‘Super Movers’ Show Signs of Exceptional Brain Aging

Super movers — adults 80 and older who walk as fast as people 30 years younger — had lower risks of cognitive impairment, data from multiple cohorts suggested.

Across five cohorts in the Health and Retirement Study International Network of Studies, super movers had a lower risk of incident cognitive impairment (HR 0.49, 95% CI 0.28-0.71) compared with non-super movers over follow-up periods that ranged from 3.4 to 5.4 years, reported Joe Verghese, MD, MS, of the Renaissance School of Medicine at Stony Brook University in New York, and colleagues.

In the LonGenity study, super movers also showed slower cognitive decline and preserved hippocampal volume in specific subfields, Verghese and co-authors wrote in Neurology.

Autopsy data from the Rush Memory and Aging Project suggested that super movers had a trend toward better cognition before they died and a lower prevalence of clinically diagnosed Alzheimer’s disease and other dementias compared with non-super movers. There were no differences in any of the Alzheimer’s or dementia pathologies examined.

“Most aging research focuses on risk factors for cognitive decline,” Verghese told MedPage Today. “We studied the opposite end of the spectrum: older adults in their 80s who walk as fast as people decades younger.”

Understanding how exceptional brain aging occurs may help identify factors that promote cognitive resilience, he noted.

“Walking reflects the integrated function of multiple systems, including the brain, cardiovascular system, muscles, and sensory pathways,” Verghese pointed out.

“Super movers appear to represent an exceptional aging phenotype, with a lower burden of disease, healthier lifestyles, and potentially younger biological age,” he said. “A combination of favorable biology, preserved brain health, and lifelong healthy behaviors may help them maintain both mobility and cognition into late life.”

Verghese and colleagues introduced the concept of super movers in earlier research that highlighted a group of older adults with a unique biological and clinical profile.

“Super movers were defined as individuals ages 80 and up with gait speeds at least 1.5 standard deviations above age- and sex-adjusted cut-scores in each cohort, which corresponded to gait speeds of adults 30 years younger,” Verghese said.

The current study assessed data from people ages 80 and older without Alzheimer’s disease or dementia at baseline enrolled in five cohorts of the Health and Retirement Study (HRS) international network, plus participants in the LonGenity study and the Rush Memory and Aging Project.

The five HRS network cohorts contributed 3,989 participants with a baseline age of approximately 84 years; 47% to 65% were women and 358 people were super movers. The prevalence of super movers ranged from 6.4% to 9.8% across cohorts. The cohorts had harmonized cognitive assessments that tested total recall, orientation, serial 7s, and counting backwards. In pooled data from four network cohorts, super movers had a lower risk of survey-reported Alzheimer’s disease or dementia (HR 0.40, 95% CI 0.22-0.58).

In the LonGenity cohort, 197 participants had a baseline age of approximately 85 years; 57.8% were women, and 14 were classified as super movers. Over a mean follow-up of 4.4 years, super movers demonstrated a slower decline in memory (P=0.016) and specific non-memory measures (P=0.004) compared with non-super movers. Structural brain data suggested greater mean right hippocampal volume among super movers (P=0.032), although the sample size was limited. Mean cortical thickness did not differ between groups.

The Rush cohort included 692 volunteers with a baseline age of 86 years; 68.9% were women and 84 people were super movers. Mean age at death was 95 years for super movers and 93 years for non-super movers (P<0.001). At their last clinical assessment, super movers showed trends toward better global cognition scores (mean z score -0.79 vs -0.81, P=0.86) and a lower prevalence of clinically diagnosed Alzheimer’s or other dementias (86.7% vs 13.2%, P=0.65) compared with non-super movers, but differences were not statistically significant.

The study had several limitations, Verghese and colleagues acknowledged. The definition of super movers was based on gait speed, but other measurements like step-to-step variability may offer different insights into relationships between gait and cognition, they said.

The Rush cohort had a high prevalence of super movers, likely due to the study’s prevalence of “older adults who are highly educated, more health conscious, and generally high-functioning, hence introducing potential selection biases,” the researchers suggested. Other limitations included relatively small sub-samples of people 80 and older with neuroimaging and biomarker data, and the possibility of unmeasured confounding.