Feeling that your life has no purpose and that there are few opportunities for personal growth in old age may precede the development of mild cognitive impairment (MCI), a frequent precursor to dementia, suggests research published online in the Journal of Neurology Neurosurgery and psychiatry.
These aspects of psychological well-being decline noticeably two to six years before MCI is diagnosed, even if there are no obvious signs, and regardless of whether those affected continue to develop dementia, the findings show.
Growing evidence links psychological well-being to brain aging, including the development of dementia. But much of the published research focuses on a sense of purpose to the exclusion of other aspects of well-being, the researchers explain.
These include self-acceptance, autonomy, feeling able to manage one’s immediate environment, having meaningful connections with others, and personal growth.
To strengthen the evidence base, researchers examined changes in psychological well-being over time before and after diagnosis of MCI and dementia among 910 cognitively intact older adults (average age 79) participating in the Rush Memory and Aging Project .
This project is an ongoing, long-term study that began in 1997. It includes older adults from senior and subsidized housing, continuing care retirement communities, social service agencies, church groups, and individual homes in northeastern Illinois, USA.
Study participants undergo annual checkups that include neurological examinations, cognitive testing, medical history and psychological well-being assessment, which as of 2008 includes all six components.
Over a mean monitoring period of 14 years, 265 (29%) developed MCI, of whom 89 (34%) developed dementia. The final analysis is based on 229 participants with complete before and after data, including 73 who developed dementia.
Compared with participants who remained cognitively intact, those who developed MCI were more likely to be older, weigh less, and have fewer depressive symptoms and psychological well-being.
Similar to those who did not develop dementia, those who did were more likely to be older, female, to carry the gene linked to dementia (APOE ε4) and to have lower levels of psychological well-being.
After taking into account potentially influential factors such as age, vascular disease and its risk factors, lifestyle, social activities and feelings of loneliness, those who developed MCI experienced a more rapid decline in psychological well-being, leading to lower levels of it 2 years before the diagnosis. than those who remained cognitively intact.
Specifically, these people had lower levels of purpose in life and personal growth, starting 3 and 6 years before their diagnosis, respectively.
The rate of decline in psychological well-being was similar for each component before and after diagnosis, except for meaningful connections with others, which declined more rapidly afterward.
Well-being trajectories were similar for all participants with MCI, regardless of whether they subsequently developed dementia, prompting the researchers to suggest that their findings “indicate that reduced psychological well-being, even in the absence of overt cognitive impairment, may be a predictor of subsequent dementia impairment.”
This is an observational study and as such no firm conclusions can be drawn about cause and effect. The study participants were well-educated, which may introduce selection bias due to the “healthy volunteer” effect, and most of them were white and female, which may limit the generalizability of the findings, the researchers acknowledge.
And the mechanisms underlying the association between well-being and cognitive functions are not yet well understood, they add.
These two can be bidirectional: in other words, poorer cognition can affect psychological well-being or vice versa; Greater well-being and better cognitive function may also share certain protective factors, they suggest.
And the discrepancies between the different well-being components may lie in differences in the level of cognitive processing required, they say.
“Our findings indicate that personal growth and purpose in life may be more cognitively demanding than other components of well-being, and therefore may serve as more sensitive indicators of cognitive aging,” they write.
“Additionally, we found that positive relationships with others declined rapidly after MCI diagnosis. People with impaired cognitive function may be less likely to participate in social and leisure activities than before, which may further worsen their relationships with friends or others.” cause.” they add.
They argue that psychological support should be planned for people diagnosed with dementia.
Source:
Magazine reference:
Guo, J., et al. (2024). Psychological well-being trajectories prior to incident mild cognitive impairment and dementia. Journal of neurology, neurosurgery and psychiatry. doi.org/10.1136/jnnp-2024-333837.