ASSOCIATE ING OLD AGE WITH THE INCRESED WISDOM
We often generally associate old age with increased wisdom, life
experience and acquiescence. Yet, once we reach a respectable age, we might
find, that elderly life is burdened by failures in physical and mental
functions and subsequent concerns about possible permanent impairments.
Vaccination, medication, surgical procedures and other scientific and
medical breakthroughs have and still continue to increase longevity. Due to
the decline in death rate as well as in birth rate, the proportion of older
adults among the world’s population is rapidly expanding. Whereas in 2017,
24% of European populations consisted of people older than 60, in 2050 this
number is expected to rise to 35% (United Nations, 2017). Yet, while in
most corners of the world people are living longer lives, enjoying their
grandchildren, exploring the globe, or (re)discovering old or new hobbies,
many of them fear the looming decline of cognitive functions and the
possibility of debilitation by progressive aging diseases such as
Alzheimer’s or Parkinson’s disease Symptoms of age-related neurological
diseases worsen over time, leading to a decline in quality of life and
interfering with daily functioning, eventually rendering one fully
dependent on others.
Although the majority of older adults will not be diagnosed with
one these progressive diseases, many will at some point experience
cognitive loss through the process of normal aging. The main patterns of
age-related decline pertaining to subjective complaints, cognitive
(dys)function, and neural efficiency (deterioration in brain structure and
connectivity, and reduced neurotransmission), respectively. Subjective
complaints of daily-life functioning With increasing cognitive decline,
older individuals become more aware of the transient nature of the human
body and their own mental capacities. Although older adults often report to
be more emotionally stable and to suffer less from external stressors
compared to middle-aged adults, deterioration of cognitive abilities can
provide another source of stress. Many individuals worry about declining
memory functions and impending dementia, and some will experience increased
anxiety when confronted with losses in memory. Despite some continuing to
actively seek out social engagement and activities, others find
interactions with friends becoming much sparser, and with the loss in
friendly and societal relationships people’s sense of purpose may fade.
Subsequent loneliness and isolation are common phenomena in old age,
leading to impaired quality of life, depression, and further reduction of
mental activity.
1 • Although evidently, quantifiable cognitive decline can be a risk factor
for further impairment, the presence of subjective complaints of cognitive
failure in daily activities also is an important predictor of the
longitudinal course of memory decline over time. Additionally, the
prevalence of both anxiety and depression are found to be positively
correlated with progressing cognitive decline, posing a risk for mild
cognitive impairment and dementia. In other words, presence of subjectively
reported symptoms can also be a relevant indication of future memory loss
and cognitive problems. Collecting frequent reports of subjective
complaints therefore seems warranted to depict gradual decline over time
before objective cognitive changes would become visible.
Cognitive Dysfunction
In healthy aging, whether largely unnoticed or dramatically present, some
cognitive functions will slowly start to decline. As mentioned before, many
will complain about their short-term memory failing, while some find it
harder to concentrate on a task or notice that they can no longer perform
more than one central task as a time. Other changes are so subtle they are
not likely to be noticed on a day-to-day basis, such as changes in speed of
processing or reaction time. As such, there is considerable interindividual
variation in the rate and fashion in which functions deteriorate. Several
studies link these age related declines to deficits in executive control
functions, such as the ability to inhibit inappropriate responses or
irrelevant information or to maintain and manipulate information in working
memory. As these functions rely especially on the frontostriatal pathways,
weakened by aging processes early on, deficits in these executive functions
are thought to underlie the changes noticed by older individuals in
day-today life. One frequently used classification of executive functions
is the three-component model which separates the functions into the three
domains of shifting, inhibition and updating. As these functions support
our day-to-day activities, individuals might gradually experience more
difficulties in planning, multi-tasking, remembering information, and
setting priorities. Deterioration in brain structure and connectivity Along
with the decline of valuable cognitive functions, a number of neuronal
changes are identified that correlate with increased age and are thought to
be strongly associated with these cognitive changes. Shrinkage of cortical
gray matter networks across the brain correlates with decreasing memory and
executive functions. Volume decrease in specific subcortical structures,
such as the hippocampus, are seen in healthy older individuals with memory
dysfunctions. White matter volume declines across the whole brain but
especially in anterior parts, with large individual differences in the
degree of atrophy. Although neuronal death has long been believed to be
responsible for age-related loss of volume, it is more likely to be due to
shrinkage of neurons and change in dendritic systems and loss of myelinated
fibers. Moreover, on structural MRI, white matter hyperintensities can
often be seen: small lesions visible in the deep white matter and around
the ventricles. Although previously thought to be a trivial occurrence in
healthy aging, they are now known to be associated with higher cognitive
dysfunctions and risk of stroke and dementia.
Declines in neurotransmission
A number of marked changes in neurotransmission occur with increased age
that are important to note, as they explain some of the age-related
dysfunctions. For instance, serotonin signal transmission is thought to be
reduced due to decreases in expression of receptors and binding sites in
multiple brain areas. Low levels of serotonin can have adverse effects on
learning and memory, anxiety and sleep and can pose a risk for dementia and
depression. Boosting these levels, on the other hand, has a positive effect
on cognition both in healthy adults and in those suffering from Alzheimer’s
disease, and especially improves memory. Dopaminergic function has also
been shown to be affected by advanced age. Although dopamine synthesis is
upregulated in older adults’ receptors density in basal ganglia is seen to
decrease. Reductions in receptor binding are demonstrated specifically in
the caudate and DLPFC , which is associated with increased interindividual
variability with age . These changes in dopamine function are demonstrated
to be responsible for dysfunctions dependent on frontostriatal networks,
such as inhibition and f lexibility deficits. However, correlations with
performance on (executive) functioning tasks, such as working memory and
processing
1 • General introduction speed, are stronger than the relationship with
age, and remain present even after age is taken into account , signifying
that individual differences in striatal dopamine receptor binding predicts
cognitive decline more strongly than age itself, and that dopamine
dysfunctioning lies at the core of the problem of cognitive aging
symptomology. Measuring internal dopamine functioning in humans remains a
challenge Dopaminergic binding is frequently measured with ligand-PET using
radioactive tracers, though due to the invasive and costly nature of this
method, recent studies have explored other means, such as spontaneous eye
blink rate. This measure proves to be a good predictor of the density of
striatal dopamine receptors, for instance, in individuals with dopaminergic
dysfunctions such as Parkinson’s disease and schizophrenia. Yet, eye blink
rate also has been shown to be a reliable measure of the link between
executive control and D2 dopaminergic function and as such, might also
predict this relationship in the older population. Models and theories of
neurocognitive aging Although large changes can be seen with aging both in
the brain and in functional performance, the visible onset of decline
typically varies greatly between individuals. A prominent theory
explaining the different trajectories of developing age-related
deterioration or clinical dementia is that of brain reserve and cognitive
reserve. Brain reserve is thought to be associated with larger brain volume
or number of neurons, leading to a decreased susceptibility to pathological
changes, while cognitive reserve is defined as the ability to manage the
use of these remaining systems using alternate mechanisms and processes to
compensate for change. In other words, the degree of brain reserve denotes
the threshold after which agerelated changes lead to noticeable cognitive
decline, while cognitive reserve defines the active ability to cope with
these changes. In this way, both brain reserve and cognitive reserve offer
a type of compensation for alterations brought on by aging. Higher brain-
and cognitive reserve are suggested to be related to *increased cognitive
stimulation and challenging environments throughout life*, for instance
through increased mental activities and education . Although this
consequently lowered susceptibility, also known as resilience, is expressed
as a reduction or a delay in functional decline, physical changes still
occur, as can be seen in the brain. Older individuals with high reserve
still show structural decline, which is, in fact, often more pronounced in
high reserve individuals than in those with low reserve. Thus, when
confronted with neuronal changes, it is thought that those with higher
cognitive reserve learn to compensate, generally by recruiting different
networks One of them is the Compensation-Related Utilization of Neural
Circuits Hypothesis (CRUNCH), which states that different structures or
neural networks are necessary in performing a task to compensate for
declining brain functions . Overactivation is suggested to be the case
especially at lower levels of cognitive load, as older adults need to
recruit additional brain capacity compared to young to get similar
performance results. For higher loads, smaller increments in activation are
seen, and performance falls behind. For instance, demonstrate in a
longitudinal study that individuals that have sustained greater decline in
memory recruit additional frontal regions compared to older adults with
less or no memory dysfunctions. *As this reduction of overactivation is
especially the case for individuals with additional decline, this might be
indicative of a lower threshold in brain reserve*. On the other hand,
activation of additional brain regions has also been found to predict
increased performance on a task. Given that both improved and impaired
performance is seen as a confirmation of this theory, caution about
falsifiability is warranted; Other studies find that initially specialized
structures become functional for different or multiple purposes, a trend
referred to as ‘dedifferentiation’. Dedifferentiation is considered a
separate process, not based on compensatory activity. For example, when
administered two distinct memory tasks, young adults preferentially use one
area above the other for different tasks, whereas among older adults such
differentiation is less prevalent.
1 General introduction
This theory postulates that despite the adverse neurocognitive changes, *many
functions remain intact in aging adults*. To achieve this, the brain
actively reorganizes in response to the neuronal declines, in order to
reinforce task performance. According to this model, a dependence on these
scaffolding networks is thought to be essential for healthy aging. Evidence
for this model comes from studies showing that extra, often prefrontal,
activity occurs together with age-related underactivation of structures
dedicated to specific functions . *This theory also indicates that the
aging brain is still capable of positive change with continuous engagement,
or exposure to old or new challenges,* a proposition corresponding to the
concept of brain- and cognitive reserve and emphasizing the possibility
for positive change over time. Consequences for individuals and for society
Altogether, the aging brain ultimately is a slowly deteriorating system, on
neuronal, structural, and functional levels. Moreover, the majority of
older adults will retire after a certain age, limiting the engagement in
regular cognitive and social activities and lowering the demand on
cognitive systems. As the percentage of older people in society is rising
rapidly, so will the number of individuals with healthy aging deficits and
illnesses.
Geriatric care, in nursing homes or as in-home care, is provided to
those no longer able to care for themselves. However, due to the growing
number of aging adults, the healthcare system is being challenged. Costs
have risen to an overall high that society is no longer able to finance, a
shortage of staff has ensued, leaving the remaining care workers carrying
an unsustainable burden, and more individuals are subject to elder neglect
or –abuse. Furthermore, as a result of economic shifts, fewer people are
able to take up regular care for their parents, leading to a further
increase in the use of in-home care workers and placement in retirement
homes. National governments have attempted to regulate the situation in
geriatric care by discouraging the use of nursing homes, and urging older
individuals to prolong living independently. As promising as this prospect
might be, this has elicited further issues. Many older adults, even when
mostly independent, feel increasingly lonely and insecure, first aid
services and GP care are used extensively, and the chance of depression and
other negative (mental) health outcomes is rising . For those suffering
decreasing cognitive flexibility and memory, day-to-day chores around the
house become more encumbering, and regular external care must be called
upon. To this end, an imminent solution is needed to maintain cognitive
functions in the aging population to extend independent, dignified life.
Preserved plasticity? Although these statements might appear to paint a
bleak picture of our society of the future, a number of possible outlooks
exist, a few of which have gotten ample attention during the last decade
especially. Their feasibility builds on the phenomenon of plasticity. For
long, it was believed that aging brains were no longer capable of
neurogenesis, the generation of new cells. Although neurogenesis does slow
down with advanced age , *studies now show that new neurons continue to be
produced, especially in dentate gyrus and the subventricular zone of the
hippocampus*. Similarly, plasticity continues to take place, first of all,
as functional plasticity: the aforementioned reorganization by
dedifferentiation and compensation Besides* this, structural plasticity can
occur by learning, for instance after acquiring a new skill*.
Gray matter volume increases have been found in older adults after
juggling training and dancing when compared to active controls. Besides,
tDCS, a form of noninvasive electrical stimulation of the brain, has shown
to facilitate motor learning in older adults on a task normally subject to
decline. *In other words, plasticity remains possible in older ages, both
by direct stimulation of the brain and by learning of new skills.*
Preventive interventions for preservation and recovery of cognitive
functioning
In solving the dilemma of how to keep the aging population mentally fit,
most studies *emphasize not the learning of new skills, but rather the
preservation and recovery of declining cognitive functions central to
day-to-day life*. Through the possibility of training-induced plasticity,
older adults are offered training protocols, in order to attempt to
counteract age-related cognitive decline, measured most frequently using
tasks of transfer. Transfer refers to the degree to which generalisation of
the trained skills occurs on untrained tasks, with near and far transfer
indicating improvements on domains similar or more dissimilar to the
training tasks, respectively.
1• General introduction
A number of different possible interventions have been investigated over
the years. Aerobic exercise has been demonstrated to preserve cognitive
health in aging adults by improving executive functions, processing speed,
and attention and by increasing frontal and temporal grey- and white-matter
volume and functional connectivity. Incorporating both physical and
cognitive training into one intervention, for instance by using exergaming
or cybercycling has also been a promising way to enhance functions such as
executive control and processing speed, and to affect prefrontal activation
patterns. This type of combined training has also been shown to provide a
buffer for normal age-related volume decreases. For instance, after a
spatial navigation training in which participants walked on a treadmill
performing search tasks in a virtual environment, researchers found that
hippocampal volumes remained stable, compared to an active control group in
which volumes decreased.
By far the most investigated type of intervention is that
directly stimulating cognitive functions, also known as brain training.
Many studies attempt to generate improvement by targeting one domain of
functioning, such as working memory), reasoning, speed of processing, or
long-term memory. Others integrate different domains, for instance by
offering game-based training. Additionally, as increasing numbers of
European older adults are successfully using the Internet from their own
homes , the use of computerized at-home interventions becomes a more likely
alternative to clinician-guided clinical trials. Although these unmonitored
settings can create a number of challenges, such as the inability to offer
individual attention, motivation or explanation to training participants,
and the likelihood that home environments might differ between participants
and between sessions, computerized interventions pose a number of important
advantages. For instance, besides being more time- and cost-efficient, it
offers the possibility of standardizing certain elements, such as timing,
and tailoring others, such as a session’s difficulty levels; individuals
can keep track of their own progress and might be given a choice in the
contents of a session, allowing them more control over their own mental
health; and more diverse populations can be 18approached, i.e. to include
those with physical or medical issues or those living further away. At the
same time, outcomes of brain training studies are met with some criticism.
According to a number of recent meta-analyses, training studies, especially
those targeting specific functions, tend to have low effect sizes and show
no more than near transfer to the domains trained, even if only including
studies with a minimum of 6 months. Lastly, transfer tasks are often
reported as composite scores or are not validated, rendering comparisons
between studies more difficult. Based on these points of criticism, it
seems essential to tailor future brain training programs to include this
knowledge. A clear overview must be made from the training literature,
listing the most fundamental components to attain higher effect sizes and
sustained or far transfer. Assessment should include measures of daily life
functioning, and validated, separately defined transfer tasks.
Hence old age is a bliss or blows subjected to our sustenance. It
means, one cannot jump 2 staircases at a time as in 40s; but claiming may
be slower than aspirated energy through the mind. But styrain is stretched
beyond the energy when far exceeded the limits toop. So do all as far as
the best you can do. At the same time, avoid the sulking that Oh God why do
you do it to me; on the contrary, say God help me to do it; the best can be
God thank you for finishing it with a madonna smile. Each old age is
unique. So, no common rule will apply. Each day is different. But neurons
must be active; if you feel like not moving on a day much, try your best;
and keep singing loudly or even be commanding like a kernel. Literature
develops a lot of people. Keep reading; and on the way if your eyes are
closed, sleep well. Fresh neurons will await to complete the rest of the
tasks. Be prepared as a bold man to dance with Tamanna or Deppika padu
kone, yet stay aloof from over stretching. OLD AGE IS A BLISS; DANCING IN
BETWEEN THE THEN AND NOW DISTINGUISHING THE ABILITY TO CONTROL THE BODY AND
THE MIND. Vedango veda vittama:
K Rajaram IRS 221024
On Tue, 22 Oct 2024 at 07:19, 'venkat giri' via iyer123 <
[email protected]> wrote:
> THANK YOU SIR
>
> On Tuesday 22 October, 2024 at 05:02:13 am IST, APS Mani <[email protected]>
> wrote:
>
>
> Fantastic tips to maintain ourselves usefully, Mr Sridharan, Mani
>
> On Mon, Oct 21, 2024 at 11:28 PM 'venkat giri' via iyer123 <
> [email protected]> wrote:
>
> *Here are some tips for living a happy life in old age: *
>
> - *1.Social activity is a key to happiness, and visiting with family
> and friends can help ward off isolation. *
> - *2.Exercise*
> *Exercise releases endorphins, which make you feel happy. Simple
> movements like walking, biking, or gardening can help. *
> - *3.Eat healthy*
> *A healthy diet provides the energy needs to be active. It's also
> easier to get around without carrying extra weight. *
>
>
> - *4.Practice gratitude*
> *Being grateful for the life one has lived so far and the people and
> things around us can helps one age well. *
>
>
> - *Find meaning and purpose*
> *People who feel like they have a sense of purpose are generally
> happier. Continue to contribute to society or learn new things. *
>
>
> - *Get enough sleep*
> *Make sure to get enough rest every night. *
>
>
> - *Stimulate the brain*
> *Brain-stimulating activities can help with memory loss and cognitive
> decline. One can try playing games like Sudoku, crossword puzzles, and
> Scrabble. *
>
>
> - *Volunteer*
> *Volunteering can be a rewarding activity that allows one to meet new
> people, give back to the community. This keeps the brain sharp. *
>
>
> - *Manage stress*
> *Try yoga or keeping a journal to help manage stress. *
> -
>
>
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