Dr. Tariq Jagnarine
Fam Med, Endocrinology/ Diabetes
As people get older, they may experience a gradual loss of some thinking abilities. A significant change may indicate another health condition. Their minds are central to their identity. The sharpness of our thinking, our ability to communicate and connect with others, and the rich trove of memories we’ve collected over a lifetime all have enormous value.
As you get older, you may notice changes in some of your thinking skills, including cognitive decline. Cognitive decline is the gradual loss of thinking abilities such as learning, remembering, paying attention, and reasoning.
For some people, a small amount of cognitive decline occurs with age. However, more significant changes can be a sign of a cognitive disorder. Injury, illness, and health habits can influence how much and how fast your cognitive abilities change over time.
RISK FACTORS
Genes and family history are major risk factors for cognitive decline. But other factors may also lead to a faster or more noticeable decline. These include diabetes, high blood pressure, stroke, smoking, high cholesterol, and hearing loss.
Some of these factors can be controlled, and some can’t. Try working with a healthcare team to create a plan to stay healthy — mentally and physically.
CAUSES
There are many reasons you may experience age-related changes in thinking and memory. Sometimes, another health condition may be the cause. Examples include:
• High blood pressure
• Vascular (blood vessel) disease
• Depression
• Sleep deprivation
• Diabetes
Sometimes, neurological conditions such as Alzheimer’s Disease or frontotemporal dementia are the underlying cause.
Genes and family history also play a role in whether you will experience cognitive decline as you get older. Genes may be responsible for up to 60% to 70% of the various ways cognition decline due to aging.
STAGES OF COGNITIVE DECLINE
Specialists generally recognize four stages of cognition as people age:
• No cognitive impairment (NCI): Not experiencing any differences in your thinking ability or in the complex skills that make up cognition.
• Subjective cognitive decline (SCD): Noticing that some of your thinking abilities have begun to decline but not enough to interfere with how you function day to day.
• Mild cognitive impairment (MCI): Experiencing a decline in your ability to reason, remember, use language, make judgments, and perceive the world around you accurately.
• Dementia: Having trouble with activities of daily living. These include driving, paying bills, taking care of your living space, and caring for your body and your health.
NCI and SCD are typical as people get older. MCI and dementia are cognitive disorders with symptoms that can occur along a spectrum of severity.
SIGNS
Cognitive decline looks different from person to person. That may be because people vary in their health profiles, life circumstances, and capabilities. Still, some patterns have emerged from the research. People with mild cognitive decline might:
• Having trouble finding the right words to express themselves, especially when compared with others of the same age
• Lose or misplace things
• Forget appointments and scheduled events
• Become overwhelmed by complex tasks and projects
Keep in mind that typical forgetfulness is not the same as cognitive decline. It’s not helpful to assume that regular forgetfulness is necessarily a sign of cognitive decline. Such worrying can affect your well-being.
If you notice any of these signs, it may be time to visit a healthcare professional:
• You get lost in once-familiar areas.
• You become frustrated with communication difficulties.
• You experience mood or personality changes, such as more anxiety or aggression.
• You ask the same questions over and over.
• You have trouble recognizing friends and family members.
DIAGNOSIS
A doctor can help you determine whether you’re experiencing typical signs of aging or symptoms of cognitive decline. They may assign you a brief self-screening test to check for symptoms of cognitive decline.
• Self-administered gerocognitive Examination (SAGE) and other screening tests
• AD8 Dementia Screening Interview
• Quick Dementia Rating System (QDRS)
• Mini-Cog
Neuropsychological tests
In an evaluation, doctors often use neuropsychological tests to see whether your thinking and memory skills are changing. Some of the most common tests are:
• Mini-Mental State Examination (MMSE)
• Montreal Cognitive Assessment (MoCA)
Other tests
A doctor might order a blood test to see if something else — like hypothyroidism or a B12 deficiency — may be causing a change in your thinking abilities.
Brain imaging, such as magnetic resonance imaging (MRI), may help a doctor determine whether something like a stroke or brain tumor is at the root of your symptoms.
AGE AND COGNITIVE DECLINE
Each person is different. Your health behaviors have some influence on your brain function as you age. A 2020 analysis of the Health and Retirement Study, which involved around 29,000 participants, found that women first experienced cognitive impairment around age 73. Those women who went on to develop dementia did so at about 83 years old. Men, the study found, experienced cognitive decline near age 70 and dementia at 79 years.
It’s important to know that not everyone with cognitive decline will later have dementia. The study also found that race and education level affect the age of onset.
People with higher education levels tend to experience cognitive decline at a later age. This may be because they stay active mentally and have more social connections later in life, researchers said. They may also have greater access to healthcare and earlier treatment of medical problems.
MENTAL HEALTH, PERSONALITY, AND COGNITIVE DECLINE
Some personality traits or mental health conditions may be early signs of cognitive decline. These include depression, stress, anxiety, and neuroticism.
A 2017 study suggested that this might be related to changes in the medial temporal lobe of the brain.
PREVENTION
Some age-related cognitive changes are tied to our genetics. There may not be much someone can do to change that risk factor. But there are many other ways to keep your brain healthy and preserve its ability to think. Here are a few research-supported steps you can take:
• Eat a nutritious diet with lots of leafy green vegetables. Studies suggest that the Mediterranean and DASH diets both slow cognitive declines.
• Stay physically active.
• Connect with other people socially.
• Stimulate your brain with activities, reading, games, and hobbies.
• Protect yourself from brain injury.
• Limit the amount of alcohol you drink.
• Avoid the use of tobacco products.
A 2022 study suggests that taking a daily multivitamin might help slow cognitive decline. However, more research is needed to confirm the results.
It depends on what’s causing the changes. If your symptoms are related to an underlying health condition, such as sleep deprivation, treating the cause may reduce the symptoms.
