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The beginning of a new year is a time to think about the future, and perhaps think about healthy lifestyles and how to age well. One important issue to think about is: why do some older people have "young" minds while others do not? Can anything be done to improve our odds later in life of being a "superager" and having a youthful, sharp, clear mind?

Unfortunately, as humans age, memory and many other cognitive functions often decline. “Normal” performance on various cognitive tests may be substantially lower than that of a younger adult, but... there is substantial variation in the degree of cognitive decline with age. Some older adults—referred to by some as “superagers”—continue to perform mentally at a level similar to middle-aged adults and sometimes even young adults.

Earlier posts have examined some of the things that help people age well and keep their brains more "youthful" - from diet (herehere, and here), to daily coffee consumption, vitamin D levels (here and here), regular physical activity and exercise (herehere, and here), not living in polluted areas (here and here), civic engagement, higher education, learning new skills, doing arts or crafts, and using a computer (here). Also frequently mentioned are social activities, intellectual stimulation, and genetics.

One recent study (discussed below) found that doing something hard and really challenging (that means forget pleasant puzzles), something that tires you out (whether physically or mentally) is what is good for the brain. So go out and learn a new language or musical instrument, sign up for a course, or anything else that is really challenging - whether physical or mental. Excerpts from a piece written by Lisa F. Barrett, a professor of psychology at Northeastern University, from the NY Times:

How to Become a ‘Superager’

Think about the people in your life who are 65 or older. Some of them are experiencing the usual mental difficulties of old age, like forgetfulness or a dwindling attention span. Yet others somehow manage to remain mentally sharp....Why do some older people remain mentally nimble while others decline?Superagers” (a term coined by the neurologist Marsel Mesulam) are those whose memory and attention isn’t merely above average for their age, but is actually on par with healthy, active 25-year-olds. My colleagues and I at Massachusetts General Hospital recently studied superagers to understand what made them tick.

Our lab used functional magnetic resonance imaging to scan and compare the brains of 17 superagers with those of other people of similar age. We succeeded in identifying a set of brain regions that distinguished the two groups. These regions were thinner for regular agers, a result of age-related atrophy, but in superagers they were indistinguishable from those of young adults, seemingly untouched by the ravages of time...... The thicker these regions of cortex are, the better a person’s performance on tests of memory and attention, such as memorizing a list of nouns and recalling it 20 minutes later.

Of course, the big question is: How do you become a superager? Which activities, if any, will increase your chances of remaining mentally sharp into old age? We’re still studying this question, but our best answer at the moment is: work hard at something. Many labs have observed that these critical brain regions increase in activity when people perform difficult tasks, whether the effort is physical or mental. You can therefore help keep these regions thick and healthy through vigorous exercise and bouts of strenuous mental effort. My father-in-law, for example, swims every day and plays tournament bridge.

The road to superaging is difficult, though, because these brain regions have another intriguing property: When they increase in activity, you tend to feel pretty bad — tired, stymied, frustrated. Think about the last time you grappled with a math problem or pushed yourself to your physical limits. Hard work makes you feel bad in the moment. The Marine Corps has a motto that embodies this principle: “Pain is weakness leaving the body.” That is, the discomfort of exertion means you’re building muscle and discipline. Superagers are like Marines: They excel at pushing past the temporary unpleasantness of intense effort. Studies suggest that the result is a more youthful brain that helps maintain a sharper memory and a greater ability to pay attention.

This means that pleasant puzzles like Sudoku are not enough to provide the benefits of superaging. Neither are the popular diversions of various “brain game” websites. You must expend enough effort that you feel some “yuck.” Do it till it hurts, and then a bit more.

In the United States, we are obsessed with happiness. But as people get older, research shows, they cultivate happiness by avoiding unpleasant situations. This is sometimes a good idea, as when you avoid a rude neighbor. But if people consistently sidestep the discomfort of mental effort or physical exertion, this restraint can be detrimental to the brain. All brain tissue gets thinner from disuse. If you don’t use it, you lose it. So, make a New Year’s resolution to take up a challenging activity. Learn a foreign language. Take an online college course. Master a musical instrument. Work that brain. Make it a year to remember. [Original study]

The wonderful blog posts of Dr. John Mandrola (physician, blogger, and columnist at Medscape) are always thoughtful, and this latest points out things a number of studies have pointed out for a while. Which is to stop obsessing or focusing on "preventive tests" and screenings and numbers, and instead focus on a healthy lifestyle - which means getting regular exercise or physical activity, don't smoke cigarettes, maintaining a healthy weight, and eating a healthy diet with lots of fruits, vegetables, nuts, seeds, whole grains, and legumes (think Mediterranean-style diet).

Don't want overdiagnosis and overtreatment (here, here, here, and here). Excerpts from Dr. John M:

I am changing…

The main thing that has changed about me is my views as a doctor, especially when it comes to dealing with people who complain of nothing. Medicine is most pure when we treat people with illness. The infirmed come to us with a problem and we use our intelligence, experience and procedural skills to help them. It’s immensely gratifying. The joy of helping people still negates the stifling burden of administrative nonsense. I’ll do your damn corporate safety modules one more year because helping sick people get well feels so good.

But when people complain of nothing, our first job is to do no harm. I know prevention of disease is better than treating it, but the process of prevention gets dicey. When we prescribe things (screening tests, statins, aspirin, diabetes drugs etc) to people who complain of nothing, we should have the highest evidence these therapies deliver benefit. Too often, we cite eminence rather than evidence.

I’ve come to believe the medical profession is too paternalistic, too arrogant. I fear the medicalization of the human condition. These days, I order fewer tests. Medical tests put people into the “system,” on the metaphorical train of healthcare. This train accelerates quickly, and it’s often hard to get off. Even a simple echo scares me. I could tell you stories.

More often than not, I tell patients to stop checking their “numbers.” If they insist on health numbers, I favor three–the scale, the belt size and a Timex to measure walking speed.

A 2002 article from Dr. David Sackett (a pioneer of evidence-based medicine) perfectly captures my views on preventive medicine. It’s called The Arrogance of Preventive Medicine. It’s worth a look, now more than ever.

Recently some studies have found that a diminished sense of smell occurs in persons with mild cognitive impairment and Alzheimer's disease. Doctors have long observed that patients with Alzheimer's frequently complain that food doesn't taste good anymore (because they can't smell what they are eating). This is because odor signals from the nose are processed in areas of the brain that are among the first to be affected by Alzheimer's disease. It is thought that as dementia starts and progresses, the parts of the brain that distinguish odors start to deteriorate.

This is why various odor tests have been devised. One such odor test (used in the following study) is called "Sniffin Sticks", which tests for 16 odors such as orange, peppermint, leather, banana, garlic, rose, fish, and coffee. However, note that other degenerative brain diseases (including Parkinson's) can also affect odor detection, and the ability to smell can be diminished by smoking, certain head injuries, and even normal aging. From Medical Xpress:

Study confirms 'sniff test' may be useful in diagnosing early Alzheimer's disease

Tests that measure the sense of smell may soon become common in neurologists' offices. Scientists have been finding increasing evidence that the sense of smell declines sharply in the early stages of Alzheimer's, and now a new study from the Perelman School of Medicine at the University of Pennsylvania published today in the Journal of Alzheimer's Disease confirms that administering a simple "sniff test" can enhance the accuracy of diagnosing this dreaded disease. The sniff test also appears to be useful for diagnosing a pre-dementia condition called mild cognitive impairment (MCI), which often progresses to Alzheimer's dementia within a few years.

Roalf and his colleagues used a simple, commercially available test known as the Sniffin' Sticks Odor Identification Test, in which subjects must try to identify 16 different odors. They administered the sniff test, and a standard cognitive test (the Montreal Cognitive Assessment), to 728 elderly people. The subjects had already been evaluated by doctors at Penn with an array of neurological methods, and according to expert consensus had been placed in one of three categories: "healthy older adult," "mild cognitive impairment," or "Alzheimer's dementia." Roalf and his team used the results from the cognitive test alone, or combined with the sniff test, to see how well they identified subjects in each category.

As researchers report, the sniff test added significantly to diagnostic accuracy when combined with the cognitive test. For example, the cognitive test alone correctly classified only 75 percent of people with MCI, but that figure rose to 87 percent when the sniff test results were added. Combining the two tests also enabled more accurate identification of healthy older adults and those with Alzheimer's dementia. The combination even boosted accuracy in assigning people to milder or more advanced categories of MCI.

Prompted by prior studies that have linked a weakening sense of smell to Alzheimer's, doctors in a few larger dementia clinics already have begun to use smell tests in their assessments of elderly patients. Part of the reason the practice has not yet become common is that the tests that seem most useful take too long to administer. 

New research further confirms a link between higher lutein levels (as measured in the blood) and the preservation of "crystallized intelligence" in older adults.  Crystallized intelligence is the ability to use the skills and knowledge one has acquired over a lifetime. Lutein is in foods such as leafy green vegetables, cruciferous vegetables (broccoli, brussels sprouts, cauliflower, and cabbage) and egg yolks. Lutein is also found in small amounts in other fruits and vegetables. Bottom line: eat a variety of fresh fruits and vegetables daily. [Original study.]Medical Xpress:

Study links nutrition to brain health and intelligence in older adults

A study of older adults links consumption of a pigment found in leafy greens to the preservation of "crystallized intelligence," the ability to use the skills and knowledge one has acquired over a lifetime.

Lutein (LOO-teen) is one of several plant pigments that humans acquire through the diet, primarily by eating leafy green vegetables, cruciferous vegetables such as broccoli, or egg yolks, said University of Illinois graduate student Marta Zamroziewicz, who led the study with Illinois psychology professor Aron Barbey. Lutein accumulates in the brain, embedding in cell membranes, where it likely plays "a neuroprotective role," she said. "Previous studies have found that a person's lutein status is linked to cognitive performance across the lifespan," Zamroziewicz said. 

The study enrolled 122 healthy participants aged 65 to 75 who solved problems and answered questions on a standard test of crystallized intelligence. Researchers also collected blood samples to determine blood serum levels of lutein and imaged participants' brains using MRI to measure the volume of different brain structures. The team focused on parts of the temporal cortex, a brain region that other studies suggest plays a role in the preservation of crystallized intelligence.

The researchers found that participants with higher blood serum levels of lutein tended to do better on tests of crystallized intelligence. Serum lutein levels reflect only recent dietary intakes, Zamroziewicz said, but are associated with brain concentrations of lutein in older adults, which reflect long-term dietary intake. Those with higher serum lutein levels also tended to have thicker gray matter in the parahippocampal cortex, a brain region that, like crystallized intelligence, is preserved in healthy aging, the researchers report..... "Our findings do not demonstrate causality," Zamroziewicz said. "We did find that lutein is linked to crystallized intelligence through the parahippocampal cortex."

Tobacco use is a leading cause of cancer and early death in the U.S. and throughout the world. According to a new study looking at people 70 years old and older, the good news is that quitting smoking at any time in life (even as late as the 60s) is better for immediate health and also reduces the risk of death.

The study compared people who had never smoked to people currently smoking - and found that in the 6 year follow up period current smokers were more than three times more likely to die than people who had never smoked. Furthermore, quitting smoking at any age was associated with a lower risk of death. Former smokers who quit smoking earlier in life received the largest benefit from quitting smoking. But even people who quit during their 60s were at substantially decreased risk of death (when compared to people who continued to smoke). Bottom line: It's never too late to quit smoking. But best is to never even start smoking. From MedicalXpress:

Quitting smoking at any age reduces the risk of death after 70

Tobacco use continues to be a major cause of cancer and premature death. Most studies of cigarette smoking and mortality have focused on middle-aged populations, with fewer studies examining the impact of tobacco cessation on disease and mortality risk among the elderly. A new study published in the American Journal of Preventive Medicine, found that people aged 70 or older currently smoking were more than three times more likely to die than never-smokers, while former smokers were less likely to die the sooner they quit.

Investigators reviewed data for more than 160,000 individuals aged 70 and over who participated in the NIH-AARP Diet and Health Study. They completed a questionnaire in 2004-2005 detailing their smoking use, and reported deaths were tracked until the end of 2011....For this study, participants still smoking in their 70s were identified as current smokers, and former smokers were classified by the decade of life when quitting. At the beginning of the study (2004-2005), the median age of participants was 75 years. Almost 56% were former smokers and 6% were current smokers. Males were less likely (31% vs 48% of females) to be never-smokers. 

During an average follow-up of 6.4 years, almost 16% of the participants died. While 12.1% of the never smokers died, 16.2%, 19.7%, 23.9%, and 27.9% of former smokers who quit between ages 30-39, 40-49, 50-59, and 60-69 years died, respectively. Current smokers fared the worst, with 33.1% dying. Mortality rates for women were lower than men at each level of smoking use.

"These data show that age at smoking initiation and cessation, both key components of smoking duration, are important predictors of mortality in U.S. adults aged 70 years and older," commented Dr. Nash. "In the NIH-AARP study population, younger age at initiation was associated with increased risk of mortality, highlighting the importance of youth and early-adult smoking on lifetime mortality risk, even among people who live to age 70 years. In addition, former smokers were at substantially reduced risk of mortality after age 70 years relative to current smokers, even those who quit in their 60s. These findings show that smoking cessation should be emphasized to all smokers, regardless of age."

Interesting preliminary research that suggests that daily intake for 12 weeks of several beneficial bacteria species (Lactobacillus acidophilus, L. casei, L. fermentum, and Bifidobacterium bifidum) resulted in improved mental (cognitive) functioning in 52 people with Alzheimer's Disease. Could this be true - daily probiotics to improve mental functioning in those with Alzheimer's?

Many more studies need to be done, but this is definitely interesting. The nice thing in this study was that the patients were randomly assigned to the groups, and it was "double-blind" so no one knew who got just plain milk and who drank probiotic milk in the study (so no biases to distort results). There were also metabolic and inflammation improvements in those taking the probiotics. From Medical Xpress:

Probiotics improve cognition in Alzheimer's patients

For the first time, scientists have shown that probiotics—beneficial live bacteria and yeasts taken as dietary supplements—can improve cognitive function in humans. In a new clinical trial, scientists show that a daily dose of probiotic Lactobacillus and Bifidobacterium bacteria taken over a period of just 12 weeks is enough to yield a moderate but significant improvement in the score of elderly Alzheimer's patients on the Mini-Mental State Examination (MMSE) scale, a standard measure of cognitive impairment.

Probiotics are known to give partial protection against certain infectious diarrheas, irritable bowel syndrome, inflammatory bowel disease, eczema, allergies, colds, tooth decay, and periodontal disease. But scientists have long hypothesized that probiotics might also boost cognition, as there is continuous two-way communication between the intestinal microflora, the gastrointestinal tract, and the brain through the nervous system, the immune system, and hormones (along the so-called "microbiota-gut-brain axis"). In mice, probiotics have indeed been shown to improve learning and memory, and reduce anxiety and depression- and OCD-like symptoms. But prior to the present study there was very limited evidence of any cognitive benefits in humans.

Here, the researchers, from Kashan University of Medical Sciences, Kashan, and Islamic Azad University, Tehran, Iran, present results from a randomized, double-blind, controlled clinical trial on a total of 52 women and men with Alzheimer's between 60 and 95 years of age. Half of the patients daily received 200 ml milk enriched with four probiotic bacteria Lactobacillus acidophilus, L. casei, L. fermentum, and Bifidobacterium bifidum (approximately 400 billion bacteria per species), while the other half received untreated milk.

At the beginning and the end of the 12-week experimental period, the scientists took blood samples for biochemical analyses and tested the cognitive function of the subjects with the MMSE questionnaire, which includes tasks like giving the current date, counting backwards from 100 by sevens, naming objects, repeating a phrase, and copying a picture.

Over the course of the study, the average score on the MMSE questionnaire significantly increased (from 8.7 to 10.6, out of a maximum of 30) in the group receiving probiotics, but not in the control group (from 8.5 to 8.0). Even though this increase is moderate, and all patients remained severely cognitively impaired, these results are important because they are the first to show that probiotics can improve human cognition. Future research, on more patients and over longer time-scales, is necessary to test if the beneficial effects of probiotics become stronger after longer treatment.

Treatment with probiotics also resulted in lower levels of triglycerides, Very Low Density Lipoprotein (VLDL), high-sensitivity C-Reactive Protein (hs-CRP) in the blood of the Alzheimer patients, and likewise a reduction in two common measures (called "Homeostatic Model Assessment", HOMA-IR and HOMA-B) of insulin resistance and the activity of the insulin-producing cells in the pancreas. "These findings indicate that change in the metabolic adjustments might be a mechanism by which probiotics affect Alzheimer's and possibly other neurological disorders," says Salami. "We plan to look at these mechanisms in greater detail in our next study." [The original study.]

  Eating lots of fruits and vegetables (more than 10 servings a day!)  is linked to better cognitive functioning in both normal weight and overweight adults (both young and older adults), and may delay the onset of cognitive decline that occurs with aging and also dementia. Overweight and obese older adults with a daily fruit and vegetable consumption of less than 5 servings generally had worse cognitive functioning. Higher levels of physical activity and higher daily fruit and vegetable consumption were both associated with better cognitive functioning. Cognitive functioning generally refers to a person’s ability to reason and think, the mental processes needed to gather and process information, and all aspects of language and memory.

The York University researchers found that fruit and vegetable consumptionphysical activity, and BMI or body mass index (normal, overweight, obese) all appear to interact in how a person mentally functions (cognitive functioning), especially as they age. The ideal goal as one ages is to preserve the mind. It appears that eating lots of fruits and vegetables daily (10 or more servings), being physically active (this includes daily walks), and being a healthy weight help with this goal. It helps to also be highly educated (or read books?) so that the brain has a "cognitive reserve",

Why is daily fruit and vegetable consumption (FVC) good for cognitive functioning and the brain? Studies find that daily consumption of fruits and vegetables is strongly associated with a reduced risk of cardiovascular disease, cancer, diabetes and age-related declines. They appear to be "protective" against cognitive decline. The study researchers point out that fruits and vegetables contain high quantities of vitamin C and E, fiber, micronutrients, flavonoids, beta-carotenes and other classes of phytochemicals. These are important in various ways: "they modulate detoxifying enzymes, stimulate the immune system, modulate cholesterol synthesis, and act as antibacterial, antioxidant or neuroprotective agents." NOTE: A serving of fruit is generally 1 medium fruit or 1/2 cup of fruit. A serving of vegetables is 1 cup of raw leafy greens or 1/2 cup of other vegetables. From Medical Xpress:

Healthy living linked to higher brain function, delay of dementia

It's tempting to dip into the leftover Halloween treats, but new research out of York University has found eating plenty of fruits and vegetables, combined with regular exercise, leads to better cognitive functioning for younger and older adults, and may delay the onset of dementia. York U post-doctoral fellow Alina Cohen and her team, including Professors Chris I. Ardern and Joseph Baker, looked at cross-sectional data of 45,522 participants, age 30 to 80+, from the 2012 annual component of the Canadian Community Health Survey.

What they found was that for those who are normal weight or overweight, but not obese, eating more than 10 servings of fruit and vegetable daily was linked to better cognitive functioning. When moderate exercise was added, those eating less than five servings, reported better cognitive functioning. Higher levels of physical activity were linked to the relationship between higher daily fruit and vegetable consumption and better cognitive performance. Those with higher body mass indexes, low activity levels and fruit and vegetable consumption were associated with poorer cognitive functioning.

More details from the original study in the Journal of Public Health: Physical activity mediates the relationship between fruit and vegetable consumption and cognitive functioning: a cross-sectional analysis

Results: Higher BMIs, lower PA [physical activity] and FVC [fruit and vegetable consumption] were associated with poorer cognitive functioning. Additionally, PA statistically mediated the relationship between FVC and cognitive function (Sobel test: t = −3.15; P < 0.002); and higher education levels and daily FVC were associated with better cognitive function (P < 0.001). Conclusion: Higher PA levels were associated with better cognitive functioning in younger and older adults. Also, higher daily FVC and education levels were associated with better cognitive scores.

Individuals who were normal weight or overweight and reported a FVC of >10 servings per day reported better cognitive functioning scores than those who reported <10 servings, as well as those individuals with obesity . As well, both active and inactive individuals who reported a FVC of >10 servings per day had better cognitive scores than those who consumed fewer servings. However, in those who were moderately active, individuals with a daily FVC of <5 or 5–10 servings reported better cognitive functioning than those with a daily FVC of 10 or more servings; this may have resulted because of underestimations of the number of servings of fruits and vegetables actually consumed... Thus, increasing FVC and PA levels as well as having a healthy BMI may aid in the delay of cognitive decline.

Results also indicated that higher education levels along with a daily FVC of five or more servings were associated with better cognitive functioning. Education may be assisting in the process of delaying cognitive decline by increasing cognitive reserve, the ability of the human brain to cope with damage by using different brain processes to retain the ability to function well. Cognitive reserve is developed through intellectual stimulation and translates into a higher volume of connections between neurons and stronger rates of cerebral blood flow.

One of the dreaded afflictions of getting older is age-related macular degeneration (AMD), which is a leading cause of vision loss in Americans 60 years and older. It has no cure. Thus this study finding that eating a Mediterranean diet, and especially lots of fruit, was associated with a lower risk of macular degeneration was welcome news. They also found a protective effect from drinking caffeinated beverages - about 78 mg of caffeine per day (about one cup of coffee or one shot of espresso). A Mediterranean diet stresses eating fruits, vegetables, nuts, whole grains, legumes, fish, seeds, and olive oil. From Science Daily:

Fruit-rich Mediterranean diet with antioxidants may cut age-related macular degeneration risk by more than a third

People who closely follow the Mediterranean diet -- especially by eating fruit -- may be more than a third less likely to develop age-related macular degeneration, a leading cause of blindness, according to a study presented at AAO 2016, the 120th annual meeting of the American Academy of Ophthalmology. The study is the first to identify that caffeine may be especially protective against AMD.

Many studies have confirmed the health benefits of the Mediterranean diet, which emphasizes eating fruits, vegetables, whole grains, legumes, nuts, healthy fats and fish, and limiting red meat and butter. The diet has been shown to improve heart health and reduced risk of cancer, but there has been little research on whether its benefits can extend to eye disease. To determine this, researchers studied a Portuguese population to see whether adherence to the diet impacted people's risk of AMD. Their findings revealed a significant reduction in risk in those who ate a Mediterranean diet most frequently, and particularly among those who consumed more fruit and caffeine.

Researchers at the University of Coimbra in Portugal studied 883 people age 55 or older in the central region of the country between 2013 and 2015. Of those, 449 had AMD in its early stages before vision loss, and 434 did not have AMD. Researchers assessed their diets based on a questionnaire asking how often they ate foods associated with the Mediterranean diet. The more they ate foods associated with the diet, the higher the score, from 0-9. Those who closely followed the diet scored a 6 or greater. Their findings were as follows:

Higher diet adherence scores meant lower AMD risk Of those who did not closely follow the diet (scored below a 6), 50 percent had AMD. Of those who did closely follow the diet (scored 6 or above), only 39 percent had AMD. This represents a 35 percent lower risk compared to those who did not adhere to the diet.

Fruits were especially beneficial Researchers analyzed consumption of foods and found that people who consumed higher levels of fruit were significantly less likely to have AMD. Of those who consumed 150 grams (about five ounces) or more of fruit a day: 54.5 percent did not have AMD and 45.5 percent had AMD. Overall, people who ate that much fruit or more each day were almost 15 percent less likely to have AMD, based on an odds ratio calculation.

Caffeine and antioxidants also were protective Researchers used a computer program to analyze the participants' consumption of micronutrients, according to their answers on the questionnaire. They found higher consumption of antioxidants such as caffeine, beta-carotene and vitamins C and E was protective against AMD. Of those who consumed high levels of caffeine (about 78 mg a day, or the equivalent of one shot of espresso): 54.4 percent did not have AMD and 45.1 percent had AMD....The researchers opted to look at caffeine because it is a powerful antioxidant that is known to be protective against other conditions, such as Alzheimer's disease.

More great news about drinking coffee daily - for women. Older women (between ages of 65 to 80 at the start of the study) reporting drinking higher amounts of caffeinated beverages (about 261 mg which is about 2 to 3 cups of coffee per day) had a lower incidence of dementia and cognitive impairment over a 10 year period (as compared to the low caffeine group). The low caffeine group averaged 64 mg of caffeine per day.  Other studies also found a reduction in "cognitive decline" in older people with coffee consumption. This study, among others, is more evidence of caffeine being "neuroprotective". NOTE: an 8-ounce cup of brewed coffee contains about 95 mg of caffeine, 8-ounces of brewed black tea contains about 47 mg, a 12-ounce can of carbonated cola contains 33 mg, and 8-ounces of decaffeinated coffee has about 5 mg of caffeine. Science Daily:

For women, caffeine could be ally in warding off dementia

Among a group of older women, self-reported caffeine consumption of more than 261 mg per day was associated with a 36 percent reduction in the risk of incident dementia over 10 years of follow-up. This level is equivalent to two to three 8-oz cups of coffee per day, five to six 8-oz cups of black tea, or seven to eight 12-ounce cans of cola.

"The mounting evidence of caffeine consumption as a potentially protective factor against cognitive impairment is exciting given that caffeine is also an easily modifiable dietary factor with very few contraindications," said Ira Driscoll, PhD, the study's lead author and a professor of psychology at the University of Wisconsin-Milwaukee. "What is unique about this study is that we had an unprecedented opportunity to examine the relationships between caffeine intake and dementia incidence in a large and well-defined, prospectively-studied cohort of women."

The findings come from participants in the Women's Health Initiative Memory Study, which is funded by the National Heart, Lung, and Blood Institute. Driscoll and her research colleagues used data from 6,467 community-dwelling, postmenopausal women aged 65 and older who reported some level of caffeine consumption. Intake was estimated from questions about coffee, tea, and cola beverage intake, including frequency and serving size.

In 10 years or less of follow-up with annual assessments of cognitive function, 388 of these women received a diagnosis of probable dementia or some form of global cognitive impairment. Those who consumed above the median amount of caffeine for this group (with an average intake of 261 mg per day) were diagnosed at a lower rate than those who fell below the median (with an average intake of 64 mg per day). The researchers adjusted for risk factors such as hormone therapy, age, race, education, body mass index, sleep quality, depression, hypertension, prior cardiovascular disease, diabetes, smoking, and alcohol consumption. (The original study in the Journal of Gerontology.)

 Image result for books wikipedia There are some things we can do that are linked to living longer, such as not smoking and exercising regularly, but could reading books also have such an effect? A study published in the journal Social Science and Medicine concludes that those who regularly read books add several years to their lives. They found this effect in both men and women, found that reading books are "protective regardless of gender, wealth, education", but the effect holds only for books and not magazines and newspapers. Since surveys show that 87% of book readers read fiction, then it is likely that most of the book readers were reading fiction.

In the long-term (12 years) study of 3,635 people, the researchers found that those that read books for more than 3.5 hours per week lived on average two years longer than non-readers, and that there was a dose-response effect (the more one reads, the better). This appeared to be linked to cognitive enhancement rather than any other associated factor, such as age, sex, education, race, health, wealth, etc. The research team from the Yale University School of Public Health divided their subjects into three groups: those who didn’t read at all, those who read for 3.5 hours per week or less, and those who read for more than 3.5 hours per week. They found that the occasional readers were 17 percent less likely to die during the follow-up period than those who did not. This beneficial effect of reading was only linked to books, and not other forms of reading material such as magazines or newspapers. From the journal Social Science and Medicine:

A chapter a day: Association of book reading with longevity

This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline.....based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile.....Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines. Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers. Cognition mediated the book reading-survival advantage. These findings suggest that the benefits of reading books include a longer life in which to read them.

While most sedentary behaviors are well-established risk factors for mortality in older individuals (Wullems et al., 2016; de Rezenade et al., 2014, Katzmaryk & Lee, 2012; Muennig, Rosen, & Johnson, 2013), previous studies of a behavior which is often sedentary, reading, have had mixed outcomes....We speculated that books engage readers’ minds more than newspapers and magazines, leading to cognitive benefits that drive the effect of reading on longevity

Reading books tends to involve two cognitive processes that could create a survival advantage. First, it promotes "deep reading,” which is a slow, immersive process; this cognitive engagement occurs as the reader draws connections to other parts of the material, finds applications to the outside world, and asks questions about the content presented (Wolf, Barzillai, & Dunne, 2009). Cognitive engagement may explain why vocabulary, reasoning, concentration, and critical thinking skills are improved by exposure to books (Stanovich, West, & Harrison, 1995; Stanovich & Cunningham, 1998; Wolf, Barzillai, & Dunne, 2009). Second, books can promote empathy, social perception, and emotional intelligence, which are cognitive processes that can lead to greater survival (Bassuk, Wypij, & Berkmann, 2000; Djikic, Oatley, & Moldoveanu 2013; Kidd & Castano 2013; Shipley, Der, Taylor, & Deary 2008; Olsen, Olsen, Gunner-Svensson, & Waldstrom, 1991).

The final sample consisted of 3635 individuals that were followed over 34,496 person years, with 27.4% of the sample dying during an average 9.49 years of follow-up. Consistent with the older population, the sample was predominantly (62%) female.....The average time spent reading per week was 3.92 hours for books and 6.10 hours for periodicals. The two types of reading were not strongly correlated, and 38% of the sample (n=1390) read only books or only periodicals; this allowed them to be treated as separate constructs.....Cognitive engagement was assessed with total cognitive score (available in the supplemental Imputation of Cognitive Function Measures) which is a summary variable based on 8 items, including immediate recall, delayed recall, serial 7s, backwards count from 20, object naming, President naming, Vice President naming, and date naming.

A 20% reduction in mortality was observed for those who read books, compared to those who did not read books. Further, our analyses demonstrated that any level of book reading gave a significantly stronger survival advantage than reading periodicals.....The mediation analyses showed for the first time that the survival advantage was due to the effect that book reading had on cognition....This finding suggests that reading books provide a survival advantage due to the immersive nature that helps maintain cognitive status.