Brain Science: As we grow older and as we mature we wonder what our brain is doing. Can it keep up with everything we need to know? What happens to our memory as we age? Am I able to comprehend everything that is changing at work. Is my brain wearing out? Why can't I just learn Spanish. Why can't I remember my grandkids and great grandkids names the minute we see them? All of this change is driving me nuts!
We have talked about what happens within the brain as we get older so this blog is not about the aging process in the brain but how to measure it.
As it turns out, there are a few measuring instruments that do attempt to do just that . The simplest is what your Doctor is required to do as you grow older. Most of us have had to go through that humiliating experience. The Doctor gives you a few words. He/she then begins talking to you about something else. Then he/she returns to the original statements and asks what was said previously. Essentially they are checking the status of your recall. They write down your response and then moves on. (I've asked where this response goes and haven't got a good answer yet!)
There are two more sophisticated assessments that Health care providers often use as brief tests:
They are The Montreal Cognitive Assessment (MoCA), or the Mini-Mental State Examination (MMSE). They are as follows:
The Montreal Cognitive Assessment is a well-validated, reliable, and freely accessible screening tool for detecting Mild Cognitive Impairment (MCI), which has been translated into and validated in 36 languages and dialects including Japanese, Mandarin (Simplified), and Korean. It has also been shown to be useful at detecting cognitive dysfunction in a variety of conditions, including Huntington’s disease, Parkinson’s disease, poststroke cognitive impairment, and brain metastases. More detailed testing may help determine the degree memory is impaired.
It is scored on the basis of 30 points, The test includes naming three uncommon animals, recalling five words, doing a simple Trail Making Test (Part B), and copying a cube and other items.Typically a cut off score of 25 is used to indicate impairment.
A second test is the MMSE (Mini-Mental State Examination). It measures time and place, attention and concentration, short-term memory recall, language skills, visuospatial abilities, and the ability to understand and follow instructions. It takes about 10 minutes to complete in a doctor's office. This test has two important uses: first, it is widely used for screening for Alzheimer's. The second reason is that it is used as a means of evaluating cognitive changes in an individual over time. The sensitivity and specificity of the MMSE are reasonably good. Sensitivity refers to the test's accuracy in identifying individuals with cognitive decline and Alzheimer's. Specificity refers to the test's effectiveness in identifying people who do not have the disease. This evaluation has a 30-point scale. We will go into that scale in greater detail under brain facts.
The MoCA is more difficult than the MMSE. It is scored on the basis of 30 points, as is the MMSE, but scores for the same patient average about 5 points lower than on the MMSE.
Brain Facts:
According to psychology and education experts, the best age to learn a second language is during the first years of life, from birth until age 18. This is known as a critical period for language acquisition.
The ability to think quickly and recall information,like names peaks at age 18!
Learning unfamiliar names peaks at 22.
Researchers have found that while some mental abilities tend to peak earlier in life, many people don't reach their highest point until around the age of 40 or later.
IQ tests tend to peak between 25 and 29 years old.
After 29 IQ tends to decline throughout the rest of adulthood, with the decline becoming more steep after the age of 70.
90% of brain growth happens before kindergarten
In a child, the brain doubles in size the first year.
While it may seem like an 18, 20 or 22-year -old is able to make adult decisions, they are not developmentally ready just yet. This is because the brain's frontal lobe, especially the prefrontal cortex, isn't fully mature until around 25.
Strength and physical performance reach their peak between 20 and 35 years of age.
At age 35, statistically, short term memory begins to weaken and decline.
A man is statiscically fully emotionally mature around 43.
There is not a whole lot of agreement on this: But... When are you considered old? One study distinguishes the young old(60 to69), the middle-old (70-79), and the very old at (80+).
A 1970s study revealed the peak and median age at the onset for any mental disorder is 14.5 years and 18 years years respectively.
Now for the scale on the MMSE ! a score of 25 or better is traditionally considered normal with the minimal following degrees of impairment. 20-25 indicates mild cognitive development. 10-20 score usually shows a clear impairment and the individual may need assistance. A 0-10 score is indicative of a severe impairment. The individual is likely to require 24 hour supervision.
So What;
So... I have taken the MMSE and got a score of 27. So there.. you might think that is great. But a score below 25 is mild cognitive development. I didn't feel so great when I found that out.
So what then about the assessments? Well lets start with the normal cautions on all tests like this. They are simply predictors based on statistics. The reliability and validity of both tests are really good but there are always butterflies. Butterflies are those people who defy the statistics. There are even people who have past that once they die their brains show significant grey and white matter deterioration. Yet they displayed no symptoms of decline! It is rare but happens. There are some other considerations I would propose from my experience.
The assessment in my case was a computer generated devise. It calls for quick responses to experiences shown on the screen. I would propose that for a lot of older Americans just the setting is intimidating and that, I think, could result in "test phobia" and could significantly affect timely responses. I also find there is a need to hear well to adequately respond. In my case I had not as yet had the hearing aides that I now have. I found that very distracting. As another point, we all now know on this blog that the brain slows as we age. I was looking for some scale or differentiation of score categories based on age. So far the only thing I have seen is the doctor giving leeway because of age.
Having said the above, I find I am better off for having taken the assessment. At age 79 and almost 80 I do find that my brain is slowing down. I also have trouble recalling names and have tried to learn Spanish. ( I should have read the above about all of these!) I think we older people make up for a slow brain by having so much up there, in the brain I mean. We might not be able to remember a great grand childs nickname but we can tell you all about emotional maturity and even how to recognize it!
So I guess from the above I am normal. Which has got to be a relief for all of us in this shape. Probably the most significant use of these assessments comes in looking at them over time. Taking it again tends to offset the test freeze syndrome and can show issues before they become too big to do anything about it.
or..... Maybe not knowing allows us to think we are "butterflies" a little longer!!.
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