From Life Span to Health Span

She shared the story of how, when her aging father was hospitalized with kidney failure after a complication from a coronary bypass graft, even she couldn’t prevent him from becoming delirious.

“I realized, no one person, even a world expert, can prevent delirium,” she said. “It has to be a coordinated effort of the entire health care system working together to provide optimal care.”

Inouye said the incident motivated her to become a Health and Aging Policy Fellow in Washington, D.C. She said she continues to work to improve public awareness of delirium and other conditions and to create health care systems that enhance cognitive health.

Need for REST

Long-term memory is one of our cardinal human attributes, said the symposium’s other keynote speaker, Bruce Yankner, professor of genetics in the Blavatnik Institute at HMS and co-director of the Paul F. Glenn Center for the Biology of Aging.

“The idea that we could lose this intrinsic part of ourselves is a terrifying thought for a very large segment of our population,” he said.

Fortunately, Yankner explained, researchers have come to recognize that dementia, like delirium, is not an inescapable consequence of aging. He described ways researchers are trying to understand and prevent age-related cognitive decline.

In the 1990s, Yankner led the team that first demonstrated the toxic effects of amyloid beta, the hallmark of Alzheimer’s disease.

More recently, he showed that a protein called REST, known to regulate neural differentiation during early development and then subside in the young brain, later resurfaces in a subset of aging brains to potentially protect against neurodegeneration and other stresses.

Yankner spoke about differences in brain organization, neural activity and genetics that he said may help explain why some older adults maintain high cognitive performance while others decline—and why some people can harbor brain changes characteristic of Alzheimer’s pathology without developing symptoms of dementia.

By conducting basic science that reveals the workings of Alzheimer’s at the molecular and cellular levels and translating that knowledge into new therapies, Yankner said he believes “it won’t be long before we’re able to intervene fundamentally in this dreaded disorder.”

Optimistic outlook

Each year at the symposium, the Hollis L. Albright, MD ’31 Scholar Award is presented to an outstanding medical student at HMS.

The 2019 award went to fourth-year student Samantha Landino.

Having had to make difficult decisions about whether to undergo surgery herself as a young patient in a rural area with few medical services, Landino developed clinical and scientific interests in surgery. She now plans to become a cardiothoracic surgeon, researcher and teacher.

Landino will start her residency in general surgery at Massachusetts General Hospital in the fall.

The panelists closed with a discussion about other factors related to healthy aging—such as exercise, diet, sleep and meaningful relationships—that included questions from the audience.

In response to an inquiry about whether aging is a disease, Yankner said, “The way I see it, aging is part of normal human development. It’s important to bear in mind that some aspects of brain development improve with age, such as vocabulary and the ability to express yourself, as do certain emotional attributes […], such as contentment with life.”

“There are some positive aspects of aging that are overlooked in the obsession our society has with youth,” he said.

“I think it’s a natural life process,” Inouye added, “that can be, as Bruce says, filled with wonderful, fulfilling things.”