Cognition and AgingMedical School
• Frail body, reduced BMI
Crystallized Vs Fluid intelligence
– Crystallized intelligence (e.g. knowledge)
– Fluid intelligence (native wit)
• Tested by IQ test.
Bridge and chess
• Strong correlation; sensory abilities & intellectual
• Visual & auditory acuity account for 49% of the recorded
variance of the difference in intelligence in the elderly.
– Impaired metabolic and cardiovascular systems.
– Decline in CNS transmission speed, cell loss & increased
– What are the possible problematic confounders?
• Different generations
• Materialistic differences
• Effect of education
• How to control??!!
The peak of intellectual performance is around 25 years of age, and
gradually decline thereafter.
– Drop out effect (less well more likely to drop out)
– Still cohort study.
Intellectual functions remain static till about the age of 53, then
start to decline.
60-80 years; great individual variations, 60- 80% remain stable or
80-100 decline in all subtests
Ageing and cognitive decline
Age related cognitive can occur in the healthiest elderly
The normal elderly less frequently experience impairment in
cognitive areas other than memory.
Not universal but variable
Slowing of intellectual and physical performance but maintain
reasonable level of functioning.
Other factors associated with age: • Illness
Slowed neuronal processing
Accentuation of personality traits • Decreased flexibility and
tolerance to change
• Decreased excitability & impulsivity; more cautious
Ageing and intelligence: • Preserved crystalized intelligence
• Decreased fluid intelligence
Decrease in naming ability
Decreased retrieval of stored memory
Language relatively well spared
What is Cognition?
basic capacities such as perception,
language, behaviour, actions, memory and
thoughts in order to interact appropriately
with the world.
Assessment of Cognition
Attention and Concentration
3. RETRIEVAL - locate and retrieve on request
Forgetting – Loss and decay
Where is memory based?
system (Hippocampus, Parahippocampal
100% of all individuals over ??
50% of all individuals in nursing homes.
820,000 persons in the UK.
People with/without dementia
Census 2001 : 20% above the age of 65. • How many in
750,000 in UK today with dementia.
More with cognitive impairment …!!
37% in institutional care
13% live alone, usually supported by a carer.
Size and cost of Dementia It is estimated that 35.6 million people
dementia worldwide in 2010, – increasing to 65.7 million by 2030
and 115.4 million by
– The total estimated worldwide costs of dementia are US$604
billion in 2010.
– The United Dementia Republic • What if dementia was a republic in
terms of population economy? • It would have ranked 18th Largest
economy in the world
About 70% of the costs occur in Western Europe and North
Approximately 30% of the total annual cost of AD is invested in the
direct management of BPSD.
820,000 people with dementia in the UK – The cost of dementia care
exceeds that of cancer, heart
disease and stroke combined. – £17 billions/ year – Triple to £50
billions/ year over the next 30 years
Definition of dementia
multiple areas of intellectual function, not
due to delirium.
three or more of the following nine
spheres of mental activities:
– Memory, language, perception, praxis,
calculation, conceptual or semantic
knowledge, executive functions, personality,
– Memory (STM & LTM)
– Visiuo-special awareness.
In mid-frontal area, superior temporal area, parietal area and
Limbic system is primarily affected.
cell loss in nucleus basalis of Meynert reduce acetyl- transferase
reduce acetyl choline. NFT
particularly in hippocampus.
of the tangles.
Plaques not seen in white matter
No. of plaques = impairment of
Causes and types of dementia
Not just due to aging but increased risk with age. – Alzheimer’s
– Vascular dementia (multiple infarctions)
– Dementia of Lewy Body
1. Parkinsonian signs
2. Speech impairment
3. Cognitive impairment
Behavioural and Psychological
• Agitation, pacing,
Infections e.g. AIDS, Syphilis.
I. Causes Psychological
Biological Disease (vascular pathology, Parkinson,
Medication (Hypotensives, antibiotics .... Etc)
Older people tend not to complain about depression
More somatic symptoms
is different from younger
is different from younger
Psychological symptoms CBT
Difficulty with accessibility
ECT Severe depression
• Late onset Psychosis
Late Onset Psychosis
?? Charles Bonnett Syndrome