Patients commonly experience some cognitive decline in their 80s, including signs of memory loss and reduced cognitive function. But according to Alzheimer’s Association facts and figures, 13.2% of people age 75 to 84, and 33.4% of people age 85 or older have Alzheimer’s dementia, so it’s critical for clinicians to be able to distinguish between symptoms of cognitive impairment and normal aging.
Fear of dementia keeps many patients from talking to their doctors about their cognition. According to a study from the Alzheimer’s Society, over 62% of people believe that a dementia diagnosis would mean that “their life is over,” even though early intervention is an important factor in cognitive care.
Measuring cognitive function with scientifically-backed cognitive screens can provide essential data and give clinicians a starting point for educating senior patients about preventing and managing cognitive decline in their 80s. That work can start with routine cognitive testing and encouraging good brain health practices in their 60s and 70s.
This approach supports broader goals around cognitive care for seniors, helping clinicians track changes and intervene when needed. In this article, we’ll discuss the prevalence of dementia among seniors, as well as strategies and tools that clinicians can use to help discuss cognitive decline and introduce practices for better brain health.
Article Highlights
Some signs of memory loss and reduced cognitive function are normal for patients in their 80s, and routine cognitive assessments help clinicians identify when these problems are signs of a more serious condition.
- According to the Alzheimer’s Association, 13.2% of people age 75 to 84, and 33.4% of people age 85 or older have Alzheimer’s dementia.
- In studies from the Alzheimer’s Society, over 62% of people believed a dementia diagnosis would mean “their life is over,” and 37% said they would put off talking to their primary doctor about memory problems because they assumed dementia was a normal part of aging.
- An estimated 10–15% of people with mild cognitive impairment (MCI) develop dementia each year, according to the Alzheimer’s Association, which makes catching symptoms early all the more important.
- While there is no 100% guaranteed way to prevent dementia, lifestyle strategies such as controlling blood pressure, consistent sleep, social activities, and lifelong learning can reduce the risk factors.
Measuring and delivering care for cognitive decline
Under Medicare, an annual wellness visit is a requirement for patients over 65, and a great opportunity to implement routine cognitive testing. With assessment tools that can generate reports in minutes, clinicians have more time to get to know patients and understand their unique needs.
Here are our tools and tips for measuring patient cognition and building collaborative treatment plans:
Assessing older adults’ cognitive ability
Some of the most common cognitive tests for dementia, Alzheimer’s disease, and mild cognitive impairment (MCI) include:
- Mini Mental State Examination (MMSE) to identify difficulties with cognitive function.
- Mini-Cog, a dementia screen that combines a memory test and clock drawing test.
- Montreal Cognitive Assessment (MoCA) to assess spatial awareness, naming, short-term memory, language abilities, executive function, and attention.
- Saint Louis University Mental Status (SLUMS) to measure attention, delayed and immediate recall, calculation, executive function, and visuospatial response.
Many cognitive screeners, including the MMSE, Mini-Cog, MoCA, and SLUMS, are administered by pen and paper. While they provide quick results, they’re often limited in how much data they can provide about a patient’s ability to perform simple tasks.
- Instrumental Activities of Daily Living (IADL) Questionnaire, which measures a patient’s capacity to complete daily tasks that let them live independently. A digital version of the IADL is available in Creyos alongside other behavioral questionnaires.
- Creyos Dementia Protocol, which can be completed remotely or in office in under 10 minutes, and produce instant reports that are easy for patients and clinicians to understand. It includes a cognitive screener that is sensitive to potential early signs of dementia, detailed information about DSM-5 diagnostic guidelines, and can track symptoms over time.
Should the test results reveal signs of cognitive decline, clinicians may have the patients take blood tests, get brain imaging, or go in for neurological testing. Once a diagnosis is made, measurement-based care helps track how patients’ cognitive ability changes over time.
Delivering care for cognitive impairment
If a patient is displaying signs of mild cognitive impairment or progressing dementia, it may be time to set up a cognitive care plan. This plan helps give patients better quality treatment while also taking the needs and capabilities of caregivers into account.
For about 75% of people with dementia in the United States, unpaid family members are the primary caregivers, with 60% of that work belonging to wives, daughters, daughters-in-law, granddaughters, and other female relatives. In order to avoid caregiver burnout, understanding caregivers’ work schedules, health needs, and emotional state helps doctors determine which treatment plans are realistic.
Along with this, according to the National Alliance for Caregiving and AARP, nearly 20% of caregivers in the U.S. are age 65+ themselves. When patients are experiencing cognitive decline in their 80s, it’s likely that their spouses or aging children will be looking after them, possibly while struggling with their own cognitive impairment.
How can patients reduce the risk of cognitive decline in their 80s?
While there is no 100% guaranteed way to prevent dementia, there are many lifestyle strategies that can reduce the risk factors, including:
- Controlling blood pressure. Hypertension is associated with an increased risk of vascular dementia, which is the second most common dementia in the world. Regular exercise, stopping smoking, and following a healthy diet such as the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) are several ways to reduce high blood pressure.
- Consistent sleep. One study, summarized in NIH Research Matters, found that people in their 50s–60s who got less than 6 hours of sleep per night were 30% more likely to be diagnosed with dementia. Another study in the journal Sleep that used Creyos cognitive testing found that getting 4 hours of sleep per night was equivalent to being 8 years older, compared to individuals who get a more typical 7–8 hours.
- Keeping up with social activities. Social isolation is associated with a 50% increased risk of dementia. This is alarming, as almost 25% of adults aged 65+ are socially isolated.
- Education and lifelong learning. Early education and keeping a cognitively active lifestyle through reading, playing games, and learning new activities may help build up a person’s “cognitive reserve” and reduce their risk of dementia.
As patients start getting older, and especially if they’re showing signs of cognitive impairment, creating an advance care plan can identify lifestyle factors to slow decline. Even for patients who cannot fully prevent cognitive decline, this gives them an opportunity to advocate for their wishes while it’s still possible.
What should clinicians consider when caring for patients 80+?
Delivering cognitive health care to older adults comes with some unique considerations for providing an accessible patient experience:
- Technological barriers: Since COVID-19, more adults over 65 have begun to use virtual primary care as part of their medical care. However, Baby Boomers use technology differently than the older Silent Generation, and patients experiencing cognitive decline in their 80s may be intimidated by remote, entirely digital health care, and could benefit from familiar in-person appointments.
- Stigma: Despite the rising prevalence of dementia, there is still significant social stigma for seniors with cognitive impairment. Normalizing cognitive testing in primary care is one way to take the fear out of conversations about cognitive decline and get patients on track for treatment.
- Hearing and vision loss: Vision and hearing-based disabilities in older adults can add an additional challenge to cognitive testing. For example, struggling to recognize loved ones could either be a sign of cognitive decline or a need for stronger glasses. According to the Alzheimer’s Society, performing hearing and vision tests alongside cognitive screens is one way to identify the source of a patient’s symptoms, and the Lancet Commission on dementia prevention reports that treating hearing and vision problems can in fact prevent some cases of dementia.
- Mobility challenges: Approximately one-third of 70 year olds and most people over 80 report having challenges with mobility, according to a study in BMC Geriatrics. Seeking accessible home modifications is one way to encourage patient safety if cognitive decline is beginning to interfere with their physical abilities.
How can you tell the difference between dementia and aging?
Misunderstandings about the symptoms of normal aging versus cognitive decline often keep patients from talking to their doctors about their cognitive health. In one study from the Alzheimer’s Society, 37% of people said they would put off talking to their primary doctor about memory problems because they assumed that dementia was a normal part of aging.
Cognitive assessments can objectively assess if a patient is experiencing cognitive impairment. However, there are a few immediate differences between symptoms of dementia and normal aging.
Normal aging
According to the World Health Organization, as cited by the Alzheimer Society of Canada, almost 40% of people will experience some sort of memory loss after the age of 65. Normal age-related memory problems shouldn’t dramatically interfere with people’s ability to live their daily lives. Along with this, they shouldn’t get in the way of problem-solving or the ability to pick up new skills.
However, while memory problems are often seen as a normal part of aging, a study in the Journal of Neuroscience found some “superagers” whose brain structures in their 60s–80s are anatomically comparable to those of young adults.
This study’s researchers believe that consistent physical activity and embracing challenging mental activities (such as learning an instrument, trying out new technology, or teaching skills to others) are key to becoming a superager, as reported by Harvard Health Publishing. Encouraging aging patients to keep their minds active may help reduce the likelihood of cognitive decline in their 80s.
Mild cognitive impairment (MCI)
Mild cognitive impairment can resemble the normal signs of aging, but the decline is severe enough to be noticeable and measurable. If symptoms begin to affect the patient or become noticed by others, but are not interfering with daily activities, they might be dealing with MCI.
An estimated 10–15% of people with MCI develop dementia each year, according to the Alzheimer’s Association, which makes catching symptoms early all the more important. Sensitive, scientifically-backed cognitive screens are key to catching the early stages of cognitive impairment.
Not all MCI progresses to dementia, so it is important to identify potential temporary and reversible causes, such as certain nutritional deficiencies. Cognitive screeners, alongside physical biomarkers, can give clinicians a full look at the source of cognitive impairment and help identify appropriate treatment plans.
Dementia
Dementia is the escalation of cognitive impairment symptoms to the point where they significantly impact a patient’s capacity to safely carry out their instrumental activities of daily living (IADLs). While patients with MCI might forget they’ve already told a story a couple of times, patients with dementia might forget information such as what year it is.
Along with memory loss, dementia impacts a patient’s behavior, mood, language abilities, and sense of judgment, according to the National Institute on Aging. Challenges with executive function can also be an early sign of dementia, and play a part in struggles with working memory.
The Alzheimer’s Society identifies several different types of dementia, the most common of which include:
- Alzheimer’s disease
- Lewy body dementia
- Vascular dementia
- Frontotemporal dementia
Because there is currently no way to fully reverse dementia, symptoms will often become worse for patients as they get older. For example, patients with cognitive decline in their 80s may exhibit more extreme symptoms than patients in their 70s. Comparing patients to age-specific normative data can help distinguish normal aging from MCI or dementia, providing crucial information for clinicians and caregivers to take the appropriate next steps.
Using Creyos’ cognitive assessments for patients 80+
The Creyos Dementia Protocol includes a sensitive cognitive screener, a detailed assessment, and care planning tools to assist in the identification and management of MCI or dementia. Alongside cognitive tasks to objectively identify deficits, questionnaires, including the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), IADL, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), give a more complete look at patients’ behavioral health and help identify comorbidities.
Creyos cognitive tasks measure cognitive impairment across multiple domains to support diagnostic standards required by the DSM-5. Advanced tracking features monitor patients’ cognitive function over time, and produce reports that are easy for patients and clinicians to understand and which integrate into patients’ electronic health records.
As of 2024, Creyos has added new accessibility features that make it appropriate for assessing patients in the 80+ age range who may be dealing with physical challenges. Accessibility features include:
- Multilingual audio-visual guides for patients with different abilities and learning styles. These are currently available in English, Spanish, and French, with more languages to come.
- Simple instructions and components to reduce anxiety, distractions, and confusion.
- Optimized colors and contrast for users with color blindness.
- Large text and clear fonts for patients with visual impairments.
- Dark tasks to accommodate patients with light sensitivities.
- Large buttons with user-friendly placements for patients with mobility challenges.
For researchers, Creyos has become a trusted measurement tool in cognitive health studies. For example, the Maintain Your Brain study used Creyos cognitive tasks as primary outcome measures in studying the use of online interventions in preventing cognitive decline. And in positive news, the intervention group appears to have improved significantly on cognitive measures after the three years of personalized coaching to address dementia risk factors.
Contact Creyos today to learn about how our cognitive tasks can efficiently and effectively measure your patients’ brain health.
Measuring cognitive decline as patients age
For patients in their 80s, it is normal to see some signs of memory loss and reduced cognitive function. By keeping up with routine cognitive assessments, clinicians can identify when these problems are signs of a more serious condition, and set up the treatment plans that will give patients the best quality of life as they continue to age.
Connect with us today to learn about how Creyos’ scientifically-backed cognitive assessment tools can be incorporated into your medical practice.
Reviewed by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.