Chapter 18: Cognitive Development in Late Adulthood

Multidimensionality and multidirectionality

Cognition is a multidimensional concept

• Cognitive mechanics

• Cognitive pragmatics

• Speed of processing

• Attention

• Memory

• Metacognition

• Mindfulness

• Wisdom

Cognitive mechanics

Hardware of the mind and reflect the neurophysiological architecture of the brain that was developed through evolution

• Decline with age: begin as soon as early midlife

Three components

• Speed and accuracy of the processes involved in sensory input,

• Attention, visual and motor memory,

• Comparison, and categorization

Cognitive pragmatics

Culture-based “software programs” of the mind

• Continue improving into old age

Components of cogntiive pragmatics

Reading and writing skills, language comprehension, educational qualifications, professional skills, and also the self-understanding and life skills that help us to master or cope with challenges

Speed of processing

Processing speed increases during childhood and adolescence, decline at some point during the latter part of early adulthood, decline through the remainder of adult years 

• Individual variation is still taken into account: physical aspects of aging

Faster processing

Linked to greater life satisfaction

Slower processing

Accumulated knowledge, emergence of dementia in the next 6 years, due to decline in functioning of the brain and CNS

Importance of speed

Ability of older adults to continue to safely drive a vehicle

• Intensity aerobic training was more effective than moderate-intensity aerobic training or resistance training in improving older adults’ processing speed

Attention

Being alert and attentive are especially important to prevent older adults from falling and also to improve their capacity to focus attention while driving

• Older adults are less able to ignore distracting information than younger adults, and this distractibility becomes more pronounced as attentional demands increase

Divided attention and sustained attention (vigilance) tasks

Older adults often perform as well as younger adults, but as the tasks become more complex, older adults’ performance usually worsens

• Older adults’ experience and wisdom might offset some of their declines in vigilance

Activities to improve attention

• Mindfulness meditation: goal-directed attention improved

• Game-based training: improved older adults’ selective attention

• Executive attention training: improved the selective attention and divided attention of older adults

Types of memory

• Explicit and implicit memory

• Episodic and semantic memory

• working memory

• source memory

• prospective memory 

Explicit/ declarative memory

Facts and experiences that individuals consciously know and can state (e.g., recounting the events in a movie you have seen)

Implicit memory

Without conscious recollection; it involves skills and routine procedures that are performed automatically (e.g., driving a car)

• Less likely to be adversely affected by aging

Episodic memory

Retention of information about the details of life’s happenings (e.g., colors of walls in your bedroom when you were a child)

• Younger adults better than older adults

• Individual variations

• Some older adults even have an excellent level

Subconcepts in episodic memory

• Autobiographical memory

• Mental time travel

Autobiographical memories

Stored as episodic

Reminiscence bump

• adults remember more events from the second and third decades of their lives than from other decades (more positive)

Mental time travel

Older adults often initially will speak in generalities about the past and the future, but when asked to give more details about such events, they veer off course and produce inaccurate accounts

Semantic memory

Person’s knowledge about the world: fields of expertise, general academic knowledge of the sort learned in school, “everyday knowledge”

• Independent of an individual’s personal identity with the past

• Older adults often take longer to retrieve semantic information, but usually they can ultimately retrieve it

• Ability to retrieve very specific information (such as names) usually declines in older adults

Tip-of-the-tongue (TOT) phenomenon

Individuals can’t quite retrieve familiar information but have the feeling that they should be able to retrieve it

Working memory

Closely linked to short-term memory but places more emphasis on using memory to perform mental tasks

• Declines during late adulthood

• Less efficient inhibition (capacity to prevent irrelevant information from entering working memory) and their increased distractibility

• Older adults’ skills can be improved through training

  • Less improvement in older adults than in younger adults

Source memory

Ability to remember where one learned something

• Failures of source memory increase with age can create awkward situations, such as when an older adult forgets who told a joke and retells it to the source

• Referenced encoding improved

• Older adults with better source memory were characterized by healthy cardiovascular markers and psychological traits

• Old people do every bit as well as young adults . . . young people have mental resources to burn. As people get older, they get more selective in how they use their resources

Prospective memory

Involves remembering to do something in the future, such as remembering to take your medicine or remembering to do an errand

• Remembering to remember

• important role in older adults’ successful management of the medications they needed to take

• Depends on factors such as the nature of the task, what is being assessed, and the context of the assessment

Executive function

Umbrella-like concept that consists of a number of higher-level cognitive processes linked to the development of the brain’s prefrontal cortex 

• Involves managing one’s thoughts to engage in goal-directed behavior and to exercise self-control

Executive function decline

Older adults show decreases in working memory, inhibition, and cognitive control, though adolescence and early adulthood show growth in these skills

Working memory declines

Difficulty updating relevant info and discarding outdated info

Variability

Some older adults maintain strong executive function; high performers tend to have higher education, more cognitive activity, better health markers, faster gait, and better balance

Interventions

Aerobic and mind-body exercises improve working memory, cognitive flexibility, inhibitory control, and prefrontal cortex activity

Importance

Supports cognitive performance, health, emotion regulation, adaptation, motivation, and social functioning; deficits predict higher risk of heart disease and stroke, while better executive function boosts sense of control, life satisfaction, and positive affect

Metacognition

Adults have accumulated a great deal of metacognitive knowledge

• Draw on this to help them combat a decline in memory skills

• Older adults’ accuracy declined beyond the expected decline in task performance 

• When engaged in metacognitive monitoring of their performance, their visual short-term memory benefitted 

• Performed worse on metacognition tasks, including those involve false beliefs, deception, and emotion recognition, than young adults did

• Lower level of metamemory engaged in impaired financial decision making

Mindfulness

Being alert, mentally present, and cognitively flexible while performing everyday activities and tasks

• Engaging in present- moment attention was linked to better affective well-being 

• Growing interest in training older adults to use techniques that promote mindfulness, particularly meditation 

• Mindfulness training improves older adults’ cognitive functioning

• Mindfulness-based stress reduction program involving meditation improved older adults’ memory and inhibitory control 

  • Improved the working memory and divided attention of older adults with mild cognitive impairment

  • Positive aging expectations

Wisdom

Expert knowledge about the practical aspects of life that permits excellent judgment about important matters

• This practical knowledge involves exceptional insight into human development, good judgment, and an understanding of how to cope with difficult life problems

• Wisdom may peak in midlife, with education linked to higher levels

Wisdom and its development

Self-reflection and meaning-making of life experiences, openness to experience in early adulthood, supportive childhoods, adolescent competence, emotional stability, and generativity in midlife all contribute to higher wisdom in late adulthood

New integrative model

Expanded integrative model of wisdom proposes that in challenging real-life situations, non-cognitive wisdom components moderate the effect of cognitive components

• Exploratory orientation means being highly curious

• Wise individuals are characterized by the Big Five personality trait of openness to experience 

• Knowledge consists of life knowledge and self-knowledge

Use it or lose it

Changes in cognitive activity patterns might result in disuse and consequent atrophy of cognitive skills

• Mental activities that likely benefit the maintenance of cognitive skills in older adults include reading or writing books, doing crossword puzzles, and going to lectures and concerts

Studies supporting use and lose

• Higher cognitive activity

• More mentally stimulating activities

• Volunteering and engaging in challenging activities

• Regular mental exercise

Higher cognitive activity

Reading, writing, games is linked to better executive function, processing speed, and semantic skills

More mentally stimulating activities

Reduce risk of mild cognitive impairment

Volunteering and engaging in challenging activities

Improves cognitive and brain functioning

Regular mental exercise

Lowers Alzheimer’s risk

• e.g., active priests were 47% less likely to develop the disease

Training cognitive skills

Possible to some degree

• Training can improve the cognitive skills of many older adults

• But there often is some loss in plasticity in late adulthood, especially in those who are 85 years and older

Results of cognitive training

• Sustained engagement in cognitively demanding, novel activities

• Physical fitness of older adults

• Changes in cognitive activity

• Products to boost abilities

• Software based cognitive training

• Physical-cognitive combined training

Sustained engagement in cognitively demanding, novel activities

Improved the older adults’ episodic memory

Physical fitness of older adults

Enhance their cognitive functioning

• Physical activity significantly improved the cognitive function of sedentary older adults compared with a control group

Changes in cognitive activity

Predicted cognitive outcomes as long as 2 decades later

• When older adults continued to increase their engagement in cognitive and physical activities, they were better able to maintain their cognitive functioning in late adulthood

Products to boost abilities

Many products claiming to boost older adults’ cognitive abilities, like supplements and brain games, often lack strong scientific evidence

• Some evidence supports ginkgo biloba for attention and fish oil for executive function, working memory, and reduced brain atrophy, but overall results are inconsistent

Software based cognitive training

Brain-training software may improve performance on specific tasks but generally does not transfer to broad cognitive skills or everyday functioning

Physical-cognitive combined training

Including interactive game-based and strength exercises, shows promise in improving cognition and reducing fall risk

Work and retirement

Retirement is a process, not just an event

• Older adults who adjust best to retirement are healthy, have adequate income, are active, are better educated, have an extended social network including both friends and family, and usually were satisfied with their lives before they retired

Flexibility in work and retirement

No longer have the structured environment they had when they were working, so they need to be flexible and discover and pursue their own interests.

• Cultivating interests and friends unrelated to work improves adaptation to retirement

Planning ahead and then successfully carrying out the plan in retirement

Special concern in retirement planning involves the recognition that women are likely to live longer than men, to live alone, and to have lower retirement income because they are less likely to remarry and more likely to be widowed

Consider other aspects of life

What am I going to do with my leisure time?” “How am I going to stay physically fit?” “What am I going to do socially?” “What will I do to keep my mind active?”

Mental health

• Dementia

• Alzheimers disease

• Parkinsons diseae

Dementia

Global term for several neurological disorders involving an irreversible decline in mental function severe enough to interfere with daily life 

• Alzheimer disease accounts for 60 to 80 percent of dementia

Risk factors of dementia

Depression and white matter (mainly axon and myelin sheath connectivity and transfer in the brain) impairment

Alzheimer Disease

Progressive, irreversible brain disorder that is characterized by a gradual deterioration of memory, reasoning, language, and eventually, physical function

Causes of Alzheimers disease

Deficiency in acetylcholine, which plays an important role in memory

• As it progresses, brain shrinks and deteriorates

Amyloid plaques

Dense deposits of protein that accumulate in the blood vessels

Neurofibrillary tangles

Twisted fibers that build up in neurons; contains tau (protein)

Role of oxidative stress and mitochondria in Alzheimers

Don’t cope effectively with free radical attacks and oxidation in the body

Age is an important risk factor and genes in Alzheimers

Apolipoprotein E (ApoE) is a gene linked to increased presence of plaques and tangles in the brain

• ApoE4: allele strongest risk factor for Alzheimer disease

DNA methylation

Tiny atoms attaching themselves to the outside of a gene, a process that is increased by exercise and healthy diet but reduced by tobacco use

Mild cognitive impairment (MCI)

• Potential transitional state between the cognitive changes of normal aging and very early stages of Alzheimer disease and other dementias

• Recognized as a risk factor for Alzheimer disease

Drugs

• Cholinesterase inhibitors

• Glutamate regulator

• Combination drug

• Aduhelm

Cholinesterase inhibitors

Aricept (donepezil), Razadyne (galantamine), Exelon (rivastigmine) – boost acetylcholine to improve memory/cognition

Glutamate regulator

Namenda (memantine) – regulates glutamate for information processing

Combination drug

Namzatric (memantine + donepezil) enhances cognition and mental ability

Aduhelm

First disease-modifying drug in 17 years, clears amyloid plaques (verified by PET scan), approved for mild cognitive impairment related to Alzheimer’s

Limitations of drugs

Slow progression but do not treat the cause of Alzheimer’s; cholinesterase inhibitors do not prevent dementia from mild cognitive impairment

Caring for people with Alzheimers

Family is a key support system but caregiving can be emotionally and physically draining.

• Health-related quality of life declines more in caregivers during the first three years compared with non-caregivers of the same age/gender

• Respite care provides temporary relief from daily caregiving duties.

• Many roles involve working with Alzheimer patients, including positions in organizations like the Alzheimer’s Association

Parkinson disease

Chronic, progressive disorder characterized by muscle tremors, slowing of movement, and partial facial paralysis

• Degeneration of dopamine-producing neurons in the brain

Treatment of Parkinson disease

Administering drugs that enhance the effect of dopamine (dopamine agonists) in the disease’s earlier stages and later administering the drug L-dopa, which is converted by the brain into dopamine

Deep brain stimulation (DBS)

Implantation of electrodes within the brain