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Normal vs Abnormal Aging Processes



The normal aging process has five primary stages:


  • Independence (typically 60-70 years old) – Although there might be some decline in functioning, it doesn’t effect most adults from living independently and taking care of all of thteir needs.

  • Interdependence (typically 70-80 years old) - physical activity and mental health may be deteriorating, making cognitive and tasks and daily living skills more taxing. Some adults might need some assistance with day to day chores and driving.

  • Dependency (Late 70’s and on) physical and cognitive health has declined such that these adults will; require assistance to manage day to day living. Additionally, More than 30 percent of U.S citizens aged 65 years or older will also have some disability that prevents them from living independently and actively. According to the ADA statistics, more than 50 percent of seniors aged 75 and older experience some disabling condition such as hypertension, arthritis, diabetes, or dementia. Seniors in this age group are prone to experience injuries or problems with seeing or hearing.

  • Crisis management & End of life – these last two stages of the aging process require  almost 24-hour care and assistance and the adult may need to live in  assisted living facilities or hospice care.




There are six key ways that cognition changes with aging.

Processing speed - This refers to how quickly the brain can process information and then give a response.  It is not a mental task per se.  Rather, it describes the speed in which you can manage a mental task. Processing speed decreases in a nearly linear fashion over time.  As a result, it might take an older adult a longer time to formulate a response than a younger person is expecting.  Reaction times might also be slower for an older adult when driving.

Memory – there are different types of memory which are affected differently by the ageing process and our understanding of how we store memories and later retrieve them is complicated.  Here are some of the main types of memory:

  • Working memory – temporarily holding info to solve problems or make a decision.  This type of memory tends to decline over age, making complex decision making more difficult.

  • Semantic long-term memory – remembering facts we over time. This type of memory stays stable over time, and then very slowly deteriorates after age 70.  However, retrieving facts can sometimes take longer.

  • Episodic memory –remembering  personal facts from a specific time or place. Episodic memories decline with aging, especially for more recent events.

  • Prospective memory – recalling things you planned to do in the future, which declines with aging.

  • Procedural memory - This refers to learning a skill which take time and practice to build. Older adults require more practice and repetition to remember a skill that was learnt.


Attention – refers to the ability to concentrate and focus. Key sub-types include:

  • Selective attention – the ability to select what is important and deal with distractions.  As we age we have difficulty tuning out irrelevant sounds or stimuli.

  • Multi-Tasking – the ability to switch between tasks or to do two things at once becomes more difficult with aging.

  • Sustained attention – the ability to concentrate on something over time.  Sustained attention is less affected than other types of attention.

Language Skills – these involve understanding, speaking, reading and writing.  Vocabulary and comprehending written language tend to remain stable.  However, understanding what someone is saying can decline with age.  This is more rapid for someone who has hearing difficulties because their brain cannot process the words rapidly enough to compensate for words that were not heard or sounded similar to one another.  Speaking abilities decline with age.  Older people need more time to find a word or to name common objects.


Executive Functioning – refers to mental skills needed to:

  • Solve new problems

  • Organize information and plan activities

  • Think abstractly

  • Use reason (especially when it comes to reasoning with unfamiliar material)

  • Adapt to new situations

  • Behave in socially appropriate ways

  • Make complex decisions

Executive function generally declines with age, especially after age 70.  This is more pronounced as a task becomes more complicated, or when the older adult is tired or taxed.

Emotional Processing – refers to how we process and regulate emotions. Older adults tend to become more positive with age because they minimize their exposure to negative situations.  Older people are more likely to remember positive things.  This is referred to as a positivity bias.  They also become better at denying or avoiding situations which could be unpleasant.




After the age of 30 we notice small and subtle changes in our abilities to do things.  Some of these changes include:

  • Our thoughts slowing down

  • Increasing difficulty in paying attention

  • Difficulties multi-tasking

  • Slower Word retrieval – increase in the frequency or those “it’s on the tip of my tongue” phenomenon.  On a positive note, our vocabulary and reasoning skills might improve.


It is important to point out that normal aging is NOT A DISEASE.  There is no damage to the brain or degeneration in the neurons.  However, Dementia and Alzheimers are not normal processes, and they occur because there is damage to the brain.  Specifically, neurons become damaged and eventually die.  Brain functioning deteriorates much more rapidly in these instances and can be observed quickly in the older person’s ability to remember things, to express themselves, and to behave appropriately.  A person with Dementia or Alzheimers may be more prone to falling and tremors.


Mild Cognitive Impairment (MCI) is a decline in functioning which is greater than would be expected as part of normal ageing.  Dementia is more serious and is a term given to individuals who are unlikely to be able to take care of themselves. The most common causes of MCI and dementia are Alzheimer’s disease, vascular disease, frontotemporal degeneration and Lewy body disease.  

Leslie Kernisan, MD MPH

For more information about Neuropsychological Assessment and Evaluation, follow the link below.

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