What is it? 

It encompasses the physiological and psychological processes that accompany aging. This process is not merely biological but also involves social, economic, cultural, and psychological factors, many of which can act as risk or protective factors. Note that there are several definitions of aging depending on the perspective highlighted (social, administrative, biological, healthcare use, etc.). That said, aging is inevitable, slow, and progressive.

Differences between successful, typical, and difficult (pathological) aging? 

With age, there is a progressive decline in the functional abilities of our organs, modulated by health issues encountered throughout life. This leads to increased fragility, which varies among individuals and even within the same person (from one organ to another). Aging should be understood as a dynamic process. A successful aging process is one in which a person maintains satisfactory physical, mental, and psychosocial functioning, while typical aging involves functional impairments without well-defined pathologies or conditions. In contrast, difficult aging is marked by dependency and the presence of severe pathologies (respiratory, cardiovascular, renal function, immune system, etc.).

What happens to the brain as we age?

All brains age, but each at its own pace, influenced by individual life experiences. With age, there appear to be changes in attention and memory, as well as in information processing speed. Accumulated knowledge seems to be retained but using it flexibly and appropriately becomes more challenging. This, of course, varies from person to person, related to genetic, environmental, and psychological factors.

As we age, some neural circuits become less efficient, and communication between them deteriorates. Blood circulation may also be affected, with a heart that pumps less efficiently, hardened veins, and possible vascular lesions. These changes lead to suboptimal brain irrigation. Consequently, certain variations become evident, such as increased mental fatigue after exertion, occasional difficulties in finding words, forgetfulness (like misplacing keys), or heightened worry about loved ones or unfinished tasks.

Certain factors like education, social life, good sleep, dietary hygiene, and reduced stress can help maintain cognitive functions. Meanwhile, cardiovascular diseases, hypertension, diabetes, visual and auditory impairments, alcohol and substance use, and depressive disorders act as risk factors.

However, alongside normal aging, several forms of pathological aging can develop in the brain, commonly referred to as neurocognitive disorders (NCDs). NCD refers to symptoms associated with brain diseases, often irreversible, that impact cognitive abilities and lead to behavioral changes. NCD can be mild, where the individual can still manage certain activities, or severe, resulting in significant loss of autonomy.

In NCDs, the individual feels lost, and those around them may no longer recognize them (persistent mood changes, stress, excessive anxiety, loss of interest, difficulties expressing oneself, finding words, exhibiting strange new behaviors, etc.). This should be distinguished from normal behaviors that may appear with age, such as occasionally forgetting names, appointments, conversation topics, or grocery items; misplacing keys and personal belongings; feeling tired, less motivated; needing help with complex financial decisions or handling unexpected situations; mood variations over weeks; self-doubt; decreased concentration, etc.

The most common NCD is Alzheimer’s disease, which should be distinguished from other NCDs (Lewy body dementia, vascular dementia, dementia due to Parkinson’s disease, etc.).

Early signs of Alzheimer (according to Alzheimer Society Canada):

• Memory loss (frequently forgetting recent and important events, not just an appointment or a colleague’s name)
• Difficulty performing familiar tasks (cooking, writing, dressing, etc.)
• Impaired judgment (taking unreasonable risks)
• Language problems (difficulty finishing sentences, substituting words, etc.)
• Misplacing items (e.g., putting an iron in the freezer)
• Difficulty with abstract concepts (no longer understanding the meaning of numbers and making significant expenses that are not usual)
• Changes in mood or behavior (rapid mood swings for no apparent reason)
• Changes in personality (becoming closed off and suspicious instead of open)
• Disorientation in space and time
• Lack of enthusiasm (passivity and disinterest without depressive speech)

Is there anything I can do?

If you are concerned about your cognitive health discuss it with a healthcare professional. If your concern is for someone close to you, share your observations and worries with them and do not hesitate to consult a professional. There are some tools known as quick screening or assessment tools that can be utilized.

Some suggestions that help:

• Education and activities (reflection, leisure, social and professional engagement, volunteering, etc.) can help by fostering initiative and planning. 
• Stay active and exercise, while being cautious of head trauma. 
• Maintain a daily routine (set daily goals) and promote good sleep and dietary hygiene (reduce alcohol and tobacco consumption, etc.). 
• Take care of your mental health and manage stress. 
• Take care of your body (hearing, vision, etc.) and your heart.

Support for caregivers

When assisting a loved one living with an NCD, it is important to consider the person and their needs while respecting their personal space, sense of comfort, and security, and to help foster their autonomy. Over time, an elderly person may need to leave their home; this difficult decision should be made when safety concerns outweigh the benefits of remaining at home. Be aware that there is no magic solution.

Being a caregiver can be a challenging journey. It is important to recognize your limits to avoid burnout. “Compassion fatigue” can occur if you do not take care of yourself. It is crucial to recognize signs of overexertion, such as irritability, sadness, or a desire to isolate oneself. Taking care of yourself, planning tasks, and connecting with other caregivers are essential steps.

Conclusion

Despite the challenges of aging, it is possible to preserve and enhance cognitive health through positive lifestyle habits and mutual support.