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Centenarians: Lessons on Living Long and Living Well 2003 Special Lecture by Thomas Perls

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Centenarians: Lessons on Living Long and Living Well 2003 Special Lecture by Thomas Perls MIND ALERT Photo: Bob Levy CENTENARIANS: LESSONS ON LIVING LONG AND LIVING WELL 2003 SPECIAL LECTURE BY THOMAS PERLS A JOINT PROGRAM OF THE AMERICAN SOCIETY ON AGING AND THE METLIFE FOUNDATION TABLE OF CONTENTS Introduction . 1 MindAlert Lecture: Centenarians—Lessons on Living Long and Living Well . 2 About the Author . 12 For Further Reading . 13 Longevity Calculator . 14 2003 MindAlert Awards . 17 About the MindAlert Program . 19 MindAlert on the Web . 20 Copyright © 2003 American Society on Aging ementia affects elders of all cultures and classes, but cognitive decline is not Dan inevitable consequence of aging. The MindAlert Program, sponsored by the American Society on Aging and MetLife Foundation, is dedicated to sharing the findings of new research on how to maintain and enhance cognitive function in later life. What does it mean to reach 100? What can centenarians tell us about our own future and the future of our aging society? According to Thomas Perls, director of the widely publicized New England Centenarian Study, the growing numbers of cen- tenarians in our society may show us the way to finding a longevity gene—but they also demonstrate the effects of making the right health choices throughout life. “For most people, the average set of genetic variations should get us to our mid to late 80s, which I think is fantastic,” Dr. Perls says. “That’s a great poker hand. The question is, how are you going to play that hand?” This booklet contains the transcript of a lecture given by Dr. Perls in March 2003 at the Joint Conference of the National Council on the Aging and the American Society on Aging as part of the MindAlert program. In his lecture, Dr. Perls discuss- es why people who live to 100 are fascinating to medical researchers, biologists, and geneticists—and what we can learn from them about extending our own life expectancy. Also profiled are the winners of the third annual MindAlert Awards, which recog- nize programs that support enhanced cognitive function in later life. • 1 CENTENARIANS: LESSONS ON LIVING LONG AND LIVING WELL Thomas Perls Last year, Paul Nussbaum gave a wonder- for everybody.At the age of , she was ful lecture on the inner workings of the playing beautiful Mozart and Chopin. Ed brain and its relationship to the rest of our Fisher, age , had been a tailor all his life. body. (To view the transcript from Dr. He was out and about mending every- Nussbaum’s speech, visit www.asaging.org/ body’s clothes.And when he wasn’t hem- mindalert.) He spoke on brain health from ming, he was with his -year-old girl- one to 100. I’m going to center our atten- friend. Robbing the cradle! tion on the 100 end of that spectrum. These two people sparked my interest. They were very different from what I had Debunking the expected. I had been interested in Alz- Conventional Wisdom heimer’s disease for a long time. Most neu- rologists back then would say that We started the centenarian study back in Alzheimer’s disease is already very common , when I was a geriatrics fellow at Har- at age . In the East Boston Study, Drs. vard Medical School looking for a research Marilyn Albert, Dennis Evans, and col- project. I started with some fairly ingrained leagues demonstrated that about half of all notions that I shared with many people, people ages and older had a diagnosis of namely that the older you get,the sicker you Alzheimer’s disease. Given that neurofibril- get. I think this notion is dissipating these lary tangles and neuritic plaques accumu- days,perhaps in part because of our research. late over time, most researchers in the field When I was an orderly in a nursing home at accepted the notion that by the age of age ,the things I saw weren’t too different, everybody should have Alzheimer’s.Clearly, unfortunately,from scenes out of One Flew these two centenarians didn’t.What was Over the Cuckoo’s Nest—some pretty hor- going on here? rendous care. Even at age , I recognized Eventually I discovered that of the that some of the residents had absolutely no people living at the Hebrew Rehabilitation business being there.They were fine.There Center for Aged, there were other cen- certainly should have been alternative places tenarians.When I went looking for the for them to be, if not just in their home.At other centenarians in this long-term care the same time, though, because the only setting, I found that some weren’t doing so older people I knew were living in a nursing well. About three-fourths of them had home, my view of how old people fared in some degree of cognitive impairment rang- general was pretty skewed. ing from mild to fairly severe.The other When I went through college and med- percent to percent were fine, despite ical school, the idea that the older you get, being in a long-term care setting. the sicker you get was pretty much a tenet I decided to initiate a population-based of medicine. So there I was, in the second study in New England in which we would year of my geriatric fellowship at Harvard, take eight towns—about , people in in charge of patients at the Hebrew Re- total—and try to find all the centenarians habilitation Center for Aged.Two of the we could and see what they were like. By patients were the first centenarians I had finding all the people with the specific trait ever met. One of my tasks was to conduct we were interested in—that is, exceptional physical exams on all the patients. Over the longevity—we were hopeful of minimizing first six months, I got to see everybody, but selection bias and therefore obtaining a rep- every time I attempted to find these two resentative sample of New England’s cente- individuals they were never around. I narians. Massachusetts is a good place to thought they were probably off seeing their conduct such a study because it has an an- specialists for the myriad problems they nual census.The -year census that takes were having. But I eventually tracked them place in most states as a part of the federal down. Celia Bloom was out playing piano census is much too infrequent as a tool for • 2 finding centenarians, given their nearly tually immortal. Normal cognitive function percent annual mortality rate. at this extreme age is a powerful predictor Margery Silver, a neuropsychologist, of future health. Individuals who go on to joined the New England Centenarian be , , or , and only then develop Study early in its inception and set out to some cognitive impairment, only then tend see what the prevalence of dementia was to have a very rapid decline. But what a among centenarians.What she found was payoff! To live such an incredibly long pe- fairly similar to the eventual findings of the riod of time and then compress the time handful of other centenarian studies con- that one is sick toward the end of life is ducted around the world:About per- cent of the centenar- ians were cognitively intact and about percent showed varying degrees of cognitive impair- ment.At first glance, a percent rate of cognitive impair- ment would appear not to be consistent with our hypothesis that centenarians have a decreased sus- ceptibility to Alzhei- mer’s disease. However, we sus- pected that if these Figure 1. Functional status of centenarians in a population-based sample. individuals devel- Ninety-two percent were functionally independent at the average age of 92 oped Alzheimer’s dis- years. Source: Hitt et al., 1999. ease, it was not until late in their very long lives that they clini- something I think all of us would want, cally expressed the disease. Rachel Hitt, a whatever age we live to be. medical student at Harvard Medical School So the picture was beginning to emerge who received funding from the American for us that living to was actually a Federation for Aging Research and the tremendous advantage. It wasn’t something Hartford Foundation to conduct geriatrics to be shunned. In , I authored, along research during her summer break from with Margery Silver and John Lauerman, a school, obtained all the clinical information book titled Living to :Lessons in Maximiz- she could on these individuals. She talked to ingYour Potential at Any Age.That book did caregivers, physicians, and family members, OK, though not as well as any author hopes and also interviewed patients and reviewed for his or her book.Actually,I think the issue their medical records.What she found was was the title.Many people have this idea that that percent of the centenarians had the older you get, the sicker you get, and been functionally independent years ear- they looked at the cover and thought,“Who lier at the average age of .They developed would want to live to ?”And they’d go functionally significant impairment in only for the book next to it that told them they the remaining percent of their very long could grow young with human growth lives (see figure ). hormone and similar nonsense. As for the centenarians who were totally At the time, I felt that if centenarians fine at —not to be sensationalistic, but if were at least delaying Alzheimer’s, it would you’re cognitively intact at , you’re vir- be good to study them to find out how and • 3 why they were able to do it.The Alzheim- with major events in it; the story lasts er’s Association gave us our first grant to about minutes.The subject is then asked start to look at these issues.
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