This chapter will enlighten you to know about cognitive functions in the elderly and how these functions get affected and lead to downfall progression (neurodegeneration) with aging not only in terms of structural changes but also functional which cause age-associated illnesses. The evidence of cognitive deficit is obvious among the elderly population and needs to be tackled very effectively in keeping the view of maintaining functional independence in their routine activities. Throughout the chapter, different phenomena related to age-associated disorders and comorbidity have highlighted the high frequency of cognitive impairment and we will also be going to know about the role of the COVID-19 pandemic in worsening these symptoms. Neuropsychological assessment at an early stage plays a crucial role in pointing out cognitive deficits earlier which can further lead to decelerating of symptoms through pharmacological and psychosocial rehabilitation.
TopIntroduction
The term cognition can be understood as the process of knowing, including attending, remembering, and reasoning. It can also be defined as the content of these processes, such as concepts and memories (American Psychological Association, 2000). Cognition includes all forms of awareness such as perceiving, remembering, reasoning, judging, imagining, and problem-solving. In the early stages of childhood, this cognition developed through the interaction of genetic or innate capacities, and psychosocial environmental factors but as the age of the individuals increases chances become higher of having a cognitive decline (CD). The CD is more common in the elderly but not every elderly has a CD.
CD is a comprehensive term that involves difficulty in processing thoughts that leads to memory loss, difficulties in decision-making, poor concentration, and learning difficulties. A cross-sectional study in the age ranges from 18 to 60 years suggested that increased age is correlated with lower levels of cognition/cognitive performance (Salthouse, T. A. 2009). CD is inclined to defy Occam’s razor, challenging clinicians and nosologists with comorbidity, multiplicity, and unclear boundaries. Such concerns are of utmost true for the elderly, the demographic group most at risk for cognitive disorders. The CD is associated with multimorbidity in the elderly. Older adults are living with multimorbidity with the coexistence of multiple chronic conditions (Goodman, R. A., et al., 2013). Multiple chronic conditions are ongoing causes of substantial ill health and disability that further leads to premature death.
The decline in cognition can range from mild impairment to dementia and this decline further leads to physical impairment. The early stage of decline in cognition is sometimes self-reported by individuals with symptoms of memory problems or confusion, known as the subjective decline in cognition. This self-reported memory problem that has been happening more often or getting worse in the past twelve months becoming common with a prevalence of 11.1% or 1 in 9 adults after the age of 45 years (CDC, 2015-16).
CD represents the complex interface among medicine, neurology, and psychiatry in those neurological or medical circumstances that often lead to cognitive disorders which in return are correlated with behavioral symptoms. According to the Centers for disease control and prevention (CDC), impaired cognition has a profound impact on an individual’s overall health and well-being. A severe decline in CD is the major predictor of mortality and has a marked adverse impact on survival (Bassuk, S. S., Wypij, D., & Berkmann, L. F. 2000).
Numerous studies have been provided by the researchers and it was found that age-related illnesses can increase the chance of neural dysfunction, loss of neuronal structure, and loss of synapses among the elderly population which can significantly lead to cognitive deficits and impaired normal functioning (Persson, 2006).
Age-related losses, the number of changes in the brain stem, and in other parts of brain regions can alter normal functioning and lead decline in cognition significantly. Researchers have also provided a number of reasons and protective factors, and lifestyle modifications that can contribute to reducing the early onset of decline (Murman DL, 2015).
The high frequency of cognitive impairment and the COVID-19 pandemic serves as one objective of future studies to be addressed on this topic. A systematic review conducted by Tavares-Júnior, J. W. L. et al., (2022) and they have pointed out several phenomena (impairment in executive functions, attention, and episodic memory) are related to cognitive deficits, functional impairment, and the role of COVID-19 and how these correlated to each other.