Normal Aging
Neurodegenerative Conditions
CONTENTS
1. Objectives
2. Basic Cognitive Processes in Normal Aging
3. Higher-level Cognitive Processes in Normal
Aging
4. Memory and Attention in Seniors with Normal
Aging
5. Conclusions
6. References
Normal Aging 3
Objectives However, others show an accelerated decline in their
cognitive abilities and may develop some type of
• To understand the main changes in the distinct dementia.
cognitive functions during normal aging.
Currently (Andrews-Hanna et al., 2019), the striking
• To identify the relevant modifications for alternative differences between normal aging and dementia are
interventions. more quantitative than qualitative.
• To evaluate the potential of natural aging
in connections to seniors' quality of life Perception
.
Seniors experience sensory and perception changes, a
decline in visual and auditory acuity, and a high incidence
Basic Cognitive Functions In of hyperopia (loss of near vision due to hardening of the
Normal Aging crystalline lens, which prevents sharp projection of visual
images onto the retina)
Aging involves physical, psychological and social
Difficulties adjusting to darkness are noted because the
changes that affect all organs, including the brain, with
pupil shrinks with age.
modifications affecting many different functions such as
memory, language, perception, and attention. An additional reason for decreased visual acuity is
cataracts, which are becoming more common.
The increase in life expectancy has gone from 48 years at
the beginning of the 20th century to 85 years for women Visual examination challenges have to do with movement
and 79–80 years for men at the beginning of the 21st tracking, which is slightly different in healthy subjects
century (Federal Interagency Forum on Aging-Related and significantly different in cases of cortical atrophy.
Statistics, 2000).
Scanning failures, even minor ones, can alter the
This is the result of numerous factors, including perceptual process, as can issues with three-
developments in medicine and pharmacology, high dimensionality discrimination and figure-ground
nutritional standards, and improved hygienic conditions. recognition.
It would be important to recognize that science and Generally, it can be stated that there are impediments
technology have been able to modify the causes of early to integrating visual information, requiring more time to
death, but not extend life itself. recognize and integrate the stimuli.
It is predicted that there may be a greater number It is estimated (Wilson et al., 2000) that most of the
of senior patients needing the services of clinical impaired profiles in other neuropsychological functions,
neuropsychologists in the coming years. such as memory, may be due to a slowing of perception.
This calls for a better understanding of the changes that The senses of taste and smell, on the other hand, do not
occur at this stage of life as well as a new classification appear to change significantly with age, although there
of the senior population, and the appropriate tools to is hypoacusis, specifically difficulty discriminating high
make the distinction between pathological aging and frequencies, especially in seniors.
normal aging.
It can be said that, after the age of sixty, there is a
As such, for example, individuals between 55 and 74 decline in the tactile recognition of shapes and in the
years of age are considered young seniors, those over 75 discrimination of discomfort levels, and that, generally,
years of age are considered old seniors, and those over all sensory acuity and perceptual ability are gradually
85 years of age are considered elder seniors (Backman deteriorating.
., 2000).
Such changes have an impact on the person's daily
An important fact regarding the cognitive changes activities and all cognitive functions (Fletcher et al.,
brought on by aging has been observed: the higher the 2018).
age range of the population evaluated, the greater the
heterogeneity, or the greater the dispersion in the test Visual-Motor Skills.
results.
Later in life, visuospatial and visoconstructive skills start
Some people continue to exhibit relatively high to show some deterioration.
performance, known as "successful aging," i.e., seniors
with appropriate performance on cognitive tests and a For these individuals, complex tasks like assembling
relatively normal life span. cubes or drawing three-dimensional and complex objects
require a high level of difficulty.
Normal Aging 4
When the execution of the tasks is timed, the differences people in their thirties. (Turner et al., 2015).
between young and old adults are highly evident due to
motor delay and increased reaction times, in addition to That being said, language disintegration can be
impaired recognition of partial shapes, errors made when considered an important indicator of pathological
copying two-dimensional and three-dimensional shapes, decline.
as well as segmentation and perseveration mistakes. In senile dementia, there is a clear lexical deterioration,
(Beason-Held et al., 2009). with evident anomia and relative preservation of
grammatical organization.
High-Level Cognitive And in the advanced stages, the language is transformed
Functions In Normal Aging into an empty speech until it reaches a semimutism
(Turner et al., 2015).
Language
Intelligence
Verbal test performance does not significantly change
with age. When it comes to intelligence, we must recognize that
there is no agreed - upon definition.
In contrast to empirical knowledge and spatial skills,
verbal functions are generally quite impervious to aging. Therefore, in view of clinical interest, the psychometric
definition is used, in which certain components decrease
Semantic memory is frequently preserved into old age, with age while others remain stable or even increase.
with episodic memory suffering the most.
In general, it is considered that scores on subtests that
These findings, while understandable in a Western and measure verbal skills and that are part of the so-called
literate context, may not be true for non-literate people or "crystallized intelligence" (which allows the expression
people from other cultures, i.e., the typical aging pattern of previously acquired knowledge) tend to remain stable
(better preservation of verbal skills and greater decline and even progress; on the contrary, scores on visuomotor
in non - verbal skills) may only hold true under certain and spatial reasoning tests, which constitute what is
conditions. (Spreng et al., 2019). called "fluid intelligence" (which uses current information
to solve new problems), reach a maximum at some point
It's commonly agreed that language changes brought in adulthood and then decline in old age.(Maillet et al.,
on by aging aren't evident until after the age of eighty, 2016).
although some subtle changes may initially be noticed
after the age of sixty. The most widel used intelligence test for this population
is the Wechsler Adult Intelligence Scale (WAIS), which
The results of word memory studies are not always shows a considerable decrease in the performance
consistent. (non-verbal) subtests, while the verbal subtests are not
significant.
In some, they found no lexical decrease associated
with aging and with certain stability in the process of Because of age-related changes, scores include
recording and evoking semantic information, moreover, corrections for age range.
linguistic functions such as narrative style can improve
and become more complex and sophisticated at an When it comes to the execution of intellectual tasks,
advanced age. speed is decisive; whenever time limits are used, seniors
are at a disadvantage.
However, other scholars have found that age affects
semantic verbal fluency more than phonological fluency, Age leads to an evident slowdown of information
suggesting that semantic memory is more sensitive to processing.
aging.
There are additional factors to consider: 1) performance
In normal aging, there are discrete failures in the ability to tends to improve in tasks that allow for flexibility in
find words and a tendency for lexicon reduction with an approach, compensatory changes in solution, or without
increase in the time to access verbal information. time limits; and 2) seniors perform worse on tasks that
are less meaningful or pointless, which may be explained
The ability to name words is clearly reduced, especially by the pragmatic approach seniors take in attempting to
after the seventh decade, which is manifested by a delay solve the problems. (Fox et al., 218).
in finding the necessary words, and by the so-called
"tip-of-the-tongue phenomenon" (characterized by the It is important to remember that education level affects
feeling of knowing which word is being sought, but not performance on neuropsychological tests; the higher the
being able to access it), a phenomenon that also affects level of education, the better the performance.
This being a valid consideration for a lifetime.
Normal Aging 5
Emotional changes However, performance on immediate memory tests, such
as digit retention, does not change significantly with age.
It is common to reduce the number of activities as we (Parikh et al., 2016).
get older; it seems that novelty is less appealing and, for
many, routine is a source of tranquility. The capacity to store recent information decreases
with age, i.e., it is possible to assimilate immediate
There are a lot of variations and exceptions to these information, but not adequately encode it for long-term
generalizations. retrieval.
The propensity to depression is one of the most frequent These storage difficulties are evident for both verbal and
affective disorders. non-verbal material, with a greater impact on the latter.
Emotional states are known to have an impact on The process of recovery, however, is the one that is most
cognitive function, just as negative thoughts or moods affected by seniority.
can inhibit effective good performance on cognitive
tests. Semantic cues improve memory test performance in
seniors, implying that retrieving stored information is
The fact that depression occurs frequently in seniors difficult.
may be explained by common life experiences shared
by most seniors, such as illnesses, whether their own or Poor performance on memory tests is a result of the
those of their spouse, the death of a spouse, the absence information processing slowing down.
of immediate family members, the loss of interests, and
general physical limitations. Back in 1980, Arenberg compared learning in seniors
when information was presented at high and low rates,
A severe depressive episode may have such an impact on finding that seniors exhibited amnesic behavior at high
neuropsychological test performance that it resembles rates and youthful behavior at low rates.
pseudodementia. (Duda et al., 2019).
Working memory is the ability to process information
Aging is not necessarily related to negative emotional while storing the goals, strategies used and outcomes in
changes; rather, it appears to be associated with greater the short-term memory.
emotional control and a lower recurrence of psychiatric
disorders. Some studies suggest that reduced working memory
capacity limits the ability to simultaneously store, monitor
Negative emotional changes are mostly linked to social and manipulate information (Schneider et al., 2000).
and cultural factors, and cultures that associate aging
with positive aspects (such as wisdom) have seniors The impairment of short-term memory is linked to the
who are more active and have less emotional impact. slowing down of the storage process and to the decrease
in metamemory strategies, which means that it takes
more time and more attempts to learn verbal material,
Attention And Memory In since neither storage nor information retrieval strategies
are adequately used.
Seniors With Normal Aging
If this storage process is weak, interference agents
Old age is associated with a decline in memory become more prevalent.
and learning disabilities due to an increased rate of
forgetfulness and a decrease in the ability to acquire new Some proactive and retroactive interference is normal, as
information. are challenges with irrelevant stimulus inhibition (Parikh
et al., 2019).
It has been found that these complications begin around
the age of fifty and increase progressively. Another characteristic of aging is problems with
chronological events, also known as temporal or
Memory deterioration is slow in normal aging, but sequential memory.
accelerated in case of dementia.
The temporal dimension of memory is markedly reduced
One of the most well-known aspects is the difficulty in during normal aging and impairments in short-term
recalling recent events despite describing past events memory may be secondary to other cognitive defects.
with relative ease, particularly those related to emotional
situations. In another classic study, Horn (1982) demonstrated
that memory impairment in seniors is one of the many
Sensory memory is also impaired and immediate components that characterize a comprehensive age-
memory is clearly slowed down. associated decline.
Normal Aging 6
The slowdown in all cognitive processes can reduce It is crucial to emphasize that age-related memory loss
memory processing. manifests itself completely different in each individual.
It is clear, however, that the scores depend not only on Theoretical Explanations For Memory Impairment
the age of the subject, but also on his or her educational
level. Aging-related memory loss has been explained
theoretically in a number of ways.
Educational and cultural factors can affect performance
on neuropsychological tests. A first attempt at providing an explanation claims that
these deficits are the result of a decline in information
Kral coined the term "benign senile forgetting" in 1962 processing abilities, which is reflected in a decline in
to describe the age-related decline in short-term memory memory, performance, and attention capacities.
that is distinct from general cognitive decline.
As a result of aging, self-generated personal resources
In a similar vein, Crook et al. (1986) established differential for storing and retrieving information diminish; the ability
diagnostic criteria between memory impairments linked to make associations between new learning and carrying
to normal aging and those indicative of dementia, which out recovery or evocation plans is lost, which improve
have served for the development of instruments: with external help in the form of keys.
• During normal aging, discrete memory problems A second explanation is based on the slowing down of
are observed. information processing, impacting perception and a
• Memory complaints in benign senile dementia generalized cognitive decline that includes memory.
manifest in everyday activities like forgetting
Salthouse (1996) proposed two mechanisms underlying
names, phone numbers, and the like.
this slowing down: a) aging inhibits the mechanism that
• The memory deficits must develop gradually over allows activities to be performed under time constraints
time, without a sudden aggravation in the previous and, b) it inhibits the synchronization mechanism that
months. renders the results of immediately preceding cognitive
• Memory test results in benign senile forgetfulness processes useless as they have been lost.
should be within one standard deviation of the
average for normal adults. The third explanation is related to a decrease in the
inhibitory process of attention on working memory
• There is adequate overall intellectual functioning,
functions.
resulting in age-appropriate performance on
intelligence tests. According to this hypothesis, aging would be
• There is no evidence of dementia. characterized by the presence of irrelevant information
and by a reduction in self-control.
Crook et al. (1986) proposed the diagnosis of "age-
associated memory impairment" for patients with This lack of inhibitory control would overwhelm the
memory failure who meet the above criteria. capacity of the working memory, diminishing its efficiency
to store new information and increasing the possibility of
While failing free retrieval tests, these patients seem to interference in the recovery process.
benefit from recognition retrieval techniques.
The fourth explanation is related to the diminished recall
In 1991, Flicker et al. adopted the term "mild cognitive of the contextual details of lived experiences and the
impairment" to refer to individuals with significant origin of those memories.
memory impairment, but whose day-to-day activities
were normal. The memory of any event requires links between the
characteristics of the event and the surrounding situation.
Further research (Smith et al., 2006) indicated that, in
many cases, mild cognitive impairment constitutes an These links, whether perceptual or cognitive in nature,
early stage of Alzheimer's type dementia. are most likely weakened.
In some seniors, short-term memory deficits can affect Reaction And Attention Times
their performance in day-to-day activities, such as The aging process is characterized by slower reactions.
forgetting the names of people they have just met or
activities they need to do. Seniors have slower reactions and less overall motor
activity.
Some subjects accept memory changes as just another
limitation associated with aging; for others, however, it Reaction time refers to the latency of a response; the
becomes a source of anxiety, a constant fear that they time between the presentation of a stimulus and the
are undergoing a process of pathological deterioration. beginning of the corresponding response.
Simple reaction time tasks measure the speed of
response to a specific stimulus.
Normal Aging 7
In a standard tests, the subject is presented with any In general, aging results in cell changes, cell death, as
given stimulus (a light, a sound, etc.) and is required to well as the presence of senile plaques and neurofibrillary
respond by pressing a button or lowering a lever. spindles (Gomez et al., 2003).
While selective reaction time tasks require a response The differences in pathological disorders found between
to be chosen from several after the stimulus has been healthy adults over 50 and patients with Alzheimer's
presented. reaction time represents a simple age-related disease are more quantitative than qualitative.
measure: it tends to increase in children, gradually decline
as the brain matures, and then increase again in old age. Other studies, however, distinguish between normal
aging and Alzheimer's disease, based on the distribution
Reaction time relates to the motor deceleration that and extent of neuropathological changes.
appears during aging.
Apoptosis (genetically directed cell death), an interruption
Men and women experience this deceleration in different in protein synthesis, and the generation of free radicals
ways. are a few identified brain mechanisms that may account
for these modifications.
Bleecker et al. (1987) studied reaction time in 176 adult
men and women, between the ages of 40 and 90 years. Neurotransmitter concentrations like acetylcholine,
noradrenaline, serotonin, and dopamine are also reduced
Men were consistently faster than women in all age as the brain ages.
groups and showed an increase in reaction times after
the age of 80, while in the women's group this increase Many of the biochemical changes linked to normal aging
occurred after the age of 70. are comparable to those seen in Alzheimer's disease
patients, though less pronounced (Harrington et al.,
Attentional deficits have been studied in divided attention 2017).
tasks (such as with the dichotic listening method), Craik
(1977) found attentional disturbances in normal senior Some psychophysiological functions also change as we
subjects. get older.
However, the effects of normal aging on attention The cerebral blood flow is reduced in some areas,
functions, focus, selective attention, and distractibility background electroencephalographic (EEG) activity
have not been sufficiently studied. tends to slow down, and alpha rhythm frequency drops
(Spreng et al., 2018).
Anatomopathological Changes
The lengthening of response times to several peaks in
The size of the brain changes with age, and these changes evoked potentials is another electrophysiological change
appear to become more noticeable after the age of 50. associated with aging.
Apparently, brain volume peaks around the age of 20 to As such, one of the components that has been most
then begin a slow but gradual decline. closely related to the cognitive processing of information
Some brain structures are more affected than others; for is the so-called P300, which is recorded mainly in the
instance, ventricular dilatation and sulci widening occur vertex.
around the age of 40 ((Scullin et al., 2015). In young adults, the latency of P300 is approximately 300
Memory deficits are related to loss of plasticity of the milliseconds and increases by 1.64 to 2.22 milliseconds
nervous system, cortical atrophy, atherosclerosis, etc. per year; thus, its latency reaches 400 milliseconds by
the eighth decade of life.
Several studies show that there is cell death in the
cerebral cortex, hippocampus, amygdala, basal ganglia It is believed (Sylvain-Roy et al., 2015) that this increase in
and raphe nuclei (Hubbard y Anderson, 1981). latency is related to the general slowdown in information
processing.
The hippocampus and frontal lobes appear to be the
brain areas most vulnerable to aging.
Conclusions
Thus, after the age of 40, the hippocampus loses 5%
of its neurons every ten years, while other areas of the Aging brings about physical, psychological, and social
cortex, such as the occipital lobes, remain unchanged. changes that affect organs and functions.
However, the results show a wide range of variability, Increased life expectancy will significantly increase the
with cortical atrofia predominating in some subjects and number of seniors who will require neuropsychological
subcortical atrofia predominating in others. care as part of normal aging.
Some patients with severe cognitive deficits may not
show cortical atrophy.
Normal Aging 8
The observation that the higher the age range of the age.
population being evaluated, the greater the heterogeneity,
i.e., the greater the dispersion in test results, and the The ability to perform well on cognitive tests can be
less specificity there is likely to be in specific scales or hampered by emotional states.
instruments, is among the general considerations to The tendency toward depression is one of the more
be taken into account in the context of care for senior common affective changes.
patients.
However, aging should not always be associated
What has been referred to as "successful aging," or older with negative emotional changes. Similarly, there is
people who perform appropriately on cognitive tests and better emotional regulation and a lower recurrence of
lead relatively normal lives, is the result of awareness psychiatric disorders, so the undesirable aspects appear
and improved self-care. to be more closely related to social and cultural factors.
In general, the stark differences between normal aging Memory impairment is associated with a slowing of the
and dementia are more quantitative than qualitative. storage process, a decline in metamemory strategies,
Seniors report sensory and perceptual changes; reduced and an increase in interfering agents if this process is
visual and auditory acuity, with a high incidence of not robust.
farsightedness; smell and taste do not seem to change The effects of normal aging on attentional functions,
much over time, but hearing loss is common; there is a focus, selective attention, and distractibility have not
decline in the tactile recognition of shapes and forms. been sufficiently studied.
Overall, perceptual ability progressively declines, as well Thereby, although much progress has already been
as visuospatial and visoconstructive skills. made, it can be said in general that more studies with
Typically, verbal processes are resistant to aging, so that older populations without pathologies are needed to
language disintegration can be considered an important allow a deeper understanding of normal aging, despite
sign of pathological deterioration. the improvements in quality of life and life expectancy.
It's also worth noting that speed matters when performing
intellectual tasks, so whenever time constraints are in References
place, seniors are at a disadvantage.
Andrews-Hanna, J. R., Grilli, M. D., & Irish, M. (2019). A
There is a clear slowdown in information processing with review and reappraisal of the default network in normal
aging and dementia. Oxford research encyclopedia of
psychology.
Normal Aging 9
Arenberg, D. (1980) Comments on the process that cognitive Impairment. Oxford University Press.
account for memory declines with age. En: L. W.
Poon, J. L. Fozard, L. S. Cermak, D. Arenberg, y L. W. Harrington, K. D., Lim, Y. Y., Ames, D., Hassenstab,
Thompson (eds.). Nueva directions in memory and J., Rainey-Smith, S., Robertson, J., .. y Maruff, P.
aging. Hillsdale, N. J. Lawrence Earlbaum Associates. (2017). Using robust normative data to investigate
the neuropsychology of cognitive aging. Archives of
Backman, L. Small, B. J. y Wahlin, A. (2000). Cognitive Clinical Neuropsychology, 32(2), 142-154.
functioning in very old. En: F. I. M. Crack y T. A.
Salthouse (eds.). The Handbook of Aging and Horn, J. L. (1982). The theory of fluid and crystallized
Cognition. Lawrence Erlbaum Associates. intelligence in relation to concepts of cognitive
psychology and aging in adulthood. En: F. I. M. Craik
Beason-Held, L. L., Kraut, M. A., y Resnick, S. M. (2009). y S. Trehub (eds.). Aging and cognitive processes.
Stability of default-mode network activity in the aging Plenum Press.
brain. Brain imaging and behavior, 3(2), 123-131.
Kral, V. A. (1962). Senescent forgetfulness: benign and
Bleecker, M. L. Bolla-Wilson, K. Agnueva, J. y Meyers, D. malignant. Canadian Medical Association Journal.
A. (1987). Simple visual reaction time: sex and age (86), 257-260.
differences. Developmental Neuropsychology. (3),
165-172. Maillet, D., y Schacter, D. L. (2016). Default network and
aging: Beyond the task-negative perspective. Trends
Craik, F. I. M. (1977). Age differences in human memory. in cognitive sciences, 20(9), 646-648.
En: J. E. Birren y K. W. Schaie (eds.). Handbook of
psychology of ageing. Van Nostrand Reinhold. Parikh, P. K., Troyer, A. K., Maione, A. M., y Murphy, K. J.
(2016). The impact of memory change on daily life
Crook, T. Bartus, R. T. Ferris, S. [Link], P. Cohen, in normal aging and mild cognitive impairment. The
G. D. y Gershon, S. (1986). Age associated memory Gerontologist, 56(5), 877-885.
impairment: Proposed diagnostic criteria and
measures of clinical change report of a National Salthouse, T. A. (1996). The processing speed theory
Institute of Mental Health Work Group. Developmental of adult age differences in cognition. Psychological
Neuropsychology, (2), 261-276. Review. (103), 403-428.
Duda, B. M., Owens, M. M., Hallowell, E. S., y Sweet, Schneider, B. A. y Pichona-Fuller, M. K. (2000).
L. H. (2019). Neurocompensatory Effects of the Implications of perceptual deterioration for cognitive
Default Network in Older Adults. Frontiers in Aging aging research. En: F. I. M. Crack y T. A. Salthouse
Neuroscience, 11, 111. (eds.). The Handbook of Aging and Cognition.
Lawrence Erlbaum Associates
Federal Interagency Forum on Aging-Related Statistics
(2000). Older Americans 2000. Key Indicators of Scullin, M. K., y Bliwise, D. L. (2015). Sleep, cognition,
[Link] D. C.: US Government Printing and normal aging: integrating a half century
Office. of multidisciplinary research. Perspectives on
Psychological Science, 10(1), 97-137.
Fletcher, E., Gavett, B., Harvey, D., Farias, S. T., Olichney, J.,
Beckett, L., .. y Mungas, D. (2018). Brain volume change Smith, G. y Rish, R. (2006). Normal aging and mild cognitive
and cognitive trajectories in aging. Neuropsychology, impairmet. En: D. K. Attix y K. A. Welsh-Bohmer
32(4), 436. (eds.). Geriatric Neuropsychology: Assessment and
Intervention. Oxford University Press.
Flicker, C. Ferris, S. H. y Reisberg, B. (1991). Mild cognitive
impairment in the eldely: predictors of dementia. Spreng, R. N., y Turner, G. R. (2019). The shifting
Neurology. (41), 1006-1009. architecture of cognition and brain function in older
adulthood. Perspectives on Psychological Science,
Fox, K. C., Foster, B. L., Kucyi, A., Daitch, A. L., y Parvizi, 14(4), 523-542.
J. (2018). Intracranial electrophysiology of the human
default network. Trends in cognitive sciences, 22(4), Spreng, R. N., Lockrow, A. W., Dupre, E., Setton, R.,
307-324. Spreng, K. A., y Turner, G. R. (2018). Semanticized
autobiographical memory and the default–executive
Gómez-Isla, T. y Hyman, B. T. (2003). Neuropathological coupling hypothesis of aging. Neuropsychologia, 110,
changes in normal aging, mild cognitive impairment 37-43.
and Alzheimer disease. En: R. C. Petersen (eds.). Mild
Sylvain-Roy, S., Lungu, O., y Belleville, S. (2015). Normal
aging of the attentional control functions that underlie
working memory. Journals of Gerontology Series B:
Psychological Sciences and Social Sciences, 70(5),
698-708.
Normal Aging10
Turner, G. R., y Spreng, R. N. (2015). Prefrontal engagement
and reduced default network suppression co-occur
and are dynamically coupled in older adults: the
default–executive coupling hypothesis of aging.
Journal of cognitive neuroscience, 27(12), 2462-2476.
Wilson, R. S. Bennett, D. A. y Swartzendruber, A. (2000).
Age-related change in cognitive function. En: F. I. M.
Crack y T. A. Salthouse (eds.). The handbook of aging
and cognition. Lawrence Erlbaum Associates.