Douglas Hyde Powell, Ed.D., ABPP

Douglas Hyde Powell Ed.D., A.B.P.P.

The Aging Intellect

What Are the Differences Between Normal and Optimal Cognitive Aging?

Recognizing the characteristics of people aging normally

Posted Aug 28, 2011

Estimates are that over half of older adults in the United States and other economically developed countries are aging normally and approximately 25% are classified as optimal agers. Most of us can list a half dozen life style habits associated with optimal, successful, or healthy aging—getting regular exercise, eating healthily, etc.  But we can say far less about those day to day behaviors that distinguish their normal contemporaries because so little has been published about these average women and men. 

The characteristics that separate those whose mental abilities are aging normally from older adults considered to be optimal cognitive agers have long interested me and are set out in my new book, The Aging Intellect.   We identified over a dozen characteristics that differentiated normal from optimally aging older adults.   Here is short list of these qualities. 

Moderate energy and activity level: Normal cognitive agers have a moderate energy level. That’s still plenty of pep to do the things they want to do, but we do not marvel at their vigor. By comparison optimal agers seem to overflow with energy. They are 3-4 times more physically active and engaged in community affairs than their normal cotemporaries.

Risky lifestyle habits:  Normal agers live with 2-3 risky lifestyle habits that research has linked to poorer health and more rapid intellectual decline. The most frequent risky habits among the normals were being sedentary and obese, drinking heavily (3 or more drinks on most days), and being non-compliant with prescription medication—taking meds as prescribed less than 80% of the time. By contrast, optimal agers exhibited no more than one risky habit.

Chronic medical conditions: Most normal agers we studied live with 2-3 medical conditions common to older adults that are known to adversely affect the mind as well as the body. Examples are hypertension, atrial fibrillation, chronic obstructive pulmonary disease, sleep apnea, and type 2 diabetes. These diagnoses were far less common among optimal agers. 

Irregular medical checkups: The majority of normal agers were not proactive about getting medical checkups when they were not symptomatic. Some didn't like being lectured to by their health care providers about giving up their bad habits while others just didn’t seem tuned in to their bodies.  Optimal agers were tuned in, and scheduled regular physical exams even though they were in good health, had regular screenings (pap smears and mammograms), and lined up for their flu shots.  

Higher levels of stress: The normal elders in our study lived with more stress than those aging optimally. More often they cared for elderly parents or grandchildren, or were living with serious physical problems themselves. Sometimes they worsened their situation by risky habits—usually by being sedentary, eating poorly, drinking too much, and non-compliance. Infrequently did they seek professional help for their problems. Typically they have 2-3 psychologically “down” days a month. Optimal agers dealing with the same degree of stress had less than one “down” day per month, perhaps because they rarely allowed risky behaviors into their daily routines and more often sought professional help to cope with their stress. 

Shrinking size and diversity of social networks: The more people we can count on during times of stress, and how different from one another these individuals are, is correlated with better health and stronger mental acuity among senior citizens. Normally aging people report a fewer number of people in their social networks and less diversity among them compared to age 55. By contrast optimal agers had a similarly large number of close family and friends, and about the same heterogeneous mix of people in their lives, as they had in their mid-50s.  

Let new experiences and challenges come to them: Normal cognitive agers are aware of the benefit to them of new experiences and challenges, and are not opposed to them.  But, unlike most optimal agers but they don’t seek out these opportunities. Yet, they often respond positively when a friend suggests a Roads Scholar trip to Yellowstone National Park or spending the afternoon seeing the King Tut exhibit.

Not everyone aging normally has all of these distinguishing characteristics, and not every optimal ager bats a 1,000. What strikes the clinical psychologist in me is the potential of so many normally functioning older people to become optimal agers. Quite a few were just one improved habit or attitude change away from aging optimally. 

And many of those we interviewed haven’t given up entirely on trading their bad habits for good ones. But for these normal older individuals it was daunting to look at the long list of factors associated with optimal aging and think about what it would take to modify their lifestyle. After all, they have been trying to lose that same ten pounds for a decade without success. How can they hope to change a dozen of their habits?

The answer is that every little bit helps. Harvard Medical School investigators followed middle-aged doctors for two decades.  They found that each healthy lifestyle habit—e.g., exercising or eating cereal for breakfast once a week—reduced the likelihood of heart failure by 15-20%. Both of these factors are also linked to reducing the rate of cognitive decline. That’s a lot of benefit for relatively little effort. 

Three times in the past year I ran into older friends I hadn’t seen in several months. Some I barely recognized because they had changed so much. Now aging optimally, each had lost considerable weight, were much more active and looked younger than the last time I had seen them. In addition to the weight loss, all said they had been exercising regularly, altered their eating habits, and some had changed their wardrobes and their appearance. 

How were these individuals able to make the change from aging normally to aging optimally? What caused the light to go on, and what sustained them during the long months of eating differently and exercising regularly? I wish I had asked those questions.  We know relatively little about what triggers those non-optimal agers to make another attempt to lose weight or start working out again. What can be certain about is that each effort carries within it the possibility of success.