Characteristics of cognitive health in the elderly are

The core feature of cognitive health in the elderly has never been "the complete absence of cognitive decline", but the "dynamic adaptation of cognitive functions and life needs" in the natural aging process - there is no unified quantitative standard, individual differences are huge, and there is strong room for intervention.

Let me tell you something I encountered while doing cognitive screening in the community two years ago: 68-year-old Aunt Zhang and 72-year-old Aunt Li live in the same community and took the same cognitive screening scale. Aunt Zhang’s instant memory score just crossed the passing line. She even learned how to operate the new health code for almost half a month and still can’t remember it. Not all, but she is in charge of the catering schedule for the 27 elderly households living alone in the community. Those with diabetes cannot eat sweets, those with high blood pressure should use less salt, and those who are not at home on Wednesdays and Fridays need to change the meal delivery time. She is very knowledgeable and has not made any mistakes for more than half a year. No one will think that she has cognitive problems. On the other hand, Aunt Li’s score is much higher than Aunt Zhang’s. She plays short videos and cuts videos faster than young people. However, her family has to ask the real estate agent to help open the door every day. She often forgets to bring her keys when she goes out to take out the garbage. She often forgets to boil the pot when making porridge. She paid for groceries three times without any response. Finally, she went to the hospital for a check-up and was diagnosed with mild cognitive impairment.

When I first entered the industry, I was stuck on scales and brain imaging indicators, and encountered many failures. In the past, there were quite some differences in the academic standards for judging cognitive health in the elderly: Neuroscientists focused more on physiological indicators, such as hippocampal atrophy and brain wave abnormalities, and believed that as long as there were degenerative changes, it would be considered a risk. ； The public health school pays more attention to social functions and believes that as long as the cognitive level can support independent life and complete the social participation that one cares about, one is healthy. In the past two years, the consensus between the two sides has gradually unified: cognitive health is inherently a "personalized" matter, and there is no need to use a unified ruler to measure everyone. I met a 76-year-old rural man before. The degree of hippocampus atrophy shown by brain CT was more obvious than that of many patients with mild cognitive impairment. But he has been planting fruit trees all his life. He remembers when to fertilize, when to thin the fruit, and which tree has the sweetest fruit. He remembers it better than anyone else. He rides to town every day to sell fruit and settle accounts. Can you say that he is cognitively unhealthy?

Many people always think that the elderly cannot remember new things because they have "bad brains", but this is not true. Just think about it, young people’s brains are like new hard drives that have just been used for two or three years. There are few things to store, so of course it is faster to store new data. ； The brains of the elderly are full-capacity hard drives that have been used for sixty or seventy years. They store most of a lifetime's experience, memories, and business logic. Of course, retrieving new information is slower, but if you really want to use the accumulated content, it is much more reliable than that of young people. Last summer, gas pipelines were cut during water pipe repairs in the community. A bunch of young people were hurriedly using their mobile phones to check what to do. The 73-year-old Uncle Wang downstairs immediately told everyone to close the windows, stop turning on open flames, and stop talking on cell phones. He stood at the intersection and stopped passers-by from smoking. He was quicker than the management to respond - do you think this is cognitive unhealthy?

There is another point that is easily overlooked: the plasticity of cognitive health in the elderly is actually much stronger than everyone imagines. Last year, our community provided 3 months of non-pharmacological intervention to 22 elderly people with mild symptoms of memory loss. There was no complicated training. They just gathered together for an hour every day to play poetry, do crafts, and talk about old memories. Each person was paired with a companion to remind them to take medicine and remember important things. After 3 months, the review showed that 17 elderly people's attention and short-term memory scores had improved. Several elderly people who had always forgotten things before were able to sign up for short outings in the community.

Of course, this does not mean that all memory decline is normal. If you suddenly cannot find your home, you are asked the same question repeatedly, you suddenly can’t cook the food you have been cooking for decades, or your personality suddenly becomes withdrawn and irritable, you still need to go to the hospital for a check-up in time, and don’t bear it. I have been working in this industry for almost 6 years, and my biggest feeling is that you should not use the standards of young people to apply the cognitive status of the elderly. Just like you cannot ask an old man who has been climbing mountains all his life to run faster than a 20-year-old boy in the 100-meter run - if he can walk slowly by himself, remember the way home, taste the fragrance of rice, and chat happily with his old friends, he is already in the best health state.