By Pamela T. Boykin, M.Ed., CCC-SLP
Rainbow Rehabilitation Centers
Basic knowledge of neurological systems indicate that the brain and nervous system are the body’s control center. These neurological systems control the movements, senses, thoughts, memories and all of the organs in the body.
Natural changes with aging occur in the brain and nervous system and are referred to as “atrophy” or the partial or complete wasting away of a part of the body (Johns Hopkins Medicine, 2010). Abnormal changes can result from residual plaque, which is the buildup of white blood cell deposits within the wall of the artery. A fatty brown pigment called lipofuscin can also buildup in nerve tissue (Johns Hopkins Medicine, 2010).
Individuals gradually become aware of the slowing of thought, memory and thinking as they get older. The amount of change varies with each individual. A person may experience big and sudden changes or minimal changes over time. The ability to think may not always be affected (Johns Hopkins Medicine, 2010).
A report by Johns Hopkins Medicine (2013) stated that knowing the course of the aging brain, and how memory is affected, can make “senior moments” less of a constant worry. The report also provides a timetable of the normal aging brain by decades. “Shrink” is the term allocated to the aging nerve cells.
There are predictable changes that occur as an individual ages. Individuals with good genes and a healthy lifestyle can moderate age-related changes but not terminate them. Brain neurons or nerve cells do not undergo a die-off with age as dictated by popular belief. Present day research suggests neurons are often lost but the brain continues to regenerate new ones at a slower pace.
The onset of dementia
In reviewing deficits that affect normal aging, dementia consistently appears in the literature. Dementia is defined as a group of symptoms caused by disorders that affect the brain. According to the National Institutes of Health, dementia is not a specific disease—it affects memory, thinking, language, judgment and behavior. The ability to problem solve or control emotions is reduced. Some individuals may experience agitation or hallucinations.
Memory loss is a common symptom of dementia, though memory loss by itself does not mean an individual has dementia. Individuals with dementia have serious problems with two or more brain functions such as memory and language. Though dementia is not a part of normal aging, it is very common in elderly people.
Drugs cannot cure dementia or repair brain damage but may improve symptoms or slow the disease. Some types of dementia are nonreversible and degenerative. Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer’s disease is the most common type of dementia (Lopez, 2008).
Vascular dementia is caused by many small strokes. Medical conditions that can lead to dementia are Huntington’s disease,multiple sclerosis, and infections that can affect the brain such as HIV/AIDS and Lyme disease (Lopez, 2008).
Dementia symptoms relate to areas of mental function which include language, memory, perception, emotional behavior/ personality, and cognitive skills. In severe dementia, activities of daily living can no longer be performed, comprehension of language is impaired, incontinence occurs, and dysphagia (swallowing dysfunction) may be present (Lopez, 2008).
- The course of treatment may be the following:
- Hospitalization
- Control of maladaptive behaviors (antipsychotics, mood stabilizers, stimulants)
Change in medication A study published in the April 3, 2013 edition of the New England Journal of Medicine found that dementia costs the nation as much as $215 billion per year.
Traumatic brain injury and aging
Recent studies indicate that adults over the age of 75 are at a high risk for a traumatic brain injury (TBI). Falls are the leading cause of a TBI according to the U.S. Department of Health and Human Services. Seniors sustaining a TBI recover more slowly and die more often from TBI than younger people.
On brainline.org, Dr. Steven Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine, NYU Langone Medical Center, states that there is an increased risk for traumatic brain injury with aging, and older adults with a TBI are at an increased risk for seizures.
Research studies note that the more physically disabled an individual is post-injury, the more likely the possibility of a shorter life span.
Dr. Flanagan recommends medical checks when significant physical or cognitive problems occur after a moderate or severe brain injury.
An initiative of The Centers for Disease Control and Prevention recommends the following for seniors with traumatic brain injury:
- Increase awareness about techniques for preventing and recognizing TBIs related to falls among adults 75 and older.
- Encourage exercise.
- Make home and surroundings safe.
- Check vision.
- Give TBI information to their adult children.
The following statement by Dr. Flanagan succinctly identifies the process of aging and the positive goal to be implemented:
Here is a summary of the timeframe for the normal aging brain, by age group:
20s
- Top of mental game in forming long-term memories
- Able to engage in complex reasoning
- Highest creativity level
30s
- Loss of brain volume with neuron shrinkage
- Cognitive test battery shows slight decline in some areas
- Indicators of mild cognitive decline not apparent to the individual, family or friends
40s
- Slowing of mental processing, especially in the area of short-term memory
- Noted challenges with remembering phone numbers and completing math calculations
50s
- Slow loss of brain volume continues and may begin to accelerate
- Multi-tasking (doing several things at once) becomes more difficult
- Decreased attention to detail
- Difficulty in remembering when or where an event occurred
60s
- Critical brain structures that relate to memory and cognitive function such as the hippocampus and amygdala may become affected
- As much as 25% shrinkage may occur as compared to the size of the brain in young adulthood. (Johns Hopkins Medicine, Health Alerts, Memory, 2010)
- Areas of change: processing speed, difficulty in learning new information, completing complex mental tasks
Older adults by the numbers
- People 50 and older own 70 percent of the total number of homes in the U.S. (Gillon, 2004).
- 90 percent of older adults have living children and 15 percent of older adults live with their children (Gillon, 2004).
- The 50+ age group is the fastest growing group of Internet users (Gillon, 2004).
- About 19 percent of older adults have a college degree (Gillon, 2004).
- Over nine million are veterans (Gillon, 2004).
- Five million are in the labor force (Gillon, 2004).
- The Baby Boom generation (those born between 1946 and 1964) is the largest and wealthiest in U.S. history (Gillon, 2004).
- The number of people over the age of 60 is projected to reach one billion by 2020 and almost two billion by 2050, representing 22 percent of the world’s population (Bloom et al, 2011).
- The proportion of people aged 80 and over is projected to rise from one percent to four percent of the global population between today and 2050 (Bloom et al, 2011).
The following statement by Dr. Flanagan succinctly identifies the process of aging and the positive goal to be implemented:
“The stronger peoples’ bodies, minds and spirits are— whether they have a TBI or not— the more effectively they will postpone the effects of aging…and enjoy life.”
About the Author
Pamela T. Boykin, M.Ed., CCC-SLP
Speech & Language Pathologist
Pamela, a Speech & Language Pathologist with Rainbow since 2004, works with pediatric and young adult clients at the Oakland Treatment Center in Farmington, MI. She received her undergraduate degree in Speech & Language Pathology from The Catholic University of America, Washington, D.C. and completed graduate studies at Northeastern University, Boston, MA.
Pamela has previous experience in hospital and clinical settings where her case load consisted of adult patients with varying levels of neurological impairments that affected cognition and physical function.
References
Bloom, David E., Canning, David, and Fink, Gunther (2011). Implications of Population Aging for Economic Growth. The Harvard Initiative for Global Health, 64, pp. 1-39
Lopez, OL. The dementias. In: Bradley, WG, Daroff, RB, Fenichel, GM, Jankovic, J. eds: Bradley: Neurology in Clinical Practice. 5th ed: Philadelphia, PA. Butterworth-Heinemann Elsever, 2008. chap. 70
Gillon, S. (2004). Boomer Nation: The Largest and Richest Generation Ever, and How It Changed America.
Johns Hopkins Medicine, Health Alerts, Your Aging Brain: What’s Normal, What’s Not, 2010, http://www.johnshopkinshealthalerts.com/ reports/memory/3435-1.html, Accessed July 30, 2013.