It is necessary to maintain healthy and productive responses to the stresses and declines associated with aging. A key factor is the choice of attitude. It is critical to see opportunities for growth in aging – they are there to be had. Aging is accompanied by declines in the speed of learning, working memory, and memory capacity. These declines are not caused by disease and are nearly universal. Devoting memory resources to what is important, and ignoring things that are not important is an excellent strategy. The best way to avoid negative emotions caused by events and experiences in the past is to be actively involved in the present moment and planning for the future. Meditation is a valuable method to practice letting go and enhancing your awareness of the opportunities that are available now. Aging also presents an opportunity to demonstrate self-compassion. Frequently, persons express compassion to others throughout their lives with loving devotion and selfless actions, without realizing that that are worthy of compassion themselves. Psychological reserve can be enhanced by attention to the development of self-compassion and appreciation of what give your life meaning.

Sleep is incredibly important for the creation and maintenance of memories. It is an active process managed by the brain to allow for bodily rest and repair and maintenance of homeostasis. Good sleep is necessary for life and health and is essential for the encoding and storage or memories made during wakefulness. Poor sleep can interfere with all aspects of cognitive function, particularly attention and memory. Reduced sleep amount and quality has been linked to depression and impaired immune function. The length of sleep is not the only important factor; the quality of sleep is also vital. Animal studies have revealed that sleep deprivation damages gut bacteria and produces hazardous free radicals, called oxidative stress. Cognitive reserve is closely related to sleep. Too many people take sleep for granted or think getting a restful sleep is a luxury, not a necessity. But recent research shows the pattern on neuronal firing is replayed during sleep, which enhances the formation of memories. Older people frequently have sleeping problems that may impact the quality of life. This chapter reviews several things that you can do to improve the quality of your sleep.

As we age, we have a little bit less of everything: less energy, less physical flexibility, less learning capacity. That’s why the concept of multiple reserves is so important. Aging well isn’t just about avoiding death and disease. Aging healthy also means keeping the reserve capacity of our component systems high so that, as function declines with age, performance is less severely affected, and fitness is better maintained. The body’s organ systems are all interconnected and interdependent. And the brain is dependent upon the healthy functioning of all organ systems. It needs to be a goal of our aging to enhance the possibility that negative interactions do not take place. In order to pursue this goal, we need to manage our lifestyle activities so that our fitness levels can be enhanced. By this I mean fitness in the sense of interdependence—fitness of all the body parts, not only one of them. The good news is there are lots of things everyone can do to maximize healthful interactions inside our body and between ourselves and friends, family, and community.

We are not prepared by our genes for a sedentary lifestyle. Studies have shown that higher levels of physical activity throughout life are very good for you. Physical activity leads to good physical reserve and has beneficial effects on development of Alzheimer’s, as well as stroke, cardiovascular disease, and depression, in both humans and animals. It increases the production of new neurons in the brain that activates learning and also enhances the production of growth factors which can facilitate the communication among neurons and the maintenance of mental function. Exercise also enhances the immune system, producing more protective cells and antibodies and assists with skeletal, endocrine, and cardiac health. The function of blood vessels in the heart, brain, and everywhere in the body is enhanced with exercise. Research has shown that people who become less physically and mentally active in the years from midlife to later life have a higher risk of developing Alzheimer’s, compared to those whose participation stayed the same or became more active. Almost everyone is capable of some physical activity. Two rules of physical exercise must be followed: 1. Start; 2. Continue.

Our dietary choices affect our health and fitness in two ways: diet has a direct influence on the brain and other body parts and also influence the nature of our microbial populations in the gut. These two mechanisms frequently work together; a high salt diet can make high blood pressure worse and will influence the nature of our microbiota increasing inflammation – two issues which increase the risk of heart disease and stroke. Our dietary choices strongly affect our health through direct influence on all our organ systems, and the nature of our microbial communities has profound influence on our health and fitness. In order to have a diverse bacterial community we need a diverse diet with different good sources of nutritional support. Fiber-rich foods enhance the gut barrier and lower inflammation throughout the body. Good sources of fiber are reviewed in this chapter, along with recommendations for a plant-based diet with antioxidants, little meat, and low levels of saturated fat. High levels of sugar and salt intake, alcohol, and processed foods should be avoided. Fish consumption is advised and vitamin and mineral containing foods are also considered.

A life filled with learning is advisable. Tasks involving some degree of cognitive complexity is desirable, but there is no reason to believe that certain forms of learning are better than others. What is critical is that the activity needs to be consistent and persistent. Involvement of cognitive activity at work is important and jobs that involve high stress, passive participation, and lack of complexity are associated with higher levels of cognitive impairment in later life. There is also no reason to believe that mental activities must be limited to the early years of life. People are able to learn at all ages and participation in learning is valuable for the brain throughout life. The concept of diversity refers as well to learning and mental activities. It is good to learn new things! Participation in cognitive activities throughout the lifespan both at home and at work and avoiding multi-tasking can help build cognitive reserve capacity. Cognitive activities directly impair disease processes. Being cognitively active and paying attention to the world helps to protect the brain from free radicals and toxins. Cognitive activities also assists in the management of stress.

Important worldwide changes in human aging are developing rapidly. Life expectancy has doubled during the past century. Due to advances in public health, vaccines, and science, people are living longer. The increase in the elderly population is happening in varying degrees all over the world. Although heart disease and cancer rates are falling, Alzheimer’s is increasing because of its strong link to aging and lack of disease-modifying therapies. It is important to consider what can be done about the expansion of aged populations. A forward-looking approach to health care will provide resources to people throughout life to keep them healthy and enhance their four reserve factors. This is ethically and economically preferable to a health care system which only takes care of people when they’re sick and doesn’t strive to prevent illness. Recent advances in diagnosis, metagenomics (studies of gut bacteria), and artificial intelligence will hopefully assist in the growth of preventive measures. Advances in public policy and technology can help people to enhance their four reserve factors and help them to avoid disease and remain fit as they age.

To maintain the highest level of your four reserve factors it is necessary to know how to interact with the medical profession and the medications they prescribe. It is also valuable to understand and appreciate the perspective of clinical research. As patients, we have the right to have our story and voice heard, to be treated like human beings. Our stories are an important part of who we are. Many people are exceptionally passive in their pursuit of medical care and will accept whatever negligence, avoidance, or abuse they receive. It’s up to us to be a powerful advocate for our own welfare and insist on having medical professionals listen to our stories and attend to our needs. Ways to choose physicians are discussed. Also reviewed are how to manage your medications, vaccines, and how to lower the risk of medical errors. Guidelines are presented on the advantages and dangers of participation in clinic research. It is necessary to be an active participant in your own care and fierce in the pursuit of what’s best for you.

There are many things we can do to reduce the risk of Alzheimer’s, including high levels of physical and mental activity, avoidance of hypertension, head injury, high-fat, low-fiber diet, smoking, etc. These risk factors have been documented by decades of human and animal research and have allowed for the development of protective lifestyle measures that lead to a lowered risk of disease. These lifestyle factors apply to all phases of the life cycle, including childhood, as well as late life, and contribute to diminishing the risk of getting dementia, as well as delaying its onset and speed of progression. In the applications section there is a comprehensive discussion of these factors that will lower the risk of neurodegenerative diseases, improve our resilience so that function can be maintained despite development of disease, and enhance the capacity of all of the four reserve factors: cognitive, physical, psychological, and social. The actions recommended are all also valuable for lowering the risk of heart disease and stroke as well as some forms of cancer. Enhancing these reserve factors will enable you to augment your enjoyment of the opportunity aging presents.

Our attitude is something we carry around with us at all times. As the psychiatrist Victor Frankl said, “Our greatest freedom is the freedom to choose our attitude.” Our attitude is determined in large part by the focusing of our attention. If our attention is focused on losses and regrets, our attitude will be gloomy. If our attention is focused on opportunities, such as the opportunity of aging, our attitude will be more positive. This is a fundamental daily choice. Because the world is too multifaceted for us to process all possible perceptions, it is our attention which is critical for the quality of our experience. Our attitude is determined by the object of our attention. And our capacity of paying attention can be exercised and practiced every day. Viewing aging as an opportunity helps to focus the reality that what happens to us is determined in large part by what we do. Paying attention can enhance all of our reserves. Diet, physical and mental activities, and social and family contacts are all critical. Our enhancement of the four reserve factors will increase our chance to be healthy and fit as we age.

We need to have three goals for aging. The first two are clear; survival and avoiding disease. Equally important is a third goal, to maintain fitness and a high level of four reserve factors. These reserve factors allow us to successfully respond to the challenges we face as we age. Cognitive reserve is the capacity to maintain effective cognitive function despite age-related changes in the brain. Maintaining high cognitive reserve is not our only goal. We must also maintain high physical, psychological, and social reserves. Physical reserve reflects the capacity of all our body systems. Psychological reserve is our ability to maintain healthy mental function, and social reserve describes our interpersonal network and supports. With aging, our ability to function is dependent upon the interaction of these four reserve factors. Our capacity to respond well to adversity is called resilience and is a fundamental goal of aging. It is important to realize the critical nature of these four reserve factors because through our actions we can enhance our capacity for resilience and enhanced fitness with aging.

Our bodies are home to a vast sea of microorganisms. They reside inside us and on all our body surfaces. There are as many cells of these microbial partners as there are cells inside our bodies. The word microbiota describes all the organisms that are on our body surfaces as well as inside us. The important role of these partners of ours in our health and fitness has only been realized in the past ten years. They are invisible and do not receive the attention they deserve. The microbiota are a key component of our physical reserve and are vital to our health and fitness. The microbiota influence all of our organ systems, assist in digestion, disease resistance, contribute to metabolism, and are critical for the maintenance of health and fitness. A vital feature of the microbiota is their diversity of organisms—a wide variety of organisms are normally present. Our history with the microbiota is best described by the word coevolution - we evolved with them, and they evolved with us.The good news about the microbiota is that it is relatively easy to change bacterial populations in the gut through diet. Ways to do this are comprehensively outlined in the book.

Memory and cognition are critical parts of who we are. Our capacity for recall allows us to use past experience to guide our actions. Our cognitive abilities allow us to monitor events and evaluate plans for action. In aging there are varying degrees of decline in cognitive function which begin in the 30s and are quite common. They are not a disease and are accompanied by the growth of wisdom which can negate the influence of age-related memory changes. Memory losses with aging can be avoided with consideration of the importance of attention for memory. The role of forgetting as a normal activity of the brain is critical. It is necessary to realize that the influences of aging and age-related disease (such as Alzheimer’s) on brain function are not determined only on the processes of aging and disease -- the effect of these processes on our performance abilities depends upon our cognitive, physical, psychological, and social reserves. We all need to enhance these reserve capacities to decrease the influence of the aging process and developing brain disease on our function. This chapter reviews the functions of memory and how losses that accompany aging can best be managed.

For most of human history few people got to be old. Older persons are not as well pepared to face stresses as younger persons because of evolutionary factors. So, it is necessary for older persons to consider the effects of their lifestyle choices on their ability to age successfully. Awareness of these factors is important for our appreciation of the impact which our activities have on our aging. For most of the past 100,000 years of human history we were living in a different environment than the one we have today. The genes we have now were chosen through natural selection because they enhanced the survival of our ancestors who were living in these different environments. This view provides valuable insights into the role environmental factors have in determining maintenance of function with aging. This chapter presents the vital perspective that what we do affects the accomplishment of our goals for aging. These goals must go beyond survival and avoidance of disease and also strive for maintenance of the highest level of fitness and resistance to loss of function (reserve capacities) so that we can resist the declines with aging, as well as the challenges which inevitably occur.

Stroke is the leading cause of disability worldwide and the second leading cause of death. Large and small strokes and disease of small cerebral blood vessels can lead to dementia, as well as milder degrees of cognitive deficit (vascular cognitive impairment). Strokes may be large or small and may occur with or without bleeding in the brain. The brain can also be damaged by a long-term lack of sufficient blood flow with loss of the axons, needed for neurons to communicate with each other. Attention to the four reserve factors (cognitive, physical, psychological, and social) can help to prevent stroke as well as improve recovery and diminish the effect of stroke on cognitive function. Cerebrovascular disease makes a very important contribution to cognitive impairment with aging. Recent studies have demonstrated several ways in which bacteria that reside in the mouth are involved in causing strokes. There are many modifiable risk factors for stroke including a high-fat diet, obesity, smoking, poor oral hygiene, physical inactivity, atrial fibrillation, alcoholism. Lifestyle factors play a large role in the risk of all forms of stroke