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How Brains Change in Old Age

Following my 12-hour surgery last year, I was plagued with what I learned is popularly called “anesthesia brain,” a relative of “chemo brain.”

Among the symptoms are

Difficulty concentrating
Difficulty finding the right word
Difficulty multitasking
Being disorganized
Feeling of mental fogginess
Short attention span

Inability to concentrate, mental fogginess and shortened attention span were my biggest difficulties. For a few weeks, it affected my ability to carry on conversations, to read and even to follow a movie or TV plot.

I had no trouble knowing the meaning of each word, but there was a lag time of a second or two in putting together the meaning of an entire sentence – just enough for me to notice (and be irritated by) the slowdown of my brain. I learned to take notes when doctors were speaking with me so not to lose important information.

Nurses in the hospital assured me this was a temporary consequence of long anesthesia and that it would dissipate over time.

Fortunately it did, but the experience of the temporary diminished cognition got me wondering how anesthesia brain compares to the brain changes that can accompany old age. The U.S. National Institute on Aging (NIA) tell us that among common changes to thinking in old age are

Increased difficulty finding words and recalling names
More problems with multi-tasking
Mild decreases in the ability to pay attention

Sounds a lot like anesthesia brain to me. In fact, however, I couldn't multi-task well when I was 20 or 30, and recalling words and names? Don't even ask. But the NIA also tells us that elders have more knowledge and inisight due to a lifetime of experience and contrary to all-too-common myth, can still

Learn new things
Create new memories
Improve vocabulary and language skills

A frustrating thing about looking into brain and cognition science is that researchers, as hard at work as they are, don't know much. Almost every statement includes such weasel words as: it may be, the results suggest, could be associated with, is far from clear, etc.

In a story from last year, Medical News Today (MNT) tells us that

”As we age, all our body systems gradually decline - including the brain. 'Slips of the mind' are associated with getting older. People often experienced those same slight memory lapses in their 20s and yet did not give it a second thought.

“Older individuals often become anxious about memory slips due to the link between impaired memory and Alzheimer's disease. However, Alzheimer's and other dementias are not a part of the normal aging process.”

Here is some of what is known about normal physical changes to the brain as we grow old – again from MNT:

Brain mass: Shrinkage in the frontal lobe and hippocampus - areas involved in higher cognitive function and encoding new memories - starting around the age of 60 or 70 years.

Cortical density: Thinning of the outer-ridged surface of the brain due to declining synaptic connections. Fewer connections may contribute to slower cognitive processing.

White matter: White matter consists of myelinated nerve fibers that are bundled into tracts and carry nerve signals between brains cells. Myelin is thought to shrink with age, and as a result, slow processing and reduce cognitive function.

Neurotransmitter systems: Researchers suggest that the brain generates less (sic) chemical messengers with aging, and it is this decrease in dopamine, acetylcholine, serotonin, and norepinephrine activity that may play a role in declining cognition and memory and increased depression.

(Did you notice all the weasel words: may, is thought to, suggests, etc.? It can't be helped with science's current level of understanding.)

Nevertheless, eventual results from such studies will help researchers discover what therapies and strategies can help slow or prevent brain decline. Meanwhile, you probably know the current prescription to help preserve cognitive ability:

Regular physical activity
Be socially active
Manage stress
Eat healthy foods
Get enough sleep
Pursue intellectually stimulating activities

In regard to the last item, sales of so-called brain games bring in millions if not billions of dollars a year to their purveyors who promise their products will improve or, at least maintain memory and brain function. Studies are showing otherwise.

A year ago, Psychology Today reported on a study from The Journal of Neuroscience:

”The results were disappointing. There was no effect on brain activity, no effect on cognitive performance, and no effect on decision-making.

“The participants who trained with Lumosity did improve on the cognitive assessment, but so did the control group and so did a group who played no games whatsoever.

“In other words, it wasn’t the game that was having an effect. Kable attributes the gains to the fact that everyone had taken the test once before.

Research into ageing brains is not far enough along for us to have much understanding of who may be afflicted with declining function and who not.

Meanwhile, I'm sticking with those suggestions for maintaining a healthy brain because it is well known that they also contribute to good health overall.


I'm just reading an excellent book, Happiness Is a Choice You Make: Lessons From a Year Among the Oldest Old (excellent book, you might want to add it to your Books on Aging list Ronni) and among other things the author (John Leland) mentions a study that appears to show that while dementia does reduce mental capabilities it does not necessarily reduce quality of life for the "sufferer". We hear so much about how terrible dementia is from the point of view of loved ones and caregivers but rarely from the person with the diagnosis. A bit of a relief for me, I'm not going to worry too much about my own risk of dementia.

Annie, that's a good thought! It's one that caregivers need to know, too. The burden of caring for someone with dementia is huge, just on a practical day to day level. It shouldn't be needlessly compounded by guilt and worry that the loved one is suffering terribly, locked and alone, unable to communicate.

What I'd suggest here is to also add mindfulness practice...the simple practice of taking a few minutes on a daily basis to allow thoughts to come and go, while breathing and staying connected (kindly reconnecting when distracted, again and again). This not only calms the Central Nervous System, a key component in focus, but also builds sensitivity of when one has gone "off line" due to any number of factors. Really powerful, actually.

As I grow older ( currently 71) I find myself realizing I’m getting older. My brain works well but slower. Simply put, I can’t think as fast as I used to. And I wonder how old age effects politicians. All of them that are in their 70s and 80s and still holding office and making decisions that impact up all...politicians of every level appointed and elected. If I feel my abilities are slower than when I was in my 50s and wonder... are they concerned?

I would like to point out that this blog post is meant to present some of what is known about what happens to brains during normal ageing - like the rest of our bodies, brains age too.

Dementia is an important topic we have discussed here in the past and will certainly do again, but today addresses the equally important changes to healthy brains and which I'm curious to hear about from you, dear readers.

I've noticed in the last few years that I sometimes have difficulty recalling names, or even specific words, that I've known for years. It's very annoying when it happens. For the most part I attribute it to natural aging, but always wonder too if it's a bit of residual chemo brain. I know my attention span is shorter if I'm not really interested in something, and I tend to become impatient more quickly than I used to. I try to reassure myself that it's all perfectly normal, but there's always that little worry in the back of my mind ...

I also recommend the book. Happiness is a choice you make...well written, entertaining, insightful.

At a young 67, I do notice that my brain ain't what it once was...excuse the vernacular. It's ok. I roll with it and have a laugh. I don't panic or get frustrated because I understand that these changes are normal and to be expected. This is why your post is so helpful as otherwise, otherwise these changes could be cause to panic.

Panic, catastrophizing, worrying about things to do with health are with me more at this stage of my life. I don't know why I do this but it seems to be part of aging for me.

Loved the suggestions you made Ronnie to keep our brain cells vibrant.



There is another factor that has not been mentioned. In addition to chemo and anesthesia causing the symptoms you listed, Ronni, some medications cause the same symptoms. I recently started using a new prescription for RLS (Restless Leg Syndrome) and it definitely causes foggy brain and really interferes with my ability to think clearly. I am afraid of the symptoms, even though it gives me a wonderful night's sleep.

I already have all of the problems on your list, Ronni. So anything that changes my brain function is something I don't like to experiment with and I only take that medication when desperation from RLS begs for relief.

I used to do crossword puzzles daily, including the New York Times difficult one. If it helped my brain I didn't notice it. I gave it up when I didn't have time to spend thinking of the words and maybe that was a mistake. I doubt if I could finish the NYT puzzle now.

My cousin cares for a woman who has dementia and she is not always happy. A few months ago she was aware of what is happening to her and cried often. She has trouble articulating what she is thinking and my friend had to do a lot of guessing by studying her body language to understand what she is trying to say. The woman is bi-lingual and switches from one language to another so that makes it doubly difficult. But her tears and depression were clear signals that she is not happy. She has now progressed to rages and crying. In time she may be happier, but after two years there is no sign of permanent happiness. She does have periods of being happy and when she attended a recent family party she remained happy all day, but when she got home the screaming and crying began again. It's a very sad disease.

I so agree with two other readers that happiness is a choice. To that I would only add that it requires attentiveness and a certain effort. Like any skill, practice of some sort seems to be required.......... meditation, physical, learning a new language. I know one thing about my brain, and that is that it loves new input on subjects that I love. So while our brains may shrink, or otherwise deteriorate, there's usually an up side. It takes a bit of time to really see and touch and smell and be thrilled by the butterfly weed.
I used to think that meditating and doing yoga would keep me safe from bad things. Now I know that what really happens is that, while never safe from "bad things," we do have choice about how we integrate, and come to understand, even appreciate them.

I am so so grateful to you Ronnie and ALL of YOU. Reading through the blog and then the comments helps me reconcile with what happens to me as I age. You are a wonderful lot. Thank you thank you.

I agree that John Leland's book "Happiness is a choice. . ." is a helpful one. In fact, Ronni herself recommended it in a previous post, which some of you may not have seen . That's how I learned about it and immediately ordered it.

Forgetting words I know that I know, and names, happens more than I like (I'm 74); however, the word usually makes its way after a while to my consciousness. I really believe that physical activity is the elixir of youth, if anything is, and am conscientious about it. Besides, it makes me feel good.

What alarms me is that my memory will take the course which my mother's (97) has. We're so alike in many ways, and I don't want to follow her down that road though there may be no choice. Fortunately I am more social than she is, which may help.

Unfortunately, our brains, like the rest of us, tend to shrink and "dry up" as we age....dust to dust, you know.

I notice that there is a lot of denial when t comes to thinking one is still quick and bright and sharp still as we age.
I used to notice it especially at the voting stations where old people aways volunteered to sit and go through the books looking for peoples names-- It is not that they can't do it --- it just goes slower than when the book is manned by a young person.

I was a trainer of new employees in my last years working in a laboratory and there was a big difference in speed and catching on to new things amongst older new employees sad to say.

And when employed--- the radio on and people talking and able to work was very distracting to older employees and they complained and grumped cause they were working hard -- however, the young mostly could outwork the older workers while talking and being distracted.

Just saying there is a lot of denial with a "positive attitude" that they are as capable as younger brains.

There are always exceptions---

There are careful looking articles available that report studies that chemotherapy can indeed produce long-term cognitive deficits. I know a woman who complains about her chemo brain. I wondered if it was really from the chemo, but these articles back her up.

I'm pushing 81. My cognition is doing very well, but my memory has the usual stuff--where did I go yesterday, did I already clean out the litter box or am I thinking of yesterday, oh, God, where did I just put the phone, that kind of stuff. And I'm slower than I used to be, but that's more physical than mental.

What I notice is that I feel weird in a really unpleasant way when I first wake up in the mornings. It may be a result of my not having family. I need to make more effort to spend time with people--though I do see people several times every week. But, no question, I feel, not disoriented, but somewhat despairing, on first waking and until my feet hit the floor and I start moving. I'd love to know I'm not alone in this . . . ?

What Kate says is interesting to me. I never want to get up for much the same reason she mentions--I feel outright depressed and anxious. But my first cup of coffee saves me, thank goodness. I too forget--did I wash my face? Take the meds? Where are the glasses I took off a minute ago. And names, and words. They come when I dig into the dank recesses of my mind.

Otherwise, at 78, I'm doing well. But, dang. . .

About 10 years ago, when the drama and trauma in our life began to stack up and feel overwhelming I truly thought I was 'losing it'. Long story/short version....Since I was, in the words of Willie Nelson, ''the last man standing'', I started searching almost frantically for answers and/or solutions. Whereas I had always had a good memory, that skill seemed to be melting like an overheated glacier and it worried me a lot. I read "THE BRAIN THAT CHANGES ITSELF" by Norman Doidge MD

The line between hard science and wishful thinking is hard to define, yet one on the most helpful and hopeful bits of information I came upon was what has become the new "Buzz-word'' in brain research ...neuroplasticity. Essentially, what happens in young brains can still happen in my old brain. Well sign me up folks, I need this!

The forgetfulness was the most unsettling part of this to me, so I started taking prodigious notes....embarrassingly... about nearly everything I needed to remember. This could turn into a novella describing it all, but to simplify; it helped. I never argue with success. I don't have to write everything down now. Was it just a placebo? I don't know, but it didn't require a pricey prescription and had no annoying side effects. Whereas the brain was always thought to be a fixed organ, it turns out that isn't true. It has an amazing changing ability; e.g. the cells and neurons we use will duplicate and expand when there is purpose and need.

In concert with others commenting ,'happiness' is a choice we make, yet it isn't, as Salinda observed, a "set it and forget it" event. The physical brain needs a reason to build new nerve pathways and cells. I too, profit from learning something new, meeting a new person, and remembering that any sort of quieting the flurry of worry and giving it rest from my 'inner chatter', changes mood and attitude. Sleep does not do that, sleep is when the physical brain cleans house and makes repairs. In my opinion, that is why meditation and mindfulness works so well for many.

Anne and Kate's concerns speak to me also. Waking up alone has been the hardest part of losing my husband 7 years ago. Kate's word "despairing" defines it quite accurately. Giving myself time, still lying down, to stretch, think about the coffee coming up, and plan something (almost anything, but name it) for the day ahead has been the most helpful thing I have come up with for me. Thank you, Ronni, and all for sharing your ideas here.

One factor no one has mentioned so far is pain's effects on cognition. It takes everything I have in the morning to crawl out of bed. If it were possible I'd curl up and sleep all day rather than face the pain. I've got a neuromuscular disorder and a connective tissue disorder and while I could ignore the pain while I was younger, at 72 I find it interferes with my memory and concentration and consumes my energy. I recently had minor surgery using IV anaesthetic, and didn't notice any cognitive changes. On the other hand my 77-y-o husband broke his hip in Dec and he's just recovered from the post-anaesthetic cognitive effects in the last few weeks.

Dear Kate, you are not alone in this. I am 80 and feel the same way in the morning, until I get moving and get the coffee on.. I also live alone and am pretty active, but there is a certain lack of connection to the world around me that I have to remember I am still a part of, even though my role has changed, Good luck as you make your way through this new Reality. A lot of this seems to revolve around wondering what things mean now and how I am supposed to feel. etc etc have a good day Marcia

I can relate to Deb's comment. My brain still seems to be functioning albeit not at the pace it once did, but chronic pain can rob life of joy and definitely sap one's energy, at some times more than others. I was a very high-energy, productive, quick-moving individual--even as recently as 3 years ago. I didn't sign up for this, and I'm not sure I totally concur that "happiness is (always) a choice". . .It is what it is.

I'm fortunate in that I still have my spouse. He's 88 and we depend on each other. We also have 3 senior kitties who need us. Hopefully, our brains (and bodies) will continue to function--more or less--for as long as we need them.

Weasel words that are qualifiers can be very important if you believe individuals are unique and as much as we are the same we all are different. Absolute terms can be detrimental if you are outside those parameters but allowance for that fact is not accommodated for in your treatment. In fact, when writers describing studies leave out those qualifiers they are doing their reader’s a great disservice, even misleading them. That’s one reason why I oppose health care prouncements (interpreted as absolutes) by some that are basically a “cookie cutter approach”, or “one size fits all” which can be one of the dangers of national health care systems.

Reassuring individuals, especially once they were older, that their occasional memory slips did not automatically mean they were “abnormal” was something I often was called upon to do. Glad you pointed that out so people don’t jump to wrong conclusion about themselves.

I guess difficulty concentrating was inclusive in the NIH’s “mild decreases in the ability to pay attention.”

Glad you pointed out the results of these memory games. Little has changed since years ago soon after they burst on the scene and then became commercially promoted. The brain area may show change in select anatomical regions, the player’s game or task score may improve but that’s all that happens. The desired generalization/carry-over/improvement in skills in other important life functions does not occur, disappointingly — as those of us providing rehabilitation therapy for stroke, brain injury, neurological diseases, etc. would welcome.

-Mostly now that I’m older, I notice paper work I move from its usual location to a new one, thinking this will insure it being more readily available, often proves not to be true — very frustrating trying to find it.
-I work out systems with signals known only to me for when I was taking several pills earlier this year at different hours of the day using empty (labels removed) pill bottles (could have labeled them). I found this preferable to those multi-compartment pill holders for every day in week.
-I do a lot more note-taking, noting tasks I might want to do, recording of appts, then challenge myself to remember what they were and can check them out on my calendar.
-I still try to task myself with rembering what I want to buy at each of the different stores where I shop, but shopping for just one and frequently, I’m not usually buying a lot.

Well, yes, my aging brain probably functions more slowly than it used to ... but I prefer to blame it on too many (recreational) drugs in my youth, even if not strictly true. Sounds more fun, doesn't it?

But, seriously, to quote Darwin: "It is not the strongest species that survive, nor the most intelligent, but the ones most responsive to change.” In other words, Adadpt or die. So when I discovered that the time I spent looking for my glasses was becoming ridiculous, I bought a handy holder that sits on my bedside table and my glasses go in it before I close my eyes at night. I'm planning on getting one for each room so whenever my glasses come off, I'll be able to find them them no matter where. I already write everything down because my memory is shot -- once again, rather than to aging, I attribute the decline to having raised a child through the teenage years.

Exercise, mindfulness, gratitude and laughter. Until "they" come up with an implantable chip to boost my brains's slower processing speeds, I'll work with what I've got: increasingly more like dial-up in a Fios world.

Thanks, Roni for this post and the questions about brain function. I have a closed head injury from a car accident in 1991. Car lights coming in the opposite direction at night are hard for me to handle- I go the dark routes. Like other readers of your blog posts, lots of notes help me remember what to buy where. Live music rests and restores me like nothing else. I am a subscriber to Portland Baroque Orchestra and some Symphony concerts. There is research to back this up according to Andy Weil MD. I haven't looked at it- I just know from my experience that live music helps me feel better all over. Is this true for an other readers?
Ellen Greenlaw

I saw this post today...I was in China with no internet for a few weeks. A good hunk of that time was spent in Beijing hospital with a badly broken arm. The Chinese medical system is interesting, but I'm writing to report that for the first time, I went to sleep for surgery easily...and woke just as easily. No anesthesia brain! I woke up clear as a bell. I slept a lot, was tired, my arm hurts (it's only been a week), but whatever they did to put me to sleep, I'd like to see it imported!

Oh, that’s interesting, Majorie! Would surely like to know more about that.

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