SuperAgers: Who They Are and What They Can Tell Us about Alzheimer’s Disease

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doctor emily rogalski
Emily Rogalski, PhD

SuperAgers are people over age 80 who have the memory and thinking abilities of someone in their 50s. This week, Dr. Emily Rogalski discusses the science of SuperAging and how examining SuperAgers’ brains can help us learn about Alzheimer’s disease and dementia.

Guest: Emily Rogalski, PhD, Associate Professor of Psychiatry and Behavioral Sciences at Northwestern University, Feinberg School of Medicine, Associate Director at Mesulam Cognitive Neurology and Alzheimer's Disease Center in Chicago

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Transcript

Dr. Nathaniel Chin: Welcome to Dementia Matters, a podcast presented by the Wisconsin Alzheiemer’s Disease Research Center. Our podcast is here to educate you on the latest research, caregiver strategies, and available resources for fighting back against Alzheimer’s disease. I’m your host, Nathaniel Chin. Thanks for joining us.

Welcome to Dementia Matters. Before I introduce our guest today, I want to answer a listener's question. This person asked, “What are some signs and symptoms of dementia my spouse and I should be watching for in our aging parents?” This is a timely question with the holidays right around the corner because we are perhaps interacting with family members we might not see often and can recognize changes in memory or personality. First, a few changes that happen with normal aging. We learn at a slower rate. We require more repetition than we did before, but we still can learn. Processing speed is slower. We need more cues for recalling that fact or piece of information during a conversation. We may have mild word finding issues or difficulty with people’s names. Lastly, we experience increased difficulty with concentration - we can still do the things that matter, but it might take more focus than before. It’s difficult to know what is normal aging and what is actually a disease, especially since these symptoms are present in both. A general rule is that in disease, a symptom is noticeable and bothersome to the individual. It starts to interfere with behavior and how one gets through the day. Now the Alzheimer's Association has ten early signs and symptoms concerning cognitive impairment, and you can find that list online. The ones that I think are most important are experiencing memory loss that disrupts your daily life, or having new challenges in planning or solving problems. A very common one I see in clinic - difficulty completing familiar tasks, whether it's at home, at work, or doing things you previously enjoyed like cooking. Other issues would include misplacing things and losing the ability to retrace your steps in finding them. And lastly, being more withdrawn from work and social activities. If you have concerns about your memory or thinking, please talk to your primary care provider. Your primary care provider will look at reversible causes, possibly get blood tests, and can even do a quick thinking test to see if you need more evaluation. And now, back to the show.

I am here with Dr. Emily Rogalski. She is an associate professor of psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine. She has her PhD in neurosciences and serves as the associate director of the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease Center in Chicago. Her research focuses on communication disorders, in particular primary progressive aphasia as well as superaging. Welcome, Dr. Rogalski.

Dr. Emily Rogalski: Thank you for having me here today!

Chin: To begin, can you define for us, superaging?

Rogalski: Sure. SuperAging is kind of a quirky term and might sound a little bit funny when you first hear it. But the idea was, we wanted to focus on not what was wrong with the brain and aging but what was going right with the brain and aging. And when we think about aging, it’s often associated with all of the bad things that happen. So from our hair being more likely to turn grey or fall out, to our skin getting wrinkled and, just like there are things happening to the exterior of our body, there are also things happening in our brain that are common with aging. It’s - memory loss is one of the things that people complain about the most. So the question was, could we identify people who seem to be on a different trajectory of aging when it came to memory. We define SuperAgers as individuals who are over age 80 and have memory performance at least as good as individuals in their 50s and 60s. We’ve got people who are over age 80 with memory performance at least as good as individuals who are 20 to 30 years their junior

Chin: So superaging isn’t just a number. It’s not that you’re living to be 110. It’s actually the quality of your brian performance.

Rogalski: You've got it! So we're not talking about longevity, or just about longevity. We're talking about lifespan paired with healthspan. I think we've gotten really good at, as a medical community, at helping to extend that lifespan, helping people live longer. But sometimes that's coming with the unintended consequence of our healthspans not keeping up. The goal is not to live long and not live well. People want to live long and live well, and if we can identify some of the secrets that the SuperAgers might hold in that space, we think that could be informative not only for healthy aging but also potentially informing our understanding of Alzheimer's disease. So one way to look at Alzheimer's disease is to study what's going wrong in the individuals who have Alzheimer's dementia and Alzheimer's disease and then try to figure out how to correct what has gone wrong. But I think what we've learned from that is that Alzheimer's disease is immensely complex and it's not as simple as one medication or there's one way perhaps that you get Alzheimer's disease. When you have a really complex problem, sometimes it's useful to turn it on its head and say, “Well, let's look at the opposite end of the spectrum and can we learn from these people who have avoided memory loss and in fact have extraordinary memory for their age.”

Chin: Well it's a really positive term and it's a nice way of looking at getting older in a super healthy way. So can you tell me, how common is Super Aging and do you feel like it's occurring more often as our population changes?

Rogalski: So I think that's an excellent question and one that I can't fully answer because the type of study that we're doing at Northwestern is not an epidemiologic study, which is kind of a big word to say we're not looking across all people who are over age 80 and then figuring out how many people have extraordinary memory performance. Instead, we're trying to identify these people in a relatively local cohort. Most of the people in our study come from the Chicago-land area or surrounding states, Wisconsin included. What we do find is that - we set the bar so high for the super aging criteria - is that it is rare. We've screened over a thousand people and we've only found a little over 80 in the past ten years who meet these criteria. That might sound depressing at first, but we think that that's really important scientifically to really focus on these people who have kind of a rare memory performance - not to make everybody else SuperAgers but to identify factors that might really be making a difference. And if we've identified these unique factors and some of them are modifiable, then they're more likely to be translatable if they're truly something that's contributing versus something that's maybe more common.

Chin: Well, in your study on SuperAgers, what factors have you found associated?

Rogalski: Yeah, so maybe it's important to also think about well, how are we studying these individuals? What kind of questions are we asking them? What are we - how are we putting them through the ringer? And in that sense, I like to say that we're focused on first and foremost kind of four biologic cores, if you think about it like that. So we require SuperAgers to have outstanding memory performance, but are they also great in other areas of cognition? Do they have wonderful attention, their language abilities, something called executive functioning so being able to plan, good judgment. How is that compared to their peers? And then when they came into our study, did they have a lucky memory day or are they able to maintain this outstanding memory performance over time? We're also interested in what their brain structure looks like. We ask them to do MRI or PET scans which give us 3D images of the brain. There we can say well, if they have memory performance like 50 year-olds but they're chronologically 80 years-old, what do their brains look like? More like their 80 year-old peers who they share similar birthdays with, the birth years with, or more like the 50 year-olds? When we look at that we see that SuperAgers are able to maintain - that their brain structure looks more like the 50 year-olds than it does like the 80 year-olds. When we look at that brain structure over time, we see that average 80 year-olds’ brains are shrinking at a rate that's nearly two and a half times that of SuperAgers. What this does is it tells us SuperAgers are potentially on a different trajectory of brain aging. What are the magical factors that get us there? Those are some of the million dollar questions that we have left to ask and answer. 

Chin: How does your interest in Super Aging affect the work that you also do in Alzheimer's disease and other causes of dementia?

Rogalski: I think the work that I do in super aging is really relevant to Alzheimer's disease and other rare forms of dementia and I think it's relevant for aging in general. If we stop to think about aging and we talk about it - if you talk to your neighbors - we're often focused on those negative consequences. What's going wrong with the brain or that first time we can't remember where we laid our keys and we say, “Oh, that's just a part of aging” and maybe we come to expect that or be okay with that too soon. Part of it I think is it's helpful to set our expectations a little bit higher and I think the SuperAgers are maybe an extreme example of what's possible in aging. But I think it's a good reminder that there are really people out there who are doing so well and perhaps we can all expect a little bit more in aging. I also think, scientifically, the Super Aging cohort has the opportunity to teach us a lot about Alzheimer's disease and its potential prevention. Even when we think about Alzheimer's disease, it's diagnosed by the presence of something called plaques and tangles in the brain, but these plaques and tangles are commonly seen in older adults above age 80 but just in less abundance. So one of the questions we asked was, “Well, are SuperAgers immune to the development of these plaques and tangles or do they also have them and perhaps they're resistant to the effects of the plaques and tangles?” What we see is that sometimes SuperAgers do have these plaques and tangles. So maybe that helps us to inform which things are really a part of this negative trajectory of aging, this pathologic trajectory of aging, or are there pathways to be resistant to that or do we need to redefine how we think about some of these diseases.

Chin: How long has this study been going on?

Rogalski: So we've been running the Super Aging study for about ten years but we have rolling admission. So some people enrolled ten years ago and then others enrolled last week.

Chin: Wow, and so how - do you see them every year or how often do you have them come in and do the testing and do the imaging?

Rogalski: We ask the SuperAgers to come back every two years for what we call a big visit, and then in the interim years they're either coming into the office for a smaller cognitive visit or we're keeping in touch with them on the phone if for nothing else than to wish them a happy birthday.

Chin: Well it's very nice of them to be giving so much to the study. I do wonder if, do they often talk about sort of other lifestyle things such as what they're eating or what kind of physical activity they get or even sleep as that's becoming more of a common topic in the neighborhood?

Rogalski: Yes, so I think that there's been a wonderful amount of research that's been done about lifestyle factors. We know that exercise is important, we know that diet is important, and as well as sleep. I don't think our study is the definitive answer for what is the appropriate amount of sleep or how to figure out some of those factors. We see a bit of disparity there in the Super Aging group so we have some SuperAgers who are still leading their exercise group at age 85, whether that's a weightlifting group, a stretching group, a yoga group or whatever. And then we have other SuperAgers who have - really exercise is not their thing. They never have done it and they don't plan to start anytime soon. That's where, you know, the genetics might play a role where some people are able to be okay without exercising as frequently and other people, it may have been very important to them. I don't think there necessarily has to be one path for how people became a SuperAger but when these when this group does have things in common it gives us a lead to follow up on to identify potentially modifiable factors. Diet is sort of in that same realm where we have some people who will talk about how they love their hamburgers and french fries. Even when we get to things like drinking, we'll ask SuperAgers, kind of, what they think made them a SuperAger and some people are very light-hearted about that and they'll say, “Well, it's because I have a martini every day at five o'clock,” and others have never had any alcohol so we get some disparity there. Sleep is another one that we - so we track all of these things but we haven't done a formal report on that. Part of it is, we started out with a really small cohort of twelve SuperAgers - was kind of our first when we started reporting on this group. Now that we're getting to the size of 80 and beyond, we can start to ask and answer those questions a little bit more than we could have when you've got 12 people.

Chin: Sure! So as the study is progressing, what are some key takeaways that you think would be important for our audience to know, and what are things that you have surprised you as you've gone through the study?

Rogalski: Well, I think there's a few things to kind of take away. One is that it's possible to have this positive trajectory of aging and that the next time you, sort of, pass something off as “Oh, it's just because I'm getting older,” maybe stop and say, “You know, maybe I can still do this just as well and maybe I just had a quick slip of whatever I was trying to do.” So I think our expectations with aging can be a little bit better and that we should celebrate the fact that there are so many people out there who are living long and living well and have a real opportunity to contribute to not only our scientific understanding but to our community at large. The next thing is - I think SuperAgers, really their attitude, their curiosity and the way in which they approach life, is something to be admired. Not only are they being very altruistic in their participation in research but their curiosity and this drive to find the best in life is something that is easy for us to take home no matter what age we are.

Chin: Well, you know, I really appreciate what you're saying. And frankly, as a geriatrician who sees people who are anywhere 65 to 105, this idea of a senior moment - I try to to tell my patients, “No, really many things happen as we get older, that get even better, and that our quality of life continues to get better.” It's a mindset. 

Rogalski: Mm-hmm.

Chin: And so I'm grateful for studies like yours that are starting to show that, not only is the mindset important for mood but it's also important for potentially being a SuperAger.

Rogalski: Right. And I think, so you know, to drive home that point, we hear about social engagement being important and the negative consequences of loneliness and the positive consequences of social engagement. So, you know, the next time you think about calling that friend of yours, not only does it make you feel good but it might have some benefit to your brain so you're you're doing some neuroscience at the same time 

Chin: With that, I want to thank you again for being on our show and we welcome you back the next time you're in Madison.

Rogalski: Oh, I would love to come back anytime.

Chin: Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health and the Geriatric Research Education and Clinical Center of the William S Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private, university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers.This episode was produced by Rebecca Wasieleski and edited by Bashir Aden. Our musical jingle is “Cases to Rest” by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments, email us at dementiamatters@medicine.wisc.edu. Thanks for listening.