Longevity Talks: How Can We Come Face-To-Face With Our Age

By Harshil Vijayan, B.A., RBT

Let us analyze and discuss one of the most controversial questions of all time: How old are you? This question has the power to make a room go quiet and fill a face with disgust. The social norm regarding age is simply not asking about it. But why? What is the cause of social stigma around one's age? Is it the fear of being closer to death? Is it an indication of one's beauty and fitness? Whatever the reason for the stigma, it truly clouds the meaning of that double-digit number. Your age should be a celebration of the amount of time you have persevered on this planet, not an embarrassment. Now, this is easy for me, a 23-year-old, to say, but I am here to explore ways to help people love their age.

An important concept to understand is that your chronological age (the number of days since birth) differs from your biological age (the functionality/wear and tear of your cells, tissues, and organs). The main difference between the two is that chronological age is not malleable, while biological age depends on how you care for your health. One can be chronologically 50 years old and simultaneously feel biologically 60 years old, but the same chronologically aged people can feel 40 or even 35 biological years old. Genetics can impact your biological age, but your actions can help decrease it. One of these actions is the amount of physical activity you partake in (Østhus et al., 2012); genetics gives you the poker hand, and you decide how you want to play that hand based on the situation. Is it our chronological age that has been scaring us, or is it really the effects of biological aging that raise our fear? The good news is that we can control one of them.

The Taker of Experience

One of the most daunting aspects of aging is its associated diseases, and I want to talk about one that affects 13.8 million people aged 65 and older (Rajan et al., 2020). Alzheimer's Disease (AD). While studying age-related diseases, AD felt the most painful to learn about. Sixty-five years of life for any person is filled with countless memories formed, connections made, emotions felt, and sights seen. The concept of experiencing a degeneration that eliminates all of these magical revelations from memory strikes me as quite preposterous; should we not relish all of these experiences at the end of our lives? Current medicine has it so that when AD is diagnosed, the disease will most likely have spread throughout the brain, and unfortunately, some can only watch their loved ones slowly lose the realization of the things they once knew. There is only limited research supporting the complete elimination of AD, but we can still think optimistically, knowing that there are ways we can delay the development of this disease. Inevitable for some…maybe, but the ability to delay…definitely.

The Alzheimer's Association describes dementia as a "general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life." Dementia can come in multiple forms, for example, vascular, Lewy body, or frontotemporal dementia, but the most common type of dementia is Alzheimer's disease. AD is a "degeneration of the brain," leading to the difficulty of remembering new information and progressive memory loss. On average, people with AD will start to see symptoms around their mid-60s and get diagnosed at the same time. Unfortunately, there is no cure in this story. Most people and their families can get extremely discouraged after a diagnosis, but the beauty of the human heart is that there is always hope and perseverance available to get back up and battle against this disease. Of course, many treatment plans can aid the quality of life after diagnosis, but how sustainable is this? The burning question is, 'When should we take action to fight this disease of aging?' I wrote this paper because of the discovery of people's responses to a diagnosis. For example, people who drink alcohol and smoke tobacco tend to decline in these harmful activities after a cancer diagnosis (Pinto et al., 2005), but how can we enforce this decline without having to go through the horror of a cancer diagnosis? The unfortunate situation with Alzheimer's is that by the time of diagnosis, multiple parts of the brain will have already gone through atrophy and degeneration (da Silva Filho et al., 2017). Indeed, it is never too late to start trying treatments to get better, but in this case, we should begin as soon as possible.

Even if one gets diagnosed around 65 years old, the neuropathologic hallmarks (characteristics of the disease) of AD can start developing decades earlier in the brain; the most common hallmarks are amyloid beta plaques and neurofibrillary tangles (NFTs) (Porsteinsson et al., 2021). How quickly these hallmarks start developing can be traced back to genetics. The apolipoprotein E (APOE) gene is one of the major genes influencing AD development; this gene comes in three variations—known as alleles—e2, e3, and e4 (Liu et al., 2013). When you are born, you inherit one out of six combinations of any two of these three alleles—one from each parent. For example, you could have e2/e2, e2/e3, e4/e3, …etc. Holding more copies of the e4 allele has been found to accelerate AD development, while holding more copies of the e2 allele has been found to delay the development of AD (Yamazaki et al., 2019). Now we know that if you are born with more e4 alleles, you have a higher chance of developing those neuropathological hallmarks early.

What is the point of knowing this, you may be asking? In terms of AD development, genetics plays a huge role in how our biological age can increase or decrease across the lifespan. It makes sense to feel dispirited when given such unlucky odds; how do you win with a poker hand with such a low chance of winning from the start? How can you combat this early development of amyloid beta plaques and NFTs when you were born with this disadvantage? Luckily, in the famous nature vs nurture argument, nature (genetics) does not take the whole cake. We can use the environment to our advantage. If given a horrible poker hand, we can still read the room and other people's actions to help land us in an extraordinary situation. Do not let genetics define your age. Let physical activity show you the path to youth.

This image displays a brain scan highlighting amyloid beta plaques in both positive and negative diagnoses of Alzheimer's disease. The positive scan illustrated the extent to which the amyloid plaques have accumulated at the time of diagnosis.

Movement Is The Medicine

One of the most significant complications in the world of healthcare and medicine is the high cost of treatment in the United States. Even trying to eat healthier can come with a rise in costs, but fear no less: physical activity is a free treatment for many age-related diseases. A handful of longitudinal epidemiological studies support the claim that physical activity can delay the physical and cognitive decline associated with aging (Van Gelder et al., 2004). Regular and constant physical activity has also been found to contribute to lower levels of amyloid beta plaques and NFTs—this is due to the reduced hyperphosphorylation of the tau protein from physical activity (López-Ortiz et al., 2021)—which ultimately delays the arrival of Alzheimer's disease. When is the deadline for gaining all the benefits from physical activity? Never. Physical activity has been found to slow the cognitive decline associated with dementia across the whole age spectrum (Ahlskog et al., 2011). Even though the physical activity homework assignment is not due until your death day, the assignment will require some thoughtful effort. Interestingly, in this case, the more you do your assignment, the more you will extend your due date. 

The type of physical activity that prevents AD is called aerobic physical activity, a rhythmic physical activity that utilizes more oxygen by increasing your heart rate—such as walking, jogging, and swimming. Now, for the million-dollar question. How much physical activity? One study states that being physically active for older adults—ages 65 and above—means they are aerobically exercising for a minimum of 30 minutes/day for 5 days/week. Maintaining this routine of physical activity has been found to help older adults maintain their cognition (De la Rosa et al., 2020). Even younger people who are carrying the APOE e4 alleles benefit from partaking in this physical activity; adults around 50 years old with the e4 allele were to have more amyloid beta loads if they were consistently physically inactive (Tokgöz et al., 2021). You can continually improve your brain pathology with physical activity regardless of age.

I have just described a free, indispensable technique available to everyone to battle an age-related disease that does not have a medical cure, so why do people still live sedentary lives? One study found that the main reason why older people are not physically active is simply because there is a lack of interest; physical inability is the second biggest reason (Crombie et al., 2004). Trying to help people care about their health has much to do with education, institutional policies, family background, and social stigma. We do not know what is happening in people's personal lives that may be limiting their engagement with physical activities, but we can always make these concepts more aware to the public eye. I believe many people, like me, tend to wait for a problem to occur before they start finding the solutions, but if we find the solutions before the problem occurs, we do not need to go through all of the sufferings of the problem. Finding the solutions before a problem arises is difficult, but it does not mean we need to become psychics magically; it just requires more vigilance.

The Love of Growing Up

Writing these blogs aims to spread awareness of the good and the bad aspects of brain health and how we can improve it for the next person. Alzheimer's is the problem, and physical activity is the solution. Looking at the bigger picture, physical activity is not just a way to delay AD but also to decrease our biological age and to feel younger. Sometimes, you lose the poker hand, but it is a good thing that a poker game has many opportunities to win. Each birthday is another opportunity to work to celebrate even more birthdays. It is an opportunity to love your age and live your life.

References

Crombie, I. K., Irvine, L., Williams, B., McGinnis, A. R., Slane, P. W., Alder, E. M., & McMurdo, M. E. (2004). Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents. Age and ageing, 33(3), 287-292.

da Silva Filho, S. R. B., Barbosa, J. H. O., Rondinoni, C., Dos Santos, A. C., Salmon, C. E. G., da Costa Lima, N. K., ... & Moriguti, J. C. (2017). Neuro-degeneration profile of Alzheimer's patients: a brain morphometry study. NeuroImage: Clinical, 15, 15-24.

Jylhävä, J., Pedersen, N. L., & Hägg, S. (2017). Biological age predictors. EBioMedicine, 21, 29-36.

Liu, C. C., Kanekiyo, T., Xu, H., & Bu, G. (2013). Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy. Nature Reviews Neurology, 9(2), 106-118.

López-Ortiz, S., Pinto-Fraga, J., Valenzuela, P. L., Martín-Hernández, J., Seisdedos, M. M., García-López, O., ... & Santos-Lozano, A. (2021). Physical exercise and Alzheimer’s disease: effects on pathophysiological molecular pathways of the disease. International Journal of Molecular Sciences, 22(6), 2897.

Pinto, B. M., & Trunzo, J. J. (2005). Health behaviors during and after a cancer diagnosis. Cancer: Interdisciplinary International Journal of the American Cancer Society, 104(S11), 2614-2623.

Porsteinsson, A. P., Isaacson, R. S., Knox, S., Sabbagh, M. N., & Rubino, I. (2021). Diagnosis of early Alzheimer’s disease: clinical practice in 2021. The journal of prevention of Alzheimer's disease, 8, 371-386.

Rajan, K. B., Weuve, J., Barnes, L. L., McAninch, E. A., Wilson, R. S., & Evans, D. A. (2021). Population estimate of people with clinical Alzheimer's disease and mild cognitive impairment in the United States (2020–2060). Alzheimer's & dementia, 17(12), 1966-1975.

Roses, MD, A. D. (1996). Apolipoprotein E alleles as risk factors in Alzheimer's disease. Annual review of medicine, 47(1), 387-400.

Tokgöz, S., & Claassen, J. A. (2021). Exercise as potential therapeutic target to modulate Alzheimer’s disease pathology in APOE ε4 carriers: a systematic review. Cardiology and Therapy, 10, 67-88.

Van Gelder, B. M., Tijhuis, M. A. R., Kalmijn, S., Giampaoli, S., Nissinen, A., & Kromhout, D. (2004). Physical activity in relation to cognitive decline in elderly men: the FINE Study. Neurology, 63(12), 2316-2321. 

Yamazaki, Y., Zhao, N., Caulfield, T. R., Liu, C. C., & Bu, G. (2019). Apolipoprotein E and Alzheimer disease: pathobiology and targeting strategies. Nature Reviews Neurology, 15(9), 501-518.

Østhus, I. B. Ø., Sgura, A., Berardinelli, F., Alsnes, I. V., Brønstad, E., Rehn, T., ... & Nauman, J. (2012). Telomere length and long-term endurance exercise: does exercise training affect biological age? A pilot study. PloS one, 7(12), e52769.