Body of Evidence/Volunteers tested in a 50-year-long Baltimore study provide invaluable data on the aging process

[Guest guest]

By Lori Aratani

Washington Post Staff Writer

Tuesday, May 19, 2009

\

Every year hundreds of people travel to Baltimore for an unusual purpose.

They are not here to tour the city's aquarium or sample its fabled blue

crabs. They are not in search of fame or money. Other than free lodging,

they receive nothing in exchange for their visit, which entails a certain

amount of discomfort.

No, these folks, some of whom have made this journey for decades, believe

the trip is worth their time and expense because how they live -- calculated

according to everything from the strength of their grip to how many apples

they consume in a month -- may offer clues to how the rest of us might live

better, longer, healthier lives.

These individuals -- homemakers, retirees, doctors and myriad others -- are

participants in the Baltimore Longitudinal Study of Aging (BLSA), the

country's longest-running study of aging.

Since 1958, a total of more than 1,400 volunteers have agreed to regularly

undergo in-depth physicals and memory and other screenings conducted by the

study's physicians. The resulting data span more than half a century and are

a gold mine for researchers interested in the aging process.

Because of the BLSA, scientists know that signs indicating that a person

could be at risk for dementia and other cognitive diseases may appear 20

years before symptoms emerge. Findings that today are common knowledge (that

exercise can help reduce high blood pressure, for one) can be traced back to

BLSA's annual physicals and the data analysis done by the study's

scientists.

Think of it as a vast historical record.

The BLSA is one of many projects being done by the National Institute on

Aging, but the study itself is a rarity. Few institutions will undertake

such an extensive venture, largely because the commitment required from

individuals is enormous, said the study's director, Luigi Ferrucci.

It's not just researchers who toil for years sifting through mountains of

data. BLSA participants also are devoted to helping researchers fulfill the

study's goals: One person has been enrolled for 47 years. The oldest

participant is 102 and has made the required pilgrimage to Baltimore

regularly for 38 years.

" Participants really, really love the study, " said Ferrucci, a genial,

gray-haired physician who first learned about the BLSA as a student in his

native Italy. " They feel they are making a contribution to science, and they

feel like aging is such an important and under-studied issue, anything they

can do to help, they want to do.'' Participants come from as far as Norway.

Some even donate their bodies to the BLSA autopsy study.

" It's a chance to make a unique contribution to research on aging,'' said

Sprott of Potomac, one of the participants, " since this is the only

research project of its kind in the world. "

As understanding of aging has changed, so have elements of the study.

Researchers recently incorporated a new component into their research,

Insights Into the Determinants of Exceptional Aging and Longevity study

(IDEAL), an effort to uncover the secrets of those who age exceptionally

well: Think 80-year-olds who ski and jog or 90-year-olds whose hearing and

memory put a 30-year-old to shame. Ferrucci estimates only about 0.5 percent

of the population has such abilities.

A Rigorous Three Days

The elevator doors slide open to reveal a tastefully decorated lobby. Soft

music plays in the background. A huge bank of windows offers a soothing view

of the Patapsco River. A smiling receptionist greets visitors warmly. For

three days, the fifth floor of Harbor Hospital in Baltimore will serve as

home base for the many participants who come for their physicals. Most will

stay here at the hospital in comfortable but not particularly plush rooms.

Proximity is important because researchers want them to be available for the

battery of tests they'll undergo over the next 48 to 72 hours.

A study participant has white blood cells extracted in an effort to learn

how age might influence a person's immune system. (Photo From National

Institutes Of Health, National Institute On Aging)

Down the hall is a small kitchen area stocked with fruit and pretzels. The

atmosphere is soothing. The magazines plentiful. The staff friendly.

There is homework. Along with athletic shoes and casual clothing,

participants are asked to bring with them a food diary that details

everything they ate in the previous three days. Yes, some people have been

know to temporarily clean up their diet -- a tendency that is noted in the

20-minute introductory video sent to people before they arrive.

" Please report what you actually eat, not what you think you should be

eating,'' it says.

This is no vacation. During their stay, participants will have a physical

that goes well beyond sticking their tongues out and saying " ahhhhh. " They

rarely will sit for more than 30 minutes before they are whisked away for

another exam or stuck with another needle. Sprott, now in his 12th year in

the study, confirms that the pace can be brutal.

Researchers take routine measures (temperature, blood pressure and weight),

but participants also undergo more sophisticated tests. Echocardiograms help

researchers examine hearts, and spirometry tests measure lung function. In

addition to collecting blood and urine, researchers might also take samples

of the participants' breath.

Even simple tests can provide valuable insight. Researchers will evaluate a

participant's grip strength, which previous BLSA research has shown can

predict whether someone might be at higher risk of complications after

surgery or more likely to die prematurely.

A select few will undergo a procedure called cytapheresis, in which white

blood cells are extracted from blood in a search for clues to how age might

influence a person's immune system. In another test, participants' movements

are tracked by sensors similar those used in the making of computer-animated

movies such as " Toy Story. "

The researchers do not offer treatment. They may, however, share information

gleaned from the tests with participants, who can then discuss the findings

with their regular physicians, Ferrucci said.

The researchers also evaluate changes in each person's memory and verbal

ability, using memory tests and brain scans. Should a group of participants

develop dementia, researchers can look back at those individuals' test

results for commonalities.

Measuring Memory

So, what it is like to be a test subject?

Fascinating but not always fun, according to Sprott.

Most people mark another year with an extra candle on their birthday cake.

But Sprott, 68, is reminded of his age when he slips up on one of the

routine memory tests or when he is slightly more winded after a treadmill

session he may have sailed through years earlier.

A study participant has white blood cells extracted in an effort to learn

how age might influence a person's immune system. (Photo From National

Institutes Of Health, National Institute On Aging)

" It's a three-day validation that your body is going to hell,'' Sprott said

with a chuckle. " And it reminds me every once in a while that I need to lose

a little weight.''

It's not the poking and prodding, the needles and the skin electrodes that

Sprott dislikes.

" The physical stuff doesn't bother [me],'' he said. " We're all

deteriorating.''

Rather, it's the tests of memory.

" We hate the cognitive stuff,'' he said, going on to describe the test that

he and his wife, who is also a participant, dread.

" The tester reads you a set of shopping lists, maybe 16 items,'' he

recalled. " You have to reply with as many as you can remember. The first

time you take this test, you discover a simple strategy for remembering: You

sort the items into categories. But even though you take the same test every

two years and you know the strategies, you get worse. "

Sprott is well-versed in the science of aging: For more than a decade, he

directed the National Institute on Aging's study on the biology of aging.

Since 1998, he has been executive director of the Bethesda-based Ellison

Medical Foundation, which funds basic biological and biomedical research on

aging.

" There is an incredible amount of misinformation out in the field, " he said,

adding that few programs can match the longevity of the BLSA or the breadth

of its data.

" My grandkids will benefit from this research, " he added.

In addition to his wife, Sprott's 42-year-old daughter is also a BLSA

participant.

Endless Possibilities

The work done by BLSA scientists (more than 800 scientific papers) runs the

gamut from the impact of aging on major organs to its effect on personality,

and it has become a standard reference on aging.

Halpern, a professor of psychology and neuroscience at Bucknell

University, has had students in her upper-level course on cognitive aging

review BLSA research. Already a " rich database " of information, she said,

the research will continue to grow in importance as people live longer.

" The BLSA isn't perfect, " said Alan Zonderman, senior investigator for the

cognition section of the National Institute on Aging. " There are limitations

to it. But all of the limitations are overcome by the fact that we have all

of these repeated measures on these people that no one else has. "

When a participant falls ill, researchers can examine decades' worth of

records to find a cause.

" We can say, maybe it's not what's happening to them now, but what happened

20 years ago, " said senior investigator Resnick, who is principal

investigator of the brain-imaging component of the BLSA.

" Probably the most frequent complaint people in their 70s make to their

physicians is how bad their memory is, " Zonderman said. " People worry about

dementia in some ways more than they worry about getting cancer. "

" A lot of our work focuses on early detection, " he continued. " We're able to

predict in some cases, not very accurately at this point, but with

increasing accuracy . . . who is likely to get the disease, who is at the

highest risk. "

Zonderman was part of the team that found that changes in BLSA participants'

visual memory may help predict future mental changes as well as signal the

onset of diseases such as Alzheimer's.

Other BLSA studies have found that loss of some short-term visual memory is

normal as people age, as is loss of some hearing.

BLSA researchers were able to disprove the long-held belief that people get

crankier as they age. Using data collected from the study's participants,

they found that personality traits don't generally change much after age 30:

People who were cranky at 27 were likely to be cranky at 87.

Researchers also found that older people were better able to handle stress

than their younger counterparts, who tended to cope by becoming hostile or

retreating into fantasy worlds.

In another study, 50 BLSA men were given the equivalent of three martinis

over the course of an hour to find out whether age influenced a person's

ability to metabolize alcohol. Turns out the older participants were able to

metabolize the alcohol just as well as their younger counterparts. However,

older men did show greater impairment as a result of their consumption.

The possibilities that such data offer are endless.

" This a treasure, " Ferrucci said. " Who else is going to do a study that's

going to last 50 years? "

Despite all those possibilities, there is one thing the BLSA can't do: stop

people from getting old. But Ferrucci is confident the data gathered in

2009, like the research gathered during the first years of the study, will

yield insights into how people can age gracefully.

" The definition of being old is changing; it's breaking apart, " Ferrucci

said. " [People] want to live well, no matter what their age is. "