How Super-Agers Avoid Dementia

The chance of developing some form of dementia as we age can cloud our pursuit of a long and functional life: No one wants to spend their golden years suffering from Alzheimer’s. But a recent study suggests that even centenarians can avoid cognitive dysfunction — despite the presence of the tangles and plaque associated with the disease.

These centenarian “super-agers,” who avoid dementia despite having plaque in their brains, display a level of both resistance and resilience that is uncommon among their elderly peers, explains lead study author Henne Holstege, PhD, an assistant professor at Amsterdam’s VU University Medical Center. “While centenarian brains revealed varying loads of postmortem neuropathological hallmarks of [Alzheimer’s], this was not associated with cognitive performance or rate of decline,” she reports in JAMA ­Network Open.

Her team recruited 330 centenarians who were cognitively healthy and living independently and evaluated their cognitive health at the beginning of the study and again in the months that followed — some as many as four years later. They observed a modest decline in memory among some participants but found no noticeable erosion in overall cognitive function.

For various reasons, these super-agers were able to resist the forces that typically cause dementia or were simply able to deal with them more effectively than other older adults. In fact, some exhibited the cognitive skills of people much younger, according to the New York Times.

Genes and lifestyle may play a role in allowing certain centenarians to completely avoid cognitive erosion, Boston University geriatrician Thomas Perls, MD, tells the Times.

Alzheimer’s disease is not an inevitable result of aging. Those genetically predisposed can markedly delay it or show no evidence of it before they die by doing the things we know are healthful.”

The resilience these super-agers displayed — withstanding damage to the brain until much later in life — may be due to what Holstege describes as “cognitive reserve.” Some people fortify their brains over the course of decades, allowing them to stay sharper longer.

“We found that next to physical-health factors, factors of cognitive reserve, such as education, frequency of cognitive activity, and premorbid IQ, were associated with cognitive performance,” she explains. “This is in line with our previous study, in which we demonstrated that the cognitively healthy centenarians in our cohort had higher levels of education and a higher socioeconomic background compared with birth-cohort peers.”

We can’t control all these factors, but some are within our grasp. As Perls notes, basic lifestyle choices can make a difference. “Alzheimer’s disease is not an inevitable result of aging,” he argues. “Those genetically predisposed can markedly delay it or show no evidence of it before they die by doing the things we know are healthful.”

(For more on Alzheimer’s-­prevention measures, see “Untangling Alzheimer’s“.)

This article originally appeared as “Old Bodies, Young Brains: How Super-Agers Stay Sharp” in the December 2021 issue of Experience Life.

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