MMSE – THE MINI MENTAL STATE EXAM

INTRODUCTION
Cognition
Cognition refers to the inner processes and products of the mind that lead to “knowing.” It includes all
mental activity—attending, remembering, symbolizing, categorizing, planning, reasoning, problem
solving, creating, and fantasizing.
Cognition refers to the mental processes involved in gaining knowledge and understanding, including
perception, attention, memory, language, and problem-solving." (Piaget,1952)
Cognition is the process of acquiring and using knowledge, which involves mental activities such as
perception, memory, attention, and problem-solving, influenced by social and cultural factors."
(Vygotsky,1978)
Cognitive Development
Cognitive development refers to how a person perceives, thinks, and gains understanding of his or her
world through the interaction of genetic and learned factors. Among the areas of cognitive
development are information processing, intelligence, reasoning, language development,and memory.
Historically, the cognitive development of children has been studied in a variety of ways. The oldest is
through intelligence tests, such as the widely used Stanford Binet Intelligence Quotient (IQ) test first
adopted for use in the United States by psychologist Lewis Terman (1877–1956) in 1916 from a
French model pioneered in 1905. IQ scoring is based on the concept of "mental age," according to
which the scores of a child of average intelligence match his or her age, while a gifted child's
performance is comparable to that of an older child, and a slow learner's scores are similar to those of
a younger child. IQ tests are widely used in the United States, but they have come under increasing
criticism for defining intelligence too narrowly and for being biased with regard to race and gender.
In contrast to the emphasis placed on a child's native abilities by intelligence testing, learning theory
grew out of work by behaviorist researchers such as John Watson (1878–1958) and B. F. Skinner
(1904–1990), who argued that children are completely malleable. Learning theory focuses on the role
of environmental factors in shaping the intelligence of children, especially on a child's ability to learn
by having certain behaviors rewarded and others discouraged.
Piaget’s theory of cognitive development
Piaget’s theory states that children go through four stages of cognitive development as they actively
construct their understanding of the world. Two processes underlie this cognitive construction of the
world: organization and adaptation. To make sense of our world, we organize our experiences. For
example, we separate important ideas from less important ideas, and we connect one idea to another.
In addition to organizing our observations and experiences, we adapt, adjusting to new environmental
demands (Miller, 2011). Jean Piaget (1954) also proposed that we go through four stages in
understanding the world. Each age-related stage consists of a distinct way of thinking, a different way
of understanding the world. Thus, according to Piaget, the child’s cognition is qualitatively different
in one stage compared with another. There are Piaget’s four stages of cognitive development.
The sensorimotor stage, which lasts from birth to about 2 years of age, is the first Piagetian stage. In
this stage, infants construct an understanding of the world by coordinating sensory experiences (such
as seeing and hearing) with physical, motoric actions—hence the term sensorimotor.
The preoperational stage, which lasts from approximately 2 to 7 years of age, is Piaget’s second stage.
In this stage, children begin to go beyond simply connecting sensory information with physical action
and represent the world with words, images, and drawings. However, according to Piaget, preschool
children still lack the ability to perform what he calls operations, which are internalized mental
actions that allow children to do mentally what they previously could only do physically. For
example, if you imagine putting two sticks together to see whether they would be as long as another
stick, without actually moving the sticks, you are performing a concrete operation.
The concrete operational stage, which lasts from approximately 7 to 11 years of age, is the third
Piagetian stage. In this stage, children can perform operations that involve objects, and they can
reason logically when the reasoning can be applied to specific or concrete examples. For instance,
concrete operational thinkers cannot imagine the steps necessary to complete an algebraic equation,
which is too abstract for thinking at this stage of development.
The formal operational stage, which appears between the ages of 11 and 15 and continues through
adulthood, is Piaget’s fourth and final stage. In this stage, individuals move beyond concrete
experiences and think in abstract and more logical terms. As part of thinking more abstractly,
adolescents develop images of ideal circumstances. They might think about what an ideal parent is
like and compare their parents to this ideal standard. They begin to entertain possibilities for the future
and are fascinated with what they can become. In solving problems, they become more systematic,
developing hypotheses about why something is happening the way it is and then testing these
hypotheses.
Vygotsky Theory of social learning
Like Piaget, the Russian developmentalist Lev Vygotsky (1896–1934) maintained that children
actively construct their knowledge. However, Vygotsky (1962) gave social interaction and culture far
more important roles in cognitive development than Piaget did. Vygotsky’s theory is a sociocultural
cognitive theory that emphasizes how culture and social interaction guide cognitive development.
Vygotsky portrayed the child’s development as inseparable from social and cultural activities
(Daniels, 2011). He argued that cognitive development involves learning to use the inventions of
society, such as language, mathematical systems, and memory strategies. Thus, in one culture,
children might learn to count with the help of a computer; in another, they might learn by using beads.
According to Vygotsky, children’s social interaction with more-skilled adults and peers is
indispensable to their cognitive development (Gauvain & Parke, 2010). Through this interaction, they
learn to use the tools that will help them adapt and be successful in the culture.
Cognitive development in Older Adults
Cognitive development in older adults refers to the changes and transformations that occur in
cognitive abilities as individuals age. While cognitive abilities may decline to some extent with age, it
is important to note that older adults can still exhibit remarkable cognitive resilience and continue to
learn and adapt throughout their lives. There are remarkable changes in cognitive abilities and
inconsistencies among the individuals with increasing age. This vast heterogeneity among elderly
people increases the challenges associated with understanding cognitive dysfunctions. The degree of
variability in cognition of individual changes with age.
Several key aspects of cognitive development in older adults include:
Memory: Older adults may experience some changes in memory, particularly in the retrieval of
information and working memory tasks. However, long-term memory and procedural memory tend to
remain relatively stable or even improve with age.
Processing Speed: Processing speed, which refers to the ability to perform mental operations quickly,
may decrease as individuals get older. This decline can affect tasks that require rapid information
processing or decision-making.
Attention: Older adults may experience changes in attention, such as reduced ability to filter out
irrelevant information or increased susceptibility to distractions. However, they often develop
strategies to compensate for these changes and maintain adequate attentional abilities.
Executive Functions: Executive functions, which involve higher-level cognitive processes such as
planning, problem-solving, and decision-making, may show some decline in older adults. However,
experience and accumulated knowledge can help compensate for these changes, leading to preserved
or even enhanced performance in certain domains.
Wisdom and Expertise: With age, individuals often accumulate valuable life experiences and
knowledge, leading to the development of wisdom and expertise in specific areas. Older adults may
excel in tasks that require practical problem-solving, emotional regulation, and perspective-taking.
It is important to note that cognitive aging is a highly individualized process, and there is considerable
variability in cognitive abilities among older adults.

Cognitive Functioning in older adults

Factors affecting cognitive functioning
Genetic Factors
Genetic factors contribute to aging and age associated decline in cognitive functions. They are crucial
for cognitive ability of an individual and can be studied by gnome wide methods during aging.
Cognitive functions are heritable during the course of life. Heritability of cognitive abilities changes
during life; it increases during young to adult, remains constant for adulthood and finally decreases
during aging.
Enviromental Factors
Education is a primary part of human civilization and requires high level of cognitive skill. People
with high level of education have good job opportunity and earning which leads to comfortable life
style. Most of the educated people are multilingual in nature and can speak, read and write more than
one language. Low level of education and socio-economic status are risk factors of dementia and AD.
The risk factor for AD decreases 17% for each extra year of education. People having more than eight
years of education showed maintenance of cognitive functions in old age. Though reports show
education as an important factor that influences cognition.
Moreover, alcohol consumption shows dual effect on cognition; it may be neurotoxic or
neuroprotective depending on amount, frequency, duration of consumption and type of alcohol. In old
males, who are either quitter or light and moderate alcohol drinker (20 g/d), there was no significant
cognitive decline. However, high consumption of alcohol (36 g/d) results in rapid decline of cognitive
functions, mainly executive control and memory. Smoking is always harmful in old age, Richards et
al. reported that daily smoking of 20 cigarettes/day is associated with decline in visual search speed
and verbal memory. Decline of cognitive function was faster in current smoker as compared to non-
smoker men. Further, the decline of executive function is higher in recent ex-smoker as compared to
long-term ex-smokers.

On the other hand, daily life activities are very important to maintain proper body function and health
during aging. Feiyue et al. have demonstrated that cognitive training improves the fluid intelligence of
adults. Moreover, yoga and meditation practices slow down the decline in functional network
integrity, susceptibility to damage and fluid intelligence during brain aging. It has been established
that enhancing the education, training and proper life style through exercise and enriched environment
slow down the decline in cognitive functions during aging. Therefore, it seems that one can maintain
the cognitive functions intact during aging by following a balanced life style, proper exercise,
cognitive training and enriched environment
Molecular Switch-
Different cognitive functions including learning and memory are regulated by various molecular
pathways. Several reports have shown that the expression of stress and inflammation related genes is
upregulated, while the expression of growth/trophic factors, energy metabolism, protein turn over,
neuronal survival and synaptic plasticity genes is downregulated in the cerebral cortex and
hippocampus during aging. Synaptic plasticity genes are important and play direct role in regulation
of basic synaptic structure and functions in the brain. Decline in the expression of synaptic plasticity
genes is associated with increase in oxidative stress, alteration in neurotransmitter and hormone level
and epigenetic modifications during aging.
Review of Literature
References

 Berk, L. E. (2010). Child Development (9th Ed.). New Delhi: Prentice Hall. (Unit 3: Chapter 12)
 Cricco, M., Simonsick, E. M., & Foley, D. J. (2001). The impact of insomnia on cognitive
functioning in older adults. Journal of the American Geriatrics Society, 49(9), 1185-1189.
 Santrock, J.W. (2012). A topical approach to life-span development. New Delhi:Tata McGraw-
Hill.
 Salthouse, T. A. (2010). Selective review of cognitive aging. Journal of the International
Neuropsychological Society, 16(5), 754-760.
 Vygotsky, L. S. (1978). Mind in Society: The Development of Higher Psychological
Processes. Harvard University Press.)

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