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1.  Cognitive Performance in Centenarians and the Oldest Old: Norms from the Georgia Centenarian Study 
We present normative data from a large population-based sample of centenarians for several brief, global neurocognitive tasks amenable for frail elders. Comparative data from octogenarians are included. A total of 244 centenarians and 80 octogenarians from Phase III of the Georgia Centenarian Study were administered the Mini-Mental Status Examination, Severe Impairment Battery, and Behavioral Dyscontrol Scale. Centenarians (age 98–107) were stratified into three age cohorts (98–99, 100–101, 102–107), octogenarians into two 5-year cohorts (80–84, 85–89). Highly significant differences were observed between groups on all measures, with greater variation and dispersion in performance among centenarians, as well as stronger associations between age and performance. Descriptive statistics and normative ranges (unweighted and population-weighted) are provided by age cohort. Additional statistics are provided by education level. While most previous centenarian studies have used convenience samples, ours is population-based and likely more valid for comparison in applied settings. Results suggest centenarians look different than do even the oldest age range of most normative aging datasets (e.g., 85–90). Results support using global measures of neurocognition to describe cognitive status in the oldest old, and we provide normative comparisons to do so.
PMCID: PMC2974270  PMID: 20521181
Normative; Centenarians; Cognition; MMSE; SIB; BDS; Population-based
2.  Correspondence of perceptions about centenarians' mental health 
Aging & mental health  2009;13(6):827-837.
The goals of this study were to uncover the criteria by which centenarians, proxy/caregivers, and interviewers rated centenarians' mental health. Often proxy and interviewer reports are obtained in studies of the oldest-old and become a primary source of information.
Data were from a population-based sample of mentally competent US centenarians in northern Georgia. The dependent variables were based on alternative reports for the centenarians' mental or emotional health. Regression analysis was used to predict each source's rating of mental health separately with the same set of variables. These variables included information obtained from the centenarians and proxies about their distal experiences, demographics, and proximal resources including Mini-Mental Status Examination (MMSE), health, personality, socioeconomic resources, and coping behaviors.
Examination of mean-level differences between sources revealed similarity across mental health ratings. For centenarians and proxies, perceived economic status was a very important predictor of mental health. For centenarians and interviewers, personality (neuroticism and extraversion) was an important common predictor. The interviewer and proxy mental health ratings were strongly associated with MMSE, but that was not the case for centenarians.
Mean-level findings and the comparative regression results provide corroborating evidence that centenarians' self-reports of mental health are similar based on average ratings and presence of common associations with other raters (i.e., perceived economic status and personality). Implications of differences across rater pairs are discussed as guidance about the comparative value of substitution of proxies as informants for addressing specific influences on mental health.
PMCID: PMC2996725  PMID: 19888703
extreme old age; mental health assessment; quality of life/well-being
3.  Centenarians – a useful model for healthy aging? A 29-year follow-up of hospitalizations among 40 000 Danes born in 1905 
Aging cell  2009;8(3):270-276.
Centenarians surpass the current human life expectancy with about 20–25 years. However, whether centenarians represent healthy aging still remains an open question. Previous studies have been hampered by a number of methodological shortcomings such as a cross-sectional design and lack of an appropriate control group. In a longitudinal population-based cohort, it was examined whether the centenarian phenotype may be a useful model for healthy aging. The study was based on a complete follow up of 39 945 individuals alive in the Danish 1905 birth cohort on January 1, 1977 identified through the Danish Civil Registration System (DCRS). Data from the Danish Demographic Database and The Danish National Patient Register (in existence since 1977) were used. The 1905 cohort was followed up from 1977 through 2004 with respect to hospitalizations and number of hospital days. Survival status was available until December 2006. Danish centenarians from the 1905 cohort were hospitalized substantially less than their shorter-lived contemporaries at the same point in time during the years 1977 through 2004. For example, at age 71–74, the proportion of nonhospitalized centenarians was 80.5% compared with 68.4% among individuals who died in their early 80s. This trend was evident in both sexes. As a result of their lower hospitalization rates and length of stay in hospital compared with their contemporaries, who died at younger ages, Danish centenarians represent healthy agers. Centenarians constitute a useful study population in the search for fixed traits associated with exceptional longevity, such as genotype.
PMCID: PMC2774420  PMID: 19627266
centenarians; exceptional longevity; fixed traits; healthy aging; hospitalization
4.  Prevalence and Predictors of Anemia in a Population-Based Study of Octogenarians and Centenarians in Georgia 
Anemia has been associated with increased physical and financial costs and occurs more frequently in older individuals. Therefore, the primary objectives of this study were to examine the prevalence and possible predictors of anemia in the very old.
Hemoglobin was used to identify those with anemia in a group of centenarians and near centenarians (98+, n = 185) and octogenarians (n = 69), who were recruited as part of the population-based multidisciplinary Georgia Centenarian Study. Blood markers, including ferritin, vitamin B12, red blood cell folate, methylmalonic acid, creatinine, and C-reactive protein, demographic variables, and medication and/or supplement usage were used to determine possible predictors of anemia.
The prevalence of anemia was 26.2% in octogenarians and 52.1% in centenarians. Low serum albumin (<3.6 g/dL) and decreased estimated glomerular filtration rate (<45 mL/min/m2) were predictors of anemia in centenarians.
Anemia is a major health issue, particularly as people age. Because of the high prevalence of anemia in older individuals, awareness of the predictors associated with anemia becomes increasingly important so as to reduce the negative consequences associated with it and allow for the identification of steps that can be taken to correct anemia, including managing chronic disease.
PMCID: PMC3260487  PMID: 21896502
Anemia; Centenarians; Renal function
5.  Engaged Lifestyle, Personality, and Mental Status Among Centenarians 
Journal of adult development  2009;16(4):199-208.
This study assessed engaged lifestyle activities (e.g., volunteering, traveling, and public speaking) for centenarians of the Georgia Centenarian Study. A total of 285 centenarians and near-centenarians (i.e., 98 years and older) and their proxy informants participated in this study. The Mini-Mental Status Examination (MMSE) was assessed for all centenarians, and proxy informants reported on lifestyle activities and personality traits of the centenarians. Results suggested that participants who had volunteered, traveled, and those who had given public talks and balanced their checkbooks were more likely to show relatively high mental status scores (i.e., MMSE > 17). Personality traits were found to be moderators in the relationship between engaged lifestyle and mental status: Participants with high levels of Emotional Stability, Extraversion, Openness, and Conscientiousness and with high levels of engaged lifestyle were more likely to show relatively high mental status scores (i.e., MMSE > 17), whereas participants with low levels of Emotional Stability, Extraversion, Openness, Agreeableness, and Conscientiousness and with low levels of engaged lifestyle were more likely to show relatively low mental status scores (i.e., MMSE < 18). The results suggest that engaged lifestyle, particularly in combination with personality traits, plays an important role in the level of cognitive functioning among oldest old adults.
PMCID: PMC2995529  PMID: 21132076
Activities; Centenarians; MMSE; Personality; Lifestyle
6.  Oxidative Stress and Longevity in Okinawa: An Investigation of Blood Lipid Peroxidation and Tocopherol in Okinawan Centenarians 
Background. The Free Radical Theory of Aging mechanistically links oxidative stress to aging. Okinawa has among the world's longest-lived populations but oxidative stress in this population has not been well characterized. Methods. We compared plasma lipid peroxide (LPO) and vitamin E—plasma and intracellular tocopherol levels (total α, β, and γ), in centenarians with younger controls. Results. Both LPO and vitamin E tocopherols were lower in centenarians, with the exception of intracellular β-tocopherol, which was significantly higher in centenarians versus younger controls. There were no significant differences between age groups for tocopherol: cholesterol and tocopherol: LPO ratios. Correlations were found between α-Tocopherol and LPO in septuagenarians but not in centenarians. Conclusions. The low plasma level of LPO in Okinawan centenarians, compared to younger controls, argues for protection against oxidative stress in the centenarian population and is consistent with the predictions of the Free Radical Theory of Aging. However, the present work does not strongly support a role for vitamin E in this phenomenon. The role of intracellular β-tocopherol deserves additional study. More research is needed on the contribution of oxidative stress and antioxidants to human longevity.
PMCID: PMC3068305  PMID: 21490698
7.  Disentangling the Roles of Disability and Morbidity in Survival to Exceptional Old Age 
Archives of internal medicine  2008;168(3):277-283.
Although it is commonly held that survival to age 100 years entails markedly delaying or escaping age-related morbidities, nearly one-third of centenarians have age-related morbidities for 15 or more years. Yet, we have previously observed that many centenarians compress disability toward the end of their lives. Therefore, we hypothesize that for some centenarians, compression of disability rather than morbidity is a key feature for survival to old age.
This cross-sectional, nationwide study included 523 women and 216 men 97 years or older. The participants were stratified by sex and age at onset (age <85 years [termed survivors]and age ≥85 years [termed delayers])of chronic obstructive pulmonary disease, dementia, diabetes, heart disease, hypertension, osteoporosis, Parkinson disease, and stroke. Dependent variables were the Barthel Activities of Daily Living Index (Barthel Index) and the Information-Memory-Concentration test of the Blessed Dementia Scale.
Thirty-two percent of the participants were survivors. For men with hypertension and/or heart disease for 15 or more years, the median Barthel Index score was 90 (independence range, 80–100). For female survivors with hypertension, heart disease, and/or osteoporosis, the median Barthel Index score was 65 (minimal assistance range, 60–79). Generally, men had better function than women: 60% of male survivors had Barthel Index scores of 90 or higher compared with 18% of female survivors (P<.001) and 50% of male delayers had Barthel Index scores of 90 or higher compared with 27% of females delayers (P<.001).
Whereas the compression of both morbidity and disability are essential features of survival to old age for some centenarians, for others, the compression of disability alone may be the key prerequisite. Though far fewer in number, male centenarians tend to have significantly better cognition and physical function than their female counterparts.
PMCID: PMC2895331  PMID: 18268168
8.  The Oldest Old: Red blood cell and plasma folate in African American and White Octogenarians and Centenarians in Georgia 
To determine the overall folate status of a population-based multi-ethnic sample of octogenarians and centenarians and the specific dietary, demographic and physiological factors associated with observed abnormalities.
Population-based multiethnic sample of adults aged 80 to 89 and 98 and above. Setting: Northern Georgia, USA
Northern Georgia, USA
Men and women aged 80 to 89 (octogenarians, n = 77) and 98 and older (centenarians, n = 198)
Wilcoxon rank sum tests, and Chi square and logistic regression analyses were used to examine associations of low and high folate status with hematological indicators and other variables of interest.
The prevalence of low red blood cell (RBC) folate was low overall, but tended to be higher in centenarians than in octogenarians (6.5% vs. 1.3%, p = 0.058; defined as RBC folate < 317 nmol/L). The risk of having lower RBC folate (< 25th vs. ≥25th percentile for RBC folate for 60yr+ in NHANES 1999–2000) was greater in association with vitamin B12 deficiency (OR = 5.36; 95%CI: 2.87–10.01), African American race (OR = 4.29; 95%CI: 2.08–8.83), and residence in a skilled nursing facility (OR = 3.25; 95%CI: 1.56–6.78) but was not influenced by age, gender, B-vitamin supplement use, high/low food score or presence of atrophic gastritis. Combined high plasma folate and low vitamin B12 status was present in some individuals (n=11), but was not associated with increased prevalence of anemia or cognitive impairment in this study.
Low RBC folate status (< 317 nmol/L) was rare in this post folic acid fortification sample of octogenarians and centenarians. RBC folate status (< 25th percentile) was strongly associated with 1) vitamin B12 deficiency, which has strong implications for vitamin treatment, and 2) with being African American, suggesting racial disparities exist even in the oldest old.
PMCID: PMC3233985  PMID: 22089222
9.  Profiles of Cognitive Functioning in a Population-Based Sample of Centenarians Using Factor Mixture Analysis 
Experimental aging research  2013;39(2):125-144.
Background/Study Context
The goal of the study was to identify and characterize latent profiles (clusters) of cognitive functioning in centenarians and the psychometric properties of cognitive measures within them.
Data were collected from cross-sectional, population-based sample of 244 centenarians (aged 98-108, 15.8% men, 20.5% African-American, 38.0% community-dwelling) from 44 counties in Northern Georgia participating in the Georgia Centenarian Study (2001-2009). Measures included the Mini-Mental State Examination (MMSE), Severe Impairment Battery (SIB), Wechsler Adult Intelligence Scale-III, Similarities sub-test (WAIS), Finger Tapping, Behavioral Dyscontrol Scale (BDS), Controlled Oral Word Association Test (COWAT), and Fuld Object Memory Evaluation (FOME). The Global Deterioration Rating Scale (GDRS) was used to independently evaluate criterion-related validity for distinguishing cognitively normal and impaired groups. Relevant covariates included directly assessed functional status for basic and instrumental activities of daily living (DAFS), race, gender, educational attainment, Geriatric Depression Scale Short Form (GDS), and vision and hearing problems.
Results suggest two distinct classes of cognitive performance in this centenarian sample. Approximately one-third of the centenarians show a pattern of markedly lower cognitive performance on most measures. Group membership is independently well-predicted (AUC=.83) by GDRS scores (sensitivity 67.7%, specificity 82.4%). Membership in the lower cognitive performance group was more likely for individuals who were older, African Americans, had more depressive symptoms, lower plasma folate, carriers of the APOE ε4 allele, facility residents, and individuals who died in the two years following interview.
In a population expected to have high prevalence of dementia, latent subtypes can be distinguished via factor mixture analysis that provide normative values for cognitive functioning. The present study allows estimates for normative cognitive performance in this age group.
PMCID: PMC3579538  PMID: 23421635
10.  Successful Recruitment of Centenarians for Post-Mortem Brain Donation: Results from the Georgia Centenarian Study 
Brain donation and neuropathological examination of brain tissues is the only way to obtain definitive diagnostic information on research subjects enrolled in aging studies. We investigated predictors of brain donation in a population-based study of centenarians in Phase III of the Georgia Centenarian Study (GCS).
Sixty-six individuals (mean age = 100.6 years, 91% female, 20% African American) were successfully recruited from the core sample of 244 individuals residing in 44 counties of Northeast Georgia to provide brain donation.
Bivariate (t-tests, chi-square tests) and multivariate analyses (logistic regression) showed no significant differences between donors and non-donors across a wide range of demographic, religious, personality, cognitive and physical functioning characteristics.
We succeeded in recruiting a diverse, population-based sample of centenarians for brain donation. Our findings also suggest that barriers to brain donation reported in other studies may have less impact in these exceptional survivors.
PMCID: PMC3763720  PMID: 24013849
11.  Regression-Based Estimates of Observed Functional Status in Centenarians 
The Gerontologist  2010;51(2):179-189.
Purpose of the Study: There is lack of consensus on the best method of functional assessment, and there is a paucity of studies on daily functioning in centenarians. We sought to compare associations between performance-based, self-report, and proxy report of functional status in centenarians. We expected the strongest relationships between proxy reports and observed performance of basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). We hypothesized that the discrepancy between self-report and observed daily functioning would be modified by cognitive status. We additionally sought to provide clinicians with estimates of centenarians’ observed daily functioning based on their mental status in combination with subjective measures of activities of daily living (ADLs). Design and Methods: Two hundred and forty-four centenarians from the Georgia Centenarian Study were included in this cross-sectional population-based study. Measures included the Direct Assessment of Functional Status, self-report and proxy report of functional status, and the Mini-Mental State Examination (MMSE). Results: Associations between observed and proxy reports were stronger than between observed and self-report across BADL and IADL measures. A significant MMSE by type of report interaction was found, indicating that lower MMSE performance is associated with a greater discrepancy between subjective and objective ADL measures. Implications: Results demonstrate associations between 3 methods of assessing functional status and suggest proxy reports are generally more accurate than self-report measures. Cognitive status accounted for some of the discrepancy between observed and self-reports, and we provide clinicians with tables to estimate centenarians’ performance on observed functional measures based on MMSE and subjective report of functional status.
PMCID: PMC3058129  PMID: 20974657
Daily functioning; Direct Assessment of Functional Status; Self-report; Proxy report; MMSE
12.  A Population Where Men Live As Long As Women: Villagrande Strisaili, Sardinia 
Journal of Aging Research  2011;2011:153756.
Usually women live longer than men and female centenarians largely outnumber male centenarians. The findings of previous studies identifying a population with a femininity ratio close to 1.0 among centenarians in the mountainous region of Sardinia was the starting point of an in-depth investigation in order to compare mortality trajectories between men and women in that population. The exceptional survival of men compared to women emerges from the comparison with similar Italian data. Age exaggeration for men has been strictly excluded as a result of the age validation procedure. The discussion suggests that besides biological/genetic factors, the behavioral factors including life style, demographic behavior, family support, and community characteristics may play an important role. No single explanation is likely to account for such an exceptional situation and a fully integrated multidisciplinary approach is urgently needed.
PMCID: PMC3205712  PMID: 22132327
13.  Centenarians and supercentenarians: a black swan. Emerging social, medical and surgical problems 
BMC Surgery  2012;12(Suppl 1):S36.
The Black Swan Theory was described by Nassim Nicholas Taleb in his book “The Black Swan”. This theory refers to “high-impact, hard-to-predict, and rare events beyond the realm of normal expectations”. According to Taleb’s criteria, a Black Swan Event is a surprise, it has a major impact and after the fact, the event is rationalized by hindsight, as if it had been expected. For most of human history centenarians were a rare and unpredictable phenomenon. The improvements of the social-environmental conditions, of medical care, and the quality of life caused a general improvement of the health status of the population and a consequent reduction of the overall morbidity and mortality, resulting in an overall increase of life expectancy. The study of centenarians and supercentenarians had the objective to consider this black swan and to evaluate the health, welfare, social and economic consequences of this phenomenon.
PMCID: PMC3499197  PMID: 23173707
Poor vitamin D status has been associated with osteoporosis, falls, cardiovascular diseases, cancer, autoimmune diseases, pain, nursing home placement, and other age-related conditions, but little is known about the prevalence and predictors of vitamin D status in those aged 80 and older. Thus, this study tested the hypothesis that vitamin D status would be 1) poorer in a population-based multi-ethnic sample of centenarians as compared with octogenarians and 2) predicted by specific dietary, demographic or environmental factors.
Cross-sectional population-based analyses.
Northern Georgia in the United States.
Men and women aged 80 to 89 (octogenarians, n = 80) and 98 and older (centenarians, n = 237).
Regression analyses were used to examine the associations of serum 25-hydroxyvitamin D [25(OH)D] with age, gender, race, living arrangements, dairy food intake, supplement intake, and season.
The prevalence of vitamin D insufficiency [25(OH)D < 50 nmol/L] was higher in centenarians than in octogenarians (p < 0.02). In logistic regression analyses, the risk of being vitamin D insufficient was significantly increased by being a centenarian vs. octogenarian (p<0.005) and by being African American vs. white (p < 0.001) and decreased by taking a supplement with vitamin D (p < 0.001) or by having vitamin D status measured in the summer or fall (each p < 0.05), compared with spring.
Centenarians and octogenarians are at high risk for vitamin D insufficiency for many of the same reasons identified in younger populations. Given the numerous potential adverse consequences of poor vitamin D status, efforts are needed to ensure vitamin D adequacy in these older adults.
PMCID: PMC2978665  PMID: 19043643
Centenarians; elderly; 25(OH)vitamin D; nutrition risk factors; nutrition supplements
15.  Cohort Changes in Cognitive Function among Danish Centenarians 
The objective was to examine cohort changes in cognitive function in 2 cohorts of centenarians born 10 years apart.
The Longitudinal Study of Danish Centenarians comprises all Danes reaching the age of 100 in the period April 1, 1995 through May 31, 1996. A total of 207 out of 276 persons participated (75%). The Danish 1905 Cohort Survey includes all individuals born in 1905. In total, 225 out of 364 persons who reached the age of 100 in the cohort participated in the most recent 2005 follow-up (62%). In both cohorts, cognitive function was assessed using the Mini-Mental State Examination.
There were no significant differences in cognitive score between the two centenarian birth cohorts. However, modest tendencies were seen towards better cognitive functioning for the centenarians in the 1905 cohort living at home compared to the home-dwelling ones in the 1895 cohort and worse cognitive performance for the centenarians in the 1905 group living in nursing homes compared to the nursing home dwellers in the 1895 cohort.
The increasing number of centenarians may not entail larger proportions of cognitively impaired individuals in this extreme age group.
PMCID: PMC2731155  PMID: 18679030
Cognition; Centenarians, Danish; Cohort effect
16.  Ashkenazi Jewish Centenarians Do Not Demonstrate Enrichment in Mitochondrial Haplogroup J 
PLoS ONE  2008;3(10):e3425.
Association of mitochondrial haplogroup J with longevity has been reported in several population subgroups. While studies from northern Italy and Finland, have described a higher frequency of haplogroup J among centenarians in comparison to non-centenarian, several other studies could not replicate these results and suggested various explanations for the discrepancy.
Methodology/Principal Findings
We have evaluated haplogroup frequencies among Ashkenazi Jewish centenarians using two different sets of matched controls. No difference was observed in the haplogroup J frequencies between the centenarians or either matched control group, despite adequate statistical power to detect such a difference. Furthermore, the lack of association was robust to population substructure in the Ashkenazi Jewish population. Given this discrepancy with the previous reported associations in the northern Italian and the Finnish populations, we conducted re-analysis of these previously published data, which supported one of several possible explanations: i) inadequate matching of cases and controls; ii) inadequate adjustment for multiple comparison testing; iii) cryptic population stratification.
There does not exist a universal association of mitochondrial haplogroup J with longevity across all population groups. Reported associations in specialized populations may reflect genetic or other interactions specific to those populations or else cryptic confounding influences, such as inadequate matching attributable to population substructure, which are of general relevance to all studies of the possible association of mitochondrial DNA haplogroups with common complex phenotypes.
PMCID: PMC2559868  PMID: 18923645
17.  Season of Birth and Exceptional Longevity: Comparative Study of American Centenarians, Their Siblings, and Spouses 
Journal of Aging Research  2011;2011:104616.
This study explores the effects of month of birth (a proxy for early-life environmental influences) on the chances of survival to age 100. Months of birth for 1,574 validated centenarians born in the United States in 1880–1895 were compared to the same information obtained for centenarians' 10,885 shorter-lived siblings and 1,083 spouses. Comparison was conducted using a within-family analysis by the method of conditional logistic regression, which allows researchers to control for unobserved shared childhood or adulthood environment and common genetic background. It was found that months of birth have significant long-lasting effect on survival to age 100: siblings born in September–November have higher odds to become centenarians compared to siblings born in March. A similar month-of-birth pattern was found for centenarian spouses. These results support the idea of early-life programming of human aging and longevity.
PMCID: PMC3236478  PMID: 22187646
18.  Common cancers in centenarians 
A Centenarian is a person who attains and lives beyond the age of 100. Four percent of centenarians die from cancer. It is therefore important to understand which cancers affect them in order to devise better methods to prevent and treat them. The aim of this study was to investigate the top cancers that affect centenarians.
We identified 1385 cases with the Surveillance Epidemiology and End Result (SEER) database. Our study included centenarians age 100–115 years diagnosed with the 5 most common cancers between 1973 and 2007 in the United States. Observed survival (OS) was calculated for each cancer type. The Kaplan-Meier (KM) method was used to calculate OS at 1-month intervals for the first 40 months after diagnosis using SEER*Stat version 7.04. A log rank test was performed on KM survival output and a Cox proportional hazard model was used to calculate hazard ratios. All statistical analyses were performed with 95% confidence intervals with significance determined at P<0.05. Cox proportional hazard analysis was done using GraphPad Prism version 5.04.
There were 879 (63.47%) females and 506 (36.53%) males. There were 1118 (80.72%) whites, 159 (11.48%) blacks, and 108 (7.80%) other. The top cancers were 405 (29.24%) breast, 267 (19.28%) colorectal, 254 (18.34%) prostate, 247 (17.83%) lung and bronchus, and 212 (15.31%) urinary and kidney cancer cases.
As the prevalence of centenarians increases, it is becoming increasingly important to become aware of the cancers that affect them in order to better manage them.
PMCID: PMC3894918  PMID: 24399367
centenarians; elderly (>70 years); cancer epidemiology
19.  Relationship between Serum and Brain Carotenoids, α-Tocopherol, and Retinol Concentrations and Cognitive Performance in the Oldest Old from the Georgia Centenarian Study 
Journal of Aging Research  2013;2013:951786.
Oxidative stress is involved in age-related cognitive decline. The dietary antioxidants, carotenoids, tocopherols, and vitamin A may play a role in the prevention or delay in cognitive decline. In this study, sera were obtained from 78 octogenarians and 220 centenarians from the Georgia Centenarian Study. Brain tissues were obtained from 47 centenarian decedents. Samples were analyzed for carotenoids, α-tocopherol, and retinol using HPLC. Analyte concentrations were compared with cognitive tests designed to evaluate global cognition, dementia, depression and cognitive domains (memory, processing speed, attention, and executive functioning). Serum lutein, zeaxanthin, and β-carotene concentrations were most consistently related to better cognition (P < 0.05) in the whole population and in the centenarians. Only serum lutein was significantly related to better cognition in the octogenarians. In brain, lutein and β-carotene were related to cognition with lutein being consistently associated with a range of measures. There were fewer significant relationships for α-tocopherol and a negative relationship between brain retinol concentrations and delayed recognition. These findings suggest that the status of certain carotenoids in the old may reflect their cognitive function. The protective effect may not be related to an antioxidant effect given that α-tocopherol was less related to cognition than these carotenoids.
PMCID: PMC3690640  PMID: 23840953
20.  Diabetes Mellitus among Centenarians 
Describe prevalence of diabetes mellitus among centenarians.
Cross-sectional, population-based.
44 counties in northern Georgia.
244 centenarians (aged 98-108, 15.8% men, 20.5% African-American, 38.0% community-dwelling) from the Georgia Centenarian Study (2001-2009).
Nonfasting blood samples assessed HbA1c and relevant clinical parameters. Demographic, diagnosis, and diabetes complications covariates were assessed.
12.5% of centenarians were known to have diabetes. Diabetes was more prevalent among African-Americans (27.7%) than Whites (8.6%, p=.0002). There were no differences between men (16.7%) and women (11.7%, p=.414), centenarians living in the community (10.2%) or facilities (13.9%, p=.540). Diabetes was more prevalent among overweight/obese (23.1%) than non-overweight (7.1%, p=.002) centenarians. Anemia (78.6% versus 48.3%, p=.004) and hypertension (79.3% versus 58.6%, p=.041) were more prevalent among centenarians with diabetes than without and centenarians with diabetes took more nonhypoglycemic medications(8.6 versus 7.0, p=.023). No centenarians with hemoglobin A1c < 6.5% had random serum glucose levels above 200 mg/dl. Diabetes was not associated with 12 month all-cause mortality, visual impairment, amputations, cardiovascular disease or neuropathy. 37% of centenarians reported onset before age 80 (survivors), 47% between 80 and 97 years (delayers) and 15% age 98 or older (escapers).
Diabetes is a risk factor for cardiovascular disease and mortality, but is seen in persons who live into very old age. Aside from higher rates of anemia and use of more medications, few clinical correlates of diabetes were observed in centenarians.
PMCID: PMC3302973  PMID: 22283370
Centenarians; Type 2 diabetes mellitus; Hemoglobin A1c
21.  Predicting Successful Aging in a Population-Based Sample of Georgia Centenarians 
Used a population-based sample (Georgia Centenarian Study, GCS), to determine proportions of centenarians reaching 100 years as (1) survivors (43%) of chronic diseases first experienced between 0–80 years of age, (2) delayers (36%) with chronic diseases first experienced between 80–98 years of age, or (3) escapers (17%) with chronic diseases only at 98 years of age or older. Diseases fall into two morbidity profiles of 11 chronic diseases; one including cardiovascular disease, cancer, anemia, and osteoporosis, and another including dementia. Centenarians at risk for cancer in their lifetime tended to be escapers (73%), while those at risk for cardiovascular disease tended to be survivors (24%), delayers (39%), or escapers (32%). Approximately half (43%) of the centenarians did not experience dementia. Psychiatric disorders were positively associated with dementia, but prevalence of depression, anxiety, and psychoses did not differ significantly between centenarians and an octogenarian control group. However, centenarians were higher on the Geriatric Depression Scale (GDS) than octogenarians. Consistent with our model of developmental adaptation in aging, distal life events contribute to predicting survivorship outcome in which health status as survivor, delayer, or escaper appears as adaptation variables late in life.
PMCID: PMC2946582  PMID: 20885919
22.  Centenarian Offspring: Start Healthier and Stay Healthier 
To assess the relative incidence of age-related diseases in a group of centenarian offspring who have thus far been considered to be predisposed to “healthy” aging.
Longitudinal study.
Nationwide sample.
Four hundred forty centenarian offspring and 192 referent cohort subjects who met inclusion criteria of having initial and follow-up health questionnaire data available. Median age of both cohorts was 72 at the initial health questionnaire.
Initial health questionnaires were collected from 1997 to 2006. Follow-up questionnaires were collected from 2004 to 2007. The mean period of follow-up was 3.5 ± 1.7 years for the centenarian offspring and 3.9 ± 2.2 years for the referent cohort.
During the follow-up period, centenarian offspring had a 78% lower risk of myocardial infarction (P < .04), 83% lower risk of stroke (P <.004), and 86% lower risk of developing diabetes mellitus (P < .005) than the referent cohort. There were no significant differences in new onset of other age-related diseases. Additionally, centenarian offspring were 81% less likely to die (P < .01) than the referent cohort during the follow-up.
These findings suggest that centenarian offspring retain some important cardiovascular advantages over time over similarly aged referent cohort subjects. These findings reinforce the notion that there may be physiological reasons that longevity runs in families and that centenarian offspring are more likely to age in better cardiovascular health and with a lower mortality than their peers.
PMCID: PMC2892731  PMID: 18811609
centenarian; longevity; morbidity; familial
23.  Personality and longevity: findings from the Georgia Centenarian Study 
Age  2006;28(4):343-352.
Centenarians are thought of as unique and exceptional survivors. This study evaluated specific personality traits and configurations of traits among participants of the Georgia Centenarian Study. Two hundred and eighty five centenarians and their nominated proxies participated in this study. Self ratings and proxy informant ratings were obtained for different traits and facets of the Big-5 personality typology. Results suggested that centenarians overall had low levels of Neuroticism, but high levels of Extraversion, Competence, and Trust. When compared to centenarian self ratings, proxies provided significantly higher ratings for Neuroticism, Hostility, and Vulnerability, but lower ratings for Competence and Trust. Among Centenarians, the personality configuration of low Neuroticism, high Competence, and high Extraversion traits is over-represented relative to chance. The results confirm that centenarians show several unique single traits, but that a special combination of traits (i.e., low levels of Neuroticism, high Competence, and high Extraversion) are also notable in this group of exceptional survivors.
PMCID: PMC3259159  PMID: 22253500
centenarians; longevity; proxy rating; self rating; traits
24.  How Well Can Centenarians Hear? 
PLoS ONE  2013;8(6):e65565.
With advancements in modern medicine and significant improvements in life conditions in the past four decades, the elderly population is rapidly expanding. There is a growing number of those aged 100 years and older. While many changes in the human body occur with physiological aging, as many as 35% to 50% of the population aged 65 to 75 years have presbycusis. Presbycusis is a progressive sensorineural hearing loss that occurs as people get older. There are many studies of the prevalence of age-related hearing loss in the United States, Europe, and Asia. However, no audiological assessment of the population aged 100 years and older has been done. Therefore, it is not clear how well centenarians can hear. We measured middle ear impedance, pure-tone behavioral thresholds, and distortion-product otoacoustic emission from 74 centenarians living in the city of Shaoxing, China, to evaluate their middle and inner ear functions. We show that most centenarian listeners had an “As” type tympanogram, suggesting reduced static compliance of the tympanic membrane. Hearing threshold tests using pure-tone audiometry show that all centenarian subjects had varying degrees of hearing loss. More than 90% suffered from moderate to severe (41 to 80 dB) hearing loss below 2,000 Hz, and profound (>81 dB) hearing loss at 4,000 and 8,000 Hz. Otoacoustic emission, which is generated by the active process of cochlear outer hair cells, was undetectable in the majority of listeners. Our study shows the extent and severity of hearing loss in the centenarian population and represents the first audiological assessment of their middle and inner ear functions.
PMCID: PMC3673943  PMID: 23755251
25.  Predicting Happiness among Centenarians 
Gerontology  2010;56(1):88-92.
Happiness is believed to evolve from the comparison of current circumstances relative to past achievement. However, gerontological literature on happiness in extreme old age has been limited.
The purpose of this study was to determine how perceptions of health, social provisions, and economics link past satisfaction with life to current feelings of happiness among persons living to 100 years of age and beyond.
A total of 158 centenarians from the Georgia Centenarian Study were included to conduct the investigation. Items reflecting congruence and happiness from the Life Satisfaction Index were used to evaluate a model of happiness. Pathways between congruence, perceived economic security, subjective health, perceived social provisions, and happiness were analyzed using structural equation modeling.
Congruence emerged as a key predictor of happiness. Furthermore, congruence predicted perceived economic security and subjective health, whereas perceived economic security had a strong influence on subjective health status.
It appears that past satisfaction with life influences how centenarians frame subjective evaluations of health status and economic security. Furthermore, past satisfaction with life is directly associated with present happiness. This presents implications relative to understanding how perception of resources may enhance quality of life among persons who live exceptionally long lives.
PMCID: PMC2874733  PMID: 20110722
Centenarians; Happiness; Economic security; Social provisions

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