Cognitive Resilience in Adulthood - Cognitive Development in Late Adulthood – Essay Example

Cognitive Resilience in Adulthood

ABSTRACT

A resilience framework for understanding cognitive aging implies a search for factors that buffer against existing risk, enabling one to thrive in what might otherwise be adverse circumstances. The cascade of biological processes associated with senescence and a cultural context that does not take into account this biological imperative each create risk for cognitive decline in later adulthood. We propose that (a) engagement, a sustained investment in mental stimulation, and (b) personal agency, which enables one to construct a niche for successful life span development, constitute the centerpiece of cognitive resilience. Numerous factors at the level of the individual and the sociocultural context set the stage for engagement and agency, thereby contributing to life span cognitive resilience, which can in turn impact factors promoting engagement and agency (e.g., health management, disposition affecting how experience in regulated) to support cognitive growth. Cognitive development shows wide variation among individuals through the adult life span, and there is long-standing concern with why some age more successfully than others. Our goal in this chapter is to explore the nature of such cognitive resilience through adulthood.

Historically, the concept of resilience arose in the child development literature as a framework to understand why some children who grow up under circumstances of great adversity, nevertheless, thrive (Masten & Wright, 2010). Thus, framing successful aging in terms of resilience puts the emphasis on the factors that protect against risks associated with aging, so that an understanding of resilience requires an analysis of both the threats to successful development and protective factors. We take for granted that both developmental continuity (e.g., Evans & Schamberg, 2009) and plasticity (e.g., Hertzog, Kramer, Wilson, & Lindenberger, 2008) are powerful forces of development, with threats and protective factors that buffer against those threats defining a lifelong resilience process. Senescence, the biological process of aging, certainly circumscribes limits on cognitive components requiring speeded information processing and executive control in later life, and increases vulnerability to pathological processes that can compromise cognitive health.

However, as a natural part of the life cycle, senescence itself is not so much a threat to successful development as is a cultural context that does accommodate this developmental period of later life. Cultural threats might be viewed as of two forms. First, it is widely recognized that attitudes about aging can be internalized in the form of negative aging stereotypes, which can compromise cognition by discouraging the recruitment of effort to the task at hand (Hess, Auman, Colcombe, & Rahhal, 2003). Beyond that, however, cultural institutions and social structures can also be a threat to successful development to the extent that they do not afford resources to prepare people to live long lives (Riley & Riley, 2000). As we will detail in this review, protective factors are diverse, but we take the organizing principle of cognitive resilience to be twofold: (a) engagement, a sustained investment in experiences that enrich mental capacity (Stine-Morrow, 2007), and (b) agency, the ability to create a niche to support such an investment amidst changing circumstances (Hertzog & Jopp, 2010; Werner, 1995).

Thus, lifelong cognitive resilience depends on the capacity to adapt to internal factors (e.g., senescence) and external factors (e.g., stressors, culture-bound expectations) to maintain habits of personally satisfying mental engagement. Agency in sustaining an engaged lifestyle does not just derive from naive optimism (e.g., the “little engine that could”), but rather from a whole constellation of resources crafted over the life span that puts force behind ones sense of agency (e.g., Infurna, Gerstorf, Ram, Schupp, & Wagner, 2011). Cognitive capacity does not come for free. By some estimates, proficiency in a substantive skill requires about 10,000 hours of deliberate practice (Ericsson, Krampe, Tesch-Römer, 1993; Gladwell, 2008). The normalization of optimal life span cognitive development, then, will ultimately derive from cultural and social institutions (e.g., health care, educational resources) that position individuals for effective engagement in experiences and activities that nurture cognition on a large scale over extended time. In the pages that follow, we consider the factors that have potential to contribute to cognitive resilience through the life span.

The ” 10,000-hour rule” implies that not all skills will be developed to an equal extent and that cognitive resilience must entail selectivity in what is optimized, as well as compensatory strategies for managing activities that depend on nonoptimized skills. Because plasticity decreases with age, the “10,000-hour rule” might be expected to become something like a “15,000-hour rule” for new skills developed in late life. However, the 10,000-hour rule also implies that by mid-to-later adulthood, investment in skill development of various sorts creates selected areas of established proficiencies, so that expanding on existing skill may depend on more like a “5,000-hour rule.”

Nevertheless, this scale of investment requires a life context that permits such a commitment. As such, developmental forces of selection, optimization, and compensation (SOC) become increasingly important to resilience through adulthood (Baltes, 1997). At the same time, resilience is a sociocultural process as well, insofar as affordances for adaptation are co-constructed by the individual and the sociocultural context in which one is embedded (Baltes, Reuter-Lorenz, & Rosier, 2006). We consider a number of broad factors that contribute to processes of life span cognitive resilience: (a) health; (b) education and cognitive reserve; (c) knowledge; (d) lifelong intellectual engagement; (e) dispositions, temperament, and motivational reserve; (0 social support; and (g) sociocultural context.

PHYSICAL HEALTH

A burgeoning literature has emerged in recent years suggesting that a healthy mind requires a healthy body Health is not simply the absence of disease, but rather a coordinated system of regulatory capacities that afford wellness.

Aerobic Exercise

Among the most consistently demonstrated health effects on cognition is that of physical activity (Hillman, Erickson, & Kramer, 2008). For example, in a meta-analysis of intervention studies in which late middle-aged and older adults were randomly assigned to an exercise condition (either aerobic or aerobic combined with strength training) or a control condition, Colcombe and Kramer (2003) showed that change in the exercise group from pretest to posttest (effect size = .49) was reliably greater than change in the control group (effect size = .16). Exercise was found to improve an array of cognitive components, but the strongest of the effects was on executive function (effect size = .68), which was robust even for interventions of a relatively modest duration (1-3 months). Effects of aerobic conditioning on cognition were found to be somewhat greater when it was augmented with strength training.

There is much recent research activity devoted to understanding the mechanisms underlying these effects using both animal and human models (Hillman et al., 2008). It appears that aerobic activity exerts its effects on mental capacity via a number of biochemical pathways that enhance neurogenesis, angiogenesis, and functional architecture of the brain. For example, improved aerobic fitness has been related to the expansion of gray matter in the prefrontal and temporal regions, changes that are related to improvements in performance. One of the most reliable effects of exercise is increased growth and survival of cells in the dentate gyrus of the hippocampus, a brain structure essential for memory consolidation. This cell growth is supported by the growth of vasculature needed for transport of nutrients and stimulated by increased upregulation of brain-derived neurotropic factor (BDNF).

fMRI data suggest that physically fit individuals exert more top-down control to avoid response conflict and show different patterns of neural recruitment (more middle frontal gyrus and superior parietal, but less activation of the anterior cingulated) that support better selective attention performance. Collectively, then, fitness engendered by aerobic exercise is an important facet of cognitive resilience. Importantly, these effects begin very early in the life span (Hillman et al., 2008), with math and reading achievement showing strong relationships with aerobic capacity. So although the Colcombe and Kramer metaanalysis shows that increased fitness can be a powerful cognitive intervention in later life, it is likely that building habits of exercise in childhood and young adulthood is a source of lifelong cognitive resilience.

Maintain a Healthy Weight

There is a fair amount of empirical support for a link between maintaining a healthy weight and cognitive resilience. For example, using longitudinal data from the Swedish Adoption/Twin Study of Aging, Dahl et al. (2010) showed that, controlling for education, cardiovascular disease (CVD), smoking, and alcohol use, the body mass index (BMI) at midlife was predictive of cognitive decline into later adulthood. This relationship was obtained whether or not individuals who were diagnosed with dementia during the study were included for analysis. The causal mechanisms of the weight-cognition link remain unclear. Obesity rarely occurs alone, but rather in conjunction with other factors that compromise health. The term “metabolic syndrome” is used to characterize the clustering of symptoms – including abdominal obesity (in which fat tissue is disproportionately distributed around the abdomen), cholesterol disorders, hypertension, and insulin resistance – that collectively increase the risk of CVD and type II diabetes.

Diabetes, which has been shown to predict declines in speed of processing and memory performance (Elias, Elias, Sullivan, Wolf, & D’Agostino, 2005; Ryan, 2005), may affect brain health through a variety of mechanisms, such as disrupting neurotransmitter pathways and transport of glucose across the blood-brain barrier. Based on a review of population-based prospective studies, Hao, Wu, Wang, and Liu (2011) concluded that metabolic syndrome was predictive of later cognitive declines, but did not increase the risk of Alzheimer’s disease (AD). Gatto et al. (2008) compared groups of postmenopausal women with and without metabolic syndrome who were screened to be free of CVD and diabetes.

Those without metabolic syndrome had an advantage on a measure of global cognition (an effect that could not have been attributable to cardiovascular health or absence of diabetes). Based on an analysis of longitudinal data from the Lothian Birth Cohort Study, Corley Gow, Starr, and Deary (2010) concluded that the correlation between BMI and cognition could be accounted for in terms of socioeconomic status and early life cognition without any direct effect of weight on cognition. Given the neurobiological correlates of obesity and related metabolic effects, a dismissal of a causal link between maintaining a healthy weight and good cognitive functioning is probably premature. Their data do suggest, however, that advantages early in life set up patterns of self-regulation through the life span that play out in both higher levels of cognitive functioning and better weight management.

Manage Stress

We are designed to adapt to challenging circumstance. Our physiology is wired for “fight or flight” as needed for adaptation to changing situations. This capacity to dynamically adjust to external demands, of course, has survival value, but unchecked chronic stress is toxic (Oitzl, Champagne, van der Veen, & de Kloet, 2010). Preparation to deal with a stressor involves the release of Cortisol that impacts carbohydrate metabolism to release energy reserves, suppresses the immune system, and affects cognitive function by both suppressing processing of information that is not relevant to the situation and promoting memory consolidation – all effects that enable coping with challenge in the short run. However, chronic exposure to Cortisol sets up a cascade of processes that can self-perpetuate damage to neurons, especially in the hippocampus. Ones emotional response to challenging situations may moderate the stress response.

Although some individuals respond to challenge with positive affect, some may be more likely to perceive challenge as threatening and react with negative affect. Such a disposition (typically characterized as neuroticism, as we will detail in the following text) may exacerbate the damaging effects of stress on cognition. Neupert, Mroczek, and Spiro (2008) analyzed diary reports of participants from the Normative Aging Study over 8 days and found that reports of stress were coupled with reports of memory failures, but that this effect was heightened for those higher in neuro ticism. There is empirical evidence for the long-term cost of stress on cognition earlier in the life span.

Evans and Schamberg (2009) showed that the link between childhood poverty and working memory capacity in adolescence could be entirely accounted for with a composite measure reflecting the cumulative physiological cost of stress (“allostatic load”), including resting blood pressure and urinary Cortisol. Research with animal models (Oitzl et al., 2010) suggests that vulnerability to stress and the development of buffers against the negative effects of stress are likely lifelong processes. Thus, the development of strategies for managing stress is an important source of cognitive resilience.

Sleep

Sleep can play an important role in protecting cognition through adulthood. It has long been known that insomnia predicts poorer cognitive performance, but it is also the case that even minor sleep disturbances in otherwise healthy, community-dwelling elders can negatively impact cognition. Nebes, Buysse, Halligan, Houck, and Monk (2009) found that individuals with better sleep quality (e.g., who fell asleep more quickly and were able to stay asleep) performed significantly better on measures of working memory, abstract problem solving, and executive control. Variation in sleep quality did not significantly relate to speed of processing or inhibition, suggesting that sleep specifically protects the ability to sustain focus in complex tasks. Day-to-day variation in sleep can impact cognitive performance as well. Gamaldo, Allaire, and Whitfield (2010) assessed sleep and cognitive performance on 8 different days across a period of 2-3 weeks, and showed that withinindividual deviations (either more or less) away from one’s mean level of sleep (in this sample, about 6 hours) was coupled with relatively poorer cognition the next day.

The causal mechanisms for this relationship are unclear. Although it seems entirely plausible that variations in sleep could directly impact cognition, it is also the case that (as noted previously) daily stress co varies with daily cognitive performance, so it may also be that stress is a third variable that compromises both cognition and sleep. Collectively, the empirical literature suggests that consistency in good quality sleep is an important source of cognitive resilience. Interestingly, poor sleepers often have higher resting levels of Cortisol, so it is probably the case that good sleep and managing stress are inevitably linked in protecting cognition.

Alcohol Consumption

Although there is some evidence that moderate levels of alcohol consumption can be favorable to cognition, the empirical case is somewhat stronger that avoiding excessive alcohol consumption is even better (Gross et al., 201 1). Gross et al. used data from the Johns Hopkins Precursors Study, a longitudinal study of medical students into middle age and later adulthood to prospectively examine the effects of alcohol consumption on cognition in old age. They showed that regardless of the time point at which alcohol use was measured, it was a negative predictor of phonemic fluency, a measure of executive control. For example, beyond about 15 drinks per week, alcohol consumption was a negative predictor of phonemic fluency 12 years later.

Recap

This brief review suggests that the effects of physical health on cognition are diverse. Health and wellness likely impact cognition in a number of ways, including direct biochemical and neural pathways that enhance plasticity, and indirect pathways of enhanced capacity to sustain engagement and agency in cognitively challenging situation. Cognitive capacity can also impact health, so that cognition and health may sustain one another through reciprocal causation. For example, cognitive capacity appears to buffer the impact of stress on affect (Stawski, Almeida, Lachman, Tun, Rosnick, 2010); also, cognitive capacity can be an important resource for continued management of health and wellness (Morrow & Durso, 2011).

EDUCATION AND COGNITIVE RESERVE

An important factor contributing to lifelong resilience in cognition is an extended period of engagement in formal education early in the life span, an effect that has been attributed to “cognitive reserve” (Stern, 2009). The explanation is that early educational experiences, when brain and behavior are at their maximum potential for plasticity, build neural networks and behavioral strategies that buffer against subsequent insults, so that the manifestation of brain pathology or damage is delayed. Approximately a quarter of community-dwelling individuals who show no obvious performance impairments before death will show evidence of brain pathology at autopsy. This proportion is greater for individuals with higher educational levels than it is for lower levels of education, suggesting that education builds a reserve, in terms of efficiency of neural networks, capacity, and/or flexibility in the use of networks or strategies that enable individuals with incipient pathology to recruit this reserve to preserve function.

A number of studies have shown that more highly educated individuals tend to be diagnosed with AD at later ages than less educated adults, but once diagnosed, their cognitive decline is more precipitous. Also, data from the Nun Study, in which a number of long-term lifestyle factors are controlled, have suggested that the rate of AD is lower among those with more years of formal education early in the life span (Mortimer, Snowdon, & Markesbery, 2003). However, based on a large sample from the Canberra Longitudinal Study, Batterham, Mackinnon, and Christensen (2011) concluded that this may depend on the particular cognitive domain assessed, with only speed of processing showing a delayed change point and slightly accelerated decline with increasing education (and not global cognitive status or memory).

One particular sort of early educational experience that shows evidence of wide-ranging effects on cognition is learning a second language (Bialystok, Craik, Green, & Gollan, 2009). Although early studies of bilingualism focused on aspects of delayed acquisition in childhood, this was a misconception that was a consequence of neglecting the combined acquisition (e.g., vocabulary) of both languages. More recent research suggests strong advantages of bilingualism for cognitive resilience. Globalization has contributed to an acceleration of research on the cognitive processes underlying bilingualism and multhingualism, with much of this literature showing lifelong benefits for language and thought. For example, the experience of negotiating two languages early in the life span gives the bilingual child an early window into the insight that one object can have more than one name, and by extension, that the description of events can depend on the observer.

There is much evidence that bilinguals communicating in their second language, nevertheless activate features of their first language, which must be suppressed in order to effectively manage the target language. This lifelong practice with flexible switching between two language systems, and controlling interference between the two, exercises executive control on a routine basis. In fact, older bilinguals show reduced decline on measures of executive control relative to monolinguals, and multhinguals appear to show a further advantage still. Collectively, educational experiences early in the life span impact cognitive resilience via a number of routes. Education builds a cognitive and neural reserve that buffers late-life pathology, but also affords skills and regulatory capacities that engender continue engagement.

KNOWLEDGE

Knowledge developed throughout the life span is a key resource for resilience in cognition. The growth of knowledge occurs in multiple arenas. Verbal ability, including vocabulary knowledge and proceduralized skills in reading, can show positive development into adulthood with continued practice in literacy activities. Domain knowledge continues to develop with continued investment in occupational and avocational activities. Such particularized knowledge can be complex and build a reservoir of declarative knowledge that can provide a context through which to assimilate new information, as well as skills that engender both effective selection and greater efficiency in domain-related learning (Miller, 2009).

COGNITIVE STIMULATION AND INTELLECTUAL ENGAGEMENT

The aphorism to “use it or lose it” has become a commonplace, and in fact, there is a well-replicated relationship between a lifestyle that incorporates engagement in intellectually stimulating activity and level of cognitive ability (e.g., Hultsch, Hertzog, Small, & Dixon, 1999; Jopp & Hertzog, 2007; Kemper, Greiner, Marquis, Prenovost, & Mitzner, 2001; Parisi, Stine-Morrow, Noh, & Morrow, 2009; Schooler, Mulatu, & Oates, 2004; Verghese et al, 2003). Intellectual stimulation has been assessed in myriad ways, including complex work or leisure activities, and frequency of participation in novel activities. Many of these studies provide interesting data consistent with the idea that habits of intellectual engagement can buffer age-related declines, with demonstrations of a crosssectional or a prospective correlation. There are two difficulties with drawing firm conclusions about causation, however.

First, if an intellectually stimulating lifestyle really acts as a buffer, one might expect for age declines or age differences to be reduced among those who are more intellectually active (statistically, an age by experience interaction), but there is actually little evidence for this. Rather, intellectually active individuals (either measured as disposition or self-reported activity) often have a cognitive advantage over inactive individuals that is sustained over the life span, but they do not age better (Salthouse, 2006). However, assuming that the senescence process places some constraints on the developmental trajectory of cognition (Hertzog et al., 2008), the expectation for differential cognitive growth among intellectually active people throughout the life span may set a bar for evidence that is too high.

A more serious concern with drawing causal conclusions from these studies is that they are vulnerable to the interpretation that those who are cognitively impaired may differentially withdraw from activity, so that it is the decline in mental capacity that leads to withdrawal from cognitive activity, rather than the reverse. Rohwedder and Willis (2010) took a clever approach to addressing this issue by comparing cognitive scores cross-nationally as a function of retirement policies – over which individuals have minimal direct control. To do this analysis, they took advantage of data from three cross-national surveys that were collaboratively designed to provide comparable assessments: the Health and Retirement Study in the United States; the English Longitudinal Study of Aging; and the Survey of Health, Ageing, and Retirement in Europe, which collected data from 11 European countries.

Surveys were based on large nationally representative samples and administered over the phone. The cognitive assessment incorporated into the larger survey was delayed recall for 10 concrete nouns, a task that very often shows reliable age declines in the literature. Results showed that individuals in countries that had policies incentivizing early retirement (e.g., by taxing earned income at a higher rate) had steeper declines in memory between the early 50s and early 60s. Thus, even though correlational, the relationship between engagement in work and mental decline reported by Rohwedder and Willis strongly implies that the mental demands of work promote cognitive resilience. Another way to address the causal ambiguity of the correlational literature is to conduct experiments in which participants are randomly assigned to some condition that promotes intellectual stimulation or to a control.

Although there is a rich history in the psychology of aging examining the effects of cognitive interventions, a long-standing focus on ability- specific training studies has been expanded in recent years to include more lifestyle interventions (Stine-Morrow & Basak, 2011). In short, the training literature has been clear in showing that there is substantial neural and behavioral plasticity into very late life, but the effects of training are highly specific to the ability trained, with no transfer to even factorial-related abilities. Lifestyle interventions embed individuals in complex environments in which multiple abilities may be exercised and/or in which individuals can shape the way they response to challenges through selective use of different abilities. There is some evidence that engagement with video games that require strategic reasoning can augment executive control among older adults (Basak, Boot, Voss, & Kramer, 2008). Community-based programs also show promise.

The Experience Corps program that places older adults in schools to work with children directly or as support staff has shown evidence of enhancing cognition (Carlson et al., 2008). The Senior Odyssey program in which older adults engage in team -based creative problem solving geared toward tournament competition has also shown evidence of improving cognition (Stine-Morrow, Parisi, Morrow, & Park, 2008). In spite of the robust of effects of early education on late-life cognition documented in an earlier section, it is possible that a lifestyle of continued cognitive stimulation can trump early experience. For example, data from the Midlife in the United States (MIDUS) study suggest that the negative effects of early impoverished educational experiences on episodic memory can to some extent be offset by frequent engagement in cognitive activities, such as literacy activities and puzzles (Lachman, Agrigoroaei, Murphy, & Tun, 2010).

Investment in activities that push the boundaries on ones abilities can be exhilarating. To the extent that one builds cognitive capacity through such patterns of engagement, one would expect cognitive capacity to be maintained or continue to grow, which makes subsequent encounters with cognitive challenge more pleasurable. In fact, there is evidence that older adults with higher levels of cognitive ability derive more pleasure with more cogniti vely challenging activities, whereas adults with lower levels of abilities enjoy less challenging activities (Payne, Jackson, N oh, & Stine-Morrow, 2011). Thus, lifestyle habits of intellectual engagement may be self-perpetuating.

DISPOSITION, TEMPERAMENT, AND MOTIVATIONAL RESERVE

Aside from the particular habits of intellectual engagement that are likely to build behavioral and brain reserve, there may be certain aspects of disposition and temperament that can impact the value of ordinary experience as an avenue for cognitive enrichment, as well as engendering or inhibiting stimulating behavioral repertoires. A rich literature is developing, which examines interrelationships between cognition and personality traits (Duberstein et al., 2011). For example, openness to experience – a trait marked by enjoyment of novelty, fantasy, and emotional experience; attunement to the environment; and mental flexibility – has been shown in a number of studies to be related to measures of cognitive performance (Parisi et al., 2009; Soubelet & Salthouse, 2010, 2011), as well as to reduced risk of AD (Duberstein et al.). This is perhaps not that surprising inasmuch as habitual enjoyment with intellectual activity would presumably enhance routine engagement of cognitive capacities to incorporate mental exercise into everyday activities, thereby building intellectual capacity. In fact, there is evidence that those who are high in the intellect facet of openness recruit more neural resources during a working memory task (De Young, Shamosh, Green, Braver, & Gray, 2009). By contrast, neuroticism, a tendency to worry and to feel anxious and threatened in ordinary situations, has been hypothesized to be a risk factor for cognitive impairment. Such thought patterns – of course – are likely to create distraction from the intellectual aspects of experience, but also neuroticism is related to higher levels of production of Cortisol, which as noted earlier is a stress hormone known to damage the hippocampus. Neuroticism has been shown to be a risk factor for AD (Duberstein et al., 2011).

However, evidence for a negative relationship between neuroticism and cognitive function in a healthy sample has been mixed (e.g., Soubelet & Salthouse , 201 1), and the effect of neuroticism on cognition may depend on its context in the larger structure of personality (Crowe, Andel, Pedersen, Fratiglioni, & Gatz, 2006). Belief that one is an active agent in effecting outcomes in the world has a profound effect on how the mind works. In a clever demonstration of this principle, Rigoni, Kühn, Sartori, and Brass (201 1) measured event-related potentials for undergraduates as they performed a volitional motor task after being randomly assigned to either an experimental condition to weaken the belief in free will (subjects read Cricks argument that free will is an illusion) or a control condition that did not (they read another passage from the same book about consciousness).

The early component of the readiness potential, a negative-going wave that precedes the conscious experience of the intention to move was reliably reduced among those whose beliefs in free will were challenged, a finding the investigators interp



Cognitive Development in Late Adulthood


AbstractThrough the different psychodevelopmental theories, the importance of the stages of development a human experiences as well as the nature of the changes that occur throughout an individual’s life can be understood. Over the years, much has been discussed about early childhood development, but relatively less about the late adulthood development, which is equally important. Thus, the objective of this research paper is to further understand the specific changes a senior citizen experiences during the late adulthood period related with cognitive development, the roots of these changes, and the possible diseases associated with cognitive development. Furthermore, this paper shall also aim to provide recommendations on how a senior citizen can cope up with the changes, and also policy recommendations, and possible future research angles on this topic.

An In-depth Discussion of the Cognitive Changes, Related Diseases, and Adjustments during Late AdulthoodThe twilight of life; old agedness; the last chapter; the peak of wisdom—these are just some of the words that are often associated with late adulthood. More often than not, old agedness is perceived as a stage when everything begins to deteriorate. However, over the years, most of the studies dealing with developmental processes centered on early childhood, while only a handful focused on developments or changes that occur during late adulthood. This may be because this stage cannot even be considered as a stage where development takes place. Rather, it is a stage characterized by deterioration. With old age come different impressions, such as degeneration, loss of one’s abilities and skills, diseases, non-productivity, and most importantly, death, which make it a frightening stage for many people.These are the things that are usually hard for the elders to face, knowing the complications that late cognitive development brings. Hence, this may cause some people to think that late adult cognitive development is a less interesting thing to study and deal with. However, contrary to more popular knowledge, old age is as important to understand as the early childhood’s stage. In this stage, serious complications can happen, and serious depression can be felt. Late adulthood is a significant phase of human life. It is also important that during this stage, the individual understands well what s/he goes through in order to cope well with the changes and avoid any further disease of complications. Thus, this paper shall center on understanding well the developmental processes a senior citizen experiences with specific focus on the cognitive development.Changes that Occur in Relation to Cognitive ProcessesGenerally, during the stage of late adulthood, most of the human physical and intellectual abilities start to slow down. This natural slowing down process is brought about by certain physical as well as cognitive changes taking place in the body. There are several categories of changes that a senior citizen may experience during this stage. Robert Gates (2007) listed these categories down in his online article entitled, Late Adulthood: Cognitive Development:Changes in Information ProcessingThroughout the early and middle development years, capabilities and skills, whether physical or cognitive, are steadily improving. However, as humans reach adulthood up to later adulthood (i.e., around 60 years and above), some of these physical and cognitive abilities would begin to decline. Part of the cognitive skills that begins to deteriorate is the 5 major mental abilities, namely: (1) verbal meaning, (2) spatial orientation, (3) inductive reasoning, (4) number ability, and (5) word fluency (Gates, 2007). The decline in these five major abilities affects the individuals in many aspects of his/her ever day life. It may affect the individual’s performance at work, interpersonal communications, learning process, and overall, process of socialization.Aside from these major cognitive abilities, the sensory register of a person is also being affected. Old agedness causes decline in the ability of the brain to retain temporary sensory memory. This implies that the older an individual grows, the more his/her sensory system’s ability to detect important sensations tends to dull over time (Gates, 2007). Aside from the short-term sensory memory, an individual’s working memory is also being affected by old agedness. The working memory of a person serves as a temporary storage of information for future conscious use. It also processes information using the integrative reasoning, mental calculations, and drawing inferences (Gates, 2007). The decline in this aspect of memory retention happens because of the fact that information processing in the brain takes longer as people age.

Changes in Cognition in Daily LifeThe main change associated with growing old is cognitive decline, specifically the failure of memory. Memory loss has been affecting adults in their personal jobs and activities every day. Through researches conducted about memory loss in adults, it has been found out that they generally find it hard to memorize a material with meaningless strings of numbers and words (Gates, 2007). Gates summarized the conclusions of his research regarding age-related changes in memory and cognition into four points: (1) mental processes slow down with age; (2) the elderly do show memory declines; (3) the elderly are less likely to use memory strategies; and (4) memory in late adulthood is not as weak as anticipated.DementiaDementia as an intellectual condition is defined as the loss of proper cognitive functioning caused by organic brain damage or disease (Gates, 2007). This illness is explained as a general term which refers to any intellectual disorder that causes several intellectual shortfalls. A person with dementia would experience several intellectual problems like impaired memory (especially the inability of remembering newly acquired information), impaired language and communication skills, impaired orientation (e.g., difficulty in identifying a person and telling time), impaired judgment and impaired overall functioning (e.g., inability to plan and make daily decisions) (Hill & Reiss, 1995). This problem has been proven a psychologically based cognitive and behavioral deterioration (Cantu, 2003).Hence, although this illness can be observed behaviorally, its roots are mainly psychological. It is also irreversible because most diseases associated with dementia are caused by organic brain damages. Given this, people suffering from dementia lose their abilities at different levels (US National Institute on Aging [NIA], 2006). Oftentimes some people are also mistaken to have dementia because of mere emotional problems. However, these emotional conditions can be very common among normal adults such as feeling sad, lonely, worried, and bored, since these people are those who are usually facing retirement or are coping with a death of a loved one (NIA, 2006).Problems and Diseases Associated With Late Adulthood Cognitive DevelopmentIn the current modern days where the medical technologies are continuously developing to help more patients, it is easier to understand diseases unlike in the earlier times. Certain mental disorders which are associated with adulthood can now be easily grasped by the patients and their families. Some of these diseases have caused fears and trauma to other people in the earlier years, but nowadays, some of these cognitive diseases are proven to be reversible. However, there are still some cognitive illnesses that are irreversible. One of the diseases associated with late adulthood cognitive development is the Parkinson’s disease. It can be described as the downgrading of the subcortical regions of the brain that are more often extended to the cerebral cortex and involves brain abnormalities which look like that of Alzheimer’s.Parkinson’s DiseaseParkinson’s disease (PD) is a progressive mental condition which affects an individual’s usual movements such as walking, talking, and writing (Parkinson’s Disease Society, n.d.). James Parkinson, the man who led the first research about this disease first calls PD as the “shaking palsy” (cited in Factor & Weiner, 2001). Parkinson published an essay on 1817 about six patients which he had observed to have shaking palsy syndrome. In this essay, he also noted the first symptoms of PD as “slight sense of weakness, with a proneness to tremble in some particular part, but most commonly of the hands and arms. These symptoms gradually increase in the part first afflicted; and at an uncertain period, but seldom in less than 12 months or more, the morbid influence is felt in some other part” (Parkinson cited in Factor & Weiner, 2001). This early description by Parkinson still resembles that of the current medical symptoms of PD.At present, Parkinson’s disease would be identified as a cognitive-related disease which starts with an unnoticeable shaking in just one hand (Mayo Clinic, 2008). The disease is also described to develop gradually which also causes a slowing and freezing movement to an individual. PD can be attributed to a lot of factors. However, medical practitioners discovered a specific cause which directly leads to PD—the lack of dopamine in the brain (i.e., dopamine serves as a chemical messenger). However, many PD physicians are still wondering about other possible factors which can bring about this disease. Some of the theorized causes of PD are genetic mutations and environmental toxins, but these causes are still to be verified (Mayo Clinic, 2008).This disease often causes fright and panic to the diagnosed patients and to their families. Aside from emotional effects like depression, PD can still bring several complications once the condition becomes worse. One major complication could be sleeping problems. This is most common among late adults because many individuals in late adulthood would always awaken in the middle of the night by certain tremors. They may also experience sudden sleep onset and called sleep attacks at day (Mayo Clinic, 2008). PD patients also experience difficulty in chewing and swallowing. This situation may come during the later stages of PD because the swallowing and chewing muscles of the patients are already being affected by the disease during this time. They would also go through urinary problems and constipation. These complications are commonly side effects of the medications the patients take for the disease. Lastly, PD patients have sexual dysfunction as the disease strikes. This is because the disease itself decreases the sexual desire of the patient, but this may also be because of the combined psychological and physical factors (Mayo Clinic, 2008).Alzheimer’s DiseaseAlzheimer’s disease has been found to be the most common cause of dementia (U.S. Office of Technology Assessment [OTA], 1991). This disease can be characterized by a loss of intellectual and social abilities which affects the usual daily activities and functioning of patients (Mayo Clinic, 2007a).Scientifically, the brain tissue of an Alzheimer’s patient deteriorates, that is why there also comes a consistent downfall in memory and mental capabilities. Just like Parkinson’s disease, Alzheimer’s is also progressive. It is a degenerative disease which causes worse forgetfulness to the extent of forgetting the identities of people a patient has known all his/her life. It usually starts with a slight gap of memory and confusions, but as time passes, it eventually leads to an irreversible mental impairment which can actually destroy a person’s ability to remember, imagine, and learn (Mayo Clinic 2007a).At onset, several signs and symptoms may be observed from patients, and the Mayo Foundation for Medical Education and Research enumerates some in their official site. The signs and symptoms of the disease may include: (1) Increasing and persistent forgetfulness; most patients usually forgets about recent events and simple directions at the start of the disease. However, eventually, this mild forgetfulness worsens, and people afflicted with Alzheimer’s may usually start repeating things and forgetting about conversations and appointments; (2) Difficulties with abstract thinking; Alzheimer’s patients tend to find it hard to dealing with numbers and abstract problem solving because of the deterioration of brain tissues; (3) Difficulty in finding the right word—caused by the degeneration of brain functions; (4) Disorientation; patients get disoriented about several things around them like the time and date since they often forget about any kind of detail; (5) Loss of judgment; knowing what to do in simple situations such as cooking and putting pieces of puzzles together can be very difficult for Alzheimer’s patients. Often, these things can also be impossible for them to accomplish.This is because things which require planning, decision making, and judgment tend to be difficult for the patients due to their cognitive degeneration; (6) Personality changes; one of the most observed traits among Alzheimer’s patients is their frequent mood swings. They often have difficulties in trusting other people as they become more hard-headed, and they also tend to withdraw socially. These attitudes can be attributed to the frustrations they feel because of the sudden memory loss they encounter. This can also be caused by the restlessness and depression they experience which coexist with the disease (Mayo Clinic, 2007a).Despite the current developments in medical technology, there remains no proven cure for Alzheimer’s disease. However, these developments gave way for certain medications which slows down the process of Alzheimer’s, hence delaying the effects and complications of the disease. However, given this fact, there is still no medication that counters Alzheimer’s or anything which can make it vanish forever in a person’s mental being. This causes much depression to patients especially to their families and caretakers who have to look after them in this condition. Alzheimer’s patients vary in their capabilities depending on their self-care abilities (U.S. OTA, 1991). This is because the disease causes the patient to acknowledge cognitive problems brought about by dementia tend to put bounds on a person’s ability to do his/her daily activities. These activities can be classified into two, such as, the “Instrumental Activities of Daily Living” or IADL’s and the “Activities of Daily Living” or the ADL’s. IADL’s include shopping, cleaning, cooking, using a telephone, and handling money. These activities differ from ADL’s because these are usually not done independently by patients; hence, they can still have some support from their care givers. On the other hand, if cognitive problems become worse, the patients may eventually be unable to do even the tasks they would have to do independently such as, bathing, dressing, or using the toilet, which is considered under the ADL category (U.S. OTA, 1991).Alzheimer’s patients may consider several difficulties even at the onset of the illness. However, towards the later part, they may still experience some worse complications that would require them to acquire proper and thorough medical attention. The patients can sometimes acquire pneumonia because of unintended inhalation of some food particles and substances that they drink. This is caused by their difficulty in swallowing foods and liquids. They may also catch several infections due to their urinary incontinence. This condition requires a catheter to be placed in them which increases the risk for urinary track infections. Aside from these, the patients are also prone to falls, thus, they are also prone to the complications of such accidents. Alzheimer patients are at risk of falling and committing certain accident because of their disorientation. Such accidents may put them in serious situations due to head injuries, internal bleedings, or even prolonged immobilization (Mayo Clinic, 2007a).DepressionThis type of cognitive illness is relatively common. This condition knows no ethnicity, racial background, and economic status (Mayo Clinic, 2007b). Depression can be observed on many young adults, but it has been observed mostly on adults and late adults. Aaron Beck (2006) defines depression in his book, Depression: Causes and Treatment, as: (1) a specific alteration in mood: sadness, loneliness, apathy; (2) a negative self-concept associated with self-reproaches and self blame; (3) regressive and self-punitive wishes: desires to escape, hide or die; (4) vegetative changes: anorexia, insomnia, loss of libido; and (5) a change in activity level: retardation or agitation. Beck (2006) further explained that depression can be a specific condition secondary to another like schizophrenia. In such case, depression may not mean same as schizophrenia. Rather, it would be termed as “schizophrenic reaction with depression.” Scientifically, the specific causes of depression are not yet discovered; however, studies provide certain factors which seem to contribute in developing depression among individuals. For example, a senior citizen experiences depression if his/her family has a history of depression. If there are members of the family who committed suicide, he went through stressful life events. If he has been used to depressed moods as a youth, if s/he has been exposed to long-term use of medications such as sleeping pills and other kinds of drugs, if she has recently given birth, and if s/he belongs in a lower socio-economic group, there might be a chance. These may not be considered direct causes, but their factors which have often contributed to several depression cases that have been studied. This kind of emotional condition especially in adults is a very serious situation that concerned relatives have to be very careful about because this illness can lead to several more serious things like suicide, alcohol abuse, anxiety, heart disease and other medical conditions, family conflicts, relationship difficulties, and social isolation (Mayo Clinic, 2007b).Coping UpThe cognitive development process of late adults can be more complex and difficult to deal with since the factors and complications involved with it are also as complicated. It is understandable that the life of individuals at this stage of life can be very difficult and challenging. However, the more they get confused about the changes and the degeneration they are experiencing, the more that they need to try hard to understand these natural phenomena brought by the old age. Dealing with depression and different kinds of degenerative illnesses can really be very hard. It will be normal for these people to feel less confident about themselves and want to be isolated from the world. This is brought by the sudden changes they experience which makes them feel like they become less of the person they used to be when they were still young. In this stage of life, the family, friends, and close relatives play a big role in lessening the burden of old age. Understanding from these people can be very helpful for the elders by making them feel that their experiences are understood (Mayo Clinic, 2007b).The experience of aging definitely causes emotional traumas (Scrutton, 1999). Most of the time, the way older people deal and react to things vary depending on different factors. One can be on how well they did in their earlier life. This factor is often considered by counselors since the people they are dealing with are actually molded people who already have solid foundations and deep experiences and learning in life. It is in this factor where the person’s ability to be open, flexible, gentle, and kind, depends (Scrutton, 1999). There are also certain things that elders fear about growing old such as uselessness and burdensomeness which causes even more psychological torture to them. Moreover, this leads to isolation, lack of respect, and most importantly, the virtual disenfranchisement from the society which is inevitable for elders at this stage (Daniel, 1994).Dealing with Degeneration Among EldersMoving onwards is the normal pace of life. Everyone may all eventually grow old in the future, and he or she shall all face old age. With old age comes different degenerative disease that the elders are very prone of acquiring. It is understandable that coping with these kinds of conditions can be tough; however, if having the right attitude towards it will bring an elder to a better state of mind and emotion, then it might be better to give it a try. People with degenerative diseases often go through a combination of different emotions like confusion, anger, fear, uncertainty, grief, and depression (Mayo Clinic, 2007). Immediate relatives or caretakers might not be able to help out the elder medically, but their willingness to listen and to show that they care and understand will be a better assistance. In most diseases like Parkinson’s and Alzheimer’s, the symptoms can be irreversible, and the patient would not be able to do about it but to try to slow down the process. This fact can be very depressing and frightening for the elders. Thus, a calm and stable environment at home can help reduce the burden of their problems and anxiety. Sudden noise, large groups of people, being rushed or pressed to remember, or being asked to do complicated tasks can worsen the anxiety of the elders and may cause them to lose focus and become disoriented (MayoClinic).Dealing with Depression Among EldersMost of the time, people tend to misunderstand certain attitudes the elders show which are actually caused by the depression they are going through. Depression may be popularly known as an emotional state; however, this condition is being affected by different cognitive and psychological factors. Even in young adults, depression caused by psychological traumas and experiences may be very difficult to deal with. With elders, it becomes more difficult, considering that they tend to be weaker, and that they are experiencing more physical difficulties than the younger ones. Talking to a doctor or to a counselor may ease the condition, but acting on one’s own and with the help of the immediate family and caretakers would be more helpful.The Mayo Foundation for Medical Education and Research enumerated ways on how one can cope with depression. In order to ease one’s depression, an elder should try to: (1) Simply his/her life — an elder can cut back on responsibilities and set achievable schedules for objectives; (2) consider writing a journal where his/her pain, anger, fear and other emotions can be let out; (3) read reputable self-help books, consider talking about their condition to a doctor or therapist; (4) not become isolated — an elder must try to take part in normal activities and socialize with their family or friends often; (5) take care of him/herself through a proper diet and sufficient sleep; (6) take a part in a group of people with similar condition so that they can connect with people facing similar challenges; (7) stay focused on their goals’ it will not be very easy to overcome depression.Elders must stay focused on what they want to happen with their condition. They should also remind themselves often that they are responsible for dealing with their condition; (8) learn relaxation and stress management; these kinds of exercises like yoga or tai chi can reduce stress which often brings about depression; (9) structure their time; elders must try to plan their daily activities as much as they can. They must try to stay organized in order to keep oriented with what they have to do; and (10) to not make important decisions while in the depths of depression, since this would not let them think straight and clearly (Mayo Clinic, 2007).Believing that this is just a phase and that this will eventually fade, some people would choose to ignore this condition. Yes, it can be normal to feel down and sad from time to time, but when it comes to prolonged depression, this condition may eventually lead to more serious dangers like suicide and aggressive behavior. Prolonged depression may even impair relationships, and may get in the way of doing daily tasks and activities. Thus, it would be helpful to know when to consult medical advice. It is time to consult a doctor or a counselor once depression leads an individual to commit suicide. This stage of depression can be considered a serious one (Mayo Clinic). However, elders are less prone to this kind of depression complication since they are usually scared of death, but the condition may further result in other complications like heart attacks or failure which can also lead to a sudden death. This makes it very important for elders to fight depression as much as they want to prolong their life. Chuck Falcon (2002), a counseling psychologist, was once quoted in the official site of HealthyPlace, “Remember sadness is always temporary. This, too, shall pass. Can’t, If, When, and But never did anything. Trials give you strength, sorrows give understanding and wisdom” (n.p.).Thus, Falcon believes that maintaining a positive attitude and a happier disposition can greatly help alleviate the condition of people elders suffering from depression. Negative thinking habit contributes a lot to depression (Falcon, 2002). Most often than not, depressed people are those people who choose to focus on exaggerating the problems they have or the conditions they are in. They would also try to recall negative things over positive things. On the other hand, happier elders may experience failure, disappointment, rejection, negative emotions, pain, and great sorrow as well, but their positive attitude makes them overcome these things which can often times pull down a problematic elder to a much worse and miserable state. Depressed people also tend to give up easily with problems and difficulties, making them commit more failures as time passes by, while happier and less problematic elders understands that every failure can be considered as a learning experience and can eventually lead to success if only they would not give up (Falcon, 2002).Today, more experts like gerontologists, physicians, psychologists, sociologists, anthropologists, philosophers, ethicists, cultural observers, and spiritual leaders are joining the movement to improve the way how people and the society view the process of growing old (Daniel, 1994). This movement has become important nowadays since the society opt to look at the process of aging as a major problem and a terrible disease. This view and perception of old age has to stop if we all want to experience growing old in a more pleasant and easier way. This effort of different institutions is a great help which can finally change the bad impression about late adult development and causes depression and other psychological disorders to elders. Sometimes, one has to understand the concept of “conscious aging” deeper (Daniel, 1994). This way, instead of denying what s/he is going through, s/he will rather accept and anticipate what is there to come. Moreover, rather than thinking about what s/he may lose, s/he would rather think about what s/he will gain through experience, wisdom, and relationships as s/he goes through the golden age.The late adult cognitive development is as complicated as the complications that also come with it, like dementia, memory losses, and other illnesses which coexist with the process. Having elders deal with this stage alone may be very difficult and, as what we have already discussed, depressing. Thus, the elders shall need all the support and the helping hand not just from their immediate families and friends, but also from the different sectors of the society which can bring about a great improvement in dealing with late adulthood cognitive changes and development. Policy RecommendationsThe late adulthood cognitive development is not a well understood and learned-about topic for all. Nevertheless, given that this is a significant topic in human development, people must be exposed and must be aware about this topic well since it concerns an important human developmental stage. Knowing that this topic is important in the lives of the people, it may go to show that this topic also plays an important part in the society as a whole. However, most people will just try to ignore this issue. Thus, the government and many non-governmental institutions’ support and help shall make a significant difference in the better awareness and understanding of this topic.The government, having its powerful ability to influence the people, may spearhead a national information campaign about the nature of late adulthood development. This campaign may also disseminate information explaining why sudden and dramatic changes occur in this specific stage of human development. Aside from this, there will also be a need to inform the people about the different complications and illnesses that go with the late adulthood development. These campaigns and information dissemination acts shall be widely conducted in order to create awareness in a wide range of people as well.Non-governmental organizations or private institutions may also provide funding and monetary support for these campaigns. These institutions may become more powerful in terms of the capability to provide better and more materials for promotion. Psychological and medical institutions can also support the movement of making this issue a well understood and accepted one through giving the late adulthood cognitive development a positive impression. This effort may help the average elders to not be scared of what this stage can bring them, and to not make them have the wrong perception about growing old. Medical institutions must also try to inform the public well, with the help of the media, about the different diseases and complication associated with this topic. This way, early prevention might be promoted to the public. Hence, they shall understand the causes, ways of getting over, and avoidance of these illnesses.Suggestions for Future ResearchesLate adulthood cognitive development is a complex and detailed topic.