How a positive attitude promotes healthy aging and a healthy brain.

       Years ago, when I first began to extend my research from diseases in Aging into understanding the positive side of Aging, finding out what is important for aging successfully, I begin interviewing acquaintances who were over 65 and enjoying full, active lives.  One of the questions I asked was what the most important factor was for their success.  My guess was it would be health, the opposite of struggling with illness or injuries.  But I was wrong.  I kept hearing that it was Attitude.  Sandra Weleford’s response was especially memorable.  A family friend, an accomplished artist, and very active in our community, Sandra was very open about her continuing battle with cancer, one of the diseases of aging.  She was also very open about her advice for making the most of every day, enjoying activities with her family and friends.   Sandra’s mantra was to repeat saying “Amen, Amen, Amen” and then get on with life.  Amen standing for the choices that kept her going: Attitude, Medications, Exercise, and Nutrition. 

       John Milton in his epic poem Paradise Lost captured one of the seminal truths for wellbeing at any age. “The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.”  Sandra was able to rise above and go beyond her illness by actively choosing to be compassionate in caring for herself and equally compassionate in caring for others.  Her choices helped her stay actively engaged in living, experiencing the joys of being that dwell there. 

     Eric is another one of the inspiring people I have met who have coped with handling their illness with courage and a positive attitude.  It was at a large conference on Parkinson’s disease where patients and support groups were learning about recent advances in treating the disease.  Eric was a patient who had been in a clinical trial involving surgery and receiving monthly drug infusions.  He was 36 years old when first diagnosed with Parkinson’s.   Seven years later he had volunteered to participate in the trial; one that we were discussing in a workshop at the meeting.  While there were initial benefits, problems had developed with his infusion site blocking delivery of the experimental drug.  He was now 50 years old and relying on standard medical treatments, which were helping some symptoms.  Like other patients, he was acutely aware his disease was relentlessly progressing.  Unlike many others, he was living a full, active life, positive about what he was doing.

     Given the circumstances of contracting an increasingly debilitating disease as a young adult and having a promising surgical treatment fail for technical problems, Eric had good reasons to be bitter, angry, and frightened.  He was not.   Instead, he was an enthusiastic volunteer for one of the major Parkinson’s Disease Foundations, working with patient support groups to help others deal with the challenges they faced as their disease progressed.  He talked with our workshop group about what would benefit patients participating in clinical trials and their families.  His voice was muted and sometimes halting, needing some assistance from a friend at times to answer the questions we asked.  He made a compelling plea for better communication, working compassionately with families and explaining what the results meant when the study was completed. 

     I had a chance to talk with Eric during breaks in the presentations.  He had a great sense of humor, was jovial and loved to talk about life, the meeting, and how he enjoyed working with other patients.  As we were standing in a large pavilion near the entrance, I asked Eric how he was able to stay so positive after all he had been through.  He thought for a minute and then answered.  “See those doors over there,” pointing to large number of glass doors leading to the street.  “I can choose how I feel when I walk through them.  I can be happy or sad. I know being sad will lead me where I do not want to go.  So, I make the decision to be happy.”     

     Charles "Chuck" Swindoll, an evangelist and motivational speaker, was right in proclaiming, “Words can never adequately convey the incredible impact of our attitude towards life.”  The benefits coming from an optimistic attitude affect everything that makes life worth living; increased life satisfaction, higher life quality, improved health, and better social relationships.  A Positive Attitude profoundly influences one’s ability to handle the trials and tribulations in Aging.  To quote Swindoll again, “The longer I live the more convinced I become that life is 10% of what happens to us and 90% how we respond to it.” 

   The benefits of a positive attitude support its leading role in successful aging. 

Health Benefits of a Positive Attitude

• Cardiovascular Disease:  Heart disease and stroke have been the leading cause of death in the United States since 1921. Even in the Covid 19 Pandemic, heart disease stayed at the top of list thru 2021.  In addition to the significant advances made in medical care for treating heart disease over the years, studies show that optimism makes good medicine work better.  Cardiologist Alan Rozanski and his colleagues analyzed the results from 10 major studies on heart disease with a total of 209,436 participants.   In their pooled analysis, optimism was associated with a 35% reduction in cardiovascular events (heart disease and stroke) over the follow-up period averaging nearly 14 years.
• Alzheimer’s Disease:  Remarkably, optimism can alter the course of some age-associated diseases, delaying onset and decreasing severity.  How large the effects can be in Alzheimer’s disease is seen in a study published in February 2018 by Dr. Becca Levy and her colleagues at Yale and the National Institutes of Health.²     They followed 1,200 individuals up to an average age of 72.  All carried the APOE ε4 gene, a strong risk factor for developing Alzheimer’s Disease.  Remarkably, those with a Positive Attitude towards aging were 50% less likely to develop dementia than those with a negative attitude.  This does not mean that they were protected from ever developing dementia; a longer duration study is needed for that.  But it does say that their attitude helped them gain good, Alzheimer’s-free years of living.  And they had an outlook to fully enjoy these years. 
• Pain: The incidence of Pain increases with aging, often in association with diseases of aging including arthritis, cancer, Multiple Sclerosis, Alzheimer’s, and Parkinson’s.  In a broad survey of 31,780 individuals in 96 studies examining pain associated with different diseases, both hope and optimism were consistently found to significantly reduce pain severity and improve physical functioning.
• Longevity:  Attitude in the pessimism-to-optimism dimension of nearly 7,000 under-graduate students attending the University of North Carolina at Chapel Hill from 1964-1996 was assessed by psychological testing.   Death from all causes were then recorded over the next 40 years.  The death rate for most pessimistic 25% of the students was 42% higher than for the most optimistic quartile.  The leading causes were cardiovascular heart disease, cancer, accidents, and suicide.  
  

How a positive attitude promotes healthy aging and a healthy brain.

   A Positive Attitude creates positive expectations, stimulating changes in the brain like those from Placebo Effects that promote healing.  Dr. Becca Levy, whose study discussed earlier showing that positive age beliefs lowered the risk for developing Alzheimer’s, has also found that positive age beliefs are associated with maintaining better cognitive functions in aging.⁵   In addition, cognitive enhancing functions of genes in aging are amplified in individuals with a Positive Attitude about aging.⁶ An example of positive epigenetic effects.  Other health promoting activities include reduction of cardiovascular stress and lower inflammatory markers in the blood.^7,8   Collectively, the power of positive expectations significantly support healthy cognitive functions and healthier physical aging. 

    What specifically does a Positive Attitude do to increase personal wellbeing?  Probably the greatest benefit comes from keeping an optimistic perspective in assessing and responding to daily events.  A perspective that lowers bad stress.  Those who have a Positive Attitude are more likely to take better care of themselves, stay active, eat healthier, sleep better, keep socially engaged with others and more fully enjoy life.  In contrast, a pessimistic outlook perceives daily activities negatively, increasing life-threatening bad stress and the risk for clinical depression.⁹ Depression increases vulnerability to isolation, disease, and injuries, which can lead to accelerated aging and earlier death. 

Worries, Bad Attitude, and EMOC

      We live in world that seems to generate at least one crisis a day, and sometime waves of crises. We need not look far to find things to worry about.  I am a natural worrier.  It probably comes from both sides of my family. Through them I have witnessed the negative effects of too much worrying that lead to excessive anger, fear, and sadness.  As in other feelings, some worrying is beneficial.  It helps identify real threats that need to be addressed.  Too much generates bad stress and a bad attitude.  And often we are worrying about things we cannot control, or do not happen. 

      I have found one way to get off the worry cart is to declare EMOC,   Enough, Move Onto Compassion.  Get onboard with compassion for myself and others. I remember the popular 1965 song Eve of Destruction sung by Barry McGuire.  The fatalist lyrics about perpetual war, injustice, and inhumanity are just as appropriate today as they were more than 50 years ago.  Rather than focus on everything that can go wrong – world crises have always there – I move on to what I can do that is positive and compassionate.  It begins with saying and doing AMEN, which for me means choosing a positive Attitude, Meditation, Exercise, and healthy Nutrition.  The optimism it generates helps appreciate the good things that are happening and more effectively work on real problems where I can make a difference.  No one likes a perpetual fatalist and it is a perpetually distressful way to live.

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The Author:  Don Gash is an emeritus professor of Neuroscience (PhD) in the College of Medicine and Lewis Honors College at the University of Kentucky.  His expertise is in drug development for diseases of aging, especially those effecting the brain.  Over fifteen years ago, he recognized that aging posed serious threats to health and wellbeing – and had many features of being a disease.  Dr. Gash felt that his experience in developing therapies for neurological diseases could be used to better understand normal aging processes and ways to promote successful aging.  Ways that activate natural healing processes in the brain and body to effectively restore true wellbeing.  Lifestyles and practices that do not replace good medical care when needed but make it work better.  The advice given is evidence-based on published studies and from his years of personally testing many programs and exercises to identify those which effectively cultivate and enable Aging Successfully.

   
Sources: 

PubMed identification numbers (PMID) are given for peer-reviewed scientific reports in mainstream science journals. The scientific papers are available online through PubMed on www.nlm.nih.gov.

1. Rozanski A et al. (2019) Association of optimism with cardiovascular events and all-cause mortality.  JAMA Netw Open e1912200.  PMID: 31560385
2. Levy B et al. (2018) Positive age beliefs protect against dementia even among elders with high-risk gene. Plos One. 13(2):e0191004.  PMID: 29414991
3. Shanahan M et al. (2021) Hope, optimism, and clinical pain: A meta-analysis. Ann Behav Med 55: 815-832.  PMID: 33580660
4. Brummett B et al. (2006) Prediction of all-cause mortality by the Minnesota Multaphasic Personality Inventory Optimism-Pessimism Scale Scores: Study of a college sample during a 40-year follow-up period. Mayo Clin Proc. 81: 1541-1544.  PMID: 17165632
5. Smith E et al. (2019) Positive aging views in the general population predict better long-term cognition for elders in eight countries. J Aging Health 31: 1739-1747. PMID: 30041558
6. Levy B et al. (2020) When culture influences genes: Positive age beliefs amplify the cognitive -aging benefit of APOE ε2. J Gerontol B Psychol Sci Soc Sci. 75: e198-203. PMID:32835364
7. Levy B et al. (2000) Reducing cardiovascular stress with positive self-stereotypes of aging. J Gerontol B Psychol Sci Soc Sci. 55: P205-213. PMID: 11584877
8. Levy B and Bavishi A. (2018) Survival advantage mechanism: Inflammation as a mediator of positive self-perceptions of aging on longevity.  J Gerontol B Psychol Sci Soc Sci. 73: 409-412. PMID: 27032428
9. Grossardt B et al. (2009) Pessimistic, anxious, and depressive personality traits predict all-cause mortality: The Mayo Clinic cohort study of personality and aging. Psychosom Med.  71: 491-500. PMID: 19321849