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Holding back the years

Reading time: 13 minutes

When it comes to growing old gracefully, the odds seem stacked against us. If you can dodge cardiovascular disease as you head into your golden years, then you are already beating the odds of the number one killer. Hypertension, coronary heart disease, heart failure and stroke rise as we age, and the likelihood we suffer from any one of them grows from 40 percent in our 40s and 50s to a whopping 79–86 percent among those aged 80 years or older.

Then there’s the cognitive challenge. Dreaded Alzheimer’s, as well as other dementias, topping the list and affecting nearly six million Americans alone, are now the sixth leading cause of death. Despite having spent more than $42 billion and more than 25 years experimenting, drug companies have failed to find a drug to treat the disorder.

By age 75, roughly 43 percent of people are at risk of developing Alzheimer’s dementia, and women, by right of living longer, have higher odds of losing their mind before they die.1

This says nothing of the perils of other diseases, from cancer and diabetes to infections. Little wonder that our culture worships youth as much as it fears aging.

“It’s paradoxical that the idea of living a long life appeals to everyone, but the idea of getting old doesn’t appeal to anyone,” former American commentator Andy Rooney once quipped.

Never mind living to 100. How do we get that holy grail of aging pleasantly—the kind of life often depicted, ironically, on television adverts for adult diapers and medications for diabetes, that show old people climbing on hilltops, frolicking with their grandchildren or playing tennis on a cruise ship?

Is aging nicely just a marketing ideal? Is it a rare gift to a handful of Hollywood elites with “good genes”? A new book suggests the contrary. Getting old is inevitable, but a healthy, active and energetic long life is more than possible if we can avoid the perils of sedentary, stressed-out and processed-food-fed modern life.

In Unaging: The Four Factors That Impact How You Age (Cambridge University Press, 2022), leading neurologist Robert Friedland says genes have little to do with the health of aging brains.

Friedland is set on throwing cold water on stereotypes about getting old. Having worked 44 years in his field, he found himself frustrated with patients who would say, “Well, when you’re gonna go, you’re gonna go.” That, and the follow-up that they might as well not bother exercising and should have another one—another drink, another slice of pizza, another Netflix binge. Eat, drink and be merry, for tomorrow we die, right?

Except what people frequently fail to account for, says Friedland, is that before death might come years or decades of living with declining cognitive function, diminished independence, deleted memories and even loss of the ability to recognize the faces of their loved ones. It’s worth changing to age well.

“The goal isn’t ‘normal aging,’” says Friedland. “The goal is to make terrific choices so you can achieve exceptional aging.”

Friedland is a professor of neurology at the University of Louisville in Kentucky, and his speciality and the focus of his book is the brain and cognitive decline. “I want people to appreciate the opportunity to influence their own life and for people to understand that that losing brain function is not a normal feature of getting old.

“Significant cognitive impairment with or without dementia is not normal at any age,” he says. Anyone—even a 95-year-old—with significant memory loss should be investigated because it might be due to any one of many treatable and reversible factors.

Genetics are overemphasized, the neurologist adds. Just 1 percent of Alzheimer’s cases, for example, are caused by genetic mutations. Even carrying the dreaded double APOE4 genes does not mean you will definitely develop the disease; people with two copies of the allele have a lifetime risk for Alzheimer’s of greater than 50 percent.

For people with one copy, the lifetime risk is 20–30 percent, and the overall risk, regardless of your genes, is 11 percent for men and 14 percent for women.2

Many people who are at the highest risk, carrying two alleles, do not develop Alzheimer’s disease. (A recent study found no raised risk at all for Native Americans with the genes, for example.3) And many people who don’t carry any APOE4 allele do get Alzheimer’s. “In short, genetic tests aren’t needed to increase commitment to preventive measures,” says Friedland.

Unlike some in his field, Friedland doesn’t believe that diagnosed Alzheimer’s disease can be reversed, but he does believe that preventing cognitive decline is possible. “You can buy yourself critical years of cognitive health,” he says. Postponing decline from 75 to 85 is a big deal. You might not live to 85, but what’s good for the brain is good for the heart and for diabetes and so on, which means you may also be adding years to your high-quality life.

“It is a myth that aging means you inevitably decline and there’s nothing you can do about it,” Friedland told WDDTY. “It’s perfectly reasonable that a 30-year-old woman will hope that she can live to be 70 years of age (and more, of course) and, at that older age, she will not have cancer, coronary artery disease, Alzheimer’s disease, or other age-related conditions.”

Friedland told WDDTY that he wrote his book to tell his patients all the ways to do this that he doesn’t have time to outline in a scheduled appointment. He’s grouped them under four categories of “reserve factors” that need to be built up to ensure good brain health. The reserves are like health bank accounts that you can make either withdrawals from or deposits into, including cognitive, physical, psychological and social accounts.

When we’re young, we have a high balance in each of these accounts, and our brains and bodies weather all sort of physical insults and stresses pretty well. But as we age, these reserves wane and we see tandem declines in cognitive functioning when we get into deficits in any one of them.

“All four reserve factors contribute directly to protection from the Alzheimer’s disease process in the brain, as well as influencing the changes in cognitive function with aging,” explains Friedland.

He doesn’t negate the physical disadvantages of the aging process but likens them to carrying a 50-pound pack. If you’re Roger Federer, with lots of physical reserve built by training, carrying that pack will impact you, but you’ll still play the game well. If, however, you are out of shape with depleted reserves, the weight of aging can sink you in the game of life.

A tight grip on your mind

In another study last year, researchers at the University of California at San Francisco looked at data on 190,406 adults in the UK Biobank with a mean age of 56.5 years and followed their outcomes for 11.7 years, studying their handgrip strength, various cognitive test results and doctor-diagnosed conditions.

They found that a 5-kg decrease in handgrip strength was associated with lower fluid intelligence scores and with worse odds of correctly responding to a memory task in both women and men. It came with higher white brain matter volume (gray matter is largely responsible for brain processing functions) as well as a 20 percent higher risk of being diagnosed with dementia for men, and 12 percent higher risk for women. The researchers found no link between handgrip strength and genetic risk score for Alzheimer’s.

Never too late

Friedland adds that it’s “almost never too late” to improve your reserves. He cringes recalling that as a young student he used to eat two hotdogs for lunch every single day. “I wouldn’t touch a hotdog now,” he adds, but splurges from the past that depleted our reserves shouldn’t keep us from good choices that add to them now.

There are so many little things we can do to shore up our reserves and help our bodies and minds to stave off aging. Here are just a few.

Add to your physical reserve

Exercise

“Exercise,” says Friedland, “should be pursued as if life depended on it, because it does.” If there was only one thing to change in life to prevent neurocognitive decline and slow aging, this would be it.

A sedentary lifestyle leads to dying before your time from coronary heart disease, stroke and diabetes, and regular exercise slashes the risk of each of these. Physical activity that elevates heart rate counters depression and anxiety4 and has also been demonstrated to work through multiple pathways to combat neurocognitive decline, including by countering inflammation, raising blood and oxygen perfusion of the brain, clearing the brain of debris and promoting DNA repair.5 It helps improve cognition, memory, and executive function.6

Aerobic exercise is best, but activities that involve complex brain processing and aerobic activity (like racquetball or dancing) are at the top of the list for preventing cognitive decline.

Even walking at a brisk pace daily can significantly decrease the risk of developing dementia, however. A recent study published in JAMA Neurology found taking just 3,800 to 9,800 steps each day does the job.

The researchers used data from the UK Biobank population-based cohort study for 78,430 adults aged 40 to 79 years. Each participant wore a device that counted their daily steps and calculated their pace. Those who took 9,826 steps per day were 50 percent less likely to develop dementia within seven years. And those who walked more briskly—more than 40 steps per minute, about 6,315 steps per day—cut their risk of dementia by 57 percent. Even the slowest walkers, who took just 3,800 steps per day, cut their dementia risk by 25 percent.7

Build muscles

Strength-building exercises are important, too. The act of contracting our muscles increases levels of brain-derived neurotrophic factor (BDNF) in our serum, and this molecule is associated with lower depression and anxiety and with cognitive benefits.8

Muscle mass declines with age, but we can build muscle long into our senior years, and this may slow the aging process and keep our brains as well as our muscles toned. People with bigger muscle mass—in their glutes, for example—have a decreased risk of being diagnosed with Alzheimer’s or mild cognitive impairment.

In one study, researchers from Rush Alzheimer’s Disease Center in Chicago, Illinois, followed 900 elderly people in the community and measured the strength in eight of their muscle groups.

Over an average of 3.6 years after initial evaluation, 138 of the research subjects developed Alzheimer’s disease. Adjusting for age, sex and education, the researchers found that “each [1-unit] increase in muscle strength at baseline was associated with about a 43 percent decrease in the risk” of an Alzheimer’s diagnosis.

The link between muscle strength and Alzheimer’s continued even when other factors, including body mass index, pulmonary function and physical activity, were taken into account. Muscle strength was further linked to a lower risk of mild cognitive impairment, which typically precedes Alzheimer’s.9

Friedland challenges his readers to exercise vigorously every day for one month. “Almost everybody can do something,” he says. “If you’re in a wheelchair, start with moving your arms.”

“After this period, see if you feel better or worse. You may surprise yourself. There are two chief rules of physical exercise that must be followed: (1) start; and (2) continue.”

Feed your microbiome

With aging, the immune system can become excessively activated in a way that causes a low-grade process of  “inflammaging.” This process is linked to diseases that kill and rob quality of life, including cardiovascular disease, stroke, diabetes, Alzheimer’s and Parkinson’s, and cancer.

Inflammation in the brain is linked to the gut microbiome, says Friedland. In 2015 he proposed the theory that gut bacteria carrying a protein called amyloid on their surface could  “misfold” proteins in the brain and trigger immune system responses that lead to Alzheimer’s disease.10

Since diet has been demonstrated to alter the species of bacteria that populate our guts, what’s on your plate every day is critical. Friedland points to the importance of high-fiber foods, including whole grains, fruit, vegetables, legumes and brown rice, to feed “good” bacteria. He also discourages saturated fats and all processed foods, which are chock-full of refined sugar, pesticide-treated grains and oil and are high in sodium.

Steer clear of these drugs

Watch out especially for anticholinergic drugs, which are linked to cognitive losses, warns Friedland. These drugs are used to treat conditions from asthma and hay fever to depression to overactive bladder and peptic ulcers. Even Benadryl has anticholinergic properties that can impair brain function, a condition that can be misdiagnosed as Alzheimer’s dementia.

Benzodiazepine drugs also raise the risk of dementia. These include psychoactive drugs such as diazepam and alprazolam, used to treat anxiety. Not only are they addictive but they impair memory, attention and motor abilities, says Friedland. “They also increase accident rates and mortality.”

Check your medicines

“Prescription drugs are the commonest cause of reversible mental impairment,” says Friedland. Antibiotics are sometimes necessary but widely overprescribed, and they decimate the healthy bacteria in our guts. About one-quarter of non-antibiotic drugs affect gut bacteria that influence our immune systems and brains, too.

One review of a large number of studies found that around the world, 30–95 percent of elderly people may be taking five or more prescribed medications at the same time.11 What’s more, nearly half of older people are taking one or more drugs that they don’t even need.12

This translates into a huge increased risk for elderly people who are prescribed multiple medications that can impact brain function with little apparent awareness of these side effects by their doctors and pharmacists.

A recent study of more than 33,000 dementia patients found that polypharmacy, the practice of taking multiple drugs at the same time, was very common in the final five years before a dementia diagnosis.

Around 65 percent of the patients were taking multiple meds for respiratory or urinary infections, rheumatism and heart disease, while a further 22 percent were being treated for infection, cardio-metabolic disease and depression.13

Look for other causes

A host of systemic conditions can also be responsible for cognitive impairment that may be misdiagnosed as Alzheimer’s or other dementia. These include anemia, B12 deficiency, B1 deficiency, leukemia, kidney failure, malabsorption, congestive heart failure, urinary tract infection, hypothyroidism and other endocrine disorders, subdural hematoma (a form of brain bleeding), HIV/AIDS and chronic obstructive pulmonary disease.

“Because these conditions can cause cognitive problems that mimic Alzheimer’s disease, it is necessary to perform screening blood tests to document their absence,” says Friedland.

Make deposits to your cognitive reserve 

Cognitive reserve is your brain and mind’s resistance to degeneration. The more fit your brain is, the more likely it is to resist damage.

Friedland points to groundbreaking research on the brains of London cab drivers. London is a tangled mess of old and new roads, and cabbies must train between two and four years to learn what’s called “The Knowledge” of thousands of roads and routes before they are certified to drive.

Neuroscientist Eleanor Maguire and her colleagues at University College London measured the size of the hippocampus, a part of the brain involved in memory and spatial processing, in prospective cabbies before and after they started studying London roads and demonstrated that their hippocampi grew with the training.14

That means that what we do can change our brains. “Physical and mental activity enhances the production of new neurons in the brain and increases the secretion of growth factors that help delay the progression of Alzheimer’s disease,” says Friedland.

In other words, a person’s behavior is determined not only by the progress of the disease but also by the brain’s ability to deal with the disease. That brain ability, in turn, is influenced by the behavior we choose.

We have some 86 billion neurons in our brain. Each one of them can connect with up to 30,000 other neurons and can continue to grow and make new neural networks throughout our lives. A 2018 study by Columbia University researchers found that the brains of teens and adults both had the same number of new nerve cells, for example.15

Brain training from Sudoku and crossword puzzles and websites such as Lumosity (lumosity.com) are useful. These don’t offer the same level of benefits that real-life learning or activities like playing a musical instrument, playing a game of ping pong or a competitive sport, painting, or learning a new language promote, however. The more complex the activity, the more of our brain is involved and the more neuronal connections are made, fueling the physical benefits.

Build your psychological reserve 

New research from Stanford University and the Chinese University of Hong Kong shows that being in a poor psychological state, such as feeling fearful and hopeless, adds up to 1.65 years to a person’s biological age and docks more life expectancy than even smoking.16

Depression and anxiety are factors that raise the risk of aging quicker and developing cognitive decline as well.17

So does stress. When a person is stressed, the body churns out excess steroid hormones called glucocorticoids, and these accelerate the aging process. They also affect memory and cognition.

Finding ways to wind down is critical. Again, exercise comes out on top as one of the most studied stress-busting activities. That may be why it affects mood disorders like depression at least as effectively as medication.18 While exercise adds huge deposits to physical reserve, it’s also a big contributor to psychological reserve.

Meditate

Meditation has also been shown to be very effective for stress reduction and is linked to delayed brain aging. Researchers from the UCLA School of Medicine, Jena University in Germany and the Australian National University examined data from previous studies using brain imaging on adults.

Their 2016 study published in the journal Neuroimage found that, at age 50, meditators had brains an average 7.5 years younger than those of controls according to a standardized BrainAGE index. Additionally, while age estimates varied slightly in controls’ brains, meditators’ brains showed significant changes: “for every additional year over fifty, meditators’ brains were estimated to be an additional 1 month and 22 days younger than their chronological age.”19

What’s great is apparently you don’t have to practice meditation for years to benefit. In a study published in 2022 in the journal Scientific Reports, German researchers detected beneficial changes in the brains of people who had never meditated before just 31 days after they began following an online practice.20

Boost your social reserve

Loneliness kills. Literally. Lonely adults are 25 percent more likely to die prematurely than those with robust social connections.21 People need people, and the detriments of depriving humans of meaningful human contact is so well documented that isolation of prisoners is strictly limited and seen by some as cruel and unusual punishment.22

No surprise, then, that social isolation is also linked to a 50 percent increased risk in the development of Alzheimer’s and other dementias.23

While this calls into question the wisdom of public health “lockdowns” to save lives, it also explains why people who are married, belong to a church and attend more activities have better cognitive function.

“Even at advanced ages, it is necessary to look for opportunities to connect with others,” says Friedland. “The loss of social contacts with aging because of the death of family members and friends, sensory and physical impairment, and lack of funds is an enormous problem for older people around the world.”

Life outside of work

Studies have also found that the more activities people engage in outside of work in midlife, the less likely they are to decline into neurocognitive disease.1

As the ever-youthful actress Sophia Loren, who enjoys sailing, swimming and tennis, once remarked: “There is a fountain of youth: it is your mind, your talents, the creativity you bring to your life and the lives of people you love. When you learn to tap this source, you will truly have defeated age.”

Get a pet

When your circle of friends dwindles, pets can help expand social interactions, adds Friedland, pointing to a systemic review of studies of the effects of dog ownership on mortality.

Owning a dog is associated with lower blood pressure, better lipid profiles and improved responses to stress as well as a 25 percent reduction in all-cause mortality (compared to non-ownership) and a 30 percent reduction in death from heart disease.1

“Dog ownership is also associated with better physical and cognitive function because, of course, owners need to walk their golden retrievers and regal French bulldogs,” says Friedland.

Although he doesn’t mention them, preliminary research shows cats confer cognitive benefits to their owners as well.2

References
Main Article

References

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Molecules, 2022; 27(20): 6804

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Lancet, 2016; doi: 10.1016/S0140-6736(15)01124-1

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Alzheimers Dement, 2022; doi: 10.1002/alz.12573

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Human Movement, 2019; 20(1): 62–74

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Int J Mol Sci, 2021; 22(6): 2897

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Medicine (Baltimore), 2020; 99(31): e20105

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JAMA Neurol, 2022; 79(10): 1059–63

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Diabetologia, 2009; 52(7): 1409–18; eLife, 2016; 5: e15092

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Arch Neurol, 2009; 66(11): 1339–44

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J Alzheimers Dis, 2015; 45(2): 349–62

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Eur Geriatr Med, 2021; 12(3): 443–52

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Aging Dis, 2022; doi: 10.14336/AD.2022.0829

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Proc Natl Acad Sci U S A, 2000; 97(8): 4398–4403

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Cell Stem Cell, 2018; 22(4): 589–99.e5

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Aging, 2022; 14(18): 7206–22

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Neuroimage Clin, 2021; 32: 102864; Transl Psychiatry, 2022; 12(1): 397; J Alzheimers Dis Rep, 2021; 5(1): 171–7

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Int J Psychiatry Med, 2011; 41(1): 15–28

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Neuroimage, 2016; 134: 508–13

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Sci Rep, 2022; 12(1): 13219

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Perspect Psychol Sci, 2015; 10(2): 227-37

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Front Psychol, 2014; 5: 585

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J Gerontol B Psychol Sci Soc Sci, 2020; 75(5): 919–26

 

A tight grip on your mind

References

1 

JAMA Netw Open, 2022; 5(6): e2218314

 

Life outside of work

References

1 

Proc Natl Acad Sci U S A, 2001; 98(6): 3440–5

 

Get a pet

References

1 

Circ Cardiovasc Qual Outcomes, 2019; 12(10): e005554

2 

J Aging Health, 2022; doi: 10.1177/08982643221122641

Article Topics: age-related, aging
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