One of my greatest pleasures during the COVID-19
shutdowns was having the time to indulge in hour-long phone conversations with
friends and family whom I could not see in person. Especially uplifting were my
biweekly talks with Margaret Shryer, a twice-widowed 94-year-old Minneapolitan.
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My conversations with Margaret are substantive and
illuminating, covering topics that include politics, poetry, plays and
philosophy as well as family pleasures and problems. I relish her wisdom and
sage advice. I especially delight in the fact that she seems not to have lost
an iota of her youthful brain power. She’s as sharp now as she was when we
first met decades ago.
Recent findings about the trajectories of human cognition
suggest that if no physical insult, like a stroke, intervenes in the next six
years, Margaret is destined to be a cognitively sharp centenarian.
Fewer than 1 percent of Americans reach the age of 100, and
new data from the Netherlands indicate that those who achieve that milestone
with their mental faculties still intact are likely to remain so for their
remaining years, even if their brains are riddled with the plaques and tangles
that are the hallmarks of Alzheimer’s disease.
Findings from the Dutch study may eventually pave a path for
many more of us to become “
cognitive superagers,” as researchers call people
who approach the end of the human life span with brains that function as if
they were 30 years younger.
One day everyone who is physically able to reach 100 may
also be able to remain mentally healthy. By studying centenarians, researchers
hope to identify reliable characteristics and develop treatments that would
result in healthy cognitive aging for most of us.
Meanwhile, there is much we
can do now to keep our brains in tiptop condition, even if reaching 100 is
neither a goal nor a possibility.
These hopeful prospects stem from the study of 340 Dutch
centenarians living independently who were tested and shown to be cognitively
healthy when they enrolled. The 79 participants who neither died nor dropped
out of the study returned for repeated cognitive testing, over an average
follow-up of 19 months.
The research team, directed by Henne Holstege at Vrije
University in Amsterdam, reported in JAMA Network Open in January that these
participants experienced no decline in major cognitive measures, except for a
slight loss in memory function. Basically, the participants performed as if
they were 30 years younger in overall cognition; ability to make decisions and
plans and execute them; recreate by drawing a figure they had looked at; list
animals or objects that began with a certain letter; and not becoming easily
distracted when performing a task or getting lost when they left home.
Even those with genes linked to an elevated risk of
developing Alzheimer’s disease were able to perform well on the tests.
Nearly one-third of the participants agreed to donate their
brains after death. Brain autopsies of 44 of the original centenarians revealed
that many had substantial neuropathology common to people with Alzheimer’s
disease although they had remained cognitively healthy for up to four years
beyond 100.
Dr. Thomas T. Perls, a geriatrician at Boston University who
directs the New England Centenarian Study and who wrote an accompanying
editorial, said in an interview that the Dutch participants represented “the
crème de la crème” of centenarians who had averted the onset of Alzheimer’s
disease by at least 20 to 30 years. They seemed to be either resistant to the
disease or cognitively resilient, somehow able to ward off manifestations of
its brain-damaging effects. Perhaps both.
Resistance, Perls explained, may reflect a relative absence
of brain damage conferred by a person’s genes or lifestyle. Or they may have
“protective biological mechanisms that slow brain aging and prevent clinical
illness,” he said.
Resilience, on the other hand, characterizes people with
normal cognitive abilities even though their brains may have damage typical of
Alzheimer’s, the leading cause of dementia. In addition to plaques and tangles,
such changes include loss of neurons, inflammation and clogged blood vessels.
People with cognitive resilience are able to accumulate
“higher levels of brain damage before clinical symptoms appear,” the Dutch team
reported.
Yaakov Stern, neuropsychologist and director of cognitive
neuroscience at Columbia University College of Physicians and Surgeons, said
that while resistant individuals may be spared much of the brain pathology
typical of Alzheimer’s disease, resilient individuals have what researchers
call a cognitive reserve that enables them to cope better with pathological
brain changes.
Many studies have revealed that a variety of lifestyle
factors may contribute to resilience, Stern said. Among them are obtaining a
higher level and better quality education; choosing occupations that deal with
complex facts and data; consuming a Mediterranean-style diet; engaging in
leisure activities; socializing with other people; and exercising regularly.
“Controlled trials of exercise have shown that it improves
cognition,” he said. “It’s
not just a result of better blood flow to the brain.
Exercise thickens the
cerebral cortex and the volume of the brain, including the frontal lobes that
are associated with cognition.”
Perls said, “Alzheimer’s disease is not an inevitable result
of aging. Those genetically predisposed can markedly delay it or show no evidence
of it before they die by doing the things we know are healthful: exercising
regularly, maintaining a healthy weight, not smoking, minimizing red meat in
the diet, and doing things that are cognitively new and challenging to the
brain, like learning a new language or a musical instrument.”
Also important is to maintain good hearing, said Perls, a
60-year-old who wears a hearing aid. “I can’t emphasize enough how important it
is for people to optimize their ability to hear,” he said. “There’s a direct
connection between hearing and preserving cognitive function. Being stubborn
about wearing hearing aids is just silly. Hearing loss results in cognitive
loss because you miss so much. You lose touch with your environment.”
Vision, too, is important, especially for people who already
are cognitively challenged. “Poor vision makes cognitive impairment worse,”
Perls said. As his brain-challenging activity, he’s taken up birding, which
requires both good hearing and good vision.
For her part, my friend Margaret reads, writes and recites
poetry and occasionally acts in a relative’s films.
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