People who have a specific variant of the APOE gene run a higher risk of developing dementia than the general population. A first-of-its-kind study of this population found that an external factor could play a role in whether the person got dementia.

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"We found that even in this high-risk genetic group, if they (have) more positive age beliefs, they actually had a 40% reduced risk of developing dementia," said Becca R. Levy, PhD, a professor of epidemiology at Yale School of Public Health and a professor of psychology at Yale University. "In fact, what we found was that their risk of developing dementia was as low as people who are not born with that risky gene."

Dr. Levy, who is the author of a best-selling book Breaking the Age Code: How Your Age Beliefs Determine How Long and Well You Live, talked about the power of thinking positively and how it can influence people's health in a recent episode of “AMA Moving Medicine.”



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Dr. Levy's interest in aging began in graduate school when she received a National Science Foundation fellowship to study why Japan had the highest life expectancy in the world at the time. What she quickly noticed after traveling to Tokyo was how older people were treated in Japan compared to what she was used to in the United States.

"I noticed that older people were celebrated and integrated into society in many ways," she said. "It seemed like a very different perception and treatment of the oldest members of their culture."

Dr. Levy became fascinated by the idea that messaging around aging could play a role in a person's health. Through longitudinal, cross-cultural, and experimental studies, she discovered that ageism—the systemic stereotyping and discrimination of people solely based on their age—can impact an individual's cognitive, physical, and mental health.

One of the most common negative age beliefs Dr. Levy found in her research was that all cognition declines in older people. That, she said, is a myth, particularly because there are many types of cognition.

"For example, procedural memory, the ability to remember how to ride a bike, that is something that's maintained," she said. "There's evidence that the ability to use metacognition, which is actually the ability to think about thinking, tends to improve later in life. Another skill that there's evidence that increases is pattern recognition."

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Dr. Levy believes physicians are in a great place to bring about change in the fight against ageism, which faces structural and individual obstacles. On the structural side, she believes a widespread campaign like anti-smoking efforts could be effective at changing the public's mindset about how older people are viewed. On the individual side, the change can happen in the exam room.

"In their own interactions with patients, I think it's great to ask them about their age beliefs, assess where they are,” she said. “If they hear patients referring to their own aging in a negative way, to encourage them to think about their age beliefs and to become aware that it's possible to challenge some of the negative age beliefs.”

In Breaking the Age Code, Dr. Levy provides evidence-based tools that individuals can leverage to shift how they—or those around them—view aging. One tool is age-belief journaling. Dr. Levy recommends people note how aging is portrayed around them, whether that portrayal is positive or negative, and acknowledge when older people are not included in messaging.

"Those three activities," she said, "we've found can be quite powerful in shifting people's (mindsets) and challenging those negative age beliefs."

AMA Moving Medicine” highlights innovation and the emerging issues that impact physicians and public health today. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.

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