Unlocking the secrets of super-agers

Three senior women enjoying themselves while camping; an RV is in the background, out of focus.

Many of us have surely noticed there's a difference between getting old and getting old. The former is something that happens to everyone who's lucky enough; the latter, to a sizable subset of that group. But each of us likely knows someone who's reached their 80s, 90s, or beyond without losing that special spark — they're quick-witted, vital… and enviable.

Scientists created a term for these folks: super-agers. While staying physically and cognitively robust is everyone's ideal, super-aging focuses on the mental part. Defined as adults over 80 who have the memory capacity of someone at least three decades younger, super-agers epitomize what we'd all like to become. But to a certain extent, the phenomenon doesn't just happen—it's the result of consistent behaviors and lifestyle choices that promote optimal brain health, Harvard experts say.

"The reason super-aging, as a concept, came about is that when we look at average aging, there are clearly people who are doing it way better," says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School.

Dr. Suzanne Salamon, clinical chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center, agrees. "There's no question super-aging is being talked about a lot, because people are living longer, and they're not all alike," she says. "Some people in their 80s and 90s have the mental abilities of 50- and 60-year-olds. While physically they're pretty much the same as their peers, brain-wise they seem not to get dementia."

Super-agers set apart

There's no denying that aging changes the brain. On average, the organ shrinks in volume and weight about 5% every decade after we reach age 40, a process that speeds up after 70. As this happens, brain regions can't communicate as robustly, so cognitive tasks take longer.

As they get older, most people also have tiny, symptomless ministrokes, and they develop tangles in the part of the brain involved with learning and memory, Dr. Budson says. Additionally, certain parts of the brain that handle memory diminish over time, explaining why "even people who are aging normally have trouble finding words, names, titles of movies, things like that," he says.

But super-agers' brains don't follow this pattern. Compared to typical older adults, they have larger brain volumes in areas linked to memory and movement, and their brains shrink more slowly over time, according to an August 2023 study of 64 such people (average age 82, 59% women) in The Lancet Healthy Longevity. Notably, however, super-agers didn't have lower levels of dementia-related markers in their blood, suggesting their brain health can be attributed to natural resilience, not lower disease risk.

"Super-agers are still going to experience the physiologic changes that occur with aging," Dr. Budson says, "but they experience less of those disease-related changes that often occur, but don't have to."

Women's advantages

Women automatically have a leg up in the quest to become super-agers merely from a longevity standpoint. On average, we live about five years longer than men (until about 80), so we're more likely to meet the criteria for super-aging.

But we also enjoy other advantages. Much research indicates that women tend to outperform men on a type of cognitive quiz called a verbal episodic memory test, which checks how well someone remembers spoken information from past events. Researchers use these tests to evaluate a person's ability to recall specific details such as words, stories, or conversations.

And while reading, playing games, and taking classes improves thinking speed in both women and men, only women demonstrate greater "cognitive reserve" from taking part in these mental activities, according to a 2022 study in the journal Neurology. Cognitive reserve is the brain's ability to withstand age-related negative health effects without exhibiting declines in thinking or memory skills.

Brain-boosting strategies

A report published online Aug. 10, 2024, by The Lancet reinforces the notion that practicing a healthy lifestyle, along with other key tactics, can help keep dementia at bay — which is essential to achieving super-ager status.

For example, up to 7% of dementia cases could be avoided if people with high cholesterol were treated adequately. Another 7% could be eliminated if people with hearing loss wore hearing aids.

According to Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School, here's what else super-agers do to keep their brains sharp.

They exercise. Sure, there are tons of good reasons to be physically active: it lowers the risk for heart disease and cancer, improves mood, and helps control weight. But exercise also appears to promote the growth of new brain cells and enhance blood vessel health in the brain, while cutting inflammation levels, according to a 2020 research review published in the Journal of Aging Research. Older adults who exercised at least five times a week for 45 minutes or longer reaped the greatest brain benefits.

Many studies have also found that brain regions that control thinking and memory are larger in people who exercise than in those who don't. "Exercise helps in two different ways: by reducing cardiovascular risk factors and augmenting the size of brain structures," Dr. Budson says.

They flex their cognitive skills. Like our muscles, our brains need to be challenged to remain fit. Cognitive exercise comes in many forms: reading, writing, painting, taking classes, learning new skills or languages, playing an instrument, or playing card games.

"It's a simple analogy, but the brain is a bit like a muscle," Dr. Budson says. "There's a lot of evidence that if we don't use it, we're going to lose it."

They stay socially connected. It's no accident that older adults who gravitate toward others' company seem to stay sharper than their peers. People in their 60s who see friends most days of the week are about 12% less likely to develop dementia than peers who see friends only once or twice a month, a 2019 study in PLOS Medicine suggested. A vigorous social life also wards off loneliness and depression, both of which have been linked to a variety of health problems, including cognitive decline. "There's nothing more stimulating than interacting with other human beings," Dr. Budson says. "It's really what our brains are built for."

They prioritize restful sleep. Getting the recommended seven to nine hours of shut-eye every night helps fuel the brain's efforts to clear away waste products that can contribute to Alzheimer's disease. Indeed, chronic insomnia in older adults is tied to higher odds of memory decline. Those who have trouble falling or staying asleep for three or more nights each week for three months or longer face greater risks of worsening memory problems, according to a 2022 study in the journal Sleep.

Sleep also helps our brains transform short-term impressions into memories we can access a long time from now. Additionally, it helps get rid of "connections we don't need," Dr. Budson says. "You can probably remember what you had for dinner the past few nights, but the brain is good about letting go of those unimportant details. Sleep helps us do that."

How luck figures in

Not to be overlooked is the significant role a person's genes appear to play in whether someone achieves super-ager status. These folks are more likely to have plenty of brain cells known as von Economo neurons, which are involved in memory.

"A lot of super-agers seem to develop and grow more of these brain cells in just the first few months of life," Dr. Salamon says. "Interestingly, they're also found in the brains of animals that seem to have good memories, like elephants, whales, and dolphins."

Like favorable genes — which are beyond our control — another factor shaping super-ager status is also due to luck: avoiding infections. Research suggests that beta-amyloid, a type of protein involved in Alzheimer's-related brain plaques, is normally deposited in the brain to help it fight off bacterial, viral, or fungal infections. But some people aren't able to clear this protein out of the brain after the infection has resolved, and that buildup can contribute to Alzheimer's.

"I will say quite firmly that super-agers need to be lucky in avoiding getting an infection that might trigger a cascade of amyloid," Dr. Budson says.