Natural Aging, What’s Normal?

When do we laugh it off and when do we worry about our aging brains?

Dementia= premature aging of the brain. How do we distinguish this vs. normal aging of the brain?

This post focuses on normal aging.

Here is the short version: you will still be able to think and problem solve but it will be slower in your 60s, while remembering names of people and word recall is worse after you turn 70. You will need to think about limiting distractions in your environment so that you can pay attention and you will need to write things down. You will find it easier to do things by routine then to continuously resolve problems as early as your 50s. You keep general knowledge, life skills, recognition of things, faces, but not the quick recollection of the names of things or those faces.

What gets better? Wisdom, intelligence doesn’t go away. Knowing what is important vs frivolous. Vocabulary and trivia can improve.

Long version:

Here’s the story. You are going to eventually have a moment when you can’t think of someone’s name. Someone you know well but probably don’t speak of often. You are going to call the microwave the toaster by mistake. You are going to put your checkbook/passport/itinerary somewhere and drive yourself nuts trying to find these occasionally used things. You are going to put your phone/keys/glasses down while distracted and have to search for them. You are going to forget whether the appointment next month is Tuesday or Thursday and at 9am or 9:30am. You are going to be driving somewhere you have been before and miss the exit or forget for a minute where your actual destination was. You ARE forgetting your meds if you don’t have a visual system to double check like a pill planner. Fine, all normal. I am never going to worry about any of this.

You are going to have a completely different recollection of a remote past experience compared to someone else who was there and someone will argue that you are telling the story wrong. Normal. We remember things that are emotional or set to music much better than something that is mundane or even important. Easier to remember a bad dream (when you wake up with the emotions from it) than what you did last Tuesday even if it was an important conversation relative to what you need to do today. Annoying, but true.

As a Neurologist I worry when: I hear the same story within the same conversation presented as if it was never told. If you tell me the same story tomorrow I worry less. I worry when people drop important grammatical parts of speech, like the noun at the end of each sentence, we find ourselves filling in from context more than the occasional word search. I worry when someone has no worries about their memory and everyone else does. I worry when something you have done forever becomes too hard and you stop doing it. This includes reading, knitting, cooking your favorite recipes. I worry when you lose problem solving the most.

In clinic, we often ask the date, there is no internal calendar in our brain, you have to use some context to determine this. Some people joke about checking their watch or their phone but the reality is that is good problem solving.

The most important symptom of dementia is trouble learning new information. However I don’t expect anyone to easily learn a new language without significant effort. I do expect people to have to adjust to new tech. Change your TV remote? Good luck. It will take effort to figure it out. Keep things simple, I rarely advise people who are struggling to solve their problems with technology. Writing out your calendar by hand, you have a much greater chance of recalling the event.

If you come to me and tell me you got lost driving once last summer and now have to write things down to remember them and you used to be able to write code 15 years ago but now can’t remember your password…I will reassure you. Nobody remembers their password unless it is a totally useless one. None of this worries me.

Highlights- older people may be more accurate in judging distances than younger people. The ability to recognize familiar objects and faces, as well as to maintain appropriate visual perception of objects, remains stable over the lifetime. Whereas, language abilities (verbal fluency and the ability to name objects) demonstrate some late-life decline, particularly after age 70.

Still normal- but annoying, we naturally lose some cognitive skills.

We naturally lose some episodic, working memory and executive function.

These are late-life progressive changes, occurring after your 60s and have a linear or accelerating decline with further aging.

According to the NIH, episodic memory involves the ability to learn, store, and retrieve information about unique personal experiences that occur in daily life. These memories typically include information about the time and place of an event, as well as detailed information about the event itself.

Working memory-Keeping things in your mind. Looking at a phone number and then dialing it was always going to max out at 7 digits- this is how a phone number length was determined. Working memory is a form of memory that allows a person to temporarily hold a limited amount of information at the ready for immediate mental use. It is considered essential for learning, problem-solving, and other mental processes.

Executive function is critical to engagement in purposeful, independent, and self-preserving behavior and is necessary for a person to successfully manage their own medical illnesses. Executive function declines with age and more dramatically after age 70.

Processing speed and attention to tasks naturally decreases with age.

Processing speed can have a global effect on testing performance and cause slower speech production of older adults.  So give people some time to come up with the way they want to say something, your suggestions /fill in the blanks are probably distracting rather than helpful. Unless someone asks of course, then give it a guess.

Expected are changes in attention span with even simple attentive tasks. In particular, there is a decrease in the ability to focus on a task in a busy environment and the ability to perform multiple tasks at one time. Do one thing until complete and then tackle the next thing on the list or you will forget you are boiling water or emptying the dryer or vice versa when trying to do both. Set timers, set alarms, make a list and make life easier.

I am not being agist here. To round it out, problem-solving which is reasoning about unfamiliar things, processing and learning new information, and attending to and manipulating one’s environment show a steady decline (by about -0.02 standard deviations per year) after peaking around age 30.

You are still smart and capable so don’t get caught up on occasional missteps. Do more of the things you enjoy and yes, write everything down.