Successful Aging: A Neuroscientist Explores the Power and Potential of Our Lives

by Daniel J. Levitin

Adults who are experiencing the effects of aging may find that stimulants, carefully used (and preferably under a doctor’s supervision), can make them feel younger, more energetic, and more alert. What we don’t know for sure is whether such medications have lasting, damaging effects. Adderall is one of a group of amphetamines, which are often taken “off label” (that is, in a nonapproved application) for cognitive enhancement. There are mixed results as to whether Adderall and other amphetamines actually enhance cognition; however, they are known to increase motivation, which is no small thing. On the flip side, there are a few reports that they impair creativity.

Like Adderall, modafinil (originally sold under the brand names Provigil and Alertec) can increase motivation and promote wakefulness. Some healthy individuals who are not chronobiologically shifted have turned to it for cognitive enhancement. One systematic review found that modafinil consistently enhanced attention, executive functions, and learning, with few side effects. However, other reviews show mixed results including impairments, such as a reduction in creativity, and in another, it led to cognitive slowing with no increase in performance accuracy. Some use it when they have repetitive, boring work to do that doesn’t require creativity. Others report that it allows them to focus on a task but that the focus can be so narrow that it makes them inattentive to other things, causing them to be absentminded, misplace things, or not properly shift attention when an attentional shift is required.

Vitamin B12 Vitamin B12 (cobalamin), found in meat, poultry, eggs, milk, and fish, is necessary for the production of myelin in the brain and is involved in the metabolism of every cell in the body. Vegans are prone to B12 deficiency and are advised to take supplements. As we age, our stomachs produce less gastric acid, reducing the body’s ability to absorb vitamin B12 that’s found in food, and so B12 deficiency is more common among older adults. Much B12 research has been driven by the homocysteine hypothesis. Homocysteine is a potentially toxic amino acid, and elevated levels of it are associated with cognitive impairment, Alzheimer’s disease, dementia, and cardiovascular disease. We believe that it increases oxidative stress and increases damage to DNA and that its neurotoxicity leads to cell death. B12 (along with B6 and folate) is responsible for recycling homocysteine, thereby keeping its levels in check; insufficient amounts of B12 are therefore believed responsible for a toxic buildup of homocysteine. Vitamin B12 deficiency is associated with cognitive decline, and older individuals with higher B12 levels generally perform better on cognitive tests. Of course, the mere fact that deficient levels of B12 are correlated with cognitive deficits does not mean that B12 supplementation will correct that.

Anecdotally, many doctors and patients claim that B12 supplementation increases energy and lifts depressed mood. Taking B12 supplementation does not cause any harm as far as we know, provided that your blood plasma levels don’t exceed recommended maximums, and there is a possibility that it may be neuroprotective as we age by promoting myelination.

Meditation involves maintaining attention on your immediate experience in the moment and in the world, and away from distractions such as self-referential thinking and mind wandering. It helps to train you to avoid thinking about something other than what you’re currently doing,

Meditation reduces activity within the default mode network and increases connectivity between it and regions of the brain that are implicated in cognitive control—that is, controlling our thoughts: the dorsal anterior cingulate and dorsolateral prefrontal cortices. The result is that meditation simultaneously turns down the default mode’s pull on our attention, while streamlining and honing the network. Increased connectivity between the prefrontal region and the default areas also has an anti-inflammatory effect by reducing cytokines.

Long-term meditators show structural changes in the brain as well, including increases in cortical thickness, hippocampal gray-matter density, and the size of the hippocampus. Additional changes are enlargement of the insula, somatomotor areas, orbitofrontal cortex, parts of the prefrontal cortex that help in paying attention and in self-awareness, and regions of the cingulate cortex instrumental in self-regulation and staying focused. Even brief meditation reduces fatigue and anxiety and increases visuospatial processing, working memory, and executive functioning, and in many cases these benefits persist even after meditation practice is stopped. Meditators show lower levels of cortisol following a stressful task and decreased inflammation, not just during meditation, but day-to-day, and the benefits show up after as little as four weeks (or thirty hours) of mindfulness practice.

Davidson also showed that meditation may drive benefits at the level of genes. After an eight-hour day of practice, a group of long-term meditators (with about six thousand lifetime hours of practice) showed a significant downregulation of inflammatory genes. This decrease, if sustained over a lifetime, might help fight diseases with onsets marked by chronic low-grade inflammation—cardiovascular disorders, arthritis, diabetes, Alzheimer’s disease, and cancer.

Loneliness triggers higher levels of pro-inflammatory genes; meditation can both lower those levels and decrease feelings of loneliness, as the Dalai Lama found when he meditates on how he is just one of 7 billion people on the planet (recall his remarks about this in Chapter 1, on individual differences). Mindfulness meditation is also associated with increased telomerase. In people with mild cognitive impairment and early-stage Alzheimer’s, meditation has been shown to slow or reverse cognitive decline, reduce stress, and increase quality of life, along with the neuroplastic changes I just described.

I’ve come to see a future in which we can plan ahead to fend off some of the adverse effects of aging; a future in which we can harness what we know about neuroplasticity to write our own upcoming chapters the way we want them to unfold; a future in which a combination of medical developments and healthy lifestyle choices can temper or reverse the effects of cognitive decline, depression, and loss of energy that we have for too long assumed were a nonnegotiable part of the aging process. That future is to a large degree already here for those who are willing to harness it.

LIVING BETTER The greatest days of our lives

There is an ancient story about the tension between longevity and quality of life. According to Greek mythology, Eos was the goddess of the dawn. Every morning she rode on a purple chariot drawn by two horses, wearing a saffron-colored robe, to bring in the day. She fell deeply in love with the mortal Tithonos, the prince of Troy. As a goddess she was immortal and couldn’t stand the thought that Tithonos would eventually die and she’d have to spend eternity without him. She implored Zeus to grant immortality to Tithonos, and Zeus agreed. But Eos didn’t think to also ask for the gift of youth that she and the other gods and goddesses enjoyed. While Eos stayed eternally young, Tithonos became an old man, decrepit, lacking even enough strength to move his legs. He continued to age until he eventually lost his mind. She moved him out of her home and put him in a chamber by himself, where he continued to live mindlessly and infirm. Immortality and youth are not the same thing.

One life begins in the depths but takes an upward trend: a childhood of deprivation, a troubled youth, struggles and setbacks in early adulthood, followed finally by success and satisfaction in middle age and a peaceful retirement. Another life begins at the heights but slides downhill: a blissful childhood and youth, precocious triumphs and rewards in early adulthood, followed by a midlife strewn with disasters that lead to misery in old age.

If a good life is one in which the good outweighs the bad by a certain amount, and if well-being were simply additive, then these two lives should be seen as equally desirable. But that is not how most people look at it. Given a choice, most people would prefer the life that takes the upward trend and we’d consider the person with that life the more fortunate. What Daniel Kahneman found about pleasure and pain—that people were willing to endure pain longer if the ending was relatively pleasant—was found in the narrow context of painful medical procedures, such as colonoscopies. Does this same principle apply to life itself? Psychological scientist Ed Diener found that it does.

Velleman’s explanation about why we prefer an improving life to a declining one isn’t because we place greater weight on what happens at the end, but because later events can alter the meaning of earlier events. This may derive from our yearning to instill life with meaning. We are drawn to the story of someone who sees the error of their youthful ways and grows, someone who becomes a better person. This makes for a more satisfying trajectory, a more inspirational and aspirational theme, than someone who goes in the opposite direction. When we have the good times and the bad times actually matters. We’re sensitive to the timing of events because we seek patterns in the world around us—including our lives within it. A particular success can mean that one’s frustrations are finally over, or it can foreshadow a slump we didn’t see coming, depending on when it happens in our timeline. And that event’s perceived meaning depends very much on the events that happened before and after it.

One of my students, a refugee from Romania who settled in Canada, shared this story with me: My first encounter with the topic of quality of life was early in my childhood. I was playing with a group of local children in a small Romanian village when a team of North American missionaries approached us and pulled me aside to ask me about what they assumed to be the miserable, poverty-stricken lives of me and my friends. They looked at us dirty, barefoot children with pity, and my friends and I looked back at them with confusion—we couldn’t understand why these foreigners looked so concerned. We didn’t think anything was wrong. One could argue then, that perceived quality of life is more important to an individual’s well-being than objective measures of quality of life.

Social comparison theory states that our life satisfaction tends to be influenced not so much by what we have but by what we have in relation to others. That is, we look to see how others are living, such as whether they have shoes or have fewer aches and pains—and we judge ourselves in comparison. We are a social species, and we are attuned to fairness. If we see others who have things we don’t, like shoes or good health, we feel cheated. If no one we know has shoes or good health, we just think to ourselves, “That’s life.”

You might assume that everyone aspires to more happiness—that is, given the choice, people would want to have the maximum amount possible of something good. But that view is a biased one, held by people who live in individualist societies such as Europe and North America. For people from collectivist and holistic societies—where contradiction, change, and context are emphasized—ideal states of being for the self are more moderate than in other cultures. This approach might be called the moderation principle, under which people impose mindful ceilings on how much of a good thing they aspire to in a perfect world.

You may recognize the similarities with Aristotle’s principle of the golden mean (neither too much nor too little of a thing).

Westerners tend to see happiness and misery as opposites, and life as a challenge to minimize the negative and accentuate the positive. Easterners tend to see happiness and misery as interrelated and mutually necessary, like the yin and yang in Chinese philosophy. Indeed, studies of thousands of people have found that members of holistic cultures aspire to less happiness, pleasure, freedom, health, self-esteem, and longevity than members of individualistic cultures, although their goals for society at large are the same. Russia—which has a sociological history of being somewhat between an individualistic and collectivist culture—fell on the side of the Eastern cultures when included in this study.

Americans have been falling in the world happiness rankings over the past several years, according to The World Happiness Report. In their 2019 ranking of 156 countries, the United States dropped one rank to number 19 for its worst rank since the report began. “We finished nineteenth on the list behind Belgium,” comedian Jimmy Kimmel quipped. “The people who feel...

The report looks at six variables: GDP, social support, health span (not life span!), freedom to make life choices, generosity, and freedom from corruption. “By most accounts, Americans should be happier now than ever,” said Jean Twenge, one of the report’s authors. “The violent crime rate is low, as is the unemployment rate.” The authors speculate that the US ranking has dropped due to a spate of addictions—opioids, gambling, social media, and risky sexual behaviors—as well as the rise in obesity and major depression. The authors also blame overuse of digital devices. By 2017, the average seventeen- or eighteen-year-old spent more than six hours a day of leisure time—in addition to any time spent on schoolwork—on the Internet, social media, and texting, activities that have...

There was also a decline in other non-screen-related solitary activities, such ...

good relationships keep us happy and healthier, period . . . social connections are really good for us . . . loneliness kills. People who are more socially connected to family, to friends and community, are happier, healthier, and they live longer. And loneliness turns out to be toxic. . . . High conflict marriages without much affection are very bad for our health—worse than getting divorced.

A bigger predictor than cholesterol level at age fifty for health at age eighty is the quality of your relationships. Good relationships protect your brain. Especially in their eighties, a person who feels they are in an attached relationship, where they can count on the other person in times of need, will retain sharper memories for longer and better overall health. The Beatles were right about this (and so many other things): Love is the most important thing. A second important pillar of happiness is finding a way of coping with life that does not push love away.

A person could have a successful career, money, and good physical health, but without supportive, loving relationships, they won’t be happy.

Good sibling relationships loomed especially powerful: 93 percent of the men who were thriving at age sixty-five had been close to a brother or sister when younger. “It is social aptitude,” wrote George Vaillant, who directed the study for three decades, “not intellectual brilliance or parental social class, that leads to successful aging.” Asked what he had learned after thirty years of studying the cohort, Vaillant was clear: “That the only thing that really matters in life are your relationships to other people.”

At age eighty-five, one man in the study described the pleasure of his three-decades-long second marriage as “really just being together. Share each other’s lives and our children’s lives. Snuggle on cold nights.” One woman, after fifty years of marriage, said the secret was that they were best friends. “There’s a physical relationship. It’s not quite what it was when we were young, but the main thing is, I adore him. More than I ever did. We laugh a lot, we laugh at ourselves, and we don’t take ourselves too seriously. I don’t know how we got here, but it’s wonderful. Equally important, we hold each other loosely.” (If you love somebody, set them free.)

One interesting finding from the study is that those who married a second time were often just as happy as those who stayed in their first marriage. That is, people who divorce are not, as a group, malcontents who can’t work things out. In the 1960s and ’70s, many researchers thought that divorce was caused by personality disorders, poor coping style, passive aggression, acting out, aggression, and alcohol abuse. But that has not been borne out by research. Marriages fail for a variety of reasons, and often the simplest explanation is the most accurate: The couple were merely mismatched and didn’t realize it until later.

And for many, their marriages just get better and better in old age. As Vaillant notes, “In time, hormones can feminize the men and masculinize the wo...

Aging liberals have more sex, according to the Harvard study. The most conservative men ceased sexual relations at an average age of sixty-eight, while the most liberal men had active sex lives into their eighties.

It’s not just social connections late in life that determine happiness and other measures of life satisfaction. Although they’re crucial, they occur in a context of a lifetime of social connections. Men who had “warm” childhood relationships with their mothers earned an average of $87,000 more a year than men whose mothers were uncaring. (Wow! Thanks, Mom!) Men who had poor childhood relationships with their mothers were much more likely to develop dementia when old. Late in their professional lives, the men’s boyhood relationships with their mothers—but not with their fathers—were associated with effectiveness at work. On the other hand, warm childhood relations with fathers correlated with lower rates of adult anxiety, greater enjoyment of vacations, and increased “life satisfaction” at age seventy-five—whereas the warmth of childhood relationships with mothers had no significant bearing on life satisfaction at seventy-five.

Couples who are more satisfied with their spouses have increased longevity—up to 25 percent. So there you go—the right romantic relationship wins you the double payout of increased longevity and increased quality of life. Science says so. Love the one you’re with. Making your spouse happy will help you live better.

Work versus Retirement What is the ideal age to retire? Never. Even if you’re physically impaired, it’s best to keep working, either in a job or as a volunteer.

“I get up every morning and write for an hour or two,” he says. “It’s why the good Lord put me here.” Too much time spent with no purpose is associated with unhappiness. Stay busy! Not with busywork or trivial pursuits, but with meaningful activities. Economists have coined the term unretirement to describe the hordes of people who retire, find they don’t like it, and go back to work. Between 25 and 40 percent of people who retire reenter the workforce. Harvard economist Nicole Maestas says, “You hear certain themes: a sense of purpose. Using your brain. And another key component is social engagement.” Recall Sigmund Freud’s words that the two most important things in life are to have love and meaningful work. (He was wrong about a great number of things, but he seems to have gotten that right.)

Staying busy with meaningful activities requires some strategies and reshifting of priorities.

Most important, I think we need to work together to fight for changes in the way our societies see older adults, particularly how they see them in the workforce. Corporate culture in the United States has tended toward ageism. It is difficult for older adults to get a job or get promoted. Two-thirds of American workers said they had witnessed or experienced age discrimination at work. Employers should recognize that offering opportunities to older workers is smart business, not just a feel-good, charitable act. Multigenerational teams with older members tend to be more productive; older adults boost the productivity of those around them, and such teams outperform single-generational ones.

As Anaïs Nin observed, “Life shrinks or expands in proportion to one’s courage.” It’s true of brain volume as well. That courage, that expansion of life, can come about in a variety of ways for different people: taking classes online, such as from Coursera or Khan Academy (but be sure you interact with real, live people to discuss what you’ve learned; learning in isolation can only go so far in keeping your mind active); joining (or hosting) a book club or current events discussion group; volunteering in a hospital or church; asking your local YMCA or church what they need; working in a soup kitchen. There is a transformative effect in helping others.

I think that the right teacher, the right believer in a child or an older adult, can tip the balance for that person’s life and help them to overcome life’s obstacles, to get on a track toward happiness and success that will lead them into successful aging. My teachers did that for me.

What we can all do now is to be more intentional and mindful of how we live in the world. Remain Curious and mentally engaged. Be Open to new experiences. Keep up your social Associations. Try to be Conscientious. Follow the Healthy lifestyle practices I’ve described regarding diet, exercise, and good sleep hygiene.

the refocusing of his attention on immediate, sensory experiences, a Zen-like state:

The only thing you know for sure is the present tense. That nowness becomes so vivid to me now, that in a perverse sort of way, I’m almost serene, I can celebrate life. Below my window, for example, the blossom is out in full. It’s a plum tree. It looks like apple blossom, but it’s white. And instead of saying, “Oh, that’s a nice blossom,” looking at it through the window when I’m writing, it is the whitest, frothiest, blossomiest blossom that there ever could be. Things are both more trivial than they ever were, and more important than they ever were, and the difference between the trivial and the important doesn’t seem to matter—but the nowness of everything is absolutely wondrous. And if people could see that—there’s no way of telling you, you have to experience it—the glory of it, if you like, the comfort of it, the reassurance. . . . Not that I’m interested in reassuring people, you know. The fact is that if you see the present tense, boy, do you see it, and boy, can you celebrate it!

Putting It All Together The single most important factor in determining successful aging is the personality trait of Conscientiousness.

Adopting new lifestyle choices is difficult. But if you remember why the lifestyle change is important, you’re more likely to stay with it, even when your motivation flags a little bit. Three additional factors that determine how well we age are more important than the rest. The first is childhood experiences, in particular of parental attachment and of head injury. It’s too late for you to do anything about these now, but you can protect and nurture the young people in your life, and you can predict your own outcomes by thinking about these. Children who are poorly attached, whose parents provide on-again, off-again care and attention, grow into adults who find it difficult to establish long-term intimate relationships. If you had a concussion as a child, your chances of developing dementia in old age are increased by a factor of two to four. If you had multiple concussions, the increased risk is not additive—that is, each additional concussion doesn’t increase the risk by the same amount, but rather accelerates the chances of a bad outcome in old age. Sports in which a child’s head is used as a battering ram, or other kinds of contact with an object or another person, are dangerous to mental health. The second most important factor in retaining mental vitality later in life is to exercise in varied, natural environments. You don’t need to run marathons. Power walking in a park or forest, fast enough to get your heart rate up and your brain full of rich, oxygenated blood,...

Adapting to new things, especially in the physical world, strengthening the visual-motor-kinesthetic circuits in your brain, can make an enormous difference in fending off cognitive decline. Even just ten minutes of slow walking every day has long-term benefits for your body and mind. And if that’s not possible, do what you can. “I have a two-story house and a very bad memory,” says Betty White (age ninety-seven), “so I’m up and down those stairs all the time. That’s my exercise.”

The third most important factor is social interaction. Interacting with others is among the most complex things we can do with our brains. It could be through playing music with them, playing bridge or golf, acting in community theater, reminiscing, or discussing literature in a book group. Nearly every part of our brains is activated by interacting with others, live, face-to-face, in real time. (Sorry, Skype.) Doing so requires us to read their body language, the emotions in their faces, and the contours of their speech. We have to follow along with what they’re saying and try to figure out a way that we can contribute to the conversation without derailing it. In conversation, we need to employ empathy, compassion, logic, and turn taking—all relatively advanced cognitive operations. Isolation and lack of connectedness are strong predictors of disease and mortality. A study from the Karolinska Institute showed that people with strong social networks were 60 percent less likely to develop dementia. “Your brain was built for the very purpose of social engagement,” notes

By 2030 there will be more individuals in the United States over sixty-five than under fifteen years of age. It’s been estimated that two-thirds of the people over sixty-five who have ever lived are alive today, and three-quarters of the people over seventy-five who have ever lived are alive today. We need to change the way our society thinks about the aged.

I began this book with a question for us to ask ourselves, one that gets to the heart of how we see the future of aging. What would it mean for all of us to think of the elderly as resource rather than burden and of aging as culmination rather than denouement? I have tried to show here that it would mean harnessing a human resource that is being underutilized. It would mean restoring dignity to a marginalized group of human beings just when they need it most. It would promote stronger family bonds and stronger bonds of friendship among us all. It would mean that important decisions in every domain, from personal matters to international agreements between nations, would be informed by experience and reason, along with the perspective that old age brings. And it might even mean a more compassionate world. We can have that future if we want it. We need to educate ourselves and our families about the advantages of aging—the wisdom, the bias toward positivity, the compassion that older adults exhibit. As individuals, as community members, as a society, it is in all of our best interests to help construct a culture that embraces the gifts of the elderly, weaving cross-generational interactions into the fabric of everyday experience. By learning from the science of the brain we can create a transformative understanding of the aging process, its human story, and in the process create a richer quality of life. This is the new truth about aging.

In 2018, eighty-four-year-old Gloria Steinem was asked, “Who are you passing the torch to?” “Nobody,” she said, laughing. “I’m holding on to my torch. I’ll let other people light theirs from mine.” Hold on to your torch. Do not go gently. And don’t forget to laugh. Whatever’s going on around you, remember to laugh.

REJUVENATING YOUR BRAIN Don’t retire. Don’t stop being engaged with meaningful work. Look forward. Don’t look back. (Reminiscing doesn’t promote health.) Exercise. Get your heart rate going. Preferably in nature. Embrace a moderated lifestyle with healthy practices. Keep your social circle exciting and new. Spend time with people younger than you. See your doctor regularly, but not obsessively. Don’t think of yourself as old (other than taking prudent precautions). Appreciate your cognitive strengths—pattern recognition, crystallized intelligence, wisdom, accumulated knowledge. Promote cognitive health through experiential learning: traveling, spending time with grandchildren, and immersing yourself in new activities and situations. Do new things.