He is a celebrity with distinctive features: A ruffled beard and red work clothes. Traditionally, he wears a bishop’s hat, but sometimes a red pointed hat. His age is biblical. And yet every year he delivers outstanding mental and physical performances: In just one night, he visits countless households, filling boots, socks and gift plates. He takes meticulous care to ensure that every gift ends up in the right shoes or on the right dishes. Mix-ups or even someone being forgotten - there are never any reports of such incidents. A superbly fit senior citizen, or “super-ager” as we say today. What is it all about? An interview with Dr. Anne Maass, neuroscientist at DZNE’s Magdeburg site and visiting professor at the University of Magdeburg, about St. Nicholas, the brain and aging.
Dr. Maass, St. Nicholas is an example of perfect organization skills. Long before the advent of modern bookkeeping and planning software, he knew how to manage complex tasks. Using only his brain and a golden book. And that at an advanced age. Is he a super-ager?
Oh yes! St. Nicholas definitely meets the criteria for super-aging.
And what are they?
Well, there are various, slightly different definitions of “super-agers”. In our understanding, they are individuals over the age of 80 with the mental fitness of 50 to 60-year-olds. We should be aware that St. Nicholas was already on the road in the fourth century AD under the alias “Bishop of Myra”. This puts him in the relevant age group and there is no question that he is mentally fit. Otherwise he wouldn’t be able to do his job. He would probably score exceptionally well in our memory tests.
What kind of tests are these?
For example, our participants are presented with a list of words that they have to memorize in order to be able to recall them later. And then there are also other tests in which they have to master logical tasks as quickly as possible. All these tests are standardized. This allows us to objectively determine whether someone is particularly fit and therefore meets the criteria for super-aging.
Why are you researching super-aging?
The risk of dementia generally increases with age. Super-agers are obviously armed against it. We want to understand why this is happening and what we can learn from it so that we can all age as healthily as possible.
How large is your study?
We started recruiting at the beginning of 2022 and have now enrolled 19 super-agers in our study. It’s not that easy to find such individuals. In the long term, we would like to recruit 50 super-agers and 50 participants who are also over 80 years old and cognitively healthy, but not super-agers. In addition, there will be another 200 study participants aged between 60 and 79. We would like to examine all participants regularly over several years. Because we want to determine whether and how their cognitive performance and their brains change over time.
Mental fitness generally deteriorates with age. Even if you are not affected by dementia. What’s the reason?
In fact, the decline already begins around the age of 60. According to current knowledge, a number of things come together. On the one hand, we lose brain cells with age. This is a natural process. And brain cells generally do not regrow; according to present understanding, this only happens to a very limited extent in few regions of the brain. Furthermore, in brain areas that are relevant for memory, certain proteins are deposited that disrupt the function of the neurons. In addition, with increasing age there are often pathological changes in the tiny brain vessels that restrict blood supply. Moreover, with age, the brain’s maintenance mechanisms become less efficient. All these changes impair the function of the brain. There are fewer connections or at least less effective connections. After all, brain cells do not exist in isolation, but are linked to many other cells. The function of the brain is based on such connections. If these are compromised, mental fitness suffers.
And super-agers are immune to these consequences of aging?
To a certain extent. This is illustrated by brain volume, for example: Although more volume does not automatically mean more brain “power”, volume is nevertheless a relevant feature and, on average, brain areas relating to memory and emotions are larger in super-agers than in other people of the same age. In fact, studies have shown that super-agers lose comparatively fewer neurons and therefore less brain volume with age. However, it could also be that these brain areas are generally larger in super-agers and that they therefore have a kind of brain reserve. These questions are still open. Research on super-aging is still a young field.
You also mentioned the brain’s maintenance mechanisms ...
This is a complex, neurobiological machinery with many little wheels. But one aspect is certainly the removal of harmful materials. That’s why we scan the brains of super-agers for tiny protein deposits, which - as mentioned before – specifically accumulate in the areas that are relevant for memory. To accomplish this, we use a brain scanner that is only available at special clinics and research facilities. The protein deposits we are interested in are hallmarks of Alzheimer’s disease, but also occur to a certain extent in cognitively healthy older people. However, if there are too many of these protein deposits, this is a risk factor. And so far it appears that super-agers have comparatively few such deposits in their heads. However, we can’t say for sure yet, our study is still ongoing.
Are there differences between men and women?
An interesting question. In old age, women have a higher risk for dementia than men. We don’t know exactly why this is the case. It is assumed that, among other things, differences in hormone levels play a role. In women, specifically the decline in estrogen after the menopause. But a healthy cardiovascular system is also important for an efficient brain. And here, men also have a biological advantage. On the other hand, it is still uncertain whether women rather than men have what it takes to become a super-ager.
Is super-aging rooted in the genes?
There is some evidence that genes might play a role. Nonetheless, super-agers have the same typical risk genes for Alzheimer’s disease as other people. However, the super-aging groups that have been studied so far are quite small, so there are still little data available. Presumably, the ability to super-age is not something we are entirely born with, but it is a combination of as yet unknown genetic factors and lifestyle. Previous studies suggest that personal life history also plays an important role. In any case, super-agers are not only mentally fit for their age, but also have above-average motor skills, are usually cheerful and socially active. It also appears that super-agers are less anxious and have suffered fewer mental disorders, such as depression, in the course of their lives.
And the lessons to be learned?
From the data available so far, we can only draw preliminary conclusions. However, there is a general scientific consensus that everyone can do something to stay mentally fit in old age. There is no “patent recipe”, but you can minimize risk factors. That is quite a lot. It is estimated that around 40 percent of all dementia cases can be avoided or at least the onset of dementia can be delayed. Important risk factors for dementia include high blood pressure, obesity, diabetes, smoking and excessive alcohol consumption. Super-agers have seemingly started to take many of these things to heart early on. Although it is never too late, it is likely that important foundations for healthy aging are already laid in the middle years of life. DZNE is investigating such aspects as part of the “Rhineland Study”, a long-term study in Bonn that is set to run for decades.
And nutrition?
Nutrition has complex effects on our body. The effects are very individual and by no means all understood. Intestinal flora, metabolism, immune system, fat reserves - the brain is just one aspect. Generally speaking, a light diet with lots of fruit, vegetables, fish, pulses, cereals and olive oil, but with little meat, is considered good for the brain. This is known as “Mediterranean diet”. Various studies suggest that such a diet is indeed beneficial for mental fitness. In view of the onset of the cold season, I would also mention nuts and dried fruits. However, you shouldn’t expect any Christmas wonders from them, but rather let the enjoyment be the deciding factor.
What about brain jogging?
Generally, this is understood to mean something like solving Sudoku or crossword puzzles. If you practice this regularly, you’ll eventually be great at it, but you’re only training an isolated talent. There’s nothing wrong with that, but it doesn’t help much in terms of general mental fitness. Complex tasks, such as learning a foreign language, make more sense. Combining mental and physical training, ideally in a group with others, is particularly effective. Take dancing, for example. Here, you have to memorize step sequences, interact with your partner and also move around. Generally speaking, this is also possible in old age. Besides, good for the heart is also good for the head. And in more ways than one. A fit cardiovascular system is good for the blood flow to the brain - and if the blood pressure is within a normal range, this reduces the risk for damage to brain vessels and for stroke. A varied life and the associated challenge of constantly having to adapt to new things also promotes mental resilience. St. Nicholas is a prime example of this: Over the centuries, he has certainly developed a lot of routine, but there are always new kids and also adults that he has to visit. This requires a lot of flexibility in his route planning.
Do you think it will pass you by this year?
I hope so, I will certainly put my shoes on the doorstep. And maybe St. Nicholas will agree to a few tests. I guess we could learn a thing or two from him.
December 2023, Interview: Marcus Neitzert