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. to retell the story. It is a hard test, but she completed it perfectly.After numerous such Alzheimer’s Isn’t Inevitable tests, we were just amazed. She had a spec- tacular neuropsychological examination. Dr. Silver began to get interested in what Dr. Silver looked at Mrs. Morgan and said, the brains of the dementia-free centenari- “You know, you’re unbelievable. I’d really ans would look like.We came across one like to know what your brain looks like.” woman in particular named Anna Mor- Dr. Silver and I had heard about the nun gan—I can say her name because she’s fea- study,where older nuns were willing to un- tured in the book. She was living in dergo annual neuropsychological examina- Somerville, Mass., in a triple-decker house tions and then allow their brains to be au- with one generation of her family on each topsied once they had died.A number of floor. Mrs. Morgan was living on the top subjects who were cognitively intact had floor, and she was the matriarch, an unbe- brains full of neurofibrillary tangles and lievable lady. Plastered on the front door of neuritic plaques, bringing up the questions her apartment was a Bill Clinton sticker, so of functional reserve and adaptive capacity. we already knew we were about to have a Researchers like Dr. Nussbaum are now unique experience. We walked in, and trying to figure out the neurophysiological basis of this phenomenon. Is it building a We found that 90 percent of the centen- lot of dendrites, the connections between brain cells? Is it some kind of neuronal re- arians had been functionally independent serve? How are these individuals clinically able to be so much better than what their 10 years earlier at the average age of 92. brain autopsies indicate? What would Anna Morgan’s brain au- there she was, at eight in the morning, on topsy eventually reveal in the setting of her her exercise bicycle. She was wearing a remarkable cognitive function? Dr. Silver dental visor with magnifying glasses and a asked Mrs. Morgan if she would donate her bright light. She found that if she got up brain. Her first reaction to this request was, early in the morning when her eyes were while chuckling,“Well,I’m still using it.”She fresh, she could read while she exercised. was totally supportive of the idea. She was She wouldn’t break that routine for us; we only sorry she wouldn’t be around to learn had to calmly sit there on the couch and the results. Six months later, we returned for watch her until she was finished, come hell another round of neuropsychological test- or high water. ing, and three months after that, she passed And she was grumpy.I don’t know many away suddenly from an arrhythmic event. grumpy centenarians. She was reviewing Kathy Newell, the neuropathologist at the -page autobiography that she had Massachusetts General Hospital that we col- started at the age of .The editor had whit- laborated with, exclaimed two weeks later, tled the manuscript down to pages, and “My God, she’s got a beautiful brain.”Anna she was swearing over every little deletion. Morgan had very few if any neuritic plaques After Mrs. Morgan got off her exercise or neurofibrillary tangles (see figure ). bicycle, we asked her to do some neuropsy- Here was more objective evidence, albeit chological testing with us. So we sat down in one person, that Alzheimer’s disease was at the kitchen table, with a few -year-old not an inevitable consequence of living to kids looking on, and she was just unbeliev- . In fact, we have come to regard cases able. Dr. Silver would recite seven digits for- such as Mrs. Morgan’s as a neuropathologi- ward to her and Mrs. Morgan could recite cal model of disease-free aging.Anna Mor- them to us backwards.Another test we ad- gan showed us both clinically and patho- ministered was called the “Rochester Cow- logically that there is no such thing as boy Story,”in which the tester reads a story “changes consistent with age”—the ¥
4 diagnosis often attributed to white matter dementia. Looking at videotapes of the changes often observed on the MRI of neuropsychological testing of Jeanne Cal- older patients.We started to get very ex- ment, who still holds the record for being cited about studying centenarians to figure the oldest living person at (she passed out what made them different from other away in August ), we know that Mrs. people, allowing them to live or years Knauss had a similar clinical presentation. beyond the age of , much of that in good Madame Calment could still sing the health.That’s a third or half of a lifetime! French national anthem. In some areas, she Anna Morgan cruised on to and died was very bright and then there were other cognitive domains in which she did not do well.This type of lo- calization of deficits (rather than global involvement) suggests a component of vas- cular disease con- tributing to her clini- cal impairment. A mixed picture of Alz- heimer’s disease and vascular disease could pan out to be the typical cause of cog- nitive impairment in extreme old age. 52-year-old man with 102-year-old woman with But here’s the Alzheimer’s disease no dementia hook. Mrs. Knauss was living independ- Figure 2. Neuropathological examination of representative brain sections ently in her own in a patient with Alzheimer’s disease and a centenarian with no cognitive apartment at the age impairment. of . So it’s really relative.To get to , at , and she escaped Alzheimer’s. But you probably have to be cognitively func- what if she had lived to or ? Would tionally independent through age . Many some kind of neuropathological process of these people do fine up until age .To have become evident? Is it inevitable that live to , perhaps one has to be cogni- she would have Alzheimer’s? Well, we did tively functionally independent at age . have a -year-old who passed away and And to live to , again, Sarah Knauss was went on to autopsy: Sarah Knauss of Allen- doing very well at . dale, Penn. People ages and older are termed su- Secrets to Living to 100 percentenarians. Centenarians are rare, about one per ten thousand. Supercente- Once we realized what a tremendous ad- narians are about one per million.The old- vantage it was to live to in terms of est person in the world, a -year-old, was compressing disability toward the end of one per . billion.When we saw Sarah be- life, we of course wanted to discover the fore her death, she presented quite similarly centenarians’ secrets for such a tremendous to the other oldest people in the world survival advantage. Perhaps more for fun, who have been studied by clinicians: quiet, we always ask them what their secrets are. very frail. She had difficulty with hearing Often they’ll say it’s faith. I think that faith and vision, and her scores on neuropsycho- is quite important in this group. Perhaps logical tests indicated that she had moderate faith is an important means of effectively ¥
5 managing stress. Stress has been shown to Beyond personality,the factors that we contribute to the pathogenesis of hyperten- normally associate with longevity in the sion and vascular disease.They’ll tell you general population—more years of educa- that having a cause that gets them up in the tion, better access to healthcare, better so- morning is very important. Some will also cioeconomic status—didn’t really pan out tell you that it’s genetic; many of their fam- to be common among centenarians, who ily members have reached very old age as are quite a heterogeneous group. It was sur- well.They’ll tell you that it’s luck.And then prising to us that these factors were not im- they’ll come up with goofy things.We portant factors for living to exceptional talked to a married couple, which is rare— longevity,at least among our study cohort. actually, he was 106 and she was —and Some centenarians, in fact, have a history of he said that his secret was a set of early- very unhealthy habits such as significant to- morning range-of-motion exercises and a bacco or alcohol use.And yet,despite factors bowl of dates, raisins, nuts, and some fiber that would predispose most to premature with a half cup of olive oil poured over the mortality,these individuals were achieving top.And I’m thinking, I’m not living to extreme old age.The question remained, if that’s what it takes. what do centenarians have that allows them He looked at his wife kind of fiendishly to get away with such indulgences? and said,“Sophia Loren rubs it all over her body and she looks great!” His wife glared Longevity Runs in the Family at him—a really bad glare—and said,“That’s a bunch of hogwash.It’s the two jelly donuts Our research has yielded some clues.The and glass of orange juice every morning!” first clue came from census findings and Margery Silver is leading a pilot project local newspaper announcements of people conducting personality testing on cente- turning . One day we saw in the Patriot narians. She has preliminarily found that on Ledger, the daily newspaper of Quincy, this test called the NEO, centenarians Mass., a photo of a -year-old man blow- scored quite differently than other older ing out his birthday candles.That is rare adults on a domain called neuroticism. In- enough,but then there was his -year-old stead of internalizing stress, people who sister looking on. I couldn’t get to Quincy have low neuroticism scores seem to let it fast enough to meet these two.They were go.The amount of stress isn’t as important happy to be in the study and then said, as how the centenarians manage their “Swing by Hartford, Conn., where our stress.With such a personality, there seems -year-old sister is, and while you’re at it, to also be gregariousness—centenarians go down to New Jersey to visit our - tend to be funny.I can only recall one cen- year-old sister. It’s too bad you weren’t tenarian I’ve met—now, there’s big selec- around two years ago when our other two tion bias to this—who was really curmud- centenarian siblings were still alive.”Here geonly and just not a nice person. Clearly, was a family with five siblings out of nine the centenarians we don’t recruit are prob- achieving age or older; the other four ably more likely to fit that category,but the had passed away at a very young age be- ones that we have recruited tend to be a cause of childhood infectious diseases. lighthearted, wonderful group of folks. Back in , one-quarter of the popula- Most have lost their spouses, they’ve lost tion died during childhood. In fact, the av- other family members, they’ve lost friends, erage life expectancy back in in the but they have personalities that really draw United States was about years; child- people into their lives.Their gregariousness hood mortality pulled down the average likely facilitates social networks, social safety life expectancy. But then the problem of nets, that also become very important.We childhood mortality was solved with such are still investigating personality traits. measures as clean water, vaccinations, an- These, like many other traits that could be tibiotics, and so on, our healthcare radically linked to exceptional longevity, merit improved, and we now have an average life much more investigation. expectancy of or years. ¥
6 When you find a family where a bunch example, and they’re rife with false positive of kids or a parent and kids have a particular results. Probably six linkage studies—out of disease, you start suspecting genetic causes. hundreds—have come out as reproducible. Obviously, I wasn’t considering a disease Part of the problem is phenotyping. but rather a wonderful trait. One day I ran When you are studying the genetic basis of into Louis Kunkel, who’s a preeminent a trait, you need to be sure that it is ex- Harvard-based geneticist at Children’s Hos- tremely well defined and succinct. If you pital, and I mentioned this family of cente- just draw blood from everybody with high narians. He became pretty interested in this blood pressure, some of the people are family, and I went out and found a few going to have high blood pressure because more similar families for him to study. their kidneys are putting out too much al- There were a couple of fortunate things dosterone, for instance, and others may have about meeting up with Dr. Kunkel: He high blood pressure because their arteries didn’t know much about aging and he was- are too stiff.These two types of individuals n’t laden with a lot of preconceived notions represent a whole set of different genetic about genetics and aging.At the time the and environmental factors that cause high conventional wisdom was—and still is, to a blood pressure.A similar scenario exists for certain degree—that aging is an incredibly many syndromes and illnesses currently complex thing.Aging can be viewed as a under study. myriad of propensities for age-related dis- What was to our advantage with our eases influenced by many environmental linkage study was that living to was and behavioral factors, genetic factors, and quite definable: First, all you had to do was good old luck. count the years, and second, it was very No one in their right mind would fund a rare.Approximately one per ten thousand study to look for such a gene. All Dr. in the population is a centenarian. So we Kunkel knew was that certain families felt that it was worth pursuing. showed significant clustering. Lou Kunkel Previous Scandinavian studies of twins and Annibale Puca, a talented neurologist had shown that a relatively small amount of from Italy,took it upon themselves to at- aging had to do with genes.When the re- tempt to discover some genes related to searchers looked at pairs of twins, some of longevity. whom had been reared apart versus reared In order to do a sibling pair study to together, they found that percent to search for such genes, we had to search the percent of the variation of how long these United States for centenarians with living individuals lived was related to genes. Sev- brothers and sisters.The way these linkage enty percent to percent was related to studies work is that you enroll a lot of environment. brothers and sisters who have some trait in common—in this case, the ability to live The Human Chassis: to exceptional old age.Then, you study How Far Can It Go? their DNA for any regions they have in common—much more than you would The fact that percent to percent of expect to occur by chance.When the re- aging can be dictated by one’s behaviors searchers examined the DNA of all these and environment is a very enabling point of centenarians, to everybody’s surprise and view. In their book Successful Aging, Jack happiness, a region on chromosome four Rowe and Robert L. Kahn reported this was of significant interest. enabling view, and they got a lot of under- Now, my wife, a pediatric cardiologist at standable attention for it. Basically, they in- Children’s Hopital, always acts as my best dicate that if you do all the things your devil’s advocate. She would be the first one mom told you to do except clear your to tell you that these linkage studies need to plate, you should be able to live to quite an be taken with a grain of salt.There have old age in good health. been linkage studies on diabetes, hyperten- However, our centenarian studies are in- sion, homosexuality, and schizophrenia, for dicating an important genetic component ¥
7 to longevity.So how do these observations But with the centenarian study, we aren’t jibe with one another?The key to this story studying average life expectancy; we are is that the oldest individuals in the twins studying the ability to get to . Based on studies were in their late s and early s. the findings from the chromosome-four So what that says to me is that for most study and some genetic epidemiological people, the average set of genetic variations studies that we’ve done, I’d wager that to should get us to our mid- to late s, which get to extreme old age you need some sort I think is fantastic.That’s a great poker of genetic booster rocket. hand.The question is, how are you going to Another genetic study we did looked at play that hand? If you’re going to smoke, if the probability of the brothers and sisters you’re going to be obese, if you’re not going of centenarians reaching themselves. It to exercise, if you’re going to have a diet turned out that the brothers were times that is conducive to poor heart health and more likely to reach compared with other people born around the same time, and the sisters were eight times more likely.These relative survival probabilities just scream genetics. Also, when we looked at the age of death of all the bro- thers and sisters of centenarians, we found that from age to extreme old age, for every year, these siblings had half the mortality Figure 3. Relative survival of siblings of centenarians, compared to men and women also born in 1900. The lower horizontal dotted line indicates a rela- rate of their peers tive mortality rate of 0.5. in the general pop- Source: Perls et al., 2002. ulation. I don’t know of major ge- netic factors that obesity,then you’re not playing that hand significantly influence differential survival well.And some people have poorer hands among the general population in their s to start with. and s.We don’t really start developing But by not playing our hands well, we heart disease, stroke, or other age-related end up with an average life expectancy of diseases until our s, s, and s. And about years less than what we’re capable diseases like childhood leukemia and of achieving. Studies of Seventh Day Ad- retinoblastoma are so rare, they don’t figure ventists support this assertion. Seventh Day into these mortality rates. Adventists hold the belief that to do things The causes of death that I see happening that are bad for their bodies is a sin. So in the s, s, and s are things like not they’re vegetarian, they don’t smoke, they wearing seatbelts, or going through testos- don’t drink (although a small glass of alco- terone storms as a male and shooting some- hol a day is probably good for you), they body, or driving miles an hour down a exercise, they tend to be lean.As a result, lo country road. On the other hand, survival and behold, they have an average life ex- advantages would be at play at these ages as pectancy of years.That’s what our genes well. Having your mom taking good care are generally capable of achieving for us. of you and sequestering you from strep in- ¥
8 fections, especially at a time when penicillin centenarians who have smoked three packs was not available, or a whole host of factors a day for years, and they don’t have lung that would have given these individuals disease, cancer, or even heart disease. some kind of advantages in their s, s, I think that studying these extremely rare and s over the rest of the population centenarians will be valuable from a genetic would contribute to the impressive survival point of view—to find out what genetic at- advantage we were observing.As we start tributes protected them. In thinking about getting into the ages when age-related dis- these cases, it seems likely something pro- eases start to kick in, I would imagine that tective is going on, like some type of some genetic factors also start to play roles longevity-enabling or protective gene. in differential survival (figure ). There are all kinds of problems with hy- Our findings thus far suggest that the pothesizing that such a thing exists. For ex- chromosome-four gene is probably a similar ample, from an evolutionary point of view, story to apolipoprotein E (ApoE). If you inherit the E variation of the apolipopro- I think these extremely rare centenarians will be tein E gene from your mom or dad, you fi have a signi cantly increased risk of devel- valuable from a genetic point of view—to find out oping Alzheimer’s disease in your sors. While the E allele is very rare among cen- what genetic attributes protected them. tenarians there are actually centenarians who inherited a copy of apolipoprotein E from one parent. I’ve seen one centenarian why do a rare few people rather than lots of with two copies (one from each parent). So people have such a protective factor? having the gene doesn’t mean you’ll in- I was hopeful that we’d find such a pro- evitably get Alzheimer’s in your sors. tective gene on chromosome four because it We don’t have enough genetic epidemio- might interfere with the process of aging at logical information to be able to determine a basic biological level.You know,there are what level of risk the E allele actually con- lots of thoughts about what aging is. Some fers. Furthermore, the patterns are different people think aging is free-radical damage for different racial and ethnic groups. that destroys DNA and cellular membranes. It’s still too early to tell what will happen Or that the rate of aging relates to the ability with the discovery of these genes.We have to repair DNA damage.There are many known about ApoE since the early s, theories, some of which have quite a bit of and we still don’t know what to do with scientific evidence to support them. that information, especially since it varies A few people, including me, have a pet from race to race.There seem to be many theory about why women live longer than interactive effects with habits and health men. It relates to free-radical damage. Gen- behaviors. erally speaking, up through menopause, women delay stroke and heart disease by The Right Combination of Factors about years relative to men. People at- tribute that gap to estrogen. Estrogen could Becoming a centenarian is so rare that it provide an advantage given that it is an an- is apparent that just the right combination tioxidant. But the other thing that differen- of genetic and environmental factors—as tiates women from men, besides making well as luck—is required for a person to much more estrogen (at least before make it to . In other words, the stars menopause), is that women also menstru- have to line up just right. However, they ate. Menstruating for or so years, women need not always be the same combinations often become iron deficient.The iron defi- or “dosages” of factors. For example, we ciency is probably key, because there are have a handful of subjects who have thrown two metal ions, copper and iron, that are the equivalent of an atomic bomb at their critical to our cells’ ability to produce free bodies and they’re still getting to in radicals.We don’t have that much copper in very good shape. I have seen three or four our bodies, but we have a lot of iron. Hav- ¥
9 ing less iron in your body could mean pro- developing drugs to block or enhance the ducing fewer free radicals.And by being effect of the gene. more iron deficient than men, perhaps Given the possibility of discovering women are producing fewer free radicals longevity-enabling genes or disease genes, I over time. Free-radical damage plays a key am not interested in joining the anti-aging role in cardiovascular disease,Alzheimer’s industry with its outrageous claims and disease, and other age-related diseases.Thus, prevalent quackery.The reason I want to maybe having less iron is playing a role. study centenarians is that they markedly The major makers of adult vitamins, delay or escape the diseases associated with such as Centrum Silver, have recognized aging, and compress their disability toward this possibility and have taken iron out of the end of their lives. It’s the quality,not the their vitamin formula. But if your doctor quantity,of the years that are so important says you should be on iron because you’re to me. So I’m not expecting my research to iron deficient, you better find out why. If lead to many more people surviving to . you’re a menstruating women, then it’s ob- Ideally,I would just love to help people get vious. But if you’re a man or post- to their late s and compress the time they menopausal woman, there’s something are sick until the relative end of their lives. wrong going on.You may be losing blood Much of this can be achieved already by through your gastrointestinal tract or de- changing health-related behaviors to be stroying red blood cells for some reason. conducive to longevity,not premature mor- There are a number of possibilities. But tality.If our centenarian work results in you shouldn’t just be placed on iron. And some drugs that help people add a few more women who feel fine even though they healthy years to what their “poker hand” is are anemic due to iron deficiency do not capable of achieving, that would be won- need to be on iron. derful as well. I am hoping that out of this work we’re It’s the quality, not the quantity, of our going to discover variations of genes that specifically predispose people to Alzhei- years that are so important to me. mer’s. Maybe at some point we’ll have enough genetic epidemiological evidence to be able to do a genetic study on an indi- There have also been studies looking at vidual and estimate his or her predisposi- iron-rich diets due to meat consumption. tions to x, y, and z diseases. So if you have a Maybe one of the problems with meat isn’t certain gene that combines with a smoking the cholesterol—maybe it’s the iron in the habit to produce a disease, we could say, meat.A study in the Netherlands found “Don’t smoke.”Or even give you a pill to that individuals on heme-rich (meat) diets take to counteract the effect of a gene, say, had a percent increased risk of heart that predisposes a person to Alzheimer’s. disease compared with those who weren’t, Again, regarding the anti-aging industry, after correcting for a lot of factors. there is not some magic pill or growth hor- Getting back to the genes we’re now mone that’s going to allow people to stop searching for, I wager that whatever we find aging or to reverse it.There is no such thing will have a significant impact upon our un- as anti-aging medicine.There’s only anti- derstanding of aging, as well as on our un- aging quackery. derstanding of Alzheimer’s disease.There The Journal of the American Medical Associa- are certainly aspects of aging that set the tion just published an article (“Growth brain up to be susceptible for developing Hormone and Sex Steroid Administration Alzheimer’s.What are we going to do with in Healthy Aged Women and Men,” Nov. that information? If you discover a gene , ) about a trial using growth hor- that’s playing an important role, you have a mone.The researchers saw percent of window into the biochemical processes the study group develop adverse effects; that influence the disease. Once such path- to percent actually developed diabetes. ways are understood, the possibility exists of These are huge rates that cannot be down- ¥
10 played. But adverse side effects are not re- and complex as Paul Nussbaum suggests, ported for anti-aging therapies. People like learning a new musical instrument or don’t want to tell others that they fell for learning a new language, and thus increase this stuff, and then there are a bunch of the functional reserve of your brain, you people in the anti-aging industry who are might add a couple of years. just trying to fill their greedy pockets. That’s how the calculator works—and I Half of what I do is try to fight these think that’s how we should all think about hucksters. So I spend a lot of my time talk- aging. Many people believe the older you ing about how centenarians have this very get, the sicker you get, so there’s no reason long period of good health, and how a lot to worry about your health or put effort of people have the power in their hands to maximize their health through their s. People don’t need to fall for the quackery. Centenarians are important to us because Extending Your Own Life they raise the bar for what the rest of us
So, since I brought it up, let’s talk a little think is possible. bit more about what you can do to get to your mid- to late s in good health.There into being healthy at these older years. certainly are not a lot of purported answers However, if it’s really a case of the older you out there, and some of the things we hear get, the healthier you’ve been, one realizes about shift with the wind. For instance, vi- they could have to years of good tamin E and calcium—you’ll hear one health beyond the age of . thing one day and the next you’ll hear The last thing I would say along these they’re bad for you. But I do think some lines is that centenarians are important to things are tried and true. us because they raise the bar for what the We boiled these few true things down rest of us think is possible.When I was into a life expectancy calculator (see page growing up, I thought was ancient. ). It’s basically questions about things Eighty-five now seems to be pretty plausi- you should take into account when think- ble when you’ve got a bunch of -year- ing about your life expectancy.The way it olds running around. It’s not too different works is that you’re given (men) or from when Roger Bannister first ran the (women) years to begin with. If you smoke, four-minute mile.All of a sudden, there it knocks offyears right off the bat. If were a lot more people running five- you do regular strength training exercise, minute miles. Now that so many people you add a couple of years. If you have a run marathons, I would wager there’s even vegetarian diet, well, maybe it will just keep more people running K races. Having you the way you are; you’re taking advan- the centenarians around has a pretty signifi- tage of your genes but you may not be cant impact upon what the rest of us think adding much. If you go do something novel we’re capable of doing. ¥
11 ABOUT THE AUTHOR
Thomas Perls is a physician and researcher in the study of aging at Boston University Medical School. As associate professor in medicine and a geriatrician, he cares for older patients at Boston Medical Center. Since he first discovered that his centenarian patients were among his healthiest, Dr. Perls has become one of a handful of experts in the world who are studying these exceptional human beings. For the past eight years, he has directed the New England Centenarian Study (NECS). Funded by the Institute for the Study of Aging, the Ellison Medical Foundation, the Alzheimer’s Association, and the National Institute on Aging, the NECS is the world’s largest genetic and social study of centenarians and their families. ¥
12 FOR FURTHER READING
Here are a few of the research studies referred to in Dr. Perls’ lecture:
Hitt, R., Young-Xu, Y., and Perls, T. 1999. “Centenarians: The Older You Get, the Healthier You’ve Been.” The Lancet 354(9179):652. Perls, T., Shea-Drinkwater, M., et al. 2000. “Exceptional Familial Clustering for Extreme Longevity in Humans.” Journal of the American Geriatric Society 48:1483-85. Perls, T., Silver, M., and Lauerman, J. 1999. Living to 100: Lessons in Living to Your Maximum Potential at Any Age. New York City: Basic Books. Perls, T., Wilmoth, J., et al. 2002. “Life-Long Sustained Mortality Advantage of Siblings of Centenarians.” Proceedings of the National Academy of Sciences USA 99:8442-47. Puca, A., Daly, M. J., et al. 2001. “A Genome-Wide Scan for Linkage to Human Exceptional Longevity Identifies a Locus on Chromosome 4.” Proceedings of the National Academy of Sciences USA 98:10505-508. Silver, M. H., Jilinskaia, E., and Perls, T. 2001. “Cognitive Functional Status of Age-Confirmed Centenarians in a Population-Based Study.” Journal of Gerontology: Psychological Sciences and Social Sciences 56B:134-P140. ¥
13 THE LIVING TO 100 LIFE EXPECTANCY CALCULATOR
Reprinted with permission by the author from Living to : Lessons in Living Your Maximum Potential at Any Age (New York:Basic Books, ).
We designed the Life Expectancy Calculator to translate what we’ve learned from studies of centenarians and other longevity research into a practical tool for individuals to estimate their longevity potential. Better scores indicate a reduced risk of disability toward the end of life. Of course, no one can guarantee either con- tinued health or longevity.However,everyone should be aware of the factors that increase or decrease mortal- ity and disability risk. Some of these are under individual control, and people who want to live longer, healthier lives should try to fashion their lifestyles accordingly. The average person is born with strong enough longevity genes to live to age and maybe longer. Peo- ple who take appropriate preventive steps may add as many as quality years to that. People who fail to heed the messages of preventive medicine may substract substantial years from their lives.
To use this calculator, add your negative and positive scores separately.
. Do you smoke or chew Do you smoke or chew tobacco, or are you around tobacco, or are you around a lot of secondhand smoke? a lot of secondhand smoke? If yes . . . - If no . . . +
. Do you eat more than a Do you stay away from couple of hot dogs, slices processed meat? of bacon, or a bologna sandwich a week? If yes . . . - If yes . . . +
. Do you cook your fish, Do you minimize the poultry,or meat until amount of meat in it is charred? your diet? If yes . . . - If yes . . . +
. Do you use butter or Do you stay away from cream regularly? butter, cream, and other Do you eat cheese or fried saturated fats, as well as foods regularly? fried foods? If yes . . . - If yes . . . +
. Do you drink wine and Do you drink one glass liquor in excess? of red wine daily? If yes . . . - If yes . . . +
. Do air pollution warnings Do air pollution warnings occur where you live? occur where you live? If yes . . . - If no or rarely . . . +
. Do you drink more than Do you take an oz of coffee a day? aspirin a day? ¥ If yes . . . - If yes . . . +
14 . Do you floss your teeth Do you floss your teeth every day? every day? If no . . . - If yes . . . +
. Do you have a bowel Do you make a point of movement less than once eating plenty of fruits, every two days? vegetables, and bran every day, preferably in place of foods that are bad for you? If yes . . . - If yes . . . +
. Do you engage in risky Do you engage in risky sexual or drug-related sexual or drug-related behavior that increase behavior that increase your risk of getting HIV your risk of getting HIV or a cancer-related virus? or a cancer-related virus? If yes . . . - If no . . . +
. Do you try to get a suntan? Do you avoid the sun and use sun block? If yes . . . - If yes . . . +
12. Are there dangerous levels Have you checked and found of radon in your house? that there is no detectable radon in your house? If yes . . . - If yes . . . +
. Does your body mass Does your body mass index* put you in the index* put you in the obese category? lean category? If yes . . . - If yes . . . +
. Do you live too far away Do you live near enough to from other family members other family members that for visits to be spontaneous? you can drop by spontaneously? If yes . . . - If yes . . . +
. Does stress bother you to Can you shed stress? the extent that you can’t This might be by praying, seem to shake it of? exercising, meditation, being able to respond to humor, or by other means. If yes . . . - If yes . . . +
. Does more than one Is there diabetes in your member of your immediate family? family have diabetes? If yes . . . - If no . . . + ¥
15 . Were both of your parents Is there more than one of dead or very frail by the following relatives in their s? your family who have reached at least age in excellent health: parents, aunts/uncles, siblings, grandparents? If yes . . . - If yes . . . +
. Are you a couch potato Do you exercise 20 minutes (no regular aerobic or or more a day? resistance exercise)? If yes . . . - If yes . . . +
. Do you take vitamin E Do you take vitamin E ( IU/day) and selenium ( IU/day) and selenium ( mcg) daily? ( mcg) daily? If no . . . - If yes . . . +
Divide each of the two scores (negative and positive) by .
= = = = = = = = = = = = = = =
Now,add the negative score to the positive score for an estimate of the number of years you should add or subtract from your life expectancy.
For example: - ⁄ = - (negative score divided by 5) ⁄ = (positive score divided by 5) - + = (negative score added to positive score) + = (final score added to life expectancy)
For most men, life expectancy is about years, and for most women, about years.
____Years added to or subtracted from your life expectancy
* To calculate your body mass index determine your weight in kg (pounds/2.2) and height in meters (inches x 2.4/100) and then calculate your BMI as kg/m2.A BMI > 27 would qualify as “obese.” A BMI < 24 would be “lean.” ¥
16 2003 MINDALERT AWARDS
he ASA-MetLife Foundation MindAlert the Internet so that they can become part- T Awards were established to recognize ners in their healthcare.The project ad- innovations in mental fitness programming dresses a major barrier to health literacy in for older adults. Based on research showing elders: the wasted potential of the Internet that cognitive decline is not inevitable with to empower elders to take charge of their aging, these awards recognize programs, health, due to their inability to use comput- products, or tools that promote cognitive ers and their inability to find and read most fitness in later life.The programs are judged of the health information on the Internet. for their innovation, their basis in research, CyberSeniors has a successful educational demonstration of their effectiveness, poten- tool in place that uses hands-on workshops, tial for replicability,and the extent to which features an interactive website (www.cyberse- the programs are accessible to diverse pop- niors.org/cyberhealth), and makes elders eager ulations of elders. to learn. This year’s awards were given in three categories: Normal Mental Fitness, Early- EARLY-STAGE DEMENTIA PROGRAMS Stage Dementia Programs, and Innovative Creativity and Dementia Older Adult Learning Programs. Dalia Gottlieb-Tanaka, Consultant NORMAL MENTAL FITNESS West Mall Vancouver, CyberSeniors/CyberTeens CyberHealth British Columbia CyberSeniors.org Creativity and Dementia, developed by Portland, Maine Dalia Gottlieb-Tanaka,builds on a program promoting creative expression for older CyberSeniors/CyberTeens CyberHealth adults with early-stage dementia, providing is a unique, intergenerational partnership them with opportunities to socialize, ex- among CyberSeniors.org, the aarp Na- press, be heard, and be valued.Two compo- tional Retired Teachers Association, the nents of this program were recognized for National -H Organization, Maine Health, the award in the area of early dementia: an Maine Partnerships for Healthy Aging, the educational training workshop for care- University of New England’s Health Liter- givers of older adults with dementia, and an acy Center, Harvard University’s Geriatric exhibit of art produced by elders with de- Education Center, and the NIH/National mentia scheduled to travel across Canada Library of Medicine. and the United States. The coalition’s purpose is to raise aware- The workshops, already in progress, are ness of the many ways computer and Inter- presented by Gottlieb-Tanaka and her ad- net technologies can help elders retain their viser, Jeff Small of the University of British independence as they age, provide training Columbia.The workshops are offered to resources that allow elders to develop com- community-based professionals and to for- puter skills at their own pace, teach elders mal and informal caregivers.They consist of how to locate and use meaningful content four segments: regarding their health and well-being on the • A brief overview of the neurological, Internet, and communicate safely online. cognitive, and psychosocial aspects of de- Available in Spanish and English, Cyber- mentia and how these relate to creative Health is an inclusive, community-based, expression interactive health literacy program that • The program of creative expression, teaches elders to use computers to obtain, which includes a historical background and interpret, and understand basic health infor- examples from sessions with elders in mation and resources available to them on which principles and strategies that facili- ¥
17 tate creative expression are discussed tory—are designed to release the cognitive • Audience participation in a simulated and motivational potentials of pre- and session that provides hands-on understand- post-retirees. Participants become aware of ing of the content and process of the cre- the life they have lived and become more ative expression program confident and optimistic about facing the • Questions, discussion, and workshop years ahead.The organizers hope to en- feedback courage the emergence of late-life The traveling art exhibit began in at bloomers among people who until recently the Ferry Building Gallery in West Mall have been preoccupied with life obligations Vancouver, B.C., and finishes with an ex- and are now free to use their latent talents. hibit and education seminar at the Harbor- Many current and past participants report ucla Medical Center,Torrance, Calif.The that they feel empowered in their self- goal of this exhibit is to increase public knowledge and are forging new friend- awareness and appreciation for the capacity ships, beginning new endeavors, and pursu- of elders with dementia to use their re- ing new interests. maining abilities for creative expression. AWARDS REVIEW COMMITTEE INNOVATIVE OLDER ADULT LEARNING PROGRAM ASA thanks the members of the Mind- Alert Awards review committee for their Autobiographical Studies Program work in reviewing submissions: Sandra University of California, Los Angeles, Cusack, Gerontology Research Centre, Center on Aging and UCLA Simon Fraser University,Vancouver, B.C.; Extension, Education Division Marian Diamond, Integrative Biology Department, University of California, Los Angeles, California Berkeley; Nancy Emerson Lombardo, Center for Research on Women,Wellesley The ucla Autobiographical Studies Pro- College,Wellesley, Mass.; Marge Engel- gram is designed to help reduce the confu- man, University of Wisconsin, Madison; sion and uncertainty that middle-aged and Barbara Ginsberg, My Turn Program, older adults often experience in a rapidly Kingsborough Community College, changing society. For many people, the Brooklyn, N.Y.; Paul Nussbaum, Neu- later years of life can provide the best years robehavioral Services,Aging Research and in terms of new activities such as volun- Education Center, Mars, Pa.; Arnold teering, learning, and expanding personal Scheibel, Neurobiology Department, ucla relationships. Medical Center, Los Angeles, Calif.; and The courses in the program—Guided Beatrice Seagull, Professor Emeritus, Autobiography, Guided Autobiography II, Rutgers University,New Jersey. e-GAB, Life Portfolio, and Family His- ¥
18 ABOUT THE MINDALERT PROGRAM
he American Society on Aging’s Mind- abilities and commitment of those who T Alert Program seeks to disseminate re- work with them.To that end,ASA sponsors search and innovative practices that address a wide variety of conferences and offers an- the steps that older adults can take to main- nual networking opportunities and Web- tain and enhance their cognitive and men- based training.The society also publishes a tal functions in their later years. bimonthly newspaper, a quarterly journal, To support this ambitious goal,ASA es- and eight quarterly newsletters for its mem- tablished MindAlert with funding from bers.To obtain more information on ASA MetLife Foundation and Archstone Foun- or to join, call () - or visit dation.The program, now in its fourth year, www.asaging.org. has the following components: • An annual MetLife Foundation Mind- About the MindAlert Lecture Alert lecture and booklet, which dissemi- Sponsor: MetLife Foundation nate the latest research findings on main- taining and enhancing cognitive function in MetLife Foundation, established in late life. by the Metropolitan Life Insurance Com- • Annual MetLife Foundation MindAlert pany, has been involved in a variety of Awards, which identify and recognize inno- aging-related initiatives. Since , the vative community-based programs that foundation has supported research on translate research into practical cognitive- Alzheimer’s disease through the MetLife health-promotion activities. Foundation Awards for Medical Research • A clearinghouse of resources related to program and has contributed more than late-life maintenance and enhancement of $. million to efforts to find a cure. In ad- cognitive and mental functioning. dition, the foundation has provided support • A cognitive-health-promotion curricu- for a traveling exhibit on memory; a public lum that aging-services and healthcare education video for use by caregivers and providers can implement in a wide variety families of people with Alzheimer’s disease; of settings with older adults. and support for healthy-aging projects ad- • A trainers bureau and train-the-trainers dressing issues of caregiving, intergenera- program to facilitate the implementation of tional activities, health and wellness pro- cognitive vitality programs in such settings grams, and volunteer opportunities. as senior centers, adult learning programs in MetLife Foundation supports health, edu- community colleges, and park and recre- cation, civic, and cultural programs ation programs. throughout the United States. For more in- If you would like more information formation about the foundation, visit about the MindAlert program, including its www.metlife.org. Web-based clearinghouse of resources on mental fitness, visit www.asaging.org/min- dalert, or contact the American Society on Aging at [email protected]. About the American Society on Aging With , members, the American So- ciety on Aging (ASA) is the United States’ largest association of professionals in the field of aging. Founded in ,ASA’s mis- sion is to promote the well-being of aging people and their families by enhancing the ¥
19 MindAlert on the Web
The MindAlert monographs from 2001, 2002, and 2003 are available on ASA’s website at www.asaging.org
Good News About the Aging Brain! The MindAlert monograph for 2001 presents special lectures by the nationally known brain researchers Marian Diamond and Arnold Scheibel, who describe their ground-breaking research on brain function and the optimistic implications for successful aging.
Brain Health from 1 to 100 In the MindAlert monograph for 2002, the special lecture by Paul Nussbaum, a leading clinical neuropsychologist, describes what he refers to as a health- promotion opportunity of unprecedented stature: our ability to foster our own “brain wellness” for healthy and functional aging.
Centenarians: Lessons on Living Long and Living Well In the MindAlert monograph for 2003, Thomas Perls, head of the renowned New England Centenarian Study, shares the findings of his research and talks about how we all can make our later years healthy, vital ones. Included with all of the above are descriptions of the programs that won the 2001, 2002, and 2003 MindAlert Awards, sponsored by the American Society on Aging and the MetLife Foundation. ¥
20 ur culture alternately praises and fears Oextreme longevity. Is longevity due to genetic or environmental factors? Is everyone capable of living to 100? And why would we want to? In this monograph, Dr. Thomas Perls, head of the renowned New England Centenarian Study, shares the findings of his research—and talks about how we all can make our later years healthy, vital ones.