By Ariaratnam Gobikrishna –

Ariaratnam Gobikrishna MD

Growing up in Sri Lanka in the 60s and 70s, our ambition was to secure a government job, retire by age 55, and enjoy a good pension. I often saw my male relatives doing just that, reclining in easy chairs with their legs propped up—a common and comfortable sight. However, the 80s brought dramatic changes. We scattered across the globe, embracing diverse cultures and values. In the USA, particularly, we’ve been conditioned to believe that age is just a number and that life is endless, with us as the Energizer Bunnies, going on forever.

This optimistic view was suddenly upended last week with President Joe Biden‘s announcement of his campaign termination following his disastrous debate performance. Suddenly, age-related mental decline and dementia were thrust into the spotlight, challenging the notion that we can defy the effects of aging indefinitely.

Age-related decline in mental acuity has long been considered a norm, often dismissed as “senior moments” for those over 60. Historically, this wasn’t seen as a major concern in many societies. Even Dr. Alzheimer’s early work, over a century ago, focused primarily on presenile dementia, largely overlooking senile dementia. However, the identification of amyloid plaques and other brain deposits has shifted the focus. This discovery spurred extensive research aimed at understanding and mitigating the effects of these plaques, expanding our awareness and approach to cognitive decline associated with aging.

Despite significant progress in understanding its pathology, the ongoing spectacles in the U.S. Senate and among many elderly world leaders clearly demonstrate that we have yet to solve the problem of mitigating, let alone reversing, age-related mental decline. For over a century, scientific efforts have largely been in vain, leaving families frustrated and sometimes confrontational. Hope often outstrips reality. Consequently, I have faced criticism for speaking out against costly neurological tests that have made little impact on the relentless progression of this condition.

As the elderly population grows, the economic burden of dementia on countries is becoming increasingly unsustainable. As a result, the quest to cure dementia has emerged as a formidable contender alongside the ongoing efforts to cure cancer. Following decades of disappointing results with initial medications, there has been a resurgence of enthusiasm among researchers and the pharmaceutical industry, particularly in the realm of monoclonal antibodies. This renewed interest has invigorated the field after a prolonged period of stagnation. However, the exuberance has been tempered by again disappointing outcomes. Despite significant reductions in brain plaques, the prohibitive side effects and high costs have outweighed the negligible clinical benefits.

At this juncture, these repeated disappointments leave us with one option: to confront reality head-on. When it comes to jobs involving physical labor, there is a consensus that earlier retirement is preferable. Conversely, it is the white-collar professionals who often harbor the delusional belief in their own invincibility, conveniently shielding themselves from scrutiny. Recently, Nobel Laureate Venki Ramakrishnan addressed this issue, bluntly pointing out that the best ideas typically come from young minds, while older individuals rest on their laurels and exploit the younger generation. He cited the academic hierarchy as an example, but this phenomenon is even more rampant in politics.

As longevity increases, early retirement can become a burden on the younger generation. However, this doesn’t justify clinging to positions of power indefinitely. Elders must acknowledge that their waning productivity can stall progress and should step aside to allow the younger generation to assume leadership roles. They can still contribute meaningfully by sharing their knowledge and experience as mentors and teachers, using their skills in pattern recognition to perform valuable tasks that benefit the workforce.

As the pace of research accelerates, I’m optimistic that a solution will eventually be found for this scourge. In the meantime, we must not become delusional about life in general. The twilight years are an inevitable part of our existence; while we can push the boundaries slightly, we can never eliminate them entirely.

After all, reclining in an easy chair on your veranda, sipping king coconut water on a summer day in upcountry Sri Lanka, and watching trains wind through verdant tea terraces while reminiscing about your glory days with a friend, isn’t a bad way to spend one’s twilight years.