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yond this age, verbal intelligence does decline, but very slowly by an average of less than 5 percent through the seventh decade and less than 10 percent through the eighth decade (Schaie and Hertzog) Also, in a series of 460 community-dwelling individuals (55 to 95 years of age) studied by Smith and coworkers at the Mayo Clinic, there was no signi cant decline with age in verbal memory and in registration-attention; similar results were found by Peterson and colleagues in 161 normal, community dwelling individuals 62 to 100 years of age The most de nite effects of age were in learning and memory and in problem solving cognitive impairments probably attributable to a progressive reduction in the speed of processing information The latter is re ected in the slowing of event-related evoked potentials and by a number of special psychologic tests (see Verhaeghen et al) As regards these cognitive functions, it hardly needs to be pointed out that the ability to memorize, acquire and retain new information, recall names, and avoid distraction once set on a course of action diminishes with advancing age, particularly in those more than 70 years old Moreover, memory function may be disturbed in this way despite the relative intactness of other intellectual abilities Characteristically, there is dif culty with recall of a name or the speci c date of an experience ( episodic memory) despite a preservation of memory for the experience itself or for the many features of a person whose name is momentarily elusive ( tip-of-the-tongue syndrome ) Also characteristic is an inconsistent retrieval of the lost name or information at a later date It has been found, however, that if older persons are allowed to learn new material very well, until no errors are made, they forget this information at a rate similar to that of younger individuals (see review by Albers) Kral, who rst wrote informatively on this type of memory disturbance, referred to it as benign senescent forgetfulness He pointed out that such a memory disturbance, in distinction to that of Alzheimer disease, worsens very little or not at all over a period of many years and does not interfere signi cantly with the person s work performance or activities of daily living More recently, Crook and coworkers have re ned the diagnostic criteria for senescent forgetfulness and have proposed a new term age-associated memory impairment (AAMI) The diagnostic criteria for the latter disorder include age of 50 years or older, a subjective sense of decline in memory, impaired performance on standard tests of memory function (at least one SD below the mean), and absence of any other signs of dementia The current terminology is minimal cognitive impairment, but there has been increasing recognition that Kral s original notion of a benign condition may have been incorrect and that cognitive decline in later years may be a risk factor for Alzheimer disease In judging the degree of cognitive decline, several abbreviated tests of mental status have been developed and are of practical value (Kokmen et al; Folstein et al) in that they can be given at the bedside in 5 to 10 min Repetition of spoken items, such as a series of digits, orientation as to place and time, capacity to learn and to retain several items, tests of arithmetic and calculation (concentration), and speci c tests for memory (particularly tests of delayed recall or forgetfulness) reveal that normal aging persons invariably perform at a signi cantly higher level than patients with Alzheimer disease, and these tests readily discriminate between the two groups (Larrabee et al) With regard to performance on the mini-mental status examination (Table 21-6, Folstein and colleagues), a study by Crum and associates of a large urban population indicates a median score of 19 20 for individuals over age 80 who have a.

PROTOCOLINI files will be displayed You can modify each of these files as though it had been opened individually Using this utility, you can elect to process all, none, or some of the system s legacy configuration files By selecting a specific file s tab, you can also elect to process or ignore individual command lines Using the MSCONFIG utility is much safer than using SYSEDIT because it does not allow you to edit the configuration files directly This means that you cannot accidentally cause a fatal error by modifying or deleting the wrong entry

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fourth grade education and 27 for those with a college education (out of maximum score of 30) The foregoing effects of age on mental abilities are extremely variable Some 70-year-olds perform better on psychologic testing than some normal 20-year-olds And a few individuals retain exceptional mental power and perform creative work until late life Verdi, for example, composed Otello at the age of 73 and Falstaff at 79 Humboldt wrote the ve volumes of his Kosmos between the ages of 76 and 89 years; Goethe produced the second part of Faust when he was more than 70 years old; Galileo, Laplace, and Sherrington continued to make scienti c contributions in their eighth decades; and Picasso continued to paint in his nineties It must be pointed out, however, that these accomplishments were essentially continuations of lines of endeavor that had been initiated in early adult life Indeed, little that is new and original is started after the 40th year High intelligence, well-organized work habits, and sound judgment compensate for many of the progressive shortcomings of old age Personality Changes in the Aged These are less easily measured than cognitive functions, but certain trends are nevertheless observable and may seriously disturb the lives of aged persons and those around them Many old people become more opinionated, repetitive, self-centered, and rigid and conservative in their thinking; the opposite qualities undue pliancy, vacillation, and the uncritical acceptance of ideas are observed in others Often these changes can be recognized as exaggerations of lifelong personality traits Elderly persons tend to become increasingly cautious; many of them seem to lack self-con dence and require a strong probability of success before undertaking certain tasks These changes may impair their performance on psychologic testing Kallman s studies of senescent monozygotic twins suggest that genetic factors are more important than environmental ones in molding these traits One of the weaknesses of studies of the aged has been the bias in selection of patients Many of the reported observations have been made in cohorts of individuals residing in nursing homes Studies of functionally intact old people of comparable age and living independently, such as those of Kokmen and of Benassi and their colleagues, reveal fewer de cits, consisting mainly of forgetfulness of names, smallness of pupils, restriction of convergence and upward conjugate gaze, diminished Achilles re exes and vibratory sense in the feet, stooped posture, and impairments of balance, agility, and gait (as mentioned earlier and below).

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