As director of the Center on Aging, Health and Humanities at George Washington University, Gene Cohen finds joy and creativity in aging. He is also a professor of health-care sciences and a professor of psychiatry at George Washington as well as the director of the Center on Aging, a private think tank in Washington.
After graduating from Harvard, Cohen came to Washington for medical training at Georgetown and then earned a doctorate in gerontology from Union Institute. Cohen is a former president of the Gerontological Society and acting director of the National Institute on Aging. He was chief of the Center on Aging of the National Institute of Mental Health, where he specialized in Alzheimer’s disease.
He has written more than 100 articles on aging as well as the book “The Brain in Human Aging.” Cohen has reached beyond the ivory tower, cutting public-service announcements with George Burns and Steve Allen. He is finishing a book on aging and creativity.
His wife, Wendy Miller, is a psychologist, art therapist and sculptor who treats patients with medical problems through an approach of “creative therapy.” They live in Kensington, Md., with their daughter, 3-year-old Eliana. Cohen also has a son, Alex, 24, who is on ski patrol in Santa Fe, Calif., writing for Outside magazine.
It was in Cohen’s office in the George Washington Medical School where we discussed what he has learned.
Q: Why does memory go bad with aging?
A: Well, it doesn’t necessarily go bad. That common assumption can be very wrong. With the absence of illness, memory actually stays pretty good. But older people seem to forget names, dates and places more often.
Everybody, starting from a very early age, has trouble remembering things. Until you turn 50, you don’t pay much attention to misplacing keys or forgetting a name. With age, remembering specific names, dates and objects often does get slower. But so what? Compensating factors kick in.
Vocabulary actually improves with aging. This is key, since vocabulary affects how you define and negotiate your entire environment. A serious memory problem usually indicates not so much aging as illness — the most extreme, of course, being Alzheimer’s disease or complications from something major such as a stroke.
Serious memory problems should therefore trigger a diagnostic workup rather than an attitude: “Well, so be it. I’m getting old.”
Memory is affected by how those nerve cells that handle higher intellectual functions go about communicating with one another. For years, people thought that memory problems resulted from a loss of brain cells over time. Now we’ve learned better. Some parts of the brain, in fact, don’t lose cells at all.
Regardless, the total number of cells matters little. You had nearly all your nerve cells when you were born, and you weren’t so brilliant then. A 2-year-old has more nerve cells than you do, but you wouldn’t want that 2-year-old figuring out your income taxes.
A pioneering study in the mid-1960s demonstrated that a challenging, stimulating environment can change the anatomy and physiology of the brain itself.
Rats exposed to unusually challenging environments — more interesting objects, more complexity, more social interactions — had many more nerve-cell extensions, or dendrites, than normal rats. Their glial cells, which nourish the neurons — higher intellectual functioning cells — actually grew in numbers. Their overall brain weight was greater. Their cerebral cortex, the gray matter that contains these “intellectual” cells, actually thickened.
Now all this happened without any physical intervention whatsoever. No injections of drugs or such. All of it was due solely to behavioral stimulation. These more challenged rats increased their production of enzymes making acetylcholine, the neurotransmitter involved in memory.
Patients with Alzheimer’s disease lack those enzymes in normal quantities. We were amazed to find such anatomical and neurochemical responses to environmental stimulation. That study validated the folk advice on the mind — “use it or lose it” — in a dramatic manner.
Q: What should aging folks do to compensate for any mental slowing?
A: Give themselves more time. That’s not too hard, but it helps a lot. Most aging experiments are conducted like school exams, with a set time limit. But most of life doesn’t operate that way. So spend the five or 10 seconds more to remember Sally’s name. Give yourself more time to gather your belongings before leaving. And capitalize on greater experience.
Q: What’s the advantage of growing old?
A: Just like the folk wisdom says: gaining more wisdom and perspective. For me, wisdom comes from both the intellect and emotions. It’s no coincidence that Supreme Court justices, diplomats, and the like tend to be older. They’ve not only accumulated life experience but better understand their own emotional reactions to new phenomena. They realize more about what’s going on in their hearts as well as in the world at large.
That’s a great asset for a judge and one that grows, not declines, over time. The combination of more intellectual and emotional knowledge is powerful.
Q: Are older people happier than younger people?
A: National surveys surprise people by indicating a higher morale in older age groups. Surprising, too, are studies on depression, which show no increase with aging.
I often ask my colleagues if they’ve ever met a healthy person over 65 with a dread of death. That’s awfully rare.
Sociological studies find that the middle-aged have more dread of death than either youngsters or oldsters. That’s because they’ve started thinking about how much time is left rather than how much time has gone by. That heightens a sense of one’s own mortality. This can then lead to midlife crisis: How to deal with the brief time left?
Q: What do you, yourself, find most upsetting about growing old?
A: The prospect of being sick or disabled rather than of being gone. I fear death much less than I fear disability.
Fortunately, the outlook is changing there. For years, we were extending lives marked by disease and disability as opposed to health. Yet recent data show that the percentage of healthy elderly is growing faster than those who are ill or disabled. The absolute numbers of ill and disabled are increasing, but that’s only because of the elderly population’s general bulge.
Science should focus on quality of life and not quantity. Its goal should be a rectangular life-cycle curve. Instead of a person’s gradual decline to death, we should seek to keep someone healthy right to the end. Like cowboys in the legend, we should all die with our boots on.
Q: Which leads us to Alzheimer’s. How come we didn’t hear of it 20 years ago?
A: Because we didn’t differentiate it from normal aging. We called it senility then and deemed it fairly normal. When people spotted Alzheimer’s symptoms, they figured, “Well, that’s what you’d expect when getting old.”
By the mid-’70s, science was getting more sophisticated. Research discovered specific brain changes in Alzheimer’s patients that didn’t occur in most old people. Before long, these symptoms became indicators of a disease as opposed to normal senility.
Alzheimer’s disease was actually described around the turn of the century. A 1906 paper depicted somebody under 65 with “pre-senile dementia.” So the phenomenon has been with us over all human history.
Q: Is Alzheimer’s growing, say like AIDS?
A: No, not like infectious diseases. Yet its incidence is increasing. That’s mainly because people are living so much longer.
The absolute number of people with Alzheimer’s is huge: somewhere between 3 and 4 million in America alone. That’s as many as all people over 65 at the turn of the century — some 3 million, which then constituted 4 percent of the U.S. population.
Today about 12 percent of our population is elderly. That’s more than 30 million people. Hence we have more people over 65 than the entire population of Canada.
Q: Is there hope for Alzheimer’s patients?
A: Very much so. Molecular medicine is now moving at a rapid pace. I’d be surprised if, over the next 20 years, we didn’t have very significant breakthroughs. Before a real cure can come, breakthroughs in delaying the onset, even before its symptoms start.
During the onset of Alzheimer’s, we find a cascade of things going wrong. Each of these opens an intervention point to break that downward flow. The impact of delaying the onset can be profound. Given today’s life-expectancy curves, if we delay that onset by, say, five years, we’ll cut the number of new cases in half. And each year we delay that onset, we’ll save millions of people and billions of dollars.
Some drugs coming along may slow the disease’s progression in some patients. These drugs, given even after onset, can still have beneficial effects for those Alzheimer’s victims.
Thus we’ve learned not to think simply of “cure or no cure.” We instead think of treatment that reduces symptoms, maximizes functioning and/or lowers suffering.
Q: What’s the best way to age gracefully?
A: To practice sound health habits. Think about all the advances in this century, which began with life expectancy under 50 and is ending with it being over 75. That 50 percent hike in life expectancy is primarily due to better public health and health habits, factors like better nutrition and exercise.
Exercise is critical. A classic study in the early ’90s at a Boston nursing home found that quasi-“pumping iron” for 90-year-olds led to a remarkable response: something like a 50 percent increase in walking speed, 175 percent greater lower extremity strength and 10 percent more muscle mass.
The last element making a huge difference is in the social, intellectual and creative area.
Everyone should prepare a “social portfolio” in midlife. A “social portfolio” is analogous to the financial portfolio. Along with building financial assets, over a lifetime you build social assets — various relationships and interests. And like insurance in your financial portfolio, you should develop backup activities or interests.
These include both group and individual activities. Then if there’s a loss of a spouse or close friend, not all of your activities die along with that person.
Q: Is there more depression in retirement?
A: I haven’t found that to be true. Seventy percent of those who retire pretty much continue as they did before. Twenty percent seem to do better, and maybe 10 percent do worse. On the whole it’s a better experience. Those most at risk are those who didn’t want to retire and were forced to do so by health or job situations.
Q: What have you learned most about aging?
A: How much aging is affected by external factors that are modifiable, such as education, stimulation and health habits.
Not so long ago, in 1970, those over 65 had an average of less than nine years of education, not even high school graduation. Today it’s considerably more than a high school education. That opens far more opportunities for activities in later life, which in turn helps keep folks healthy and happy.
Second, I’ve learned to appreciate creativity among the aging. People in certain fields master it earlier. You can get on top of mathematics or physics quicker than psychology, philosophy or history, where it takes more time both to acquire the necessary information and to develop the perspective to best deal with it. With the latter, age is an asset.
But even with math and physics, it doesn’t mean things are over early. Senior scientists in these fields often channel their creativity in a different direction with aging and contribute enormously. Look at the huge impact Albert Einstein made philosophically later in life, way after he had totally changed how people think about nuclear energy and the workings of the universe.
Verdi composed operas in his 80s. Picasso painted masterpieces in his 90s. George Bernard Shaw penned great plays in his 90s. Arnold Toynbee, when in his late 70s, said he felt he was at his peak. Aging allowed him to master more information and to gain greater perspective. Sophocles did his greatest works in his 70s, especially “Oedipus Rex.”
No, these aren’t oddball cases. I gained this insight when walking around the Corcoran Gallery in 1980 looking at its half-century retrospective of American folk art. I was stunned to find that of the 20 or so artists featured, about one-third were over 80, and most were over 65!
Third, I’ve learned that aging adds to life. The poet William Carlos Williams put it nicely when saying that old age adds as it takes away. You can have significant loss but also big gain in aging.
Often after that loss, people enter new directions. Williams underwent a stroke in his 60s and could no longer practice medicine. He became quite depressed and was hospitalized for a year. He recovered enough to write “Pictures From Brueghel and Other Poems,” which won him a Pulitzer Prize at the age of 79.
Grandma Moses went through something like this twice. At 67, she lost her husband, became depressed and took up embroidery, which she did magnificently until she was 78. She then developed arthritis, couldn’t embroider anymore and so took up painting. That began a 23-year career in painting, with her final work, “Rainbow,” finished at the age of 101. It’s a beautifully vital and creative work.
Q: What have you learned about life?
A: To shape it, regardless of what comes along. A few years ago I was misdiagnosed with Lou Gehrig’s disease, obviously a dreadful illness. As a physician, I thought that in three years I could be in really bad shape. So before that physical impairment began, I set out to do something fun and beautiful.
That’s how I began designing intergenerational games. The games I designed were chosen by national and international juries to go on nationwide museum tours.
That launched a new phase in my life. I drew on the power of the human spirit, as did so many in history. After two long years, it finally was determined that I didn’t have the disease, but the games continue.
Matisse eventually became wheelchair-bound with a multisystems illness. He couldn’t approach art with the energy he had. He nonetheless changed the whole direction of his work, and of art generally, with his cutouts. Ever since then, art historians have described them as closing the gap between color and form.
So even later in life you can learn a new language, master crossword puzzles or games, move into new fields like woodworking. Challenging yourself in new ways has a profound affect on the brain — and on life.
