Intended for healthcare professionals

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Analysis Essay

Good news about the ageing brain

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6288 (Published 17 October 2011) Cite this as: BMJ 2011;343:d6288

Rapid Response:

Cognitive gains of later life have important clinical consequences

It is refreshing, if sadly rare, to read an article on cognitive ageing in the mainstream biomedical literature which recognizes that simultaneous growth and loss occur at all ages (1). That such growth is harder to measure in later life than the losses is largely due to the use of psychometric instruments developed largely for younger people and designed to detect disability rather than ability. This mirrors Stephen J Gould's The Mismeasure of Man: he describes how an early use of IQ tests was to show that white people were more intelligent than black people, outlining the perils of simplistic and indiscriminate interpretations of psychological tests (2).

There are important clinical consequences of the gains of later life that are not touched upon by Richards and Hatch. In traffic medicine this characterized by the fact that older drivers, despite the highest level of disabilities (including cognitive dysfunction), have the most enviable accident record of any age group (3). In occupational health, the strategic gains of cognitive ageing are manifest in the maintained and sometime superior performance of older workers in occupations as diverse as roofers, automobile workers and maintenance workers (4).

A failure to highlight such gains is common even in textbooks of geriatric medicine, and constitutes what one commentator perceptively described as "the new Ageism". This is where those specializing in the care of older people may allow their discourse to so focus on the negative aspects of ageing (even if describing the effectiveness of their interventions) that they may unconsciously help to create and propagate a "failure model" of ageing (5).

Explaining the complexities of this simultaneous growth and loss to students and trainees is a complex task, and may be best served through the use of metaphors. The late-life creativity of great artists presents just such an opportunity, allowing us to understand the longevity dividend without glossing over the inevitable losses of later life (6).

References

1. Richards M, Hatch SL. Good news about the ageing brain. BMJ 2011;343:d6288.

2. Gould SJ. The mismeasure of man. 1st ed. New York: Norton, 1981.

3. Langford J, Bohensky M, Koppel S, Newstead S. Do older drivers pose a risk to other road users? Traffic Inj Prev 2008;9(3):181-9.

4. O'Neill D. Ageing, Work and the Demographic Dividend. Dublin: Older and Bolder, 2010. http://www.olderandbolder.ie/sites/default/files/Creativity.pdf (accessed 2 Nov 2011)

5. Kalish RA. The new ageism and the failure models: a polemic. Gerontologist 1979;19(4):398-402.

6. O'Neill D. The art of the demographic dividend. Lancet 2011;377(9780):1828-9.

Competing interests: No competing interests

03 November 2011
Stephanie Robinson
Registrar
Desmond O'Neill
Trinity College Dublin