Speaking of Psychology - The secret to being a “SuperAger,” with Emily Rogalski, PhD

Episode Date: December 8, 2021

For most people lucky enough to live a long life, aging comes with some cognitive decline. But memory loss isn’t inevitable. Some people -- “SuperAgers” -- have memory abilities that remain intact into their 80s, 90s and even beyond. Emily Rogalski, PhD, head of the SuperAger study at Northwestern University, talks about what sets these SuperAgers apart, how their brains differ from the brains of people who age in a more typical way, and what might we learn from studying SuperAgers that could, potentially, help the rest of us to age better. Learn more about your ad choices. Visit megaphone.fm/adchoices

The U.S. population as a whole is getting older. By 2034, people over 65 will outnumber children for the first time in U.S. history. And the fastest growing segment of the population is those over age 85. For most people lucky enough to live that long, aging comes with some cognitive decline. Our memories just aren't as sharp at age 85 as they were at 45, 55, or 65. But cognitive decline isn't universal. Some people, known as super-agers, have cognitive abilities that remain intact into their 80s, 90s, and even beyond. So what sets these super-agers apart?

Do they just have lucky genes? How do their brains differ from the brains of people who age in a more typical way? Is it something about the way they've lived their lives, a better diet, more sleep, more exercise, that allows their brains to seem to escape the ravages of time? Or is it a combination of these factors? and what might we learn from studying super-agers that could potentially help the rest of us to age better? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life.

I'm Kim Mills. Our guest today is Dr. Emily Rogalski, a clinical and cognitive neuroscientist and professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine. For more than a decade, Dr. Rogalski has led the super aging study, working with hundreds of older adults in the Chicago area, all over age 80, who have the memory capacity of people at least three decades younger. She'll talk to us today about what she and other researchers have learned from these superagers. In addition to her work with them, Dr. Rogalski is interested more broadly in aging and dementia. She uses brain imaging and other techniques to study different dementia syndromes, and she develops education. programs, support groups, and internet-based therapies to improve the quality of life for patients with dementia.

Thank you for joining us, Dr. Rogalski. Thanks for having me. I'm so pleased to be here. I just mentioned that the super ages in your study are required to be at least 80 years old with the memory abilities of people in their 50s or 60s. How did you decide that that was the definition of super aging? It harkens back to what you talked about in your intro and really thinking about, gosh, what happens when we we age. And a lot of the news is not so positive. We talk about all the bad things that happen with aging. And our center in specific is focused on cognition and the brain and how the brain works. And what we know about cognition in aging is that there does on average tend to be decline.

And we know that that decline can be more precipitous past the age of 5560. And so by the time you get to age 80, the expected memory decline on average is quite striking between 80-year-olds and 1560-year-olds. So we selected age because it represents an age where people are at the greatest risk for loss of memory. And it's also the thing that people complain about the most is, I can't remember my keys or my memory is not as good as it used to be. And so these things, like really important things to zero in on. We also chose the age 80 because we are a nationally funded Alzheimer's Disease Center. And so part of our work is incredibly focused on aging and dementia. And Alzheimer's dementia, the most striking symptom is that loss of memory. So how unusual is it to be a super age?

I mean, do you have a sense of the percentage of the population over age 80 that has these great memory abilities? Another excellent question and one that I get a lot. And unfortunately, the type of research we're doing is not epidemiologic in nature. And so let me unpack that a little bit. So it's not as if I have access to the medical records and contact with all of the 80-plus-year-olds across the United States or even the 80-plus-year-olds within Chicago. And that's the type of information I'd really need to understand what's the incidence and prevalence of super aging. But what we do have is our experience of people calling us and saying, hey, I'm over H-80, and I think I'm a superager. And then we bring them through that screening. And I can tell you that

we've screened thousands of individuals at this point. And we really recognize superaging as a rare phenotype. We think that it is not the mainstream, what we would call it. It wouldn't be common. So you're interested in figuring out what sets these superagers apart from other people, and one of the ways that you've done that is through brain imaging studies. What have you found? How are the brains of superagers different from those who have just normal memories? We have the superagers in role in our study. So maybe I'll just kind of take, walk back just for a minute. And what we are looking for is these individuals who have this outstanding memory performance. And then we ask them to enroll in our research study where we're looking from multiple perspectives. And one of those

perspectives is through what's the structure of their brain look like. So does their brain look more like an 80-year-old brain of individuals that they match in chronologic age to? Or does it look more like a 50 to 60-year-old brain who these people match in cognitive performance to. And so one way we can do that is with something called structural MRI or structural magnetic resonance imaging. And so we're getting a 3D image of the brain. And we have a sophisticated computer software program that allows us to reconstruct those images and then look in a very detailed way at the outer layer of the brain and then what we call the gray-white junction. And then we measure the distance between that outer surface of the brain and what we call the gray-white junction, which is kind of like the

bark on a tree. And if we measure the thickness there, we get a proxy measure of the health of the brain. The outer layer, that bark of the tree is where the brain cells live. And so getting that proxy measure of cortical thickness can tell us about the health. And we know that with aging on average, our brains tend to become thinner or atrophied with time. When we started out to do this study, we looked at, well, what is the thickness of the superagers compared to 50 to 60 year olds? What is the thickness of the average 80 year olds compared to 50 to 60 year olds? And when we look at average 50 to 60 year olds compared to average, cognitively average 80 year olds, we see that there's significant thinning or shrinkage of the brain in those

cognitively average 80 year olds. And that change has been associated then with those changes in our thinking abilities like memory. When we compare the super age of brains to the 50 to 60 year olds, we see that there was no significant cortical thinning. So this was really shocking to us to say, wow, their brains look more like 50 to 60 year old brains than they do like 80 year old brains. And then we found something even more surprising is that when we looked in the inner surface of the brain in a place called the anterior cingulate, we actually

saw that the super ages had a thicker anterior cingulate than the 50 to 60 year olds. So there was this one region of the brain that was strikingly thicker than that of their 50 to 60 year old peers, people 20 to 30 years younger than them. Is that something that could be looked at when you're younger to sort of give you an idea of what the future holds for you? If you're 50 and you get one of these brain images, you know, would you be able to see that it's possible you're going to have a good memory when you're 80 or 90 if you live that long? It's a really interesting question and kind of begs the question, well, what happened to super agers' brains? Is it that they were born with thicker brains and they've always been this way?

Or is it they've just resisted changes to their brains over time? And so we, ideally, what we would have is MRI scans from, you know, birth to age 80 every decade on these individuals to be able to really understand that arc. We don't have that luxury, but what we do have is the superagers come back, over time and participate in this MRI scanning. And when we look longitudinally over time at the rate of shrinkage in the superager's brains, we see that that rate of shrinkage is much slower than that of their 80-plus-year-old cognitively average peers. So this gives us an idea that the superagers are really on a different trajectory than their peers. Their brains seem to be shrinking at a much slower rate. We don't think that the anterior cingulate thickness per se is the fountain of youth or

the one thing that dictates why they have great memory. It may be a contributor. And so, you know, often people will say, well, you know, what is that anterior cingulate? What does it do? Why do we have one? How do I get one? Do I want mine to be thicker? And we're starting to understand what role that might be playing in the super agers. But we do know that the anterior singlet is really important for attention. And attention, of course, supports memory. So it's not possible to remember something if you're not paying attention to it. What about other factors such as lifestyle? Are superagers you study? They generally, people who exercised a lot or ate well, do they have stress-free lives? Are there those differences that may be contributing to why their memories are as good as they are?

We are really interested in both the biologic factors and also the lifestyle factors of the super aging program. And what we can say anecdotally right now is that not all superagers exercise. Many of them report doing so, and some of them in various ways. So one person may be leading their stretching class. We have another individual who likes to bike hundreds of miles. So that would be kind of on the opposite end of the spectrum. And we have had individuals, so sometimes we'll ask them, why do you think you're a superager and to get their thoughts about how they stayed so cognitively healthy?

And I've definitely had more than one superager say, well, it's certainly not because I exercise. I've never exercised and I only run when I'm chased. So I think there's some diversity there. It's not that everybody has had that path. So I don't say that to say that we should all become couch potatoes. But I do highlight that to say, and we certainly know that there's tremendous brain benefit to and cardiovascular benefit to exercising. So I don't want to give that message.

But I think it is important to know that from a lifestyle perspective, there are different paths that people have taken with exercise. We do think that the super ages are relatively active. So we find that many of them are still working. sometimes at their first career path and other times at a second career path. We have a superager who in what he likes to call his first career, he was a lawyer. And then he retired, got bored, and then went back and got certified to do taxes seasonally and found that that was a great balance for him, that he was really busy for part of the year

and then had the rest of the year to relax. And if I'm remembering correctly, was one of the most requested. helpers during tax season. So I think these are some of the lifestyle factors that we're interested in. The super aging study, although it's more than a decade old, we still are in some ways just hitting our prime. And there's a lot of unanswered questions. And we'll probably, maybe we'll touch on this a little bit later, but we really are excited about some new directions that we're going. And one path that we're going down is going to ask the super ages to wear, monitor, something like your Fitbit, but they'll be a little bit smaller, that will actually start to track the activity of the superagers. It'll also track sleep so that we can better

understand, not just anecdotally, but what do we see? What's different about their interactions? And the last thing I'll kind of touch on from a lifestyle or personality perspective is that superagers report having stronger positive relationships with others compared to their cognitively average peers who are also in the study that we did were reporting strong positive relationships with others, but the superager has really superseded that, so an even higher level. And this finding, again, we haven't quite we haven't uncovered yet. Well, is that because they have two close friends or do they constantly have a group of people that they are with? And I think that is going to end up

being at the individual level and your personality preferences of do you really enjoy large groups or small groups and having a few close trusted friends. But we'll be able to get at some of those things by the newer studies that we have planned. What are those social interactions like? We know this is critically important because of the negative consequences of social isolation and loneliness. And I think that's all too familiar to us right now, having been through a pandemic where we've had to often be away from friends and family and those that we hold dear. Well, it's interesting that relationships would have that impact on memory. I mean, you expect it to have an impact on sort of overall well-being, but the memory key there

is important. Well, let me ask you another question. I'll personalize it a little bit. So I have an aunt who's 90, and I think she'd qualify as a super age. She remembers everything. She's very, very sharp. But her brother, who is two or three years younger, has experienced severe memory loss, and it started some years ago. And I know this is just one isolated example, but is there a genetic component? Are you looking at siblings? Do you know? Do you see in families that if one person is a superager, that you'll see other superagers in the same family? Genetics is another component that is of interest to us in the superagers. And I think the way that we've thought about genetics has really evolved over the last decade, if not longer. So we may have thought about genetics more simplistically a decade or two ago that, oh, shoot,

if I didn't have picked the right parents, then I'm out of luck. And we now know that things are much more complicated than that. And specifically, just to start with your question is I love hearing the stories of, I have a brother or a sister or an aunt or an uncle or a parent who would qualify for the study. And that's really how we get a lot of people involved in the study is through that word of mouth referral. But to speak to your point specifically, we do take a detailed family history on all the super ages who enroll in the study. And we see that there are some that have longevity in their family, while others do have a family history of dementia or other medical histories in their family. So this is something that we also take into account when we're thinking about how many medications,

are they taking? Is it different than their peers? And we're finalizing a study on that right now. So the role of genetics is likely to not be a single gene that is your super aged or gene, but more complex than that. And so we are actively pursuing studies to understand what are those genetic components and how is this playing a role? And it's possible for some individuals that their genetic profile is helping them eat their hamburgs and french fries every day without having as great deleterious effects. And others, it may have been more important that they've chosen certain lifestyle factors that have gotten them where they are. So this is a really exciting part as the superaging program has matured because genetic studies really require larger

numbers of participants. And if we kind of think back to the beginning, beginning when I told you super aging is kind of rare. So it's been hard to get the numbers to start and really dig deep in those genetic studies. I'm wondering about the relationship of physical health problems and people who age. Do you see that superagers tend on average to be somewhat healthier? Is there any relationship between that and just the fact that their memory is as good as it is? Yeah. So physical health is so important. And when we really think about the term super aging versus the term successful aging, which is just this idea that doesn't have a specific definition, many studies of successful aging, which was a great idea that was promoted by Rowan Khan

a few decades ago and really was an important turning point in thinking about the positive aspects of aging. Many of the studies that came to follow after this idea of successful aging required that individuals have great physical health, but also great memory performance or good cognitive performance, but really paired together cognitive performance and physical performance. We specifically require that superagers have good memory performance, but do not make any requirement about physical performance because some people might need a wheelchair or a walker, but still have great memory performance. And that's exactly what we find is that there's really a range of physical performance

and physical capabilities in our super-agers. And so that allows us to study those things in more depth. This is another area that we will be exploring with more quantitative data in the future. Yeah. So I think, and then from an overall well-being standpoint, as far as medical history, we have not seen anything particularly notable between the super-agers and the cognitively average group that we follow. What about education level?

Does that play any kind of a role? I mean, I've seen research that talks about people who, you know, do better, who age better, as you were talking about. If they're more intellectually stimulated and involved, that that makes a difference. Are you seeing that with your superagers, too? Yeah, there's a few things packed in there that you said. So one is education. And there's certainly been many studies talking about the importance of education as potentially

being a protective factor. We haven't specifically made an association with superagers in a certain level of education. I can report that our superagers range in education from 12 years to 20 years. And I think the important thing to note there is that not all superagers are overeducated in that we haven't just enrolled doctors and lawyers and people with advanced degrees, that there is somewhat of a range, although that range at this point doesn't fall below a high school level of education. That could change in the future and may have to do with research bias in finding individuals. Maybe we need to change our kind of recruitment practices to find other people.

So I can't really comment on super-agers in education other than to say that we have that range of education. But cognitive stimulation was the other thing that you brought up. And we do know that our brain really loves to stay active. So a common question is when I give a talk about the superagers is, you know, should I still be doing crossword puzzles and what about lumosity or what about this brain training program? And should I take, you know, this supplement? And my response commonly is, well, do you like crossword? puzzles? Are they easy for you or are they challenging for you? If they're easy for you,

you're probably not getting much brain benefit because our brains like to be challenged. If you don't like them and they bring you a lot of angst, you're probably not getting much brain benefit from them because the stress that's caused by your, in the dread that you feel when you're like, I got to work on my crossword puzzle today is going to far outweigh any brain benefit. So there's there's some really lovely work that was done by Denise Park several years ago where she did a really elegant study where there was, she trained, there was three different groups. One group was trained to knit, I believe. The other group was trained to do photography in a class. And then there was another control group. And the question was, you know, was knitting or

photography better. And they found kind of equal brain benefit from each of those activities. And I think the key point there is that it was the act of learning something new and staying engaged that makes our brain respond. So my general advice is find something that challenges you and that is exciting to you and focus on that. You've talked publicly about how personally rewarding you find it to spend time with superagers in your study and even outside of the research questions that you get to explore. What has made that aspect of your work so fulfilling? Gosh, it's just such a privilege that these individuals who have a lot to do and are very busy, choose to spend their time giving back. So this is a truly altruistic act to participate in research and to keep coming

back year after a year and then eventually at the time of death they're giving us that ultimate gift of donating their brain the majority of them so that we can really understand those cellular and molecular features and in advance the science. But on a personal note, the wisdom and grit and adaptability and resilience that these individuals offer I think is so instructive. And they give you hope and ammunition to redefine expectations when we think about aging and thinking about how do we reduce stigma. And so I think of it as an honor to have that opportunity. It was early on in the superaging study where I think maybe the right word is demand. The super ages demanded that they wanted to meet each other or strong.

strongly suggested and said, when are we having a party? We want to get together. And if you know anything about NIH funding, there's no party money. So we had to think of some creative mechanisms to bring the superagers together. And we've now had three super aging parties. And each one has been just truly remarkable and an opportunity to slow down and step away from wearing my research hat. and just have the opportunity to connect and watch those connections being made between superagers, too, has been really fun. So you recently received a National Institute of Aging Grant to expand your Super Aging Study beyond Chicago, right,

and to several new sites in the U.S. and in Canada. So what are you hoping to explore with the new funding? Where are you expanding for listeners who might be interested in maybe participating, you know, what cities and towns you're going to be in? Yes, we are very excited about this. So the majority of the superaging study has, you know, the hub, of course, has been in Chicago. And we've had the rare superager who maybe has traveled to participate in this study from outside of the Chicago land area, but the majority have been in Chicago so far. So we're really excited to say that we're expanding internationally, we like to say, but it's across the U.S. and Canada. So there'll be five sites now.

One of them in Michigan at the University of Michigan, the University of Wisconsin, Emory University and Atlanta, and then we have a partnership with a few different universities, including Waterloo and Western University in Canada. And the focus of the superaging study is, you know, first and foremost to expand in the regions that we're looking for superagers with a particular focus on identifying people of color, so that there is more diversity in the super aging sample. So that's really important for understanding generalization of what factors may play into different paths of being a superager and how does race, ethnicity, or sex contribute to those factors. And so this will allow us to do that.

We're also expanding. So the superagers program, or this initiative will allow us to have more depth and breadth in the science that we cover. So I mentioned a little bit earlier that one of the key projects will be asking this better understanding the sleep and activity and social interaction of the super agers by asking them to wear these Fitbit like sensors. And then we have other studies focused on the genetic aspects of super aging and what role does inflammation play. we're able to go in greater depth and breadth on the imaging studies that we can do and understanding not only the structure of the brain but how it's functioning. And so these are some of the exciting areas that we're looking into next. I know in addition to your work on the super aging study that you study different forms of dementia

and interventions for dementia. Is there anything that we might learn from the super aging study that will help the effort to fight or treat dementia? Absolutely. So when we think about the superaging study and why are we doing it, I think there's really important rationale. So one is that as a medical community, we've gotten good at extending our lifespan. So you mentioned that in the intro to this segment, that the above 85 plus population is really accelerating. But what's happening is our lifespan is lengthening is that it's not always keeping pace with our health span.

And so I think superagers represent a good balance of lifespan and health span. And people don't want to just live long. They want to live long and live well. Just like that, the superaging study offers us a window into studying Alzheimer's and different factors. So one way to study Alzheimer's disease is to identify the individuals who have Alzheimer's disease and then say, what's going wrong and how would we reverse that? another approach, and that approach is really important, so I don't want to discount that. But another approach is to say, well, how have some people avoided this? And I think the superagers represent that a little bit.

So when we, Alzheimer's disease is very, very complex. And what we know is that the plaques and tangles that defined Alzheimer's disease are actually commonly found in 80-plus-year-old individuals. Now, do the super-ageers, we've seen that the super-ageers, we've seen that the super-ageers, tend to have fewer of those tangles than would even be expected for average 80-plus-year-olds. Why is that? How did they avoid the development? How did they resist the development of those plaques and tangles?

And what factors drove that? Similarly, there are some individuals who do have more pathologic features than what we would expect for their age. And so it's like, well, how did these factors not have as great of enough? effect? You know, how are they resilient to the effects of what we thought would be negative consequences of aging? And so they really offer a window into thinking about resilience and resistance and what those protective factors may be. Lots and lots of open questions there. So just to wrap up, if there are listeners among us who are, they think they might be potential participants in your study or know people who could participate,

Where do they go to get more information and get screened? Sure. We would love to have them come to our website, which is brain.northwestern.edu. And we have a registry there that they can fill out a few questions and then someone can reach back out and try and find a match for a study. And I should mention, because we are an aging and dementia research center, we do more than super aging research. So even if you're not over age 80 and you are interested in research, or if you just want to join our newsletter to hear about the work that we're doing, we encourage you to visit us there and join our registry. Well, thank you, Dr. Rogowski. This has been very interesting. I really appreciate you taking the time to talk to us. Thank you for having me.

You can find previous episodes of Speaking of Psychology on our website at www.combeckycology.org or on Apple, Stitcher, or wherever you get your favorite podcast. And please leave us a review. If you have comments or ideas for future podcasts, you can email us at speaking of psychology at APA.org. Speaking of psychology is produced by Lee Wynerman. Our sound editor is Chris Condihan. Thank you for listening. For the American Psychological Association, I'm Kim Mills.