Geriatric considerations - Aging and cognition: Nursing

Cognition describes the process of receiving, storing, sharing, and making sense of information, which include mental processes such as memory, language, concentration, and problem-solving. Cognition can be impacted by one’s environment, genetics, educational background, health status, and age-related brain changes.

As the nurse, you’ll consider age-related changes to the brain, the physiologic processes that can compensate for these changes, and provide patient-centered care to promote brain health in your older adult patients.

Now, as an individual ages, there's typically a general slowing of function of the neuronal processes that doesn’t usually interfere with mental function or daily routines. This slowing in function is different for everyone and is related to changes in brain structure and neurotransmitter function.

As far as structural changes go, there’s a decrease in the size and number of neurons, which are the nerve cells that receive and send messages throughout the body. Dendrites, which branch off from the neuron cell body and receive signals from other neurons, can experience shrinkage and decreased branching. Other age-related changes include a build-up of substances like plaque within the neurons, and a decrease in myelin, which is the substance that helps the neurons to quickly transmit electrical impulses.

Additionally, there are changes that affect neurotransmitters, or chemical messengers, such as acetylcholine, glutamate, serotonin, and dopamine, that normally allow neurons to communicate with each other. These changes include alterations to enzymes that synthesize and break down neurotransmitters and changes to neurotransmitter receptor sites.

Alright, so, the brain can compensate for age-related changes by developing cognitive reserve, which is the ability of the brain to maintain cognitive functioning, even when it experiences degeneration or damage. In other words, the stronger the cognitive reserve, the more injury the brain can endure before there’s a decline in cognition.

An important component of cognitive reserve is neuroplasticity, or the ability of the brain to adapt and change in response to new stimuli. Neuroplasticity can be either positive or negative. Positive neuroplasticity refers to the brain’s resilient capacity to strengthen and reorganize neuronal connections when stimulated, by engaging in cognitive, social, sensory, and motor activities that are new and challenging. On the other hand, negative neuroplasticity is the degradation of neuronal connections due to decreased cognitive stimulation or the effects of a physiologic condition like a stroke.

As the nurse, you’ll provide patient-centered care to promote healthy brain aging. First, promote cognitive health by assisting your patient to prevent and manage chronic illnesses. To do this, implement strategies to help your patient maintain a healthy weight and to achieve optimal control of blood pressure, lipids, and blood glucose. If needed, also provide education and resources for smoking cessation.