MODULE SUPPLEMENT: NEUROLOGICAL SYSTEM
Cognitive Changes with Age

Changes in cognition do occur with age but these are not uniform across mental abilities and there are many methodological issues raised by the various designs used to assess these changes (Ashman, et al., 1999). Further, while we often think of memory when we consider cognition, cognitive functioning has many domains including: general and practical intelligence, attention, language, visuospatial ability, and executive function, as well as memory (Ashman, et al., 1999). Each of these work together to determine functional ability.

What does change with age and do they support changes in our approach to care?

In terms of general intelligence, researchers often differentiate between fluid and crystallized intelligence. Fluid intelligence relates to our ability to solve novel problems and is often viewed as important to dealing with the current rapid change in technology. Crystallized intelligence, on the other hand, refers to our accumulated knowledge and experiences and how well we can access and use these. Fluid intelligence tends to be negatively affected by age, although this varies across individuals. Crystallized intelligence is generally well preserved and may even improve in some areas, which supports the idea that wisdom comes with age and experience (Ashman et al., 1999). Similarly, practical intelligence, or the ability to solve to deal with everyday problems and situations, remains stable or can even improve (Ashman, et al., 1999).

Older adults also maintain their ability to sustain selective attention if they don't have other sensory deficits (such as hearing or vision problems), but may have some decrease in sustained attention or vigilance over extended periods of time. This latter problem, however, is significantly influenced by extraneous variables.

Some decline in visuospatial abilities occurs with age. Further, while most aspects of language are preserved, naming ability, especially the spontaneous generation of words, tends to decline. Many individuals talk about the "tip of the tongue" experience (MacKay & Abrams, 1996) or having a "senior moment" when a word doesn't come. However, this tends to be a access problem and not a retention problem--the material is there, it's just harder to retrieve. This means that cueing will often facilitate retrieval--a point we'll come back to.

What about executive function, or the ability to conceptualize, plan, and maintain self-control?  In most older adults these functions are preserved well into very late life, but this component may vary more across individuals than other factors (Ashman, et al., 1999). In contrast, executive function is one of the primary targets of fronto-temporal lobe dementia, often leading to inappropriate behaviors that cause significant stress to family caregivers and a great deal of mis-understanding from others in social situations.

Finally, what about memory? Memory is often viewed as a key cognitive process because it is so important to adaptation. We need memory to learn and to plan for the future based on the past. And our ability to learn underpins many of the other cognitive functions.

Discussion point: Consider the following. What is your earliest memory? What is your favorite memory?  How important are these memories to your sense of self and who you are? After you finish reflecting on this question, continue with the course content.