Many of us as we grow older experience a variety of changes some of which can become worrisome or concerning. We may notice that we need to write more things down, or even have difficulty finding the right words from time to time. When family members begin to notice these changes they often become worried and reach out for assistance from a health care professional. However, some changes are not always indicative of a cognitive problem and are just a normal part of getting older.
So what are normal cognitive changes versus ones of concern?
We really have 3 simple cognitive stages that can occur over the course of our life:
Mild cognitive impairment, which can develop into dementia and needs monitoring. If we are assessing cognition routinely we have a great opportunity to put in place programs to increase cognitive functioning or slow down cognitive decline.
Dementia which is an umbrella term for a variety of conditions, Alzheimer's disease being one, where one experiences degenerative, physical changes in the brain and progressive functional impairment.
And finally normal cognition which we will talk about more below. As we grow older we may not be as efficient as in the past, but at times nothing truly abnormal or pathologic is going on.
Age-related changes in brain structures such as decreased volume in the hippocampal, frontal and temporal lobe contribute to some of the thinking changes experienced by older adults. Many experience an overall slowness in thinking, difficulties in multitasking, sustaining attention, retaining or recalling information and mild word-finding. They may have subtle changes that mostly affect the speed of thinking (processing time) and maintaining attention. However, on the positive, older adults can also have areas that remain unchanged or even improve in terms of their vocabulary, reading, and verbal reasoning during the aging process.
Some cognitive changes however are not normal and can serve as a warning sign prompting further evaluation! Often times you can easily detect a noticeable decline in cognitive abilities, including short term memory, thinking and processing skills. Confusion at times especially later in the day or after changing a routine or environment, poor motor coordination, identity confusion, and impaired judgment. Those with cognitive impairments will also often withdraw due to depression, are aware of and want to hide their deficits, or find comfort and security in a familiar routine or surroundings.
Severe declines in cognition may include thinking abilities, such as rapidly forgetting information, difficulties navigating simple aspects of daily living or tasks, an inability to solve common problems, impulsive behavior or behaving outside of social rules. Cognitive changes may also impact and include the motor system issues - excessive tripping, falls, shuffling, or tremor.
If you notice these areas becoming effected further cognitive evaluation is recommended.
A full cognitive evaluation by an RN Care Manager specializing in mental health and geriatrics can be the best next step in providing answers and being helpful in guiding individuals in the right direction for support, care, and treatment.