Superagers: Defying time to stay physically, mentally fit

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Forget anything you heard about people inevitably slowing down as they grow old. When experts describe "normal aging," referring to minor memory lapses and other issues, it doesn't apply to a group of genuinely old adults who maintain a memory and activity level comparable to those two or three decades younger.

Those folks are called "superagers." And researchers have been trying for a long time to figure out what causes them to be special and the degree to which it might be genetic versus action based. The latter means others could strive to be superagers, too.

A study just out in the Journal of Neuroscience by aging experts in Spain suggests that "age-related cognitive decline is not inevitable."

They studied 64 superagers over the age of 80, comparing them against 55 age-matched typical older adults for a period of five years with annual follow-ups and found that superagers don't have drastically different brain volume. But they have what's called "better white matter microstructure" than typical older adults, including more brain volume in the hippocampus and entorhinal cortex, which are both involved in memory. Plus, the connections in the front of the brain were structurally stronger, which could be important to maintaining cognition. Superager brains also showed slower deterioration over time.

The brains in neither group showed much sign of Alzheimer's disease, which was important for the comparison.

"By having two groups that have low levels of Alzheimer's markers, but striking cognitive differences and striking differences in their brain, then we're really speaking to a resistance to age-related decline," Dr. Bryan Strange, a professor of clinical neuroscience at the Polytechnic University of Madrid who led the study, told The New York Times.

Strange said that superagers are easy to spot, should you encounter one. "They are really quite energetic people, you can see. Motivated, on the ball, elderly individuals."

The researchers published another new companion study in the journal Lancet Healthy Longevity. In that one, the primary differences they found included faster movement among superagers — in spite of the fact there were no differences in the groups in terms of exercise frequency — and better mental health, deemed the "most differentiating factors for superagers." Interestingly, dementia blood biomarker concentrations were about the same in both the superager and typical older adult group, which "suggests that group differences reflect inherent superager resistance to typical age-related memory loss," the researchers wrote.

Differences and shared traits

The groups also showed no difference in APOE4 frequency. APOE is a protein that helps metabolize fats in mammals and the variation designated APOE4 is linked to Alzheimer's disease. The researchers call it the "major genetic risk factor for non-familial Alzheimer's disease."

It's possible, the researchers wrote, that superagers are born with larger brains. But in the study, superagers showed slower atrophy compared to typical agers, so the brain at birth may not be the difference.

Mental health loomed large in the study's findings as researchers noted that an episode of depression or anxiety impacts memory tests at all ages. "In the long term, a history of depression and anxiety is not just a risk factor, but also a symptom of depression," the study reported.

Superagers also complain less than others that they don't get enough sleep, "although self-reported sleep duration was not found to be important" in the study.

They noted, too, that superagers were more likely to have either a formal or amateur musical background, compared to normal older adults. Research has shown that playing an instrument is good for the brain.

While higher education level is considered somewhat protective in Alzheimer's research, the superager study found years of education wasn't significantly important for superagers. "The superager memory phenotype is therefore unlikely to be a product of more years of education, although this variable might influence performance on non-memory tasks," the researchers wrote.

With none of the variables did the researchers show cause, just association, they noted.

One of the first studies on superagers was conducted at Northwestern University in 2012. Its lead author commented in The New York Times on the new research findings: "The behaviors of some of the Chicago superagers were similarly a surprise. Some exercised regularly, but some never had; some stuck to a Mediterranean diet, others subsisted off TV dinners; and a few of them still smoked cigarettes. However, one consistency among the group was that they tended to have strong social relationships," said Dr. Emily Rogalski, who was part of the research team and is now a neurology professor at the University of Chicago.

Tessa Harrison, an assistant project scientist at the University of California Berkeley who collaborated on an earlier study with Rogalski, told the Times she believes superagers may have "some sort of lucky predisposition or some resistance mechanism in the brain that's on the molecular level that we don't understand yet" that may be genetic.

Superager habits

Northwestern Medicine notes some habits superagers seem to share:

Be active. "Physical activity results in increased oxygen intake, which helps your body perform optimally," the article reports.

Challenge yourself. Find something that makes you think, that's at least a little hard, that teaches something. Learn to play an instrument or learn a language. Try something new.

Be sociable and nurture relationships. "Superagers tend to report strong social relationships," according to Northwestern Medicine.

The article notes risk factors you can't control, including age, family history and gender.

Correction: An earlier story said the 2012 study was conducted at the University of Chicago. It was conducted at Northwestern University.