanges

  • increased religiosity

• for most of late adulthood, women have higher rates of depression and more severe depression than males

  • lower incomes

  • having one or more chronic illnesses

• most common predictors of depression in older adults

  • earlier depressive symptoms

  • poor health

  • disability

  • losses of loved ones

  • social isolation

  • insomnia

  • curtailment of daily activities

  • increase in self-critical thinking

• depression is a treatable condition

• depressed older adults are less likely to receive treatment for their depression than younger adults are

  • 80% of older adults with depressive symptoms receive no treatment

  • antidepressants are less effective with older adults

  • ect is more effective for older adults

  • exercise can reduce depression

  • engagement in valued activities and religious / spiritual involvement

• major depression can result in suicidal tendencies

  • the older adult most likley to commit suicide is a male who lives alone, has lost his spouse, and is experiencing failing health

  • triggers for suicidal ideation

    • physical discomfort

    • loss of respect or support from family

    • impulsive emotions due to conflicts with others

    • painful memories

    • feelings of loneliness

    • sense of helplessness

    • low self-worth

    • declines in socioeconomic status

  • linked to lower levels of suicidal ideation

    • support from family and friends

    • emotional control

    • comfort from religion

Dementia, Alzheimer Disease, and Other Afflictions

• Dementia

  • neurological disorders involving an irreversible decline in mental function severe enough to interfere with daily life

  • alzheimers are the most common type

  • second most frequent: vascular dementia

  • medium to high levels of physical activity were linked with lower rates of dementia

• Alzheimer Disease

  • progressive, irreversible brain disorder

  • characterized by a gradual deterioration of memory, reasoning, language, and physical function

  • sixth leading cause of death in the us

  • ⅔ of those with alzheimer's in the us are women

  • percentage of individuals with alzheimer's increases dramatically with age

  • Causes

    • deficiency in the brain messenger chemical acetylcholine, which plays an important role in memory

    • as alzheimer's progresses, the brain shrinks and deteriorates

    • formation of amyloid plaques and neurofibrillary tangles

      • amyloid plaques: dense deposits of protein that accumulate in the blood vessels

      • neurofibrillary tangles: twisted fibers that build up in neurons. mainly consist of a protein called tau

    • increasing interest in the role that oxidative stress and mitochondria might play

      • oxidative stress occurs when the body’s antioxidant defenses don’t cope with free radical attacks and oxidation in the body

      • mitochondrial dysfunction is an early event in alzheimer’s

    • age is an important risk factor

    • genes may also play an important role

  • Early Detection

    • mild cognitive impairment: risk factor for alzheimer’s

      • distinguishing between individuals who merely have age-associated declines in memory and those with mci is difficult

      • individuals with mci who developed alzheimer’s had at least one copy of the ApoE4 gene

  • Drug Treatment of Alzheimer Disease

    • five approved drugs

    • cholinesterase inhibitors designed to improve memory and other cognitive functions by increasing levels of acetylcholine in the brain

      • do not reduce progression to dementia from mild cognitive impairment

    • regulates the activity of glutamate, which is involved in processing info

    • improve cognition and overall mental ability

    • current drugs used to treat alzheimer’s only slow the downward progression of the disease, but don’t address its cause

  • Caring for Individuals with Alzheimer Disease

    • family can be an important support system

    • family members can become emotionally and physically drained

      • family caregivers’ health-related quality of life in the first three years after they began caring for a family member with alzheimer’s deteriorated more than their same age and gender counterparts who were not caring for an alzheimer patient

    • respite care: services that provide temporary relief for those who are caring for individuals with disabilities, individuals with illnesses, or the elderly

      • provides an important break from the burden of providing chronic care

• Parkinson Disease

  • chronic, progresssive disease characterized by muscle tremors, slowing of movement, and partial facial paralysis

  • triggered by degeneration of dopamine-producing neurons in the brain

  • main treatment: administering drugs that enhance the effect of dopamine in the disease’s earlier stages and later administering the drug l-dopa, which is converted by the brain into dopamine

  • treatment for advanced parkinson’s: deep brain stimulation. involves implantation of electrodes within the brain

Religion and Spirituality

• religious service attendance was stable in middle adulthood, increased in late adulthood, then declined later in the older adult years

• individuals with a stronger spiritual / religious orientation were more likely to live longer

• secure attachment to God was linked to increased optimism and self-esteem

• religious service attendance was associated with a higher level of resilience in life and lower levels of depression

• religion can help older adults

  • face impending death

  • find and maintain a sense of meaning in life

  • accept the inevitable losses of old age

• religion can provide older adults with

  • social activities

  • social support

  • opportunity to assume teaching and leadership roles