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“Age does not depend upon years, but upon temperament and health. Some men are born old, and some never grow so.”

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Tyron Edwards

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“A man is as old as his arteries.”

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Thomas Sydenham

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The dogma that aging brings inevitable cognitive decline is being challenged by studies of the rapidly expanding oldest segment of our society, adults older than 60 years. Although some aspects of cognition are affected by aging, many changes in cognition previously considered the unavoidable consequence of brain senescence may instead result from incremental insults on brain function associated with aging-related medical conditions. The detection of such changes, which may stabilize or even reverse with appropriate intervention, and their differentiation from the cognitive changes associated with neurodegenerative disease or other neurological disorders is a critical task. The primary goal of this chapter is to describe changes in various cognitive abilities that occur with normal aging and with common age-related medical and neurological conditions.

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General Intellectual Functioning

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Intelligence is generally measured by summing the scores on a variety of verbal and performance subtests. Studies of aging have consistently shown that subtests measuring verbal abilities remain stable with normal aging. In contrast, subtests that require nonverbal creative thinking and new problem solving strategies show a slow decline with age. Crystallized abilities (information and skills gained from experience) remain relatively intact with aging, while fluid intelligence, which involves flexible reasoning and problem solving approaches, declines. Numerous studies have documented this general pattern in both cross-sectional and longitudinal research designs. Below, we review the literature on the effects of normal aging on specific cognitive functions (Table 62-1).

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Table Graphic Jump Location
Table 62-1 Cognitive Effects of Normal Aging
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Attention

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Attention involves the ability to focus on one or more pieces of information (auditory or visual) long enough to register and make meaningful use of the data. Attention requires both simple and complex immediate processing and provides a foundation for working memory and other cognitive functions. Sustained attention, or vigilance, entails attending to one type of information over a period of time. After controlling for reaction time and sensory changes, sustained attention and strategies for maintaining vigilance do not appear to change significantly with age. Divided attention, or the ability to concentrate on more than ...

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