Unlocking The Secrets Of ‘SuperAgers’, with Emily Rogalski
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When it comes to our health and getting older, there's one term that everyone is talking about these days. What's called super agers. You know, you meet people in life and you're like, wow, that person looks or acts literally half their age. Well, it turns out that literally there are some of us

that age slower than others and those people are referred to as super agers researchers now found a way to unlock our brains fountain of you as the brains of some so-called super ager seem to stay young and researchers believe they may show us how to improve our mental health.

I operationalize this term super-aging to be very specific to a group of individuals who are over age 80 that have memory performance at least as good as individuals in their 50s and 60s. That's Emily Rogalski, a professor of neurology at the University of Chicago and one of the world's leading experts on super-agers. Well, I think

I think most people that I talk with, if I start talking about the word super agers, they immediately draw a picture in their mind of, oh, I have someone like that. It's my mom or it's my uncle or it's my neighbor. People have encountered individuals who are doing better than one might expect and

but yet they don't get a lot of airtime. When we think about aging, we tend to focus on those negative aspects of aging. - Healthcare and medicine often follow one track. We look at people who are sick and work backward to figure out how they got that way.

But Rogalski is trying to change that by starting with people who are extraordinarily healthy. It's good if we're talking about positive trajectories of aging. That's a step in the right direction and that we're thinking about what can be in aging instead of what can't be. So how do people become super-agers? Is it something they eat or drink? Or maybe an exercise routine they follow? Or perhaps it's how many friends they have in their lives?

or it just may simply be the result of a genetic lottery. Rogalski's research has started to uncover all sorts of fascinating insights. By studying these individuals, we get a fuller picture of the aging spectrum. So if we just look at individuals who have Alzheimer's disease and related dementias, we can identify some risk factors and then try to target how to identify

mitigate that risk or reverse that risk. But that really only gives you kind of the left side of the bell curve, if you will, where

Identifying people who are doing extraordinarily well gives us the opportunity to identify protective factors. Welcome to Big Brains, where we translate the biggest ideas and complex discoveries into digestible brain food. Big Brains, Little Bites from the University of Chicago Podcast Network. I'm your host, Paul Rand. On today's episode, the science of super agers. ♪

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If you want to understand how someone in their 80s can have the memory of a 50-year-old, there's one obvious place to start. So my interest in aging wasn't there originally. My interest actually started with the brain. So I grew up the daughter of a school teacher, and my mom taught kids with learning challenges.

And what I learned from having the opportunity to be in her classroom and work with some of those kids and see them over time was how brilliant they were, but they learned a little bit differently. And so at a young age, I had a very naive question of,

hey, I wonder what's different about their brains. And so that kind of sparked my interest in neuroscience and always thought that I'd be working at that end of the spectrum. With kids? With kids, that's right. And then, you know, life has a funny way of taking you down different and unexpected paths.

And so when I entered graduate school, it was a requirement to do some rotations. And that was a good thing. I learned about the opposite end of the spectrum. So individuals who had Alzheimer's or related dementia. And then I learned about a rare dementia called primary progressive aphasia, where instead of there being memory loss, there was actually preservation of memory, but challenges with language.

In this dementia syndrome, individuals tend to be in their 50s or 60s instead of 70s or 80s. And at the time, there was very little research happening in this space. And so really started down the path of

this aging and dementia work, and then over time got more exposed to different trajectories of aging, particularly then again, another group kind of on the margins, if you will, are those who are over age 80 that are doing extraordinarily well. Well, before we start jumping into the whole concept of super agers, I would love just to set a baseline foundation. You talk about this a little bit in terms of what in the world happens to our brains as we age.

And what do we need to understand on a foundational level? You know, our thinking about aging trajectories and what happens as we age has really changed over time. It was once believed that we all got old and that we had only one path for aging, and that was to become senile. We now know that things are much more complex.

And we understand that our memory and thinking abilities really tends to peak in our 20s or maybe even 30s. And so just like the exterior of our body experiences some wear and tear as we age, we do see that there are changes that are happening to our brain. One of those is that the outer layer of the brain or the cortex tends to shrink a bit over time. And there's some acceleration of that as we enter our 60s.

Okay. So when it actually comes to the cortex, what is causing that shrinkage? Also another great question and one that's not really well answered. And we've started to dig into this a little bit. Is it that there are fewer neurons and there are really mixed results in the literature on some of this work versus is it the size of the neurons that is changing or really understanding which disease...

diseases or chronic challenges are maybe having different influences on different aspects of the brain, all which could end up with cortical thinning at the end of the day, but due to different causes. And if we're talking about the shrinkage, tell me the impact. Is it in memory, executive skills, motor skills? Where are we seeing that shrinkage making an impact?

So when we look at what the changes that occur in older adults, it really matters just like real estate location, location, location of what cognitive changes that you might see. So if that shrinkage occurs more in language related networks, then we're going to see an impact on language.

If those changes occur in areas of the brain that are more important for attention or executive function, then we may see challenges with planning and attention. If those changes occur more in memory-related regions, then we'll see that impact on memory. So this is why we look...

at the spatial distribution of changes as well as the magnitude of that change. And this shrinkage is a big part of what makes superagers so unique. So when we look at a biologic standpoint, when we look at the structure of the brain of superagers, they tend to look more like 50-year-old brains than they do like 80-year-old brains. Cortical thickness of the superagers

is not significantly thinner than that of 50 to 60 year olds. That outer layer of the brain, the cortex, is not atrophying at the same rate. So atrophying being, it's not thinning. And then we asked a question over time, well,

Do the super-agers show the same rate of thinning as their 80-plus-year-old peers, or do they seem to be on a different trajectory? And what we see there is that they do tend to be on a different trajectory. The average agers are thinning on that outer layer of the cortex at a rate that's more than two and a half times that of a super-ager. And then there's a region in the anterior cingulate, which is actually thicker in the super-agers than it is in the 50- to 60-year-olds.

And so usually at this point people will say, well, what is the anterior cingulate? Do I want a thicker one? And if so, how do I get one? And I cannot answer all of those questions, but I can give you a little peek there. So the anterior cingulate is a region that's really important for attention and attention supports memory. In order to remember something, you have to be attending to it first.

Because we found that thicker anterior cingulate, it led to a whole new line of research and understanding, okay, well, what are the molecular features here? So the first super-agers that came to autopsy, because we run a longitudinal study where people come back over time and ultimately give that gift of donating their brain at the time of death, we have this opportunity to look under the microscope. And we saw that super-agers have an abundance of a special type of neuron called von Economo neurons.

These neurons have only been described in higher order species. They're thought to have some relationship to social interactions and social behaviors. The loss or abnormal development of them is seen in autism, schizophrenia, bipolar disorder, as well as in a type of dementia called frontotemporal dementia, where there's changes in personality and judgment.

So these are starting to get at not only structural features that we can see on MRI, but also then we can dig deeper and understand what are the cellular molecular features there.

One of the goals of our study is to not only understand what are the biologic features and factors associated with super-agers, but what are also the psychosocial features? What are the genetic factors? What are the lifestyle factors? How does family history play a role? So far, what we've seen is that super-agers do have unique biologic genetic as well as lifestyle factors. We're at the beginning of this story, not at the end. The next chapter of that story after the break.

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Everyone wants to know how to become a superager. While genetics play a huge role, the question is, are there lifestyle factors we can change to give ourselves a better shot of ending up in this category? When we look at other factors like psychosocial factors and how people approach life, we see that superagers tend to report stronger social relationships compared to their cognitively average peers.

This fits really well with the larger literature talking about the negative consequences of social isolation, the negative consequences of loneliness,

and the positive aspects of maintaining social engagement. Now, the first founding we saw here was on a survey, so we didn't have a lot of deeper information of what are those social relationships? Who are they talking to? How often are they doing that? And so now we've followed that up in our subsequent studies. We have super agers wearing wearable sensors in their daily lives.

And so we're able to monitor how much activity they're getting. Is that activity vigorous? How often are they communicating with others? We can look at those social interactions, but now have some extra objective measurements to complement these subjective measurements that we got in the survey. And just to cover off on this area, whether it's diet or nutrition,

demographic differences or other things, those don't play into this in the way you may think they would, do they? Yeah. So when we look at diet and exercise, we see a wide variety.

We see super-agers who have paid really close attention to their diet and then others not so much. There's a super-ager who I know tells a story of, "Oh gosh, it couldn't be my diet. I ate way too many TV dinners growing up." No, I don't want that to give the impression that diet is not important and that we should all eat hamburgers and french fries for every meal.

And likely some of the tolerability of one individual's diet versus another probably has some interplay with their genetics and what their tolerance there. There is likely to be more than one pathway, but when we use really precision-based approaches to understanding, we can start to know kind of the components that have been key to getting to these different pathways.

When we look at exercise too, we also see that same variability where some people are really vigorously exercising, whether that's high intensity work in the pool or riding their bike tens of hundreds of miles. And while others who may be not as physically capable, but are still doing stretching classes or chair stretching classes. We've also had people who have firmly told me, you know what?

I've never exercised much and I don't plan to start, so please don't ask me to. And so we take all kinds there. - So some of these things as you're getting to it, whether it's your diet,

your genetics that go into this, your exercise levels. You can't really point to any of these and say, you know, a Mediterranean diet is one of the keys to becoming a super rager. There's benefits of it, but they're not adding up consistently as this is one of the key criteria.

Well, yeah, what I would say is that it's not a single, the recipe is not, it has to be this diet plus this exercise equals super aging. We don't have a precise recipe in that way. I do think both diet and exercise are important. We know that there are benefits to both. I think yet another component that is important is exercising our brains.

People will often ask me, "Hey, should I do a crossword puzzle every day? Is the New York Times the perfect one or is there another one?" And my answer to that usually is, "Do you like crossword puzzles?"

And do you find them challenging? Because if you don't like them and they cause you a lot of angst, then the stress that is induced by the crossword puzzle will far outweigh any brain benefit that you would ever gain. And likewise, if you don't find them to be particularly challenging, then the brain boost that you're going to get from them is also likely not to be that great. And I think this really harkens back to a great study that was done by Denise Park years ago where she took a group of individuals and

And she had one group that learned photography, another group that learned to knit, and then a third group that I think like sat on the couch and watched TV, but did something benign. And the question was, which one has the most brain benefit? And in that study, she found that both knitting and photography were equal. And the key there was the novelty. So the fact that there was new learning that was happening in each group.

And so I think this is an important kind of take-home point for as one thinks about what can they do in their daily life. It's finding something that is enjoyable to you, but also challenging. And I think this also ties in nicely with what we see in SuperAger's report of strong social engagement. So it turns out having a conversation is actually a good workout for your brain and maintaining social connection.

Because I don't know exactly what you're going to ask me next. And whenever you ask it to me, my brain has to do some mental gymnastics real quickly to say, okay, well, what is it that I want to say back? And so that's a good activity. My brain likes that kind of responsivity that it has to have in the moment. And so that's one of the ways that social connection is important. Of course, social connection is also important from an emotional standpoint. So when we

think about our kind of lifestyle choices. I say, you know, if you're thinking about calling your friend today on the way home from work, you should do it. It might make you feel good and there may be some brain benefit. And if you're thinking about taking up a new activity,

you should do it. Your brain likes new things. And so I think those are pretty safe features. We can't give a recipe of how you make your cortex thicker, but we do know that our brains are more pliable, plastic and capable of neurogenesis in a way that we didn't think was possible several decades ago. And so there are lots of

There's a lot of possibilities for the future. All right. If I was doing photography or knitting or any of these other activities and I wanted to have an alcoholic drink, would you discourage me? Oh, goodness. Well, the super-agers, many of them would say no. In fact, we asked them why they think that they are a super-ager, and some of them have firmly told us it's because they have a martini at 5 o'clock.

Now, I am not going to support, certainly having a lot of alcohol is not good for your brain, but there are many who would advocate that they enjoy a beverage here or there.

It almost seems too easy and I was kind of hoping for some miracle, but just saying watch what you eat, watch what you drink, get more exercise and stay mentally engaged. You know, if we had the magic answer of what exactly the precise thing is to do to maintain your perfect cognitive health, we would be in great shape, but we're not there yet.

we're bombarded in our daily lives by media that says, hey, take one of these or just do this computerized test and you'll be protective. My general rule is that if it's just one thing, it's likely to not be it. Our brains are much more complex than just one element. If we looked out 20 years and you said, I'm going to dream about

And if I could think of the applications that my work could present to the world and benefit the world, where do you see that potentially going? Where could we be in 20 or 30 years, both from a scientific point of view, but also a human longevity point of view?

So I think there's tremendous potential, one, in just changing the conversation. So there's tremendous stigma around aging and there are lowered expectations of what's possible in aging because the majority of what is in our media and on the television is really focused on that negative aspect. How old is too old to do X, Y, or Z thing instead of looking at that person and seeing what potential they have.

We see this in a really profound way in a study that was actually done in Zimbabwe, where instead of devaluing their older adults, they valued them. So in that country, which is riddled by poverty and also had a major mental health crisis where they just had a handful of psychiatrists, but a high percentage of the population that was suffering from mental health challenges. One way to solve that problem is to figure out how to rush more doctors in.

But they took a different approach. They took the grandmothers in their community and they taught them cognitive behavioral therapy. And they set them on benches around the community so that they could support the individuals who were having mental health challenges. And they ran a proper randomized control trial and showed that that intervention was just as good as what was being delivered by the psychiatrist.

So there's a great example about how if we change our viewpoint of what older adults can do and the value that they add, it can have a profound impact on the community. When we think from a biologic standpoint, I do think as we start to understand what factors may be important for providing resilience or resistance, there may be outcomes that lead to pharmacological options that help people avoid one trajectory or another, and

And then there may also be

a greater understanding of, from a precision medicine standpoint of, hey, here's my genetic factors. Thanks from mom and dad. Here are the lifestyle factors that I have been doing for the last, you know, several decades. Here's what I've been eating. Given this and given my risk profile, what do I do now to help myself best, have the best probability of being on a positive trajectory of aging? But it's really understanding that

each individual person and then being able to apply this knowledge. And so I think that's where we're going as a field is this precision medicine approach, but it's going to take us a minute to get there and do it the right way. Maybe one other thing I would add is that we are still actively enrolling super agers across the US and Canada. So if we can do a shameless plug for those who are out there who might know a super ager,

We would love to hear from you. And if we're not in your city yet, we still have a registry for you to join so that one day we may have a good home for you to participate. So encourage those to reach out. Big Brains is a production of the University of Chicago Podcast Network. We're sponsored by the Graham School. Are you a lifelong learner with an insatiable curiosity? Access more than 50 open enrollment courses every quarter. Learn more at graham.uchicago.edu slash bigbrains.

If you like what you heard on our podcast, please leave us a rating and review. The show is hosted by Paul M. Rand and produced by Leah Cesarine and me, Matt Hodap. Thanks for listening.