As a primary-care physician with more than 25 years of experience, one of the most frequent concerns people mention during their appointments with me involves memory. The age of the patient doesn't matter much. I've had people in their 30s ask me, just like I've heard it from people in their 60s and beyond. "Doc," I'll hear. "I can't keep track of my car keys and often forget people's names. Could I be losing it? Is this the start of the end?"
Usually it isn't, of course. But it makes sense to be thinking about the loss of cognitive impairment over time. As someone who is getting older myself, I worry about it, too. I find that it eases people's anxiety to know that preventive measures for mild cognitive impairment exist. It's better to put these actions into practice in midlife, rather than later, when symptoms have already started to show up.
Cognitive decline and dementia are big problems. Today, approximately 47 million people are living with dementia, and the number is expected to triple by 2050. Because we don't have a cure, prevention becomes all the more important.
If you do have a close family member with the disease, Dr. Sharon Cohen of the Toronto Memory Program suggests making an appointment yourself to establish a cognitive baseline -- basically, an assessment of your current memory. The baseline provides a point of comparison to assess your memory later on. If problematic changes do occur, the baseline provides greater opportunity to participate in clinical trials for drugs designed to keep memory from deteriorating. A cognitive baseline involves a 20-minute assessment with a qualified health care professional. "Better to keep on top of your memory than bury your head in the sand," says Dr. Cohen.
Happily, there's a tonne of academic research being conducted into prolonging lifespan and healthspan. One of the most intriguing is happening at the Scripps Translational Science Institute in San Diego, where researchers like Dr. Eric Topol are analyzing the DNA of 1,400 people who live free of chronic disease long past the age of 80 -- a group that Topol and his fellow researchers call the "wellderly." The research revealed that the group is more likely to have a set of genes that protect the brain from cognitive decline over time.
So winning the genetic lottery helps. But there's good news for the rest of us, too. Three years ago, the G8 countries created the World Dementia Council, which led an effort to comb through the scientific evidence to determine the sort of preventive strategies people should follow to ensure long-term cognitive health. The resultant review was published in the medical journal, Alzheimer's & Dementia.
Some of the biggest risk factors for cognitive decline include mid-life obesity, hypertension and smoking. Excessively low blood pressure in later life may also be a risk factor.
What decreases the risks? According to the WDC review, a big one is regular physical activity. Even walking has been linked to a decreased risk of cognitive impairment -- although more vigorous exercise is better. And it doesn't matter how late you start. Inactive seniors who began exercise programs have been shown to experience "significantly improved cognitive function."
There's limited evidence to suggest other lifestyle measures can help. I have always thought learning something new is good for the brain, and according to the review, some form of cognitive training has been shown to improve recall, although no one's yet determined the precise best form of training, which can include everything from memory games to crossword puzzles or Sudoku-type logic puzzles.
Lots of satisfying social engagement may also help. Drinking a little alcohol, like a glass of wine with dinner, seems to protect brain function, as does following a Mediterranean diet, which emphasizes whole grains, fruits and vegetables, fish, nuts and olive oil. Same with sleeping well.
But don't take it from me, or the scientists. Consider taking the advice of the people who have aged well themselves. My dad is one of these people. He's 81 and keeps moving by skiing, golfing and being involved with community events. I also have about a dozen patients who are older than the age of 80 and continue to live actively and well. I saw one of them just last week -- a retired minister who has been married for 60 years. His advice?
"Get a dog," he said, justifying his response with the need to walk the pet several times a day, which creates opportunities for social contact as well as exercise. The suggestion is supported by scientific evidence, with pet therapy for the well-being of the elderly a developing area of research.
Such superagers are not only inspiring -- they're also happy to share their thoughts on how to age well. I've collected their advice into a list. "Don't think about being old," is a good one, as is the suggestion to increase your health IQ -- which happens to be just the thing you're doing now, by reading this.
Now for my superaging patients' list of top ten most frequently suggested behaviours to age well, which shares some elements with the advice from the World Dementia Council.
Plan trips to places you've never been is number 10. Looking forward to the adventure of travel makes life more exciting, the superagers say.
Beside the cognitive benefits, regular physical activity boosts health, mitigates stress, helps you sleep better and elevates your mood.
The next two entail maintaining social connections. Stay in touch with old friends (9), and seek out opportunities to create new ones (8).
My superagers underscore the importance of staying active (7). Plan activities that encourage you to get out of the house. Maintain a sense of optimism about the world (6). And provide yourself with opportunities to recharge your batteries (5), whether that's a weekend getaway or just a walk around the neighbourhood.
Number four involves money. Plan your life so that you're not going to worry about your finances down the road.
Engage in daily exercise is the third tip -- suggesting this group knows their science. And why not? Beside the cognitive benefits, regular physical activity boosts health, mitigates stress, helps you sleep better and elevates your mood.
The second one is moderation. That means, go easy on the wine and the scotch, as well as the greasy foods, work -- and even the exercise.
Finally, the number one thing that creates a superager, according to my superaging patients, is a sense of humour. Don't take things too seriously. Let slights slide off you. Laugh at life's little indignities and they become more bearable -- as well as just possibly extending your life.
Dr. James Aw is the chief medical officer at Medcan in Toronto.
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