“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.

Supported by the Bill Collins family and the Jewish Hospital & St. Mary’s Foundation, part of KentuckyOne Health, and presented by University of Louisville Physicians and Frazier Rehab Institute, also part of KentuckyOne Health, the symposium will take place from 9:30 a.m. to 2:30 p.m. in the conference center of the Rudd Heart and Lung Building, 201 Abraham Flexner Way next to Jewish Hospital.

Speakers will provide insight into a variety of topics affecting patients with Parkinson’s, including new advancements and treatments, and new developments and services within the UofL Physicians Parkinson’s Disease and Movement Disorders program.

The keynote speaker is Michael Okun, MD, the national medical director for the Parkinson’s Foundation, a best-selling author and a leading national spokesman on Parkinson’s disease. Okun is chairman of Neurology and co-director of the Center for Movement Disorders and Neurorestoration at the University of Florida College of Medicine.

Discussion topics include:

• Breakthrough Therapies for Parkinson’s Disease
• Advances in Deep Brain Stimulation Surgery
• Hallucinations and Psychosis in Parkinson’s Disease
• Exercise in Parkinson’s Disease – What are the Benefits?
• Caregiving – Finding Your Village
• The Parkinson’s Disease Buddy Program: What Have We Learned from Each Other?

“The symposium is a great resource for patients and their families, as it’s an opportunity to hear more about what we know about Parkinson’s disease, what we are learning and how we can help,” said Kathrin LaFaver, MD, director of the UofL Physicians Movement Disorders Clinic and the Raymond Lee Lebby Chair in Parkinson’s Disease Research at the University of Louisville School of Medicine. “Patients get the opportunity to hear from and talk with several experts in one place.”

To attend the symposium, register by April 3 via email or by calling 502-582-7654 with name, number of guests, and telephone number.

The number of individuals with AD and related disorders in the region is rising due to the rapidly aging population and public health systems have not kept pace with recent developments in treatment.

“There is little awareness of dementia in the region because of prevailing biases about the loss of function in healthy aging,” Friedland said. “People in the Middle East need to know that it is never normal for a person at any age to be demented.”

Friedland, the Mason and Mary Rudd Endowed Chair in Neurology at UofL and an organizer for the previous six ICAD-ME meetings, will discuss his research into the relationship between gut microbiota and neurodegeneration, and provide information on potential preventative measures to delay the onset of AD. In addition, he hopes to learn about special features and needs of the region’s population.

The conference will cover topics including the history of Alzheimer’s disease and its basic pathophysiology, pharmacological and non-pharmacological therapies, ethical and legal issues, and aging as it is addressed in the Koran and the Bible.

The event, sponsored by the United States National Institutes of Health/National Institute on Aging and Biogen, is Feb. 23-25, 2017 in Abu Dhabi, United Arab Emirates. Additional organizers are Changiz Geula, PhD, professor at Northwestern University, Marwan Sabbagh, MD, professor at Barrow Neurological Institute of Phoenix, and Abdu Adem, PhD, professor at United Arab Emirates University.