JAGS

AUGUST 2011VOL. 59, NO. 8

LETTERS TO THE EDITOR

1567

of several factors.3 The spontaneous and natural evolution of sarcopenia can only be considered in relation to other concepts such as frailty and the development of functional problems.4 It is not a single disease with a linear process; several loops create a cascade, with a negative spiral eventually leading to disability, dependence, and death. Some clinically relevant endpoints, such as falls, fractures, functional outcome, and patient-reported outcome, could also be viewed as surrogates for one another. Thus, the denition of surrogate markers in this setting is complex; some of the proposed outcomes may be regarded as clinically relevant outcomes or as surrogate markers for other outcomes, physical performance being a good example. Consideration of some outcomes in this article seems to be weighted toward administrative rules and regulatory requirements of the FDA. We believe that research examining the important mechanisms involved in the development of sarcopenia (in our denition, muscle mass, strength, and function) as treatment outcomes may be a sensible rst step that may open the door in the future for more-complex intervention strategies using other relevant outcomes. Maurits F. J. Vandewoude, MD, PhD Department of Geriatrics University of Antwerp Antwerp, Belgium Tommy Cederholm, MD, PhD Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism Uppsala University Uppsala, Sweden Alfonso J. Cruz-Jentoft, MD, PhD Department of Geriatrics Hospital Universitario Ramo n y Cajal Madrid, Spain on behalf of the European Working Group on Sarcopenia in Older People

LANGUAGE CHANGE WITH AGING IN PELHAM GRENVILLE WODEHOUSE AND GEORGE BERNARD SHAW To the Editor: Linguistic examination of literary output has been used for posthumous detective work, with works by Iris Murdoch,1 Agatha Christie,2 and King James I3 showing an exaggerated decline in vocabulary size and syntax from earlier to later works consistent with the early effects of their later dementia. Changes in language use with age were investigated in the works of two authors who remained prolic and successful into advanced old age: Pelham Grenville (PG) Wodehouse (18811975) and George Bernard (GB) Shaw (18561950). The text of 20 novels by Wodehouse (10 Wooster and Jeeves books published between 1934 and 1974 and 10 Blandings Castle books published between 1915 and 1969) were converted to digital format using commercial software and corrected manually. The text of 21 introductions or prefaces Shaw wrote to his plays after 1906 (when he was 50 years old) that contained at least 1,500 words were downloaded from the Project Gutenberg Web sites. Language measures that could be automated were examined using Concordance 3.3 (Watt 2009) and WordSmith 5.0 (Scott 2010). The effects of age on linguistic markers in Shaw and Wodehouse were examined separately. The primary outcomes of interest were the linear relationships between the authors ages at publication and the language measures. Lexical measures made were proportion of unique words, proportion of vague words, and repetition of content words. Unique words (types) as a proportion of total words provide a simple measure of writing style and, in a long sample of writing, a measure of the size of the writers vocabulary.4 Type numbers at 45,000 words were used to examine Wodehouses vocabulary size and type numbers at 1,500 words to examine potential changes in Shaws writing style. The frequency of the vague, indenite words thing, anything, and something was examined in all texts.2 Repetition of the 20 most commonly used content words (including nouns, verbs, adjectives, and most adverbs but excluding function words such as prepositions, pronouns, conjunctions, and articles) within 20 subsequent words was also examined. Mean clauses per sentence (utterance) (MCU), calculated by averaging the total number of clauses (including main, embedded, and subordinate clauses) in a number of sentences, is the most useful and reproducible measure of age-related and individual differences in linguistic complexity and one that correlates strongly with other measures.5 MCU was calculated for each Wodehouse book for the rst 20 complete narrative sentences from each of the rst, sixth, tenth, and last chapters in each book and for each Shaw preface for the rst 80 complete narrative sentences. Twenty-sentence samples from both authors were separated, coded, and reassembled in random order for analysis by a single rater. This study of works, extending to their early 90s, by Wodehouse and Shaw did not show any decline in language production with age. There were no signicant changes in indenite word use or in repetition in either author (Table 1). Wodehouses vocabulary size and Shaws writing style

ACKNOWLEDGMENTS Conict of Interest: The editor in chief has reviewed the conict of interest checklist provided by the authors and has determined that the authors have no nancial or any other kind of personal conicts with this paper. Author Contributions: The three authors drafted the letter, which the rest of the members of the EWGSOP electronically approved. Sponsors Role: NA. REFERENCES
1. Brass E, Sietsema K. Considerations in the development of drugs to treat sarcopenia. J Am Geriatr Soc 2011;59:530535. 2. Cruz-Jentoft A, Baeyens JP, Bauer J et al. Sarcopenia: European consensus on denition and diagnosis. Age Ageing 2010;39:412423. 3. Cruz-Jentoft AJ, Landi F, Topinkova E et al. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care 2010;13:17. 4. Bauer JM, Sieber CC. Sarcopenia and frailty: A clinicians controversial point of view. Exp Gerontol 2008;43:674678.

1568

LETTERS TO THE EDITOR

AUGUST 2011VOL. 59, NO. 8

JAGS

Table 1. Linear Relationship Between Language Markers and Age

Factor Median (Range) Coefcient F P-Value

PG Wodehouse Types/45,000 words Indenite words/1,000 words Repetition/100 words Mean clauses per sentence George Bernard Shaw Types/1,500 words Indenite words/1,000 words Repetition/100 words Mean clauses per sentence

5,692 (5,2875,963) 3.53 (2.534.45) 6.60 (5.457.61) 2.21 (1.894.04) 619 (577718) 0.98 (0.392.00) 6.45 (5.507.82) 3.11 (2.723.41)

0.50 0.004 0.005 0.013 1.03 0.10 0.001 0.001

0.05 0.43 0.26 18.12 6.18 2.82 0.003 0.03

.80 .52 .62 o.001 .02 .11 .96 .87

Degrees of freedom, 1,18 for PG Wodehouse and 1,19 for George Bernard Shaw.

remained unchanged with age. MCU was unchanged in Shaw and rose slightly but signicantly with age in Wodehouse. In contrast, cross-sectional and longitudinal studies in normal healthy aging consistently show an age-related decline in language production from the mid-70s, including reduced syntactic complexity and a slight decrease in vocabulary size.68 Wodehouse and Shaw share a number of characteristics that make them particularly attractive subjects for examining language changes with optimal aging; their high level of productivity into old age provides a substantial body of work for analysis, and their stylistic consistency reduces the possibility that apparent age-related changes might be due to changes in approach. They had healthy lifestyles for their timeFrelatively so in the case of Wodehouse, who smoked a pipe and was fond of martinis, and perhaps excessively so in the case of Shaw who was a vegetarian, teetotaler, and nonsmokerFand remained physically and mentally well until close to death.9,10 They are, of course, atypical examples of cognitive aging, but examining how exceptional individuals differ from those with more-usual aging patterns may assist in understanding the intellectual potential of older people and how that potential can be achieved. Many cognitive changes seen in usual aging result from potentially modiable factors such as clinical or subclinical disease, lifestyle, and disuse. Wodehouse and Shaw shared a dedication to writing they maintained to the end.9,10 Practice or repetition are critical to the development and maintenance of skills in general,11 and experimental and observational studies of older people conrm that this is true for performance on cognitive tasks.7 This study supports the idea that the maxim use it or lose it extends to written language production. It remains unclear whether this may be achieved without regular production of a novel or play in later life. Paul E. Cotter, MB Catherine Wilkinson, MB Michelle Canavan, MB Shaun T. OKeeffe, MD Department of Geriatric Medicine Merlin Park University Hospital Galway, Ireland

ACKNOWLEDGMENTS Conict of Interest: There are no conicts of interest related to this study. Author Contributions: PEC, CW, and MC performed manual correction of the texts. STOK analyzed the data. All authors contributed to writing the paper. Sponsors Role: This study had no sponsor. REFERENCES
1. Garrard P, Maloney LM, Hodges JR et al. The effects of very early Alzheimers disease the characteristics of writing by a renowned author. Brain 2005; 128:250260. 2. Lancashire I, Hirst G. Vocabulary changes in Agatha Christies mysteries as an indication of dementia: a case study [on-line]. Available at http://www.cs. toronto.edu/pub/gh/Lancashire+Hirst-extabs-2009.pdf Accessed 20 February 2011. 3. Williams K, Holmes F, Kemper S et al. Written language clues to cognitive changes of aging: An analysis of the letters of King James VI/I. J Gerontol 2003;58B:4244. 4. Youmans G. Measuring lexical style and competence: the type-token vocabulary curve [on-line]. Available at http://web.missouri.edu/  youmansc/vmp/ help/Youmans-TypeToken.pdf. Accessed 20th February 2011. 5. Cheung H, Kemper S. Competing complexity metrics and adults production of complex sentences. Appl Psychol 1992;13:5376. 6. Schaie KW. The course of adult intellectual development. Am Psychol 1994;43:179183. 7. Burke DM, MacKay DG. Memory, language and aging. Phil Trans Royal Soc: Biol Sci 1997;352:18451856. 8. Mitzner TL, Kemper S. Oral and written language in late life: Findings from the Nun Study. Exp Aging Res 2003;29:457474. 9. McCrum R. Wodehouse. A Life. London: Penguin Viking, 2004. 10. Holroyd M. Bernard Shaw. Volume 3: The Lure of Fantasy. London: Chatto and Windus, 1991. 11. Gladwell M. Outliers. New York: Little, Brown and Company, 2008.

FIELD MEDICINE FOR RECONSIDERING OPTIMAL AGING To the Editor: Classic biology was once the study of dead things. Whether it was an animal or plant, it was collected and classied as an organism that was no longer livingFspecimen boxes neatly organized in a dimly lit laboratory. Not satised with traditional biology, scientists wanted to describe the world of living creatures as they exist in nature and founded the discipline of ecology. A similar