Discovering What It Takes to Live to 100
By: Mary Duenwald
New York Times, December 25, 2001
Dr. Thomas T. Perls leaned in close and spoke gently,
locking his eyes into Mary Lavigne's. He had pulled his chair to within
two feet of the petite, white-haired woman in her sunny living room in
Lancaster, Mass.
"When were you born?" he asked, amplifying
his voice. "What's your birthday?"
Miss Lavigne pulled back an inch. Unlike the other
two women Dr. Perls had interviewed earlier in the day, she can hear just
fine.
"Sept. 28, 1899," she said.
"You've been in three centuries!" Dr. Perls
said. "It's amazing. Do you think it's amazing?"
"Yeah, I'm thankful. I'm very thankful that I'm
able to take care of myself," Miss Lavigne (pronounced luh-VEEN) said
with her Massachusetts accent. She wore a beige and navy striped golf
shirt, and she sat perfectly straight, her delicate hands folded on her
lap.
"Do you have great-great-grandchildren?"
Dr. Perls asked.
"I never married," Miss Lavigne said with
practiced determination. "I didn't want to get into it."
They spoke for several minutes about her early
childhood in Quebec, her memory of the first automobiles and of hearing
President William Howard Taft give a speech in Westbrook, Mass., in 1911.
Then Dr. Perls, a geriatrician at Beth Israel Deaconess Medical Center, in
Boston, and an assistant professor of medicine at Harvard Medical School,
explained why he wanted to know so much about her. He wanted her to be
part of his nationwide study of centenarians. If she agreed to
participate, he would ask her to provide a DNA sample, to take a
psychological test to measure her mental acuity (though it is obviously
strong) and to consider donating her brain for research. Also, he would
want to interview her closest living relatives.
"Who are the nephews or nieces most interested
in your affairs?" Dr. Perls probed.
"Well, they're all interested in my
affairs," she replied with a laugh. "They come to visit and they
say: `I want this and I want that. I want this and I want that.' "
Like so many of the hundreds of centenarians Dr.
Perls has interviewed in the last six years, Miss Lavigne left him and his
associate, Dr. Margery Hutter Silver, a neuropsychologist who is also at
Beth Israel and Harvard, shaking their heads over her clear thinking, her
near-perfect health and her alert sense of humor.
"You don't realize it, because she doesn't act
like it," Dr. Perls said, "but she is also legally blind."
Even Miss Lavigne's denunciation of marriage sounded
familiar. About 14 percent of the women Dr. Perls has studied have stayed
single for their 100 years. Could that be because unmarried women lead
relatively unstressful lives? Maybe, Dr. Perls said. "Or maybe the
fact that they are able to live independently means that they are able to
manage stress better than the average person," he said.
In contrast, the centenarian men in the study group
are all married, or have been. But there are more than five times as many
women as men.
In nine years, Dr. Perls and his research staff have
collected health data on some 1,500 centenarians. And the work has led him
to a series of discoveries about the very old. They are healthier than
anyone ever thought they were, first of all. They avoid the most
devastating diseases of old age until the last few years of their lives.
And almost all of them seem to be exceptionally good at managing stress
and getting along with people.
Even those unmarried women are never alone.
"They're full of good humor and gregarious," Dr. Perls said.
"They're basically very happy, optimistic people. You look at a
person like Mary Lavigne and you see she has people taking her to lunch,
people looking after her, because she's so nice."
Most notably, Dr. Perls and his colleagues have
recently found, centenarians seem to carry a small handful of genes that
enable them to live to 100 or better.
In August, Dr. Perls and his colleagues — including
two molecular geneticists, Dr. Louis M. Kunkel and Dr. Annibale A. Puca of
Children's Hospital in Boston — announced the results of a study of
centenarians with very old siblings. After examining their DNA, the
researchers determined that a longevity-enabling gene might exist in a
certain small stretch of chromosome No. 4, one of the 23 pairs of human
chromosomes.
The researchers hope that Centagenetix, the
Boston-based company they founded, will home in on that gene before next
summer. Ultimately, the company hopes to identify a number of longevity
genes, figure out how they work and create drugs that mimic their actions.
Dr. Perls does not think that genes alone keep people
alive for so long. Most of his subjects have healthy life patterns. He has
met some who live to a ripe old age even while smoking cigarettes or
eating high-fat foods, but, he said, "These are the ones who you
would suppose really have some spectacular genetic stuff going on."
Still, a great majority of his subjects never smoked.
Few drink to excess. And though no particular diet seems to ensure long
life, obesity is never part of the picture.
But Dr. Perls is adamant that good habits alone
cannot get a person to the century mark. He said: "If you do
absolutely everything right — you're Jack La Lanne, you've got the
perfect diet, you're exercising for a really long time, you're happy-go-
lucky and incredibly nice, and you're thin, I would say that without the
appropriate genetic variations, it's still extremely difficult to get to
100."
The health histories of Dr. Perls's centenarians
suggest that there are three kinds of people who achieve extreme old age.
Forty percent are "survivors," those who live with chronic
diseases for decades, beginning in their 60's and 70's. Another 40 percent
are "delayers," who put off illness until their mid-80's. And
the last 20 percent are "escapers" — people who avoid all
age-related diseases until they are over 100.
Until very recently, centenarians were not numerous
enough for study. Today, about 50,000 Americans are 100 or older, up from
almost none at the turn of the previous century. By 2050, as many as
800,000 to one million Americans may still be alive at 100 or older, with
improving health care practices.
Dr. Perls became fascinated by the extremely old when
he was a geriatrics fellow at Harvard, taking his turn working at the
Hebrew Rehabilitation Center for Aging in Boston. That was in the 1970's,
and like other physicians at the time, he assumed that his centenarian
patients would be the sickest. In fact, he had trouble finding them in
their rooms. "One was playing the piano for everybody," Dr.
Perls said. "Another one was a tailor, mending people's
clothes."
In 1993, he began the New England Centenarian Study,
which at first focused on eight Massachusetts towns. One of the first
things that he and Dr. Silver found was that senility was not an
inevitable accompaniment to old age. About 70 percent of the centenarian
men, but only 30 percent of the women, were still clear-headed; the
explanation is not known, but the researchers suspect women with dementia
are more likely to survive than men with the condition.
Dr. Perls also found a surprising statistic about the
centenarian women who were mothers. One in five of them had had at least
one child after the age of 40. In the general population, only about 5
percent of mothers give birth that late.
"In other words, if you have a child after the
age of 40, you have about a four and a half times greater than average
chance of going on to 100," Dr. Perls said. "It isn't just the
act of having a child, we don't think. But late motherhood is a
marker." It shows that the entire body is aging slowly, he said.
The more centenarians Dr. Perls met over the years,
the more obvious it seemed that longevity could be inherited. He often
recalls the day he spotted a photograph in The Patriot Ledger in Quincy,
Mass., of a man celebrating his 108th birthday with his 103-year-old
sister.
The two of them turned out to have had four siblings
who lived past 100, plus another sister, still living at 97. Among these
siblings' first cousins were seven centenarians and 14 others who lived to
be at least 90. Two other families among his subjects included similarly
large collections of extremely old people.
Dr. Howard Fillit, director of the Institute for the
Study of Aging, in New York, said the age of Dr. Perls's subjects had been
the key to his discoveries. "It was Tom's great insight to recognize
the value of studying families with large numbers of 100-year-old
people," Dr. Fillit said.
By 1998, Dr. Perls had accumulated enough data to
demonstrate that a person with a centenarian brother or sister was four
and a half times as likely as the average person to live to be at least
91. This year, he has refined the statistics further: male siblings of
centenarians have a chance 17 times as great as the average man's of
living to 100. And female siblings are eight times as likely to reach 100.
On a walk through the Harvard Medical School campus
four years ago, Dr. Perls described his centenarian families to Dr.
Kunkel, the molecular geneticist. "We went back to my office and drew
out the pedigree," Dr. Kunkel said. "To me, it was clearly
genetic. I was pretty confident that if we looked for a gene, we would get
something interesting."
Ultimately, Dr. Kunkel and Dr. Puca examined the
chromosomes of 303 people in 137 families. At least one sibling in each
family was 98 or older; the others were at least 90.
In those families, a stretch of DNA on Chromosome 4
stood out; another stretch, on Chromosome 2 was also a candidate, though
not as strong. Now, Centagenetix will try to replicate the study with more
subjects, and zero in on the gene or genes in those sites that may affect
life span.
Dr. Perls says he will not be surprised if the gene
they find somehow accomplishes the twin goals of slowing the aging process
and protecting against disease.
One way such genes may operate, Dr. Perls said, is by
limiting the activity of free radicals, which are unpaired electrons that
cause corrosive damage to tissues throughout the body. Studies on
laboratory creatures — mice, worms, yeast and fruit flies — have shown
that certain genes can shield against free radical damage and prolong life
span.
"We already know that free radical damage has an
important pathogenic role in heart disease and stroke," Dr. Perls
said, "and it may also play an important role in Alzheimer's disease.
There's been pretty good research showing that it plays an important role
in aging."
Though the gene study has clearly taken center stage,
Dr. Perls's work with centenarians has raised many other questions that he
hopes to investigate. For example, he said, he would like to study the
theory that it may be possible for people to build a "cognitive
reserve" that enables them to avoid dementia in old age. He described
a 103-year-old man who, in psychological tests, showed no signs of
senility. Yet after the man's death, when his brain was examined in
autopsy, it was found to be laced with the tangles of dead cells that
characterize Alzheimer's. Perhaps the man had been able to strengthen
other parts of his brain — to build a cognitive reserve — to get
around his disease.
Dr. Perls would also like to learn more about the
psychology of longevity — how attributes like spirituality, optimism,
humor, financial security, stress management and friendships help people
live to be 100. "It would be very interesting to find out, no matter
how good your genes are, what environmental things are a must," he
said.
What are the chances that Dr. Perls himself, now 41,
has some genetic propensity for longevity? It is a question he has
definitely thought of. The good news is that his great- great-grandmother
lived to 102. His mother is in excellent health at 78. Signs are even
better for his wife, who gave birth to their youngest of three children
when she was 41.
But whatever his genes have in store, Dr. Perls
intends to do what he can to stretch their potential. In the past year, he
has dropped 30 pounds from his 5-foot-11 frame, reaching a trim 170, by
taking up spinning classes and coaching his 9-year-old's soccer team.
The way to lengthen your life, Dr. Perls pointed out,
is to add healthy years. "Even if we can't live to be
centenarians," he said, "we can all be centenarianlike, in that
we can try to compress the time that we're sick toward the very end of our
lives."
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