I cringed recently while driving to the clinic where I specialize in geriatric medicine when I heard a young radio announcer refer to old people as “wiggy,” a pejorative for wacky.
As a doctor who has extensively researched aging and age-related diseases for over 30 years, this to me is the sound of ageism unleashed.
The quip immediately underscored how easily society regards age as the sole measure of how well a person functions, rather than the person’s ability to think clearly, make decisions and perform daily tasks.
Aging and mental acuity
The tension between age and function certainly have played out on a world stage in the 2024 U.S. presidential campaign. Prior to President Joe Biden’s withdrawal from the election process in July 2024, a writer for a national magazine asked my expert opinion as to whether either or both presidential candidates exhibited signs of dementia.
My answer was that I could not make that kind of determination in the absence of neuropsychiatric testing, some laboratory tests and a comprehensive geriatric assessment. This evaluation measures the patient’s physical and mental health and assesses their ability to perform daily tasks and live independently.
The reporter then asked whether older people can be more susceptible to the effects of fatigue, stress and other psychological pressures that might be reflected in altered verbal performance.
My answer was yes, and I cited examples of how an aging brain under duress may lose a train of thought or engage in excessively long pauses or disconnected topics.
What’s more, our organs’ ability to self-regulate and maintain stability, known as homeostasis, declines as we age. In other words, our body does not bounce back from stressful situations as well as when we were young. For example, an older person may take two to three times longer to recover from jet lag than a middle-aged person.
The conundrum of the aging brain
While each organ ages at different rates, gerontologists can now estimate more accurately how a person’s biological age may differ from their chronological age. Biological age represents the physiological, biochemical or molecular profile that changes with age. The rate of this change may be slower or faster depending somewhat on genetics but mostly on lifestyle and environmental factors.
The results are often surprising. One 2021 study suggests nearly half of the 38-year-old participants were up to five years older in biological age than their actual age, while the other half were as many as five years younger.
But generally, in the absence of neurodegenerative disease, the aging brain works well. Research shows both good and not-so-good changes; the good changes include adaptations such as new learning strategies – such as using notes to augment memory.
Among the less desirable changes may be longer reaction time and reduced information processing – in other words, as we age, it may take longer to complete a task. Some older adults may also lose high-frequency hearing and miss some points in conversation, especially in a crowded environment.
But even most of those changes are subtle and really do not limit learning and executive function – that is, the ability to set and achieve goals, solve problems, regulate emotions and function normally overall.
Still, researchers are beginning to recognize a “no man’s land” between normal brain aging and late-life diseases of the brain. For example, periodic memory lapses may be recognized as mild cognitive impairment, which can represent a fork in the road, with half of these situations progressing to dementia and the other half either getting better or not worsening. Through adequate blood pressure control, regular exercise and cognitive engagement, many people show improvement.
Cognitive frailty
Physical frailty is characterized primarily by slowness, weakness and fatigue. But what’s now called “cognitive frailty” relates to increased sensitivity to stressors and less ability to bounce back from physical or mental stress.
Although cognitive frailty is not dementia, it is a potential precursor to dementia – when patients exhibit subtle but demonstrable cognitive changes.
This is an area that many clinicians, even those working in the field every day, do not fully understand. Many of them don’t dig deeply enough into those subtle changes expressed by older patients. Indeed, one study found that rural primary care doctors underrecognized dementia among their patients.
Primary care is lacking in sufficient screening for cognitive disorders. Furthermore, Medicare does not yet have a diagnostic code for cognitive frailty. That is why advocates for optimizing health care in older adults are promoting the routine use of the geriatric 4Ms in clinical practice for everyone 65 and older: medication, mentation, mobility and what matters. Mentation refers to the mind, while what matters has to do with what matters most to older adults.
This includes at least one annual screening for dementia and regular screening for the depression that can precede dementia.
Things you can do
Perhaps the most important question: What can all of us do to protect our brains and bodies from the negative effects of aging and disease as we get older?
Physical activity, cognitive stimulation and good blood pressure control are the key interventions for preventing the most common form of Alzheimer’s disease.
Research suggests that low-meat Mediterranean diets or Asian Indian diets, with spices such as turmeric, are buffers against brain aging. One emerging geriatrics concept is that slowing or reversing aging may circumvent dementia and other diseases. Current methods to slow aging include exercise and caloric restriction, or fasting. Yet others are looking toward oral supplements or alternative medicinals.
While old age itself should not be a factor for limiting people’s service to others, former presidents and senators have shown signs of cognitive impairment and frailty while in office.
The national discussion around President Biden and former president and presidential nominee Donald Trump’s mental acuity may be a catalyst to promote a larger conversation about aging, cognitive dysfunction and dementia, as well as what each of us can do to reduce our likelihood of developing cognitive problems late in life.
Donald Jurivich is Chair of Geriatrics, University of North Dakota.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
© The Conversation
23 Comments
Login to comment
ArtistAtLarge
It always depends on the person. Lifestyle, nutrition, illness and genetics are play an equal role.
ArtistAtLarge
Dang autocorrect again.
"...all play an equal..."
Banthu
Monday:
Any mention of Biden suffering from mental decline is a right wing conspiracy.
Tuesday:
Of course Biden is suffering from mental decline, everybody knows that, it’s obvious.
virusrex
Even Biden himself joked about his expected mental decline, the conspiracy is about focusing on his relatively mild case while ignoring the rapid and irreversible mental capacity shrinkage Trump has been having from many months already.
When a person ends up bragging about (very difficult!) cognitive tests as if they could prove anything more than a person barely adequate mental capacity, it only makes it clear how little of that capacity remains.
The Ripper!
Definitely is the case. The Democrats at least fooled members of their own party.
wallace
Trump is in mental decline.
Mocheake
All comments now become political. Give it a rest, please. Very enlightening article.
Banthu
More than happy to, but it's a 3 step process.
Confession / Acknowledgement of error
Apology
ForgivenessThe people who claimed right up to the TV debate that Biden was as sharp as a tack and that any questioning of his mental fitness was "spreading disinformation" need to atone for their mistake and apologize to the people who were pointing out his mental decline.
virusrex
What process do you think is necessary to make a comment about the actual content of the article instead of something unrelated? that is what everybody promised to do in order to use the comment section of the article. Unless you bring comments from Dr Donald Jurivich calling accusations "disinformation" you are not addressing the content of the article, he very clearly says that for him to make a professional determination it would be required to perform also a professional testing, he also clearly says that old people can show signs of decreased capacity on stressful situations, that runs completely contrary to what you claim everybody was saying.
falseflagsteve
It’s been obvious for a while the severe decline in Bidens physical and mental capabilities. Weird that the resident scientific expert here thinks Trump has declined more, mmmm. The usual bias showing through again I’m afraid.
My dad is having troubles now and I’m very worried about him, he rang me the other day at 4am for nothing important. I asked why would he call me at 4am in Japan and he said he thought Japan was 8 hours behind not ahead. That’s with me living here 23 years now, a mistake he’d never made before.
Bad Haircut
It probably depends on a combination of genes, diet, stimulation, exercise and other factors.
For example, my Dad is nearly 89 and while not as lightning fast or physically capable as he was a just few years ago, is still sharp and mobile. He's an avid reader, dabbles in stocks, plays lawn bowls, fixes things in his workshop, walks as much as he can, catches up with friends, eats well - good fresh food with plenty of meat and veggies and light on carbs.
My Mum is 80 and still walks 6km three or four times a week, an avid reader and book club member, out and about doing all kinds of things, and sharp of mind as well.
Dad's also from a long line of long livers - his father lived to 91 and his grandparents into their mid 80s, and great-grandparents into their late 70s - pretty impressive for the time.
Of course they are aging and I notice it every time I go home, but it's good to know their lifestyles have contributed a lot to staying mentally acute well into late life.
virusrex
This has been well reported opinions from many experts and people that know him and his family history, not a personal bias as you try to misrepresent.
https://www.statnews.com/2024/08/07/trump-mental-health-linguistic-analysis-suggests-potential-cognitive-decline-experts-say/
https://economictimes.indiatimes.com/news/international/us/donald-trumps-biographer-says-he-is-slipping-mentally-and-making-less-sense/articleshow/113199300.cms
https://www.yahoo.com/news/cognitive-decline-experts-evidence-trump-142857957.html
https://www.yahoo.com/news/donald-trumps-nephew-speaks-family-124254979.html
The signs of decline described are much more serious (and frequent) than what have been found for Biden, but for some reason are reported less, which is also something that people find puzzling.
https://www.usatoday.com/story/opinion/columnist/2024/09/09/trump-old-incoherent-biden-age-mental-fitness/75138026007/
Bad Haircut
This is patent nonsense and only a fool would believe it. Biden clearly had no idea where he was on so many occasions, and slurred his speech so frequently that even his most ardent apologists had to finally admit that he has a serious problem. Just days after that clown Joe Scarborough said that Biden was at his best ever. Go figure.
Data
Does it really matter who of the two is declining more? Neither of them is fit to lead anything else but a retiree's life. One of them has realized that, the other's mental makeup may not allow him to.
virusrex
People with degrees and expertise are simply a much better reference than nameless people on the internet saying the opposite, the same about those that have a close relationship and share the same opinion.
The many different signs of of quick cognitive decline described are much more serious than slurred speech, and they are accumulating alarmingly, it is not things that the experts observed once but were absent later, instead things that became present in every speech. This clearly points to a much more serious problem that no amount of denial is going to solve.
bass4funk
Doesn't seem so.
Bad Haircut
Virusrex, you can claim whatever you like, but all you're doing is resorting to your usual tactic of appealing to authority. Biden is clearly much further down the path of cognitive decline than Trump. Nobody needs a degree to recognise that. Just some good old eyes, ears, and a couple of brain cells. Even the Democrats finally admitted it to themselves, which is why they told Joe it was time to go. Until then, they were minimising his public exposure because of his frequent spoken and physical gaffes, and memory loss - he didn't even know where he was at times. That wasn't his fault, just the nature of his condition.
As for Trump, he mixes stuff up and gets people's names wrong at times, but to claim his cognitive decline is worse than Biden's is simply ludicrous. Just the usual gaslighting from the haters.
Moderator
Readers, although the story refers to Biden and there is a photo of him, it is not just about him. It goes into wider issues. Please do not turn this into a political argument.
virusrex
When an expert expresses a professional opinion in his field then using this becomes a valid appeal, a pilot about how to fly airplanes, a teacher about what works to educate children, an expert in geriatrics (such as the one in this article) about mental decline in elderly people. There is nothing wrong or invalid about referring to this authority to defend a claim.
As the article clearly explains fragility and slower recovery from stress is expected with old age, but repeatedly mistaken names, words, phrases, jumping and switching between topics without coherency (tangentiality), all-or-nothing words becoming prevalent, making up words after several failing several times to pronounce common terms, etc. All those are much more serious problems that evidence a degrading capacity.
Recognize these patterns is specially important for patients for whose the family history indicates Alzheimer or dementia, then the signs of diminished capacity lead to more serious diagnoses than just old age.
John-San
I 64 and I have pass my peck in me early 50,s look around the work place and take a real good valuation of your self and performance and productive compared to you follow workers. There is nothing wrong with digressing at the work place and you still have your knowledge that others can tap into.
Gene Hennigh
At, well, at an old age myself, I feel that I'm cognitively healthy. I'm cognitively healthy. I think well and read a lot and have a small knot of friends. I'm cognitively healthy. I have a pretty good diet, and I'm cognitively heathy. All you need to do is to keep your brain active and have a decently round of exercise once in a while so as you can tell I'm conitvely heath. Paint, read, play cards, get together with friends and keep that blood pressure at a healthy rate, and you too will be colitvvley heath.
John-San
Gene. You keep referring to Cognitive healthy. Mate cognitive health diminishes. It starts before retiring age. How is your tolerance today compared to 10 years ago. 15 years ago I could easily except D,E,I but today I am not excepting of It. Because I am less tolerant of it because of the performance and BS that goes along with it. It’s might be for yourself loud people were before it didn’t bother you. Less tolerant in your later years is diminishing cognitive health
Zaphod
In my experience, it totally depends on the person.