Behold the Superagers: a New Model of Brain Health

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Lower CRV Linked to Increased Mortality

A recent study in Graefe’s Archive for Clinical and Experimental Ophthalmology has discovered that in older population sets, lower central retinal volume (CRV) measured by OCT correlates with increased risk of mortality (all-cause and even noncardiovascular).

The German population-based cohort study enrolled 2,166 patients 70 to 95 years of age and tracked their outcomes over a median follow-up of 5.9 years. During that time, 374 (17.3%) of the individuals died. Using a Heidelberg Spectralis OCT, the investigators quantified the CRV reading and divided the participants according to the median value of 8.40 mm. The results were compelling: Each one-standard deviation decrease in CRV was linked to a “significant increase in all-cause mortality risk,” even after adjusting for age, sex, body size, diabetes, and hypertension. The researchers emphasized that individuals with CRV below the median had a substantially higher mortality risk than those above it.

Perhaps most shocking (at least to me) is that the study found that lower CRV was strongly associated with noncardiovascular mortality. At the same time, no significant correlation was observed with cardiovascular mortality or any of its known risk factors. The researchers believed this hints that the underlying mechanisms unrelated to cardiovascular disease may link reduced retinal volume to mortality. The study’s authors concluded that automated CRV measurement may serve as a noninvasive biomarker for identifying our elderly patients who are at an elevated risk of death, especially from noncardiovascular causes.

My Two Cents

This study further highlights how the eyes are windows to the whole body’s status. It shows how OCT-derived CRV is potentially a highly valuable noninvasive prognostic biomarker for our elderly patients’ mortality risk. It blows my mind that reduced CRV was correlated with noncardiovascular mortality. It seems extremely counterintuitive to what I would expect, but that’s why I profiled the study. Crazy stuff!

OUTSIDE THE LANE

“Superagers” Show Fewer Alzheimer-Related Brain Changes, Study Finds

“Superagers” Show Fewer Alzheimer-Related Brain Changes, Study Finds Adults 80 years of age and over with memory capacities akin to much younger individuals (aka superagers) exhibit distinct brain characteristics that set them apart from their peers, according to more than 2 decades of research summarized in a recent perspective piece published in Alzheimer's & Dementia. Led by Sandra Weintraub, PhD, at Northwestern University, the studies reveal that superagers maintain robust brain morphology—particularly in the cingulate gyrus—where their cortex is thicker than that of younger adults aged 50 to 60. This finding, confirmed in multiple studies, highlights the anterior cingulate’s role in networks governing motivation, emotion, and social behaviors, aligning with superagers’ notably sociable and extraverted personalities.

Interestingly, unlike typical older adults, superagers show fewer Alzheimer-related brain changes, such as reduced amyloid and tau buildup, and possess a higher density of von Economo neurons, which resist age-related decline. Their brains also exhibit better-preserved cholinergic innervation and fewer inflammatory microglia in white matter, suggesting enhanced resilience to neurofibrillary degeneration.

Quite stunningly, no specific lifestyle factors, such as diet, exercise, or stress management, consistently define superagers, as some adhere to typical healthy habits while others do not. However, their positive social engagement and high extraversion stand out, with superagers rating relationships more favorably than their cognitively average peers. Since 2000, Northwestern Medicine has studied 290 superagers and conducted 77 brain autopsies, providing a robust dataset. These findings challenge assumptions about cognitive decline in aging, suggesting that exceptional memory in older age is linked to a unique neurobiological profile. This research, part of a special issue marking the 40th anniversary of the National Institute on Aging’s Alzheimer’s Disease Research Centers program, opens avenues for interventions to preserve brain health and enhance resistance to age-related cognitive decline, inspiring further global investigations into the superaging phenomenon. (Read more here.)

My Two Cents

As members of the eye care profession, we’re pretty much forced to be sociable if we want to succeed, so I would assume Northwestern’s findings benefit everyone in their quest to age gracefully. After reading this summary, it makes sense to me, as it seems nearly every superager I come across in the clinic is a highly affable and kind-hearted person! Looks like it pays off in dividends to your lifespan to be a social person!

CAN YOU RELATE

Many of you are familiar with Joseph Allen, OD, FAAO. He’s a young optometrist who I would call the face of our profession on YouTube and other social media platforms. His YouTube channel, @doctoreyehealth, has more than 1.25 million subscribers, so what he says about eye care to the general public, more often than not, is the unofficial official stance of optometry.

In a fairly recent video, Dr. Allen describes to viewers how he has been the victim of AI deepfakes using his image, likeness, and even his voice to promote various products online. Many, if not all, of these products are absolute snake oil and border on dangerous with their outrageous claims. To the educated eye care professional, some of these products are BS with the promise of pills and powders to cure all eye diseases or rid you of refractive errors; however, to the uninformed public, it seems like a dream come true. Surely spending a few bucks on some pills couldn’t hurt them. As members of the health care profession, it behooves us to be aware of the sharp rise in such fake videos. These are a form of medical misinformation and should be combated. Please do yourself a favor and watch the video. At the end, Dr. Allen shares some excellent tips to help detect videos that are likely created by AI.

Joseph Allen, OD, FAAO @DoctorEyeHealth

What can we do to protect ourselves? First off, if you see a suspicious video or ad on your social media timeline, take a close look and ask yourself if anything looks a bit “off” to you, as Dr. Allen noted in his video. If it does, report it. Have your staff report it. Have everyone report it. Getting medical misinformation pulled benefits everyone. Second, educate your patients about deepfakes. There will likely come a time in clinic when a patient shows you a video or ad for some miracle drug, cure, device, etc that a well-known doctor is promoting. Think twice before believing what you see and warn your patients that these types of videos are floating around everywhere. Just keep your guard up—it’s easy to be so interested in a video’s overall message or who is delivering that message that you might miss subtle hints to tip you off that it’s AI-generated.

Be safe out there!