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Guo J, Wang J, Dove A, Bennett DA, Xu W. Psychological well-being trajectories preceding incident mild cognitive impairment and dementia. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333837. [PMID: 39137975 DOI: 10.1136/jnnp-2024-333837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/28/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Poorer psychological well-being has been related to an increased dementia risk, but changes in psychological well-being along the dementia course are unclear. We explored psychological well-being trajectories before and after the diagnosis of mild cognitive impairment (MCI) and dementia. METHODS Within the Rush Memory and Aging Project, 910 cognitively intact older adults were followed annually for up to 14 years to detect incident MCI and dementia. Psychological well-being and its six components (self-acceptance, autonomy, environmental mastery, purpose in life, positive relation with others, and personal growth) were annually measured based on Ryff's Scales of Psychological Well-Being. Data were analysed using mixed-effect models with a backward timescale. RESULTS Compared with participants who remained cognitively intact, those who developed incident MCI had a faster decline in psychological well-being (β -0.015, 95% CI -0.027 to -0.003), leading to lower well-being 2 years before MCI diagnosis (mean difference at year -2, -0.099, 95% CI -0.187 to -0.012). Considering different well-being components, those who developed MCI had lower levels of purpose in life and personal growth beginning 3 years (-0.126, 95% CI -0.251 to -0.001) and 6 years (-0.139, 95% CI -0.268 to -0.009) before MCI, respectively. The slope of psychological well-being decline was similar before and after MCI diagnosis for each component except for positive relation with others, which had an accelerated decline after MCI (β -0.042, 95% CI-0.075 to -0.009). Well-being trajectories remained similar for individuals with MCI regardless of whether they later developed dementia. CONCLUSIONS Psychological well-being (specifically purpose in life and personal growth) became significantly lower before MCI diagnosis.
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Affiliation(s)
- Jie Guo
- Department of Nutrition and Health, China Agricultural University, Beijing, China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jiao Wang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Keisari S, Krueger KR, Ben-David BM, Hainselin M. New horizon in improving ageing with improvisational theatre. Age Ageing 2024; 53:afae087. [PMID: 38706392 DOI: 10.1093/ageing/afae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Indexed: 05/07/2024] Open
Abstract
Cognitive decline, mental health and mindset factors can all affect the autonomy and well-being of older adults. As the number of older adults across the globe increases, interventions to improve well-being are urgently needed. Improvisational theatre (improv) and improv-based interventions are well-suited to address this need. Studies have shown that participation in improv-based interventions has a positive impact on mental health indicators, including depressive symptoms, well-being and social connectedness, as well as cognitive skills such as attention and memory. In addition, improv-based interventions have been beneficial for people with dementia, improving positive affect, self-esteem and communication. In this article, we describe improvisational theatre, or improv, and the reasons it has emerged from a form of spontaneous theatre that involves playfulness and creativity to an important tool to effect behavioural change in individuals and groups. We then review the literature on the effects of improv in ageing populations, with a focus on social, emotional and cognitive functioning. Finally, we make recommendations on designing improv-based interventions so that future research, using rigorous quantitative methods, larger sample sizes and randomised controlled trials, can expand the use of improv in addressing important factors related to autonomy and well-being in older adults.
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Affiliation(s)
- Shoshi Keisari
- The Drama & Health Science Lab and the Emili Sagol Creative Arts Therapies Research Centre, University of Haifa, Haifa, Israel
- The Centre for Research and Study of Aging, University of Haifa, Haifa, Israel
| | - Kristin R Krueger
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL, USA
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Mathieu Hainselin
- Department of Psychology, CRP-CPO, UR 7273, Université de Picardie Jules Verne, Amiens, France
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Piedra LM, Zhong S, Howe MJK, Compernolle E, Iveniuk J. The Interplay of Race, Ethnicity, and Language in Caregiver Health: Insights from the National Social Life, Health, and Aging Project. RESEARCH SQUARE 2024:rs.3.rs-4178612. [PMID: 38645160 PMCID: PMC11030516 DOI: 10.21203/rs.3.rs-4178612/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Recent socio-demographic shifts in the United States have underscored the growing importance of informal caregiving and raised concerns about caregivers' health and well-being. This study aims to deepen our understanding of the health dimensions of caregivers, considering their diverse backgrounds. Objective To examine five key health dimensions (physical, cognitive, mental, social, and sexual health) of caregivers, and to identify potential disparities based on ethnoracial and linguistic differences. Methods Using data from the National Social Life, Health, and Aging Project (NSHAP), this study explores the interconnections among the specified health dimensions of caregivers and their ethnoracial (Black, Hispanic, White, and others) and linguistic (Spanish, English) backgrounds, in addition to their social networks (N=1,309). Regression analysis was employed to discern the patterns and associations. Results The findings indicate that White caregivers generally report better physical, cognitive, and social health compared to their Black and Hispanic counterparts, but exhibit less favorable outcomes in sexual health than Hispanic caregivers. Spanish-speaking caregivers, while having lower cognitive and self-rated mental health than English-speaking caregivers, show stronger social health and greater relationship satisfaction. Notably, these correlations persist irrespective of the size of social networks, pointing to intrinsic links with health outcomes. Conclusion The study underscores the necessity of a comprehensive health evaluation for caregivers, acknowledging the intricate interplay between their health and various socio-demographic factors. It advocates for the development of targeted policies and interventions that address the complex health needs of caregivers, with an emphasis on their ethnoracial and linguistic contexts and social environments.
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Nair AK, Adluru N, Finley AJ, Gresham LK, Skinner SE, Alexander AL, Davidson RJ, Ryff CD, Schaefer SM. Purpose in life as a resilience factor for brain health: diffusion MRI findings from the Midlife in the U.S. study. Front Psychiatry 2024; 15:1355998. [PMID: 38505799 PMCID: PMC10948414 DOI: 10.3389/fpsyt.2024.1355998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/09/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction A greater sense of purpose in life is associated with several health benefits relevant for active aging, but the mechanisms remain unclear. We evaluated if purpose in life was associated with indices of brain health. Methods We examined data from the Midlife in the United States (MIDUS) Neuroscience Project. Diffusion weighted magnetic resonance imaging data (n=138; mean age 65.2 years, age range 48-95; 80 females; 37 black, indigenous, and people of color) were used to estimate microstructural indices of brain health such as axonal density, and axonal orientation. The seven-item purpose in life scale was used. Permutation analysis of linear models was used to examine associations between purpose in life scores and the diffusion metrics in white matter and in the bilateral hippocampus, adjusting for age, sex, education, and race. Results and discussion Greater sense of purpose in life was associated with brain microstructural features consistent with better brain health. Positive associations were found in both white matter and the right hippocampus, where multiple convergent associations were detected. The hippocampus is a brain structure involved in learning and memory that is vulnerable to stress but retains the capacity to grow and adapt through old age. Our findings suggest pathways through which an enhanced sense of purpose in life may contribute to better brain health and promote healthy aging. Since purpose in life is known to decline with age, interventions and policy changes that facilitate a greater sense of purpose may extend and improve the brain health of individuals and thus improve public health.
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Affiliation(s)
- Ajay Kumar Nair
- Institute on Aging, University of Wisconsin-Madison, Madison, WI, United States
| | - Nagesh Adluru
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna J. Finley
- Institute on Aging, University of Wisconsin-Madison, Madison, WI, United States
| | - Lauren K. Gresham
- Institute on Aging, University of Wisconsin-Madison, Madison, WI, United States
| | - Sarah E. Skinner
- Institute on Aging, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Richard J. Davidson
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, United States
| | - Carol D. Ryff
- Institute on Aging, University of Wisconsin-Madison, Madison, WI, United States
| | - Stacey M. Schaefer
- Institute on Aging, University of Wisconsin-Madison, Madison, WI, United States
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Wilson RS, Yu L, Stewart CC, Bennett DA, Boyle PA. Change in Decision-Making Analysis and Preferences in Old Age. J Gerontol B Psychol Sci Soc Sci 2023; 78:1659-1667. [PMID: 36856705 PMCID: PMC10561891 DOI: 10.1093/geronb/gbad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES To test the hypotheses that decision making ability declines in old age and that a higher level of cognitive reserve is associated with a reduced rate of decline. METHODS As part of an ongoing cohort study, 982 older adults without dementia at study enrollment completed measures of purpose in life and cognitive activity which were used as markers of cognitive reserve. At annual intervals thereafter, they completed 6 tests of decision making. RESULTS In a factor analysis of baseline decision making scores, 3 measures (financial/health literacy, financial/health decision making, scam susceptibility) loaded on an "analytic" factor and 3 (temporal discounting small stakes, temporal discounting large stakes, risk aversion) loaded on a "preferences" (for temporal discounting and avoiding risk) factor. During a mean of 4.7 years of follow-up (standard deviation = 2.9), analytic factor scores decreased (mean = 0.042-unit per year, standard error [SE] = 0.006, p < .001) and preferences factor scores increased (mean = 0.021-unit per year, SE = 0.006, p < .001), with a correlation of 0.13 (p < .001) between rates of change. Evidence of an association between cognitive reserve and decision making was mixed with purpose in life related to change in analytic decision making, whereas past (but not current) cognitive activity was related to change in decision making preferences. DISCUSSION Decision making analysis and preferences change over time in late life. Change over time in decision making components is relatively independent and differentially related to age and cognitive reserve.
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Affiliation(s)
- Robert S Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Lei Yu
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher C Stewart
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Patricia A Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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Fischer IC, Feldman DB, Tsai J, Harpaz-Rotem I, Lucas KA, Schulenberg SE, Pietrzak RH. Identifying significant correlates of purpose in life in older US military veterans: results from the national health and resilience in veterans study. Int Psychogeriatr 2023; 35:560-565. [PMID: 36715004 DOI: 10.1017/s1041610222001223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Perceived purpose in life (PIL) has been linked to a broad range of adverse physical, mental, and cognitive outcomes. However, limited research has examined factors associated with PIL that can be targeted in prevention and treatment efforts in aging populations at heightened risk of adverse outcomes. Using data from predominantly older US veterans, we sought to identify important correlates of PIL. METHODS Cross-sectional data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4069 US military veterans (Mage = 62.2). Elastic net and relative importance analyses were conducted to evaluate sociodemographic, military, health, and psychosocial variables that were strongly associated with PIL. RESULTS Of the 39 variables entered into an elastic net analysis, 10 were identified as significant correlates of PIL. In order of magnitude, these were resilience (18.7% relative variance explained [RVE]), optimism (12.1%), depressive symptoms (11.3%), community integration (10.7%), gratitude (10.2%), loneliness (9.8%), received social support (8.6%), conscientiousness (8.5%), openness to experience (5.4%), and intrinsic religiosity (4.7%). CONCLUSIONS Several modifiable psychosocial factors emerged as significant correlates of PIL in US military veterans. Interventions designed to target these factors may help increase PIL and mitigate risk for adverse health outcomes in this population.
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Affiliation(s)
- Ian C Fischer
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - David B Feldman
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | - Jack Tsai
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- National Center on Homelessness among Veterans, Homeless Programs Office, Tampa, FL, USA
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Katherine A Lucas
- Department of Psychology, University of Mississippi, Oxford, MS, USA
- Clinical-Disaster Research Center, University of Mississippi, Oxford, MS, USA
| | - Stefan E Schulenberg
- Department of Psychology, University of Mississippi, Oxford, MS, USA
- Clinical-Disaster Research Center, University of Mississippi, Oxford, MS, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Willroth E, Pfund G, McGhee C, Rule P. Well-Being as a Protective Factor Against Cognitive Decline and Dementia: A Review of the Literature and Directions for Future Research. J Gerontol B Psychol Sci Soc Sci 2023; 78:765-776. [PMID: 36734357 PMCID: PMC10174196 DOI: 10.1093/geronb/gbad020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Treatments that target the biological causes of dementia remain limited, making prevention critically important. Well-being-defined broadly as living in accordance with one's potential and experiencing one's life as enjoyable and satisfying-is a promising avenue for prevention. It can be targeted by large-scale, noninvasive interventions and has been linked with better cognitive health and lower dementia risk. In the current review, we begin by summarizing empirical evidence linking well-being to cognitive functioning, cognitive decline, dementia diagnosis, and dementia-related neuropathology. Then, we highlight 3 key areas for future research. METHODS We searched the literature on wellbeing, cognitive decline, and dementia, focusing on prospective and longitidinal evidence. RESULTS The research reviewed here provides consistent evidence for associations of well-being with cognitive decline, dementia risk, and cognitive resilience to neuropathology. However, several open questions remain regarding (1) causality and mechanism(s), (2) specificity versus generalizability of associations, and (3) timing. DISCUSSION To inform potential intervention efforts, the field must address complex open questions about whether, how, when, and for whom well-being influences dementia risk. The majority of existing research on well-being and cognitive health is correlational, and few studies have tested potential mechanisms that may explain those associations. Further, relatively little is known about the generalizability of associations across different aspects of well-being and for different sociocultural groups. Finally, we do not yet understand when in the life span and on what timescale well-being might influence cognitive health. We discuss challenges and opportunities for addressing each of these open questions, including concrete recommendations for research designs and use of open science practices.
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Affiliation(s)
- Emily C Willroth
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Gabrielle N Pfund
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chloe McGhee
- Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, California, USA
| | - Payton Rule
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
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Sutin AR, Stephan Y, Kekäläinen T, Luchetti M, Terracciano A. Purpose in life and accelerometer-measured physical activity among older adults. Psychol Health 2023:1-15. [PMID: 37073429 PMCID: PMC10582199 DOI: 10.1080/08870446.2023.2200414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/16/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Purpose in life is associated with engagement in physical activity and better cognitive health. This study examines the association between purpose in life and patterns of physical activity measured with an accelerometer and whether these patterns mediate the association between purpose and episodic memory among older adults. METHODS AND MEASURES This research is a secondary analysis of data from the accelerometry sub-study of the National Health and Aging Trends Study. Participants (N = 747; mean age = 79.20) reported on their purpose, wore an accelerometer for eight days, and completed an episodic memory task. RESULTS Purpose in life was associated with healthier patterns of physical activity, including higher total activity counts (β = .10, p = .002), more active bouts per day (β = .11, p = .003), less activity fragmentation (β = -.17, p < .001) and more sedentary fragmentation (β = .11, p = .002). These associations were generally similar across age, sex, race and education. Higher total activity counts and less activity fragmentation were associated with better episodic memory and accounted for part of the association between purpose and episodic memory. CONCLUSION Purpose in life is associated with healthier patterns of physical activity measured through accelerometry among older adults and such patterns may be one factor in the pathway from purpose to healthier episodic memory.
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Caldwell JZ, Isenberg N. The aging brain: risk factors and interventions for long term brain health in women. Curr Opin Obstet Gynecol 2023; 35:169-175. [PMID: 36912325 PMCID: PMC10023345 DOI: 10.1097/gco.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW Poor cognitive aging and dementia pose a significant public health burden, and women face unique risks compared to men. Recent research highlights the role of genetics, menopause, chronic disease, and lifestyle in risk and resilience in women's cognitive aging. This work suggests avenues for clinical action at midlife that may change the course of brain health in aging. RECENT FINDINGS Studies indicate women's risk for poor cognitive aging relates in part to hormone changes at menopause, a time when memory, brain structure and function, and Alzheimer's pathology may be observed in women and not men. Medical and lifestyle risks including diabetes, hypertension, and low physical activity also contribute to women's unique risks. At the same time, literature on resilience suggests women may benefit from lifestyle and chronic disease intervention, possibly more than men. Current studies emphasize the importance of interacting genetic and lifestyle risks, and effects of social determinants of health. SUMMARY Women have greater risk than men for poor cognitive aging; however, by treating the whole person, including genetics, lifestyle, and social environment, clinicians have an opportunity to support healthy cognitive aging in women and reduce the future public health burden of dementia.
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Affiliation(s)
- Jessica Z.K. Caldwell
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Ave., Las Vegas, NV 89106
| | - Nancy Isenberg
- Providence Swedish Center for Healthy Aging, Swedish Neuroscience Institute, 1600 E. Jefferson St. A Level, Seattle, WA 98122
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10
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Sutin DAR, Luchetti M, Aschwanden D, Stephan Y, Sesker AA, Terracciano A. Sense of meaning and purpose in life and risk of incident dementia: New data and meta-analysis. Arch Gerontol Geriatr 2023; 105:104847. [PMID: 36347158 PMCID: PMC10015423 DOI: 10.1016/j.archger.2022.104847] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE A greater sense of meaning and purpose in life is associated with lower dementia risk. The present research examines meaning and incident dementia in the largest sample to date, the UK Biobank, and combines the findings with the published literature on meaning/purpose and dementia risk in a meta-analysis. METHOD Participants from the UK Biobank reported on their meaning in life in the 2016/2017 mental health assessment (N=153,445). All-cause and cause-specific dementia were derived from hospital and death records through November 2021. Cox regression was used to test the association between meaning in life and risk of incident dementia. Results from the UK Biobank were combined with published studies identified through a systematic literature review in a random-effect meta-analysis (k=8; total N=214,270). RESULTS UK Biobank participants were followed up to five years after their assessment of meaning in life; 551 participants developed dementia. For every one-point higher feeling of meaning, there was a 35% decreased risk of all-cause dementia (HR=.74, 95% CI=.67-.82, p<.001). The association was similar controlling for clinical and behavioral risk factors and was not moderated by age, sex, education, or APOE risk status. Similar associations were found for Alzheimer's disease and vascular dementia. The meta-analysis supported the protective association between meaning/purpose and lower dementia risk (HR=.76, 95% CI=.72-.79, p<.001). CONCLUSIONS The present research supports the growing literature that meaning and purpose in life have a robust association with lower risk of developing dementia. Meaning/purpose is a promising intervention target for healthier cognitive outcomes in older adulthood.
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Affiliation(s)
- Dr Angelina R Sutin
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32306, United States.
| | - Martina Luchetti
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32306, United States
| | - Damaris Aschwanden
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32306, United States
| | | | - Amanda A Sesker
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32306, United States
| | - Antonio Terracciano
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32306, United States
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García C, Moreno L, Alacreu M, Muñoz FJ, Martínez LA. Addressing Psychosocial Factors in Cognitive Impairment Screening from a Holistic Perspective: The DeCo-Booklet Methodology Design and Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12911. [PMID: 36232215 PMCID: PMC9565987 DOI: 10.3390/ijerph191912911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Cognitive impairment (CI), an intermediate phase between the decline in physiological cognition and dementia, is known to be mediated by a variety of risk and protective factors, with age being the most influential of these. The multifactorial nature of CI and the worldwide phenomenon of an aging population makes decoupling old age from disease through the concept of healthy aging (HA) a matter of major interest. Focusing on psychosocial variables and psychological constructs, here we designed and piloted a data collection booklet (DeCo-B) to assess CI and HA from a holistic perspective. The DeCo-B comprises six sections: sociodemographic factors, CI, meaning in life, psychosocial factors, health problems, and lifestyle. The estimated prevalence of CI and HA in our cohort were 24.4% and 6.6%, respectively. Spearman correlations mainly identified pairwise associations between the meaning in life domains and psychosocial variables. Moreover, age, marital status, purpose in life, resilience, chronic pain, cognitive reserve, and obstructive sleep apnea were significantly associated with an increased risk of CI. Our results showed that DeCo-B is a suitable tool for researching how modifiable risk and protective factors influence cognitive status. The complex interrelationships between variables should be further investigated and, for practical reasons, the questionnaire should be optimized in future work.
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Affiliation(s)
- Cristina García
- Cátedra DeCo MICOF-CEU UCH, Universidad Cardenal Herrera-CEU, 46115 Valencia, Spain
- Department of Pharmacy, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain
- Community Pharmacist, 02161 Albacete, Spain
| | - Lucrecia Moreno
- Cátedra DeCo MICOF-CEU UCH, Universidad Cardenal Herrera-CEU, 46115 Valencia, Spain
- Department of Pharmacy, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain
| | - Mónica Alacreu
- Cátedra DeCo MICOF-CEU UCH, Universidad Cardenal Herrera-CEU, 46115 Valencia, Spain
- Embedded Systems and Artificial Intelligence Group, Universidad Cardenal Herrera-CEU, 46115 Valencia, Spain
| | - Francisco J. Muñoz
- Cátedra DeCo MICOF-CEU UCH, Universidad Cardenal Herrera-CEU, 46115 Valencia, Spain
- Embedded Systems and Artificial Intelligence Group, Universidad Cardenal Herrera-CEU, 46115 Valencia, Spain
| | - Luis A. Martínez
- Cátedra DeCo MICOF-CEU UCH, Universidad Cardenal Herrera-CEU, 46115 Valencia, Spain
- Community Pharmacist, 02161 Albacete, Spain
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Wyman MF, Van Hulle CA, Umucu E, Livingston S, Lambrou NH, Carter FP, Johnson SC, Asthana S, Gleason CE, Zuelsdorff M. Psychological well-being and cognitive aging in Black, Native American, and White Alzheimer's Disease Research Center participants. Front Hum Neurosci 2022; 16:924845. [PMID: 35967004 PMCID: PMC9372578 DOI: 10.3389/fnhum.2022.924845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/05/2022] [Indexed: 01/25/2023] Open
Abstract
Psychological well-being is associated with cognition in later life but has not been examined across diverse populations-including minoritized communities at disproportionately high risk of dementia. Further, most previous work has not been able to examine links between specific facets of psychological well-being and performance within distinct cognitive domains that can capture subclinical impairment. Using a well-characterized sample followed through enrollment in an NIH-funded Alzheimer's Disease Center, we sought to test these associations within three racial groups at baseline. Participants were N = 529 cognitively unimpaired Black, American Indian/Alaska Native (AI/AN), and white middle-aged and older adults (mean age = 63.6, SD = 8.1, range = 45-88 years) enrolled in the Wisconsin Alzheimer's Disease Research Center's Clinical Core. Predictors included validated NIH Toolbox Emotion Battery scales assessing positive affect, general life satisfaction, and meaning and purpose. Outcomes included performance on widely used tests of executive functioning and episodic memory. We conducted race-stratified regression models to assess within-group relationships. Black and AI/AN participants reported lower life satisfaction than white participants. Racial disparities were not observed for positive affect or meaning and purpose scores. Across groups, life satisfaction predicted better executive functioning. Similar associations were observed for positive affect in Black and AI/AN samples but not among whites. In general, well-being measures were not related to performance on tests of episodic memory. Our results highlight well-being as a potentially important determinant of late-life cognitive health, particularly executive functioning, that is modifiable if older adults are connected with appropriate resources and supports. Further, psychological well-being may represent a potent target for brain health interventions tailored for Black and Native communities.
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Affiliation(s)
- Mary F. Wyman
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Carol A. Van Hulle
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Emre Umucu
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, Lansing, MI, United States
| | - Sydnee Livingston
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
| | - Nickolas H. Lambrou
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
| | - Fabu P. Carter
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Sterling C. Johnson
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Sanjay Asthana
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Carey E. Gleason
- W.S. Middleton Memorial Veterans Hospital, Madison, WI, United States
- School of Medicine & Public Health, University of Wisconsin, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
| | - Megan Zuelsdorff
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin, Madison, WI, United States
- School of Nursing, University of Wisconsin, Madison, WI, United States
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13
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Pfund GN, Hofer M, Allemand M, Hill PL. Being Social May Be Purposeful in Older Adulthood: A Measurement Burst Design. Am J Geriatr Psychiatry 2022; 30:777-786. [PMID: 34924274 DOI: 10.1016/j.jagp.2021.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Sense of purpose predicts a wide array of positive health, cognitive, and well-being outcomes during older adulthood. However, work is limited regarding how social relations correspond to purposefulness in daily life. The current study explored daily social interactions as a route to daily purposefulness in older adults, using a measurement burst design. METHODS Older adults completed surveys for three 5-day bursts each spread 6 months apart (Mage = 70.75, SD = 7.23; N = 104). RESULTS Multilevel models demonstrated that on days when individuals reported more positive social interactions, they reported feeling more purposeful (est. = 0.39, 95% CI [0.28, 0.51]) when accounting for health, employment, and relationship status. Employment status moderated this association, as daily social interactions were more strongly associated with daily purpose for unemployed/retired individuals (est. = -0.23, 95% CI [-0.38, -0.08]). CONCLUSION Positive social interactions thus may help older adults maintain purposefulness, particularly after retirement.
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Affiliation(s)
- Gabrielle N Pfund
- Department of Psychological and Brain Sciences (GNP, PLH), Washington University in St. Louis, St. Louis, MO.
| | - Matthias Hofer
- Department of Communication and Media Research (MH), University of Zurich, Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging Research, University of Zurich (MH, MA), Zurich, Switzerland
| | - Mathias Allemand
- Department of Psychology (MA), University of Zurich, Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging Research, University of Zurich (MH, MA), Zurich, Switzerland
| | - Patrick L Hill
- Department of Psychological and Brain Sciences (GNP, PLH), Washington University in St. Louis, St. Louis, MO
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14
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Hooker K. Purpose and Social Relationships in Later Life: An Intraindividual Variability Approach. Am J Geriatr Psychiatry 2022; 30:787-789. [PMID: 35181231 DOI: 10.1016/j.jagp.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Karen Hooker
- School of Social and Behavioral Health Sciences(KH), College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.
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15
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Grodstein F, Wang T, Leurgans SE, Wilson RS, Bennett DA. Modifiable psychosocial risk factors and delayed onset of dementia in older populations: analysis of two prospective US cohorts. BMJ Open 2022; 12:e059317. [PMID: 35379643 PMCID: PMC8981290 DOI: 10.1136/bmjopen-2021-059317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Preventing Alzheimer's dementia (AD) fundamentally equates to delaying onset. Thus, we quantified associations of modifiable, psychosocial risk factors to years of delayed onset of dementia. DESIGN Two prospective cohorts (n=2860) with negative and positive psychosocial factors measured at baseline (depressive symptoms, neuroticism, cognitive activity). SETTING AND PARTICIPANTS Religious Orders Study of older priests, nuns and brothers across the USA, initiated in 1994; Rush Memory and Aging Project, of older persons in Chicago area, initiated in 1997. OUTCOME MEASURE We conducted annual neurological and neuropsychological assessments to identify AD (n=785 incident cases). We compared age at diagnosis of AD across psychosocial risk factor groups, controlling for confounders, using accelerated failure time models. RESULTS We found strong relations of three or more depressive symptoms with age at AD diagnosis; estimated mean age at diagnosis was 86.9 years with significant symptoms versus 92.1 years with no symptoms (p=0.001). In addition, neuroticism was inversely related to age at AD diagnosis; estimated mean age at diagnosis was 88.8 years for the highest neuroticism tertile and 93.1 years in the lowest tertile (p<0.001). Participants with higher cognitive activity (such as reading books) had later AD diagnosis; estimated mean age at diagnosis was 89.2 years for the lowest cognitive activity group and 92.6 years for the highest activity group (p<0.001). CONCLUSIONS Higher depressive symptoms were associated with 5-year acceleration in AD; higher neuroticism with 4-year acceleration and higher cognitive activity with a 3.5-year delay. To translate findings, prior health services research in the USA indicates delaying dementia 5 years could add 3 years of life and reduce individual costs of care >$60 000. These results provide a rigorous, easily translatable metric for communicating and evaluating the potential public health impact of psychosocial and experiential interventions.
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Affiliation(s)
- Francine Grodstein
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Tianhao Wang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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16
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Avan A, Hachinski V. Brain health: Key to health, productivity, and well-being. Alzheimers Dement 2021; 18:1396-1407. [PMID: 34569702 DOI: 10.1002/alz.12478] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Brain health is essential for physical and mental health, social well-being, productivity, and creativity. Current neurological research focuses mainly on treating a diseased brain and preventing further deterioration rather than on developing and maintaining brain health. The pandemic has forced a shift toward virtual working environments that accelerated opportunities for transdisciplinary collaboration for fostering brain health among neurologists, psychiatrists, psychologists, neuro and socio-behavioral scientists, scholars in arts and humanities, policymakers, and citizens. This could shed light on the interconnectedness of physical, mental, environmental, and socioeconomic determinants of brain disease and health. We advocate making brain health the top priority worldwide, developing common measures and definitions to enhance research and policy, and finding the cause of the decline of incidence of stroke and dementia in some countries and then applying comprehensive customized cost-effective prevention solutions in actionable implementation units. Life cycle brain health offers the best single individual, communal, and global investment.
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Affiliation(s)
- Abolfazl Avan
- Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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- Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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