“Aging is not inevitable; it is an opportunity. Not everyone has the chance to grow old,” said Robert Friedland, professor of neurology at the University of Louisville and an expert on aging. “How well we age depends on what we do.”

Inspired by his grandfather’s struggle with dementia, Friedland has spent nearly five decades as a neurologist and researcher, studying the causes of neurological diseases and seeking new ways to treat and prevent them. In addition to seeing patients with a focus on cognitive, behavioral and geriatric neurology, his ongoing research investigates the connection between microbes in the gut and mouth and the development of Alzheimer’s and Parkinson’s disease and other neurodegenerative conditions.

Based on this work, Friedland says it is possible for people to preserve health into later years by stockpiling reserves in cognitive, physical, psychological and social health.

Although Friedland admits that certain physical declines are inevitable with age and that genetics can predispose a person to certain diseases, he believes in many cases these reserves can prevent diseases or lessen their effects, delay age-related declines and allow an older person to recover from accidents and illness.

“Genetics do have a role in our health but they are not the whole story. Choices we make throughout life affect whether diseases develop and how much they reduce our health when they do,” Friedland said. “We can do things that delay or mitigate heart disease, diabetes and cognitive and neurological diseases and allow us to recover from life events that otherwise may cause permanent declines in health.”

Each of Friedland’s four factors, described below, is dependent on the others. Friedland provides tips on increasing reserves of each area. By developing habits that add to these reserves, you can maximize your opportunity to remain active and healthy as you get older.

Cognitive reserve – The ability of the brain to work effectively, solve problems and make decisions.

Since the brain controls every system in the body, it makes sense that a healthy brain will support other reserve factors (physical, psychological, social).

Keep the brain healthy by seeking opportunities to learn new things and challenge your ways of thinking throughout life. Learn a new language or a new skill, such as playing a musical instrument or crochet. Play chess or other games. Any activity that involves learning and strategy will strengthen your brain.

“Watching television is not a good activity since it is completely passive and does not require participation. Reading is a better choice as it demands involvement,” Friedland said. “Telling stories is good for your memory and attention skills.”

Physical reserve – The health of the body’s cardiovascular, neurological, musculoskeletal and other systems.

These reserves depend on eating the right food, engaging in physical activity every day and receiving regular health care.

A diverse diet of healthy foods supports both your body and your microbiota, the microorganisms that live in and on the body and are essential to your overall health. Friedland recommends a diet that is mostly plants, high in fiber and low in sugar, salt and saturated fat. When you improve your diet, you also can improve the health of your microbes which aids your own health.

“I call it gene therapy in the kitchen,” Friedland said. “By making the best choices in your food, you can alter the genetic makeup of your microbiota and improve your overall health in as little as two weeks.”

Exercising for 30 minutes each day, regardless of weather or circumstance, is enough to improve physical health, Friedland says. More is better, of course, and when you combine physical activity with social interactions and cognitive activity by playing a sport such as golf or tennis, the benefits multiply.

Taking steps to protect yourself from injury or illness also is important. Wear a helmet when you are riding a bike, wash your hands and avoid exposure to toxins.

It also is important to get enough quality sleep each night, practice good dental hygiene, avoid excess alcohol and have regular medical checkups.

Polypharmacy is another problem to avoid. Friedland said that as people age, they may accumulate prescriptions for multiple health concerns that can interact or alter the effectiveness of each other. If you are taking several prescriptions, regularly evaluate all of them with your health care provider.

Psychological reserve – A healthy mental state that is free of agitation, anxiety and depression.

Poor mental health can affect your ability to interact with others or maintain your physical health. Practice a positive mental attitude, engage in activities that are meaningful to you and manage stress with meditation or other measures.

“Depression is common in older people, and that can lead to memory problems,” Friedland said. “Physical factors can contribute to depression, such as poor sleep or vitamin deficiency. A lack of social interactions and physical activity also can cause or aggravate depression.”

Social reserve – Personal relationships and the ability to function in society.

The company of others can motivate people to take care of themselves and encourage them to maintain healthful behaviors. Positive relationships can be with a spouse, a group of friends or professional colleagues.

“Studies indicate that dementia is more common among people whose social activity declines later in life,” Friedland said. “Humans need relationships with others in order to maintain good health.”  

Social engagement can go hand in hand with the other types of activity by including friends in physical exercise, games, a craft or work. Involvement in community or religious activities also can increase a sense of belonging and a desire to stay active.

Ideally, you will begin developing habits that contribute to these reserves early in life, but Friedland says it is possible to add to reserves and improve your health at any age – even once you reach an age when you experience the effects of deficits.

“Aging is not inevitable,” Friedland said. “The chance to be alive should be recognized as an opportunity – an opportunity to manage our lifestyle factors to maximize survival, health, fitness and meaning as we age.”

More detailed advice from Friedland that may help people live longer, healthier lives and a deeper discussion of the reasons he makes these recommendations are available in his book, “.” Published in October by Cambridge University Press, the book was cited by the Wall Street Journal as one of the five best books on aging and retirement published in 2022.

To generate new ideas in Alzheimer’s disease research, the National Institute on Aging, one of the National Institutes of Health, has offered researchers in other fields already funded by the NIH additional money to explore links between their current field of research and Alzheimer’s disease. Beverly, a UofL cancer researcher, has received one of the first rounds of these $385,000 awards.

“They are hoping to spark some new directions, uncovering potential new areas for research,” said Beverly, PhD, associate professor of medicine at UofL. “This will get more people involved in the work and develop some preliminary seed data.”

Alzheimer’s and other neurodegenerative diseases affect more than 5 million people in the United States. As the population ages, this number is increasing.

Beverly’s primary research grant from the National Cancer Institute is to study ubiquilin proteins in cancer. Ubiquilin proteins are critical adapters that appear to be central to signaling pathways driving Alzheimer’s disease as well as cancer.

“The protein ubiquilin is lost in both cancer and Alzheimer’s and other neurodegenerative diseases,” Beverly said. “What we hope to discover is how this protein, which is associated with aberrant cell growth in cancer, also is associated with aberrant cell death in neurodegenerative diseases.”

Beverly plans to use the new funding to determine whether and how ubiquilin regulates contradictory signaling pathways in neuronal cells and epithelial cells, and how the loss of ubiquilin affects multiple types of tissues.

Robert Friedland, MD, professor of neurology at UofL who has conducted research in Alzheimer’s disease for more than three decades, is collaborating with Beverly on the project.  

“We have known for many years that protein folding patterns are critical to neuronal damage in Alzheimer’s,” Friedland said. “The work Dr. Beverly has done with ubiquilin has uncovered pathways that may be involved in key mechanisms of both Alzheimer’s disease and cancer. We anticipate that the interaction of researchers in cancer and neurodegeneration will help advance both fields.”

With combined annual national expenditures of approximately $300 billion for cancer and Alzheimer’s diseases in the U.S., these conditions represent two of the largest burdens on the health care system. Beverly believes the laboratory research conducted in this project will facilitate the development of therapeutic interventions for these diseases.

“Only by understanding the basic molecular, biochemical and genetic causes of these diseases will we be able to make significant progress in treating these patients,” Beverly said.