The neuropsychology of memory and aging
WWhat is the relationship between aging, memory loss, and general cognition? It is a matter of heated debate in the wake of Special Counsel Robert Hoare’s report on President Biden’s alleged mishandling of classified documents.
While the report does not recommend criminal charges against Biden, it has drawn significant attention for its focus on the president’s age, with prosecutors describing him as a “sympathetic, well-intentioned elderly man with a poor memory” and citing examples. The president has difficulty remembering dates, names, or details of events. Biden disputed those descriptions, telling a reporter on Thursday: “My memory is good.” Democrats have also responded, pointing to Donald Trump’s memory lapses.
Medical professionals are moving away from armchair diagnoses of public figures. But the current conversation provides an opportunity to reflect on what we know about memory and brain aging. To understand more, STAT spoke with Joel Kramer, a professor of neuropsychology at the University of California, San Francisco Medical Center, who focuses on the relationship between the central nervous system and behaviors and directs the Center for Memory and Aging at UCSF. The following interview has been condensed and edited for clarity.
Is aging necessarily associated with memory loss?
There are no hard and fast rules about how our memory changes with age. There are some people whose memory declines significantly, and others we follow for years and their memory does not change at all. So, there is nothing inevitable about memory decline with age.
So why do we get the impression that memory always diminishes with age?
That’s because the brain is like any other part of the body. As we age, we are more susceptible to all kinds of conditions that do not cause aging, but are associated with aging. I just got back from the orthopedist this morning because I have some arthritis in my hand joint. Well, sure this is common as you get older, but my problem with my wrists isn’t age, it’s arthritis. The same applies to memory. So, here are 30 things that can go awry in our brains as we age… Changes that you see that you are at greater risk for as you get older, but are not inevitable as part of aging.
On average, an 80-year-old will not remember as much as a 60-year-old and who will not remember as much as a 40-year-old. But these are just general trends. And you can’t really assume that this 80-year-old will remember any less well than the average 40-year-old, or any 40-year-old.
Do memory lapses and loss in old age always indicate underlying conditions? Do they indicate other cognitive impairment as well?
When there is a significant amount of disease, you may expect widespread decline in memory as well as other (mental) skills. But they are actually quite separable. In fact, one of the ways many older adults compensate for their memory problems is through thinking, planning, and very good judgment. Some people say that as we get older, you see an increase in wisdom and judgment.
There was a great study of airline pilots several years ago that showed that older pilots had slower reaction times, no doubt, but they had more experience and better judgment. So this idea that because someone is 80 years old, they have problems with memory and other skills, is completely hollow.
So, as a doctor, when do you start worrying about that? Could memory lapses be something more serious?
There are actually several things that might cause concern: if the family comments on the changes; If we see problems with our cognitive test; If (while) examining someone we see some biological marker that indicates a possible disease, we become concerned.
Going back to amnesia, is it the same? Or do some types indicate bigger problems than others?
There are many different types of memory, and each of these memory systems is based on different neuroanatomy or different neural networks. It will depend on the type of disease you have: the types of memory symptoms can vary interestingly. You can have a patient who has severely impaired one memory system and does well with another memory system, and another patient who has the exact opposite pattern. We see associations that can often help us with diagnosis.
Do you think that in Biden’s case, our ageism has come to light?
In some cultures, when the elderly are more revered and respected, the problem we face clinically is that the family does not recognize that the person is vulnerable. But in our country, I do not know whether it is cultural bias or rather the lowest level of political nonsense. I think there’s a certain degree of criticism of Biden’s memory and his cognitive function…it’s political in this case.