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Aging often comes with cognitive decline, but “SuperAgers” are showing us what is possible in our golden years.

“These are like the Betty Whites of the world,” <a href="https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=18145" target=_blank>Emily Rogalski</a> said. She is a cognitive neuroscientist at Northwestern University’s Feinberg School of Medicine and associate director of the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease.

She was part of the research team that coined the term “SuperAgers” 15 years ago. It describes people older than 80 whose memory is as good as those 20 to 30 years younger, if not better.

What researchers are learning from SuperAgers and about dementia prevention could allow us to discover new protective factors in lifestyle, genetics and resilience for common changes that arise with aging.

“It’s invigorating to know that there are good trajectories of aging,” Rogalski said. “It’s possible to live long and live well.”

What a good aging trajectory may look like

There are three major trajectories of aging’s effects on our cognition, Rogalski said.

In the pathologic trajectory, cognition deteriorates faster than expected for the age, as in the case of dementia.

The reality is that the biggest risk factor for dementia is aging, said <a href="http://www.cns-neuro.com/DrClionsky.html" target=_blank>Mitchell Clionsky</a>. Clionsky is a neuropsychiatrist who, with his wife, physician <a href="http://www.cns-neuro.com/DrGrandey.html" target=_blank>Emily Clionsky</a>, wrote “<a href="https://amzn.to/3UsGcWU" target=_blank>Dementia Prevention: Using Your Head to Save Your Brain</a>.”

A <a href="https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf" target=_blank>2023 report</a> from the Alzheimer’s Association estimates that 1 in 3 Americans older than 85 have Alzheimer’s disease, the most common form of dementia. More hopefully, research has uncovered many of the <a href="https://apps.who.int/iris/bitstream/handle/10665/312180/9789241550543-eng.pdf" target=_blank>different risk factors</a> that can be mitigated with lifestyle changes. A 2020 report from Lancet estimates that about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392084/" target=_blank>40 percent of dementias</a> may be preventable.

In the normal or average trajectory, research shows, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367038/" target=_blank>memory and cognitive abilities can begin to decline</a> around your 30s or 40s. By the time most people are 80, on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3541673/" target=_blank>certain memory tests</a>, they can remember about half as much as when they were 50, Rogalski said. Despite being less sharp, older people following this trajectory are still able to function — and thrive — in everyday life.

There is, however, a lot of individual variability.

This variability led to the discovery of the third trajectory: SuperAgers, who even past their 80s appeared to be at least as mentally acute in memory as those in their 50s and 60s.

It is not known what percent of the general population qualifies as SuperAgers, but they appear to be rare, Rogalski said. Even when researchers tried to screen only participants who believed they had good memory, less than 10 percent met the definition.

Over time, researchers followed those enrolled, examining their health, imaging their brains, recording their life histories and asking them to donate their brains to be studied after they die.

“The word I would use to describe this group is resilient,” Rogalski said. Many SuperAgers endured hardship, including extreme poverty, losing family at an early age or surviving Holocaust concentration camps, she said.

SuperAgers tend to have <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186413" target=_blank>strong positive social relationships</a>, which require a degree of adaptability when there are fewer peers of their age.

One SuperAger lives with his daughter and grandchildren, who do not know much about Frank Sinatra or Franklin Delano Roosevelt, Rogalski said. Instead, the SuperAger asks his grandchildren about their interests: Taylor Swift and Chance the Rapper.

“He laughs at this and finds joy in trying to keep up with what his grandkids are interested in instead of seeing that as too far of a reach or a burden,” Rogalski said. “And I think that that’s a really lovely outlook.”

What makes the brain of a SuperAger special

With age, <a href="https://www.washingtonpost.com/wellness/2023/02/28/brain-aging-childhood-teens-adults/" target="_blank">the brain normally shrinks</a>, especially in the cortex, which is the more evolutionarily recent part of the brain.

Not so with SuperAgers, whose brains <a href="https://www.jneurosci.org/content/36/37/9659.short" target=_blank>appear more youthful</a> in areas implicated in memory and executive abilities.

In the <a href="https://www.cambridge.org/core/journals/journal-of-the-international-neuropsychological-society/article/abs/superior-memory-and-higher-cortical-volumes-in-unusually-successful-cognitive-aging/206608D731A33A0B3CB63AF305FDBDDB" target=_blank>anterior cingulate cortex</a>, a frontal brain region important for many cognitive functions, including attention and memory, SuperAgers had a thicker cortical layer compared with cognitively normal 80-plus-year-olds and even 50-year-olds. SuperAgers also had larger, healthier neurons in the <a href="https://www.jneurosci.org/content/42/45/8587.abstract" target=_blank>entorhinal cortex</a>, another brain area critical for memory, compared with both their older and 20-to-30-years-younger counterparts.

Intriguingly, SuperAgers also have an abundance of a special type of brain cell known as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0010945217303611" target=_blank>von Economo neurons</a>, which are believed to be important for social affiliative behaviors. <a href="https://www.sciencedirect.com/science/article/abs/pii/S0010945217303611" target=_blank>Studies</a> suggest that von Economo neurons were four to five times denser in the anterior cingulate cortex of SuperAgers than in normal 80-year-olds, and even in individuals decades younger.

At the same time, SuperAger brains appear to have added protection against suspected <a href="https://www.nature.com/articles/s41380-021-01249-0#Sec35" target=_blank>biological hallmarks of Alzheimer’s</a>, with less <a href="https://www.nature.com/articles/aps201728" target=_blank>amyloid beta plaques</a>, a cellular waste product, and neurofibrillary tangles.

Preventing dementia and preserving cognition

Becoming a SuperAger is probably partly because of the genetic lottery, but there are <a href="https://www.washingtonpost.com/wellness/2023/01/26/dementia-memory-loss-lifestyle-habits/" target=_blank>many lifestyle factors</a> we can modify to lengthen our cognitive health span as we age.

“Stop being a dementia worrier, start being a prevention warrior,” Mitchell Clionsky said. “The active approach to this is what’s going to make the difference.”

And it is never too late to address the risk factors we can change, Emily Clionsky said. The average age of her patients who saw benefits was the mid-70s. “My oldest patient was over 100,” she said.

There is no one thing that will ensure healthy cognitive aging, but all these factors are interactive, researchers said. If we start chipping away at the dementia risks and pile on protective factors, we can reap positive effects. Here are some that may help:

<a href="https://www.washingtonpost.com/wellness/2023/02/14/centenarians-healthy-eating-habits/?itid=lk_inline_manual_44" target=_blank>Eat like a centenarian</a> by incorporating fiber-rich foods and nuts into your diet.

Exercise your body. Most people know the importance of getting up and moving, yet don’t always follow through. “I tell them to examine their ‘but,’” Mitchell Clionsky said. Figure out what is getting in the way of exercising and ask “how do we break it down into something you will do,” he said.

Exercise your brain. The <a href="https://www.washingtonpost.com/wellness/2022/09/29/train-brain-for-hard-things/?itid=lk_inline_manual_46" target=_blank>brain loves a challenge</a>, so do activities that engage your noggin.

<a href="https://www.washingtonpost.com/wellness/2023/01/09/how-to-adult-friends-relationships/?itid=lk_inline_manual_47" target=_blank>Stay connected</a>. Social isolation and loneliness are risk factors for dementia, while social contact is protective.

Foster resilience. When something bad occurs, try to embrace the challenge. “What in this can be a learning moment? What in this can be a turning point?” Rogalski said.

SuperAgers cannot only help us age better but also reimagine what is possible in older age.

“I think there’s the possibility to set new expectations in aging and to revalue rather than devalue older adults,” Rogalski said.

Do you have a question about human behavior or neuroscience? Email <a href="mailto:brainmatters@washpost.com">BrainMatters@washpost.com</a> and we may answer it in a future column.

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Johns Hopkins University, PhD in Neuroscience

Harvard University, BA in Neurobiology 

Richard Sima is a neuroscientist turned award-winning science journalist who writes the "Brain Matters" column for The Washington Post's Well+Being desk. 

Richard Sima

What SuperAgers show us about longevity, cognitive health as we age

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What SuperAgers show us about longevity and cognitive health