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Cognitive Ability and Age:

An Assessment Study on the Decline of Cognitive Ability through Time

Patricia Marie C. Cipriano

University of the Philippine - Manila

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Many adults today hold a fear of developing dementia or Alzheimer’s disease as they

age. Given that it is estimated that every 65 seconds someone in the United States develops

Alzheimer’s disease, one can safely say that these fears are not unfounded. By 2050, it is

estimated that the number of individuals aged 65 and older with Alzheimer’s dementia may grow

up to 13.8 million, up 138% from the current figure (Alzheimer’s Association, 2019).

Alzheimer’s disease and dementia is a frightening disease such that it affects the normal

functioning of the body. Losing phone, misplacing keys, and forgetting some information may

not be a big deal or seem mundane to someone in their early 20s, but to a 65+ year old, these

lapses can affect how they live. Alzheimer’s is a neurodegenerative disease caused by changes in

the brain following cell damage. It is suspected that the root cause of the disease lies in the

damage and death of neurons due to the accumulation of beta-amyloid proteins between neurons

and formation of tau protein tangles within the cells (Alzheimer’s Association, n.d.). Associated

risk factors to the disease includes age, family history, genetics, injuries, etc. (Alzheimer’s

Association, n.d.). From Alzheimer’s, dementia symptoms may develop. This can be manifested

as memory, reasoning, thinking, behavior, and communication problems (Alzheimer’s

Association, n.d.)

Through age, mental processing begins to slow down and learning becomes more

difficult as memory and cognition deteriorates (Cleveland Clinic, 2017). Memory is an active

information storage, organization, and retrieval system. It consists of three primary steps:

encoding, storage, and retrieval. In itself, memory can be organized into its duration as sensory,

short-term, and long-term memory. Problems with memory can arise when machineries that

govern these systems begin to fail. Forgetting may be caused by a range of reasons including
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encoding failure, memory decay, proactive interference, and retroactive interference. Changes in

brain circuitry and chemistry may also have an overall effect on one’s memory. On the other

hand, cognition or thinking is a mental activity that refers to information processing. It involves

knowing something, processing that information, and applying it to our lives (Ciccarelli &

White). Through age, these two facets of the human mind may deteriorate and introduce

problems that may interfere with normal functioning.

Measuring Memory and Cognition

A battery of memory and cognition tests have been conceived by various psychological

firms and researchers. Most of these tests are developed in the hope of helping make correct

diagnosis for cognitive impairments such as the abovementioned Alzheimer’s disease and

dementia. Currently, the Alzheimer’s Association recommends the General Practitioner

Assessment of Cognition (GPCOG), Mini-Cog - Screening for Cognitive Impairment in Older

Adults, and Memory Impairment Screen for patient assessment. These tools are primarily used to

identify the need for further evaluation (Alzheimer’s Association, n.d.).

Aside from these, tests other cognitive tests are also available for use. This includes the

Montreal Cognitive Assessment (MoCA) test. MoCA allows physicians to provide a quick

assessment of an individual’s cognitive health.It is formulated as a robust tool with the ability to

assess several cognitive domains. It has been proven to be useful in screening for diseases such

as Alzheimer’s, Parkinson’s, Huntington’s, Lewy Body, stroke, ALS, multiple sclerosis,

depression, schizophrenia, and more (Nasreddine, 2019).

MoCA is a quick 10- minute, 8-part test that establishes an assessment on the cognitive

domains of attention and concentration, executive functions, memory, language,

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visuoconstructional skills, conceptual thinking, calculations, and orientation. The test can be

administered in a variety of languages. The Philippine has MoCA-P which is formulated in

Filipino. Both tests scores a patient out of 30, with normal functioning designated at a baseline

score of 26. A score of such and above is considered normal (Nasreddine, 2010). A copy of the

MoCA test questionnaire administered to the respondents are attached in Appendix A.

MoCA Results

The MoCA test was administered to two respondents, aged 21 and 71 years old. The

21-year-old, hereby referred to as Coffee, is a female college freshman currently taking up Social

Work in UP Diliman. In her run, the MoCA test was able to be finished within 7 minutes. On the

other hand, the 71-year-old, hereby referred to as Magic, is a female senior citizen. She is a

retired elementary school teacher who is currently heading her barangay’s senior citizen

association. She finished her assessment in 11 minutes. Both tests were administered on 01

November 2019 by CIPRIANO, PATRICIA MARIE. A comparison of their results is detailed

below.

Visuospatial / Executive

From the start, Magic exhibited some difficulties following the given instructions. While

she accomplished connecting the numbers to the letters in ascending order from 1-A to 5-E, she

failed to connect each letter-number segment together (see Appendix B). Even when given

corrective instructions, Magic was too focused on doing her test. She finished this sub-test in

about 20 minutes. On the other hand, Coffee did flawlessly, accomplishing the task with 10

seconds. Coffee’s strokes were relaxed and confident, as opposed to Magic’s hesitant lines.
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The Copy Cube task also gave Magic some problems. She failed to reproduce the image

and often found herself adding more lines on top of her figure. She started by drawing a square

and was quickly confused by the additional lines. She spent much time trying to figure out how

to construct the cube. Meanwhile, Coffee produced a near perfect imitation, again using sure

stroke to construct the figure.

Both respondents did fairly well in the clock problem, drawing a passable clock at 11:10.

Magic unfortunately lost some points by not connecting the hands of the clock, but this may be

attributed to the fact that she was drawing on the glossy screen of an iPad. Both respondents

were sure of the time.

Naming

Coffee did really well with naming the animals, completing the subtest within 5 seconds.

On the other hand, Magic had some problems naming the rhinoceros and the camel. For the

former, she initially labelled it as a buffalo, while she called the latter horse. These errors can

however be attributed to the fact that these two animals are not common in the Philippines. As

such, it cannot be expected of Magic to know their names. In this case, the MoCA-P test could

have produced more reliable results.

Memory

The memory test for magic went fairly well. On the first trial, she was only able to recall

the last two words listed but she was able to relay all the words back in the second trial. It is

notable that she became noticeably flustered when she recognized that she forgot some of the

words. When flustered, she began to recall less words. On the other hand, Coffee again had a

perfect showing, recalling all five words in both trials without needing prompting.
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Attention

Magic’s forward number series went wrong when she forgot some of the numbers

relayed to her. However, she did well in recalling the backwards number series. Coffee was able

to perfectly recall the series of numbers given to her in both backwards and forwards series.

Both subjects were able to react to stimulus (A). No errors were recorded by either

respondent. Serial subtraction also encountered minimal errors with both comitting one

subtraction error.

Language

Magic was able to recite back the first sentence perfectly but had some problems with the

second sentence. She began to summarize the thought of the passage and omitted some words

from the sentence. One particular error of hers was in exchanging hid to head. Meanwhile,

Coffee had a problem with sentence one, omitting ‘only’ the sentence. She was able to relay back

sentence two without problem.

In fluency, both respondents were able to give more than eleven English words that

began in F. Coffee was able to recall more words, especially when she realized that she can add

some prefixes and suffixes to the words she have already given.

Abstraction

Both Magic and Coffee were able to provide the appropriate abstract relationship

between the pair of words given to them. Coffee had a little problem with watch-ruler but was

ultimately able to give the appropriate connection.

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Delayed Recall

Magic was able to recall three of the five words given to her without cues. She was then

able to remember the other two given prompt from category cues. Again, she became a little

flustered when she recognized that she forgot some words. Coffee recalled all five words with no

cues.

Orientation

Coffee and Magic both committed some Date-Month errors. The former said that it was

31 October while the latter said 11 November. The latter may have occurred as prior to the

administration of the test, the subject was talking about her birthday which was on 11 November.

Coffee’s error may be attributed to confusion with the day.

Conclusion

Following the administration of the Montreal Cognitive Assessment test to Magic and Coffee, it

can be said that significant differences between the two can be observed. The younger Coffee

had better cognitive function and was more confident and assured when taking the test. Her

responses were very rapid and required minimal procesing. On the other hand, Magic had some

memory lapses and was easily flustered by her mistakes. She had to take some time to think of

what and how to do the task. She was also easy to fall into a trance like state and was very

absorbed and focused on what she is doing.

Harada, Love, and Triebel (2013) detailed that processing speeds begin to decline at

round 30 years old. This slowing of speed may negatively impact the results of cognitive and

neuropsychological tests. For attention, they detailed that older people may have difficulty

ordering a string of letters and numbers in the correct alphanumerical sequence or calculating a
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tip on a restaurant bill. This can be seen in Magic's forward number series and serial subtraction.

A memory decline was also observed through age. The older subject required more time for

recall and needed some cues to remember the words.

A number of factors can be pointed to when investigating the causes of significant

decrease of cognitive function in older people. As we grow older, our brain and neurons do

degenerate. The loss of connections we had in our younger years may explain why our memory

and cognition is affected by age. Physical activity can also affect M&C. It is known that older

people begin to adopt more sedentary lifestyles. A study by Vance, et al. (2017) details that

lifestyle can be an important determinant of brain function

Alternatively, the use of more appropriate tests could have significantly affected the

results of the tests. If given in Filipino, the older subjects could have produced better results and

named more animals. Differences In education and life experience can affect an individual’s

memory and cognition.

References

Alzheimer's Association. (n.d.). Causes and risk factors. Retrieved from

https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors

Alzheimer's Association. (n.d.). Cognitive assessment. Retrieved from

https://www.alz.org/professionals/health-systems-clinicians/cognitive-assessment

Alzheimer's Association. (n.d.). Dementia vs. Alzheimer's Disease: What is the difference?

Retrieved from

https://www.alz.org/alzheimers-dementia/difference-between-dementia-and-alzheimer-s
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Alzheimer's Association. (n.d.). What is Alzheimer's? Retrieved from

https://www.alz.org/alzheimers-dementia/what-is-alzheimers#brain

Cleveland Clinic. (2017). Aging & cognitive function. Retrieved from

https://my.clevelandclinic.org/health/diseases/6437-aging--cognitive-function

Harada, C. N., Natelson Love, M. C., & Triebel, K. L. (2013). Normal cognitive aging. Clinics in

Geriatric Medicine, 29(4), 737-752. doi:10.1016/j.cger.2013.07.002

Nasreddine, Z. (2019). MoCA Montreal - Cognitive Assessment. Retrieved from

http://mocatest.org

Vance, D. E., Marson, D. C., Triebel, K. L., Ball, K. K., Wadley, V. G., & Cody, S. L. (2016).

Physical activity and cognitive function in older adults: The mediating effect of

depressive Symptoms. ​The Journal of neuroscience nursing : Journal of the American

Association of Neuroscience Nurses​, ​48​(4), E2–E12.

doi:10.1097/JNN.0000000000000197