Card sharps: Bridge club holds clues to lucid aging

LAGUNA WOODS, Calif. — The ladies in the card room are playing bridge, and, at their age, the game is no hobby. It is a way of life, a daily comfort and challenge, the last communal campfire before all goes dark.

"We play for blood," said Ruth Cummins, 92, before taking a sip of Red Bull at a recent game.

"It's what keeps us going," added Georgia Scott, 99. "It's where our closest friends are."

In recent years scientists have become intensely interested in what could be called a super-memory club, the fewer than one in 200 of us who, like Scott and Cummins, have lived past 90 without a trace of dementia.

It is a group that, for the first time, is large enough to provide a glimpse into the lucid brain at the furthest reach of human life. The group also can help researchers tease apart what is essential in preserving mental sharpness to the end.

"These are the most successful agers on Earth, and they're only just beginning to teach us what's important, in their genes, in their routines, in their lives," said Dr. Claudia Kawas, a neurologist at the University of California, Irvine. "We think, for example, that it's very important to use your brain, to keep challenging your mind, but all mental activities may not be equal. We're seeing some evidence that a social component may be crucial."

Laguna Woods, a sprawling retirement community of 20,000 south of Los Angeles, is at the center of the world's largest decadeslong study of health and mental acuity in the elderly.

Begun by University of Southern California researchers in 1981 and called the 90+ Study, it has included more than 14,000 people aged 65 or older, and more than 1,000 90 or older.

Such studies can take years to bear fruit, and the results of this study are starting to alter the way scientists understand the aging brain. The evidence suggests that people who spend long stretches of their days, three hours and more, engrossed in some mental activities such as cards may be at reduced risk of developing dementia.

Researchers are trying to distinguish cause from effect: Are they active because they are sharp, or sharp because they are active?

In the 90+ Study at Laguna Woods, now a joint project run by USC and the University of California, Irvine, researchers regularly run genetic tests, test residents' memory, track their activities, take blood samples, and in some cases do postmortem analyses of their brains.

The researchers have demonstrated that the percentage of people with dementia after 90 does not plateau or taper off, as some experts had expected. It continues to increase, so that for the one in 600 people who make it to 95, nearly 40 percent of the men and 60 percent of the women qualify for a diagnosis of dementia.

"We live for the day"

To move into the gated village of Laguna Woods, people must meet several requirements, one of which is that they do not need full-time care. Their minds are sharp when they arrive, whether they are 65 or 95.

They begin a new life at Laguna Woods and are as busy as arriving freshmen at a new campus, with one large difference: They are less interested in the future, or the past.

"We live for the day," said Dr. Leon Manheimer, a longtime resident who is in his 90s.

Yet it is precisely the ability to form new memories of the day, the present, that usually goes first in dementia cases, studies in Laguna Woods and elsewhere have found.

The very old who live among their peers know this and have developed their own expertise. They diagnose each other, based on careful observation. And they have learned to distinguish among different kinds of memory loss, which ones are manageable and which are ominous.

At Laguna Woods, many residents make such delicate calculations in one place: the bridge table.

Contract bridge requires a strong memory. It involves four players, paired off, and each player must read his or her partner's strategy by closely following what is played. Good players remember every card played and its significance for the team. Forget a card, or fall behind, and it can cost the team — and the social connection — dearly.

"When a partner starts to slip, you can't trust them," said Julie Davis, 89, a regular player living in Laguna Woods. "That's what it comes down to. It's terrible to say it that way, and worse to watch it happen. But other players get very annoyed. You can't help yourself."

Most regular players at Laguna Woods know of at least one player who, embarrassed by lapses, bowed out of the regular game. "A friend of mine, a very good player, when she thought she couldn't keep up, she automatically dropped out," Cummins said. "That's usually what happens."

Yet it is part of the tragedy of dementia that, in many cases, the condition quickly robs people of self-awareness. They will not voluntarily abandon the one thing that, perhaps more than any other, defines their existence.

"And then it's really tough," Davis said. "I mean, what do you do? These are your friends."

Staying engaged

Scientists at Laguna Woods have found little evidence that diet or exercise affects the risk of dementia in people older than 90. But some research indicates that mental engagement — doing crossword puzzles, reading books — may delay the arrival of symptoms, and social connections, including interaction with friends, may be very important.

"There is quite a bit of evidence now suggesting that the more people you have contact with, in your own home or outside, the better you do" mentally and physically, Kawas said. "Interacting with people regularly, even strangers, uses easily as much brain power as doing puzzles, and it wouldn't surprise me if this is what it's all about."

Bridge, she added, provides both kinds of stimulation.

Learning to let go

What matters most to those in the super-memory club is continued independence. And that means that, at some point, they have to let go of close friends.

"The first thing you always want to do is run and help them," Davis said. "But after a while you end up asking yourself: 'What is my role here? Am I now the caregiver?' You have to decide how far you'll go."

In this world, as in high school, it is all but impossible to take back an invitation to the party. Some players decide to break up their game, at least for a time, only to reform it with another player. Or, they might suggest a player drop down a level, from a serious game to a more casual one.