Cognitive health in old age is characterized by

The core feature of cognitive health in the elderly is not that "memory is as good as when you were young and that you are not confused at all", but that you can maintain cognitive function, emotional regulation ability and social participation that match your own life needs, without pathological and sustained functional decline.

I came across many interesting cases when doing cognitive screening in the community in the past two years. The one that impressed me the most was the 72-year-old Aunt Zhang. When she filled out the commonly used Mini-Mental State Screening Scale (MMSE), she got stuck on the question "Please repeat the names of the three items I just mentioned." After thinking for a long time, she only came up with one "ball" and couldn't remember the other two. The family members beside her rubbed their hands anxiously, and then turned to ask me if I was going to have Alzheimer's disease. But I turned around and asked her about her daily life. She can go to the vegetable market every morning carrying a vegetable basket, and she can do the math faster than a stall owner. Last month she just organized a community square dance team to compete in a neighboring city. She took care of the itinerary, accommodation, and formation arrangement. She just turned around and forgot the name of the community worker she contacted.

In fact, this involves the fact that the academic community has not yet completely unified the judgment standard: the traditional neurocognitive school pays more attention to the scale score and believes that if the score is lower than the corresponding age score, it is considered to have cognitive impairment.； However, in recent years, more and more researchers in geriatric psychiatry and social gerontology have advocated "prioritizing functional adaptation" - just like Aunt Zhang, even if her instant memory score is not high, all her cognitive abilities are enough to cover her daily needs. Even if she forgets trivial things, it still falls completely within the category of cognitive health. The WHO's updated cognitive health guidelines for the elderly in 2023 have also included "the ability to independently complete the social activities you want to participate in" as a core assessment dimension, and no longer only rely on "hard indicators" such as memory and logical reasoning.

Many family members panic when they see the elderly forgetting things. They take a test with a scale found online. If the score is lower, they feel that the sky is falling. In fact, it is really unnecessary. The difference between normal senile forgetfulness and pathological cognitive decline is actually very obvious: the former means "forgetting things but being able to be reminded of them". For example, if you forget where you put your keys, if you say "you put them in your bag when you changed your coat yesterday", he will be able to remember them right away. ； It won’t affect commonly used skills. The braised pork that I’ve been cooking for a lifetime still tastes the same, and I can still win over the old guy when playing chess. If you fail to remember reminders, ask the same question repeatedly, forget to add salt or turn off the heat when cooking, go out after walking for decades but cannot find your home, or even your originally gentle personality suddenly becomes suspicious and irritable, and you have no interest in the things you used to do, then you need to go to a neurology department for screening immediately.

I always feel that cognitive health for the elderly is actually a bit like an old mobile phone that has been used for several years. There is no need to run the latest games or install fancy apps. As long as the commonly used WeChat, payment, and taxi-hailing apps can be opened smoothly, and the occasional slow loading or crash once or twice, it does not affect the use at all. Some old people can still write articles and do research when they are 80 years old, and their responses are faster than those of young people. ； Some elderly people cannot remember the names of new people when they are 70 years old, but they can live their own lives comfortably. This is a healthy state, and there is no unified standard.

Of course, this does not mean that all forgetfulness can be ignored. I met a 70-year-old old engineer before, who had no problem tutoring his grandson in the Mathematical Olympiad. His family discovered that he could not even calculate his monthly pension, and he always said that the nanny at home stole his money. At first, they thought it was because he was old and had a weird temper. By the time he went to the hospital for a check-up, he was already in the middle stage of Alzheimer's disease and missed the best intervention period.

After all, we have been doing cognitive intervention for so long, and what I want to say to the families most is not to treat the elderly as students who need to be graded. There has never been a unified standard answer for cognitive health. It was enough that he could remember which stall he bought his favorite candy cakes from, that he could chat with the old guys all afternoon, and that he could arrange his own days in an unhurried manner. As for occasionally forgetting keys or failing to remember the names of distant relatives, it’s really not a big deal.