A recent study in BMJ Journals examined whether changes in psychological well-being trajectories precede mild cognitive impairment (MCI) and dementia. This could provide information about the potential role of this measure in predicting dementia and shaping further care for such patients.
Study: Psychological well-being trajectories prior to incident mild cognitive impairment and dementia. Image credits: PeopleImages.com – Yuri A/Shutterstock.com
Psychological well-being and risk of dementia
There are approximately 57.4 million people with dementia worldwide, and this could triple by 2050.
This progressive, incurable and debilitating condition places a heavy burden on families, healthcare systems and the economy. It is critical to identify risk factors and implement preventive care in the high-risk population, especially because dementia has a long prehospital period.
The risk of dementia is greater in people with poor psychological well-being. However, little is known about how psychological well-being changes with the development of dementia.
The current study included cognitively normal older adults who participated in the RUSH Memory and Aging Project. The 910 participants had an average age of 80 years and 77% were women.
All participants were followed for fourteen years through annual visits. The aim was to identify new MCI and dementia.
Ryffs Scales of Psychological Well-being were used at each visit to measure six aspects of psychological well-being: self-acceptance, autonomy, mastery of the environment, life purpose, positive relationships with others, and personal growth.
What did the research show?
Of the 910 participants, 265 (29%) developed MCI. Over time, 89 (33.6%) of the MCI group developed dementia. The MCI group was older and thinner and less likely to have depression than those who remained cognitively intact.
Psychological well-being and MCI
However, participants with new MCI also showed lower psychological well-being. The decline in psychological well-being was significantly greater both before and after diagnosis in the group that developed MCI, starting two years before diagnosis.
When examining individual components, life purpose and personal growth were also lower; the decline started three years and six years before MCI diagnosis, respectively. Autonomy also decreased by the time MCI was diagnosed.
There was a more rapid decline in positive relationships with others after MCI was diagnosed.
Mental well-being and dementia
Among those who developed dementia, the psychological well-being trajectory before and after diagnosis showed no significant differences, indicating that average well-being did not decline before the onset of dementia.
Conclusions
“Psychological well-being (particularly purpose in life and personal growth) became significantly lower before MCI diagnosis.”
There was no change in psychological well-being trajectories before or after dementia diagnosis, demonstrating a lack of predictive value.
As such, psychological support should be provided immediately and a diagnosis of MCI made. Conversely, reduced psychological well-being may predict future cognitive impairment.
The direction of these associations is unknown, although such associations have often been reported previously. However, participants with greater psychological well-being were less likely to become depressed, smoke heavily and were more physically, mentally and socially active.
Higher well-being is associated with less inflammation and better cardiovascular health, reducing the risk of cognitive impairment. These are all common protective factors for dementia and mental well-being.
This study confirms previous research linking cognitive resilience to better psychological well-being and shows that such resilience can reduce cognitive impairment in Alzheimer’s disease.
The specific deterioration in personal growth and life purpose may indicate that these require more cognitive functions than other aspects of psychological well-being and are therefore more susceptible to cognitive decline.
The decrease in positive relationships with others may be due to the lower involvement in social groups after the start of MCI, creating a downward spiral.
Further research is needed to determine whether interventions to improve well-being can reduce the risk of cognitive impairment.