Purpose in Life and Motoric Cognitive Risk Syndrome: Replicable Evidence from Two National Samples

Multi-trajectories in different domains of social supports and subjective motoric cognitive risk syndrome: a 16-year group-based multi-trajectory analysis

OBJECTIVE

The aim of this study was to examine the longitudinal relationships between the trajectories of distinct subtypes of various domains of social supports and risk of subjective motoric cognitive risk (MCR) syndrome.

DESIGN

Longitudinal cohort study.

SETTING AND PARTICIPANTS

2,279 participants in the Taiwan Longitudinal Study on Aging (TLSA) between 1999 and 2011.

METHOD

A group-based multi-trajectory modeling (GBMTM) was implemented to identify distinct trajectory subtypes within various social support domains, encompassing social networks, emotional support, instrumental support, as well as working and economic status. Logistic regression models were then utilized to evaluate the associations between these trajectory subtypes and the risk of subjective MCR.

RESULTS

Among 2,279 participants, GBMTM identified four distinct trajectory subtypes: "low social support" (n = 371), "medium social support " (n = 862), "high social support" (n = 292), and "high social support with employment" (n = 754). The incidence rates of subjective MCR for these groups were 9.4%, 9.0%, 4.1%, and 0.8%, respectively. After adjusting for age, sex, education level, and comorbidities, both "low social support" (adjusted odds ratio (aOR) 4.07, 95% CI [1.60-10.34]) and "medium social support" (aOR 3.10, 95% CI [1.26-7.66]) were significantly associated with an increased risk of subjective MCR compared to the "high social support with employment" group.

CONCLUSIONS AND IMPLICATIONS

The current study demonstrates that social support significantly reduces the risk of subjective MCR, with lower support levels correlating to higher risk, necessitating further intervention studies to confirm the link between social support and risk of subjective MCR.

Association between pain interference and motoric cognitive risk syndrome in older adults: a population-based cohort study

OBJECTIVES

Motoric cognitive risk syndrome (MCR) is a pre-dementia condition characterized by subjective complaints in cognition and slow gait. Pain interference has previously been linked with cognitive deterioration; however, its specific relationship with MCR remains unclear. We aimed to examine how pain interference is associated with concurrent and incident MCR.

METHODS

This study included older adults aged ≥ 65 years without dementia from the Health and Retirement Study. We combined participants with MCR information in 2006 and 2008 as baseline, and the participants were followed up 4 and 8 years later. The states of pain interference were divided into 3 categories: interfering pain, non-interfering pain, and no pain. Logistic regression analysis was done at baseline to examine the associations between pain interference and concurrent MCR. During the 8-year follow-up, Cox regression analysis was done to investigate the associations between pain interference and incident MCR.

RESULTS

The study included 7120 older adults (74.6 ± 6.7 years; 56.8% females) at baseline. The baseline prevalence of MCR was 5.7%. Individuals with interfering pain had a significantly increased risk of MCR (OR = 1.51, 95% CI = 1.17-1.95; p = 0.001). The longitudinal analysis included 4605 participants, and there were 284 (6.2%) MCR cases on follow-up. Participants with interfering pain at baseline had a higher risk for MCR at 8 years of follow-up (HR = 2.02, 95% CI = 1.52-2.69; p < 0.001).

CONCLUSIONS

Older adults with interfering pain had a higher risk for MCR versus those with non-interfering pain or without pain. Timely and adequate management of interfering pain may contribute to the prevention and treatment of MCR and its associated adverse outcomes.

Purpose in life and cognitive health: a 28-year prospective study

OBJECTIVES

To examine the prospective association between purpose in life measured at three points across middle and older adulthood and cognitive outcomes assessed 8-28 years later.

DESIGN

Prospective Study.

SETTING

Wisconsin Longitudinal Study of Aging (WLS).

PARTICIPANTS

WLS participants who reported on their purpose in life at Round 4 (1992-1994; Mage = 52.58), Round 5 (2003-2007; Mage = 63.74), and/or Round 6 (2010-2012; Mage = 70.25) and were administered a cognitive battery at Round 7 (2020; Mage = 79.94) were included in the analysis (N = 4,632).

MEASUREMENTS

Participants completed the Ryff measure of purpose in life and were administered the telephone interview for cognitive status and measures of verbal fluency, digit ordering, and numeric reasoning.

RESULTS

Purpose in life measured at age 52 was related to better global cognitive function and verbal fluency but unrelated to dementia at age 80. In contrast, purpose in life at ages 63-70 was associated with lower likelihood of dementia, as well as better global cognitive function and verbal fluency at age 80. The effect sizes were modest (median Beta coefficient = .05; median odds ratio = .85). A slightly steeper decline in purpose in life between ages 52 and 70 was found for individuals with dementia at age 80.

CONCLUSIONS

Purpose in life is associated with healthier cognitive function measured up to 28 years later. Individuals with lower purpose, especially in their 60s or older, and with steeper declines in purpose, are more likely to have dementia at age 80.

Purpose in Life and Cognitive Function: Evidence for Momentary Associations in Daily Life

Background and Objectives

Purpose in life is associated with healthier cognitive outcomes in older adulthood. This research examines within-person dynamics between momentary purpose and cognitive function to provide proof of concept that increases in purpose are associated with better cognitive performance.

Research Design and Methods

Participants (N = 303; 54% female; Mage = 51.71, SD = 7.32) completed smartphone-based momentary assessments of purpose and short cognitive tasks 3 times a day for 8 days.

Results

In moments when participants felt more purpose driven than their average, they had faster processing speed (b = -1.240, SE = 0.194; p < .001), independent of person, temporal, and contextual factors and practice effects. Momentary purpose was unrelated to visual working memory performance (b = -0.001, SE = 0.001; p = .475). In contrast to purpose, momentary hedonic affect (e.g., happiness) was unrelated to momentary cognition.

Discussion and Implications

Feeling more momentary purpose may support faster processing speed in daily life. Such evidence provides stage 0 support for a purpose-based intervention for healthier cognition, which may be particularly useful in middle adulthood and the transition to older adulthood before the onset of cognitive impairment.

Informant-rated change in personality traits, psychological distress, well-being, and social connection with dementia

OBJECTIVES

Studies of retrospective personality change with dementia consistently find caregivers report large changes in personality (e.g., increases in neuroticism) of their care recipients compared to before dementia. This work seeks to replicate the established pattern of personality change, extend it to change in psychological distress, well-being, and social connection, and evaluate whether changes vary by stage of dementia.

METHODS

Caregivers of people with dementia (N = 188) reported on the psychological and social health of their care recipient currently and how they were before they developed dementia. Personality was measured as five factor model traits. Psychological distress was measured as symptoms of depression and anxiety, perceived stress, and pessimism. Psychological well-being was measured as purpose in life, life satisfaction, happiness, self-efficacy, and optimism. Social connection was measured as loneliness, belonging, social support, and social strain.

RESULTS

There were substantial increases in neuroticism (d = 1.14) and decreases in the other four personality traits (d range=-0.85 to -1.37). There were significant increases in psychological distress (e.g., d = 1.07 for depression) and substantial decreases in well-being (e.g., d=-1.18 for purpose in life) and social connection (e.g., d=-1.12 for belonging). Change was apparent across dementia stage and generally larger in more severe dementia.

DISCUSSION

In addition to personality, there are large retrospective changes in psychological distress, well-being, and social connection with dementia. These quantitative findings complement clinical observations of the natural history of psychosocial changes in people with dementia, and can inform families, clinicians, and researchers on commonly observed changes and improve interventions to mitigate dementia burden.

Heterogeneity in Measures and Rates of Reported Dementia and Subjective Memory Complaints Across U.S. National Surveys

OBJECTIVES

Several U.S. health surveillance surveys contain items related to self- and proxy reports of dementia and subjective memory complaints (SMC). Despite their similar content, these items differ in terminology, item specificity, and time frame. The goal of this study was to analyze whether item features might influence endorsement rates for dementia and SMC.

METHODS

We calculated design-appropriate estimates for the endorsement of dementia and SMC across U.S.-based national surveys and employed pairwise comparisons to evaluate endorsement rates across surveys. We also examined item characteristics to explore possible effects on endorsement rates.

RESULTS

Endorsement rates were wide-ranging for dementia (ranging from 2.7% to 9.9%) and SMC (5.6% to 46.6%). Pairwise comparisons revealed statistically significant differences on most dementia-related items (76%), and all SMC comparisons (100%). Items varied substantially in the terminology used to assess dementia and SMC (e.g., "dementia" vs "Alzheimer's disease") and used different time frames (e.g., "past month" vs "5 years").

DISCUSSION

National survey data on reported dementia and SMC can have important research, training, and policy implications, yet endorsement rates vary widely across surveys. That variability could emerge from subtle but influential item characteristics, and our findings highlight the need for item harmonization, in even their most basic characteristics. Standardizing items across national surveillance surveys facilitates comparison across surveys so that we can better understand the true burden of these conditions to inform public health initiatives.

Purpose in life and markers of immunity and inflammation: Testing pathways of episodic memory

OBJECTIVE

This prospective cohort study examines whether purpose in life is associated with markers of immunity and inflammation and tests these markers as mediators between purpose and episodic memory.

METHODS

Participants from the Venous Blood Study of the Health and Retirement Study reported on their purpose in life, had their blood assayed for markers of immunity and inflammation, and were administered an episodic memory task (N = 8999). Regression analyses tested the association between purpose and each marker. Prospective mediation analyses (N = 6092) tested whether these markers measured in 2016 were mediators between purpose measured in 2012/2014 and episodic memory measured in 2018.

RESULTS

Higher purpose in life was associated with lower neutrophil counts (β = -0.08, p < .001), lower ratio of neutrophils/lymphocytes (β = -0.05, p < .001), and lower systemic immune inflammation index (β = -0.04, p < .001); purpose was unrelated to monocyte, platelet, and lymphocyte counts or the ratio of platelets/lymphocytes (all ns). Purpose was associated negatively with c-reactive protein (β = -0.07, p < .001), Interleukin-6 (β = -0.08, p < .001), Interleukin-10 (β = -0.07, p < .001), Interleukin-1ra (β = -0.08, p < .001), and soluble Tumor Necrosis Factor Receptor 1 (sTNFR1; β = -0.10, p < .001); purpose was unrelated to Transforming Growth Factor beta 1. These associations were largely not moderated by age, sex, race, ethnicity, and education. Lower neutrophils, Interleukin-6, and sTNFR1 were associated prospectively with better episodic memory and mediated the association between purpose and episodic memory.

CONCLUSION

Purpose in life is associated with markers of immunity and inflammation, some of which are one mechanism in the pathway between purpose and healthier episodic memory.

Testing the Reciprocal Relationship Between Social Networks and Purpose in Life Among Older Adults: Application of a Random Intercept Cross-Lagged Panel Model

Objectives: The purpose of this study is to examine if there are longitudinal reciprocal effects between social network size and purpose in life among older adults. Methods: Using data from the National Health and Aging Trends Study, the sample included 1485 male and 2058 female adults 65 years and older. We first computed t-tests to assess gender differences in social network size and purpose in life. In order to examine the reciprocal effects between social network size and purpose in life over four time points (2017, 2018, 2019, and 2020), a RI-CLPM (Model 1) was computed. In addition to the main model, two multiple group RI-CLPM analyses (Model 2 and 3) were computed to test the moderated gender effect on the relationship with models estimating unconstrained and constrained cross-lagged parameters. Results: The results of the t-tests denoted significant gender differences in social network size and purpose in life. The results indicated that Model 1 fit the data well. The carry-over effects of social networks and purpose in life and spill-over effect from wave 3 purpose in life on wave 4 social networks were significant. There were no significant differences between the constrained and unconstrained models testing for moderated gender effects. Discussion: The findings of the study highlight the significant carry-over effect of purpose in life and social network size over four years and the positive spill-over effect from purpose in life on social network size at the subsequent wave, which only appeared at the last time point.

Association of cardiometabolic multimorbidity with motoric cognitive risk syndrome in older adults

INTRODUCTION

Motoric cognitive risk syndrome (MCR) is a predementia syndrome that is characterized by cognitive complaints and slow gait. Cardiometabolic multimorbidity (CMM) is associated with an increased risk of dementia. However, the relationship between CMM and MCR is still unclear.

METHODS

We included 4744 participants (aged 65+ years) without MCR at baseline from the National Health and Aging Trends Study (NHATS), who were followed-up from 2011 to 2018. CMM was defined as the presence of two or more cardiometabolic diseases (including diabetes mellitus, heart disease, and stroke).

RESULTS

CMM was significantly associated with an increased risk of MCR (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.13-1.75) in fully adjusted models. Consistent results were observed from stratified analyses of different subgroups. Increasing numbers of cardiometabolic diseases were dose-dependently associated with increased MCR risk (HR 1.33, 95% CI 1.20-1.48).

DISCUSSION

CMM is associated with an increased risk of MCR in older adults.

HIGHLIGHTS

Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait speed and cognitive complaints.Cardiometabolic multimorbidity was associated with an increased MCR risk.An increased number of cardiometabolic diseases were dose-dependently associated with increased MCR risk.

Sense of Purpose in Life and Beliefs and Knowledge of Alzheimer's Disease

OBJECTIVE

A sense of purpose in life is associated with healthier cognitive outcomes, including lower risk of Alzheimer's Disease (ad). The present research examines whether purpose is also associated with beliefs and knowledge of ad.

METHOD

A random subsample (N = 1,187) of community-dwelling participants from the Health and Retirement Study completed a module on self-reported beliefs and knowledge of ad.

RESULTS

Purpose in life was associated with lower perceived threat of ad and greater belief that modifiable factors (e.g., physical activity) decrease risk. Associations were not moderated by experience with ad or depressive symptoms. Purpose was unrelated to beliefs that genetics or stress increase risk or knowledge of ad.

CONCLUSIONS

Individuals with a sense of purpose are less concerned about risk of developing ad and believe modifiable factors reduce risk. These beliefs may support engagement in behaviors that reduce risk and be one psychological pathway through which purpose protects against ad.

Informant-rated change in personality traits, psychological distress, well-being, and social connection with dementia

Objectives

Studies of retrospective personality change with dementia consistently find caregivers report large changes in personality (e.g., increases in neuroticism) of their care recipients compared to before dementia. This work seeks to replicate the established pattern of personality change, extend it to change in psychological distress, well-being, and social connection, and evaluate whether changes vary by stage of dementia.

Methods

Caregivers of people with dementia (N=194) reported on the psychological and social health of their care recipient currently and how they were before they developed dementia. Personality was measured as five factor model traits. Psychological distress was measured as symptoms of depression and anxiety, perceived stress, and pessimism. Psychological well-being was measured as purpose in life, life satisfaction, happiness, self-efficacy, and optimism. Social connection was measured as loneliness, belonging, social support, and social strain.

Results

There were substantial increases in neuroticism (d=1.10) and decreases in the other four personality traits (d range=-.82 to -1.31). There were significant increases in psychological distress (e.g., d=1.05 for depression) and substantial decreases in well-being (e.g., d=-1.07 for purpose in life) and social connection (e.g., d=-1.09 for belonging). Change was apparent across dementia stage and generally larger in more severe dementia.

Discussion

In addition to personality, there are large retrospective changes in psychological distress, well-being, and social connection with dementia. These quantitative findings complement clinical observations of the natural history of psychosocial changes in people with dementia, and can inform families, clinicians, and researchers on commonly observed changes and improve interventions to mitigate dementia burden.

Harmonization of Later-Life Cognitive Function Across National Contexts: Results from the Harmonized Cognitive Assessment Protocols (HCAPs)

Background

The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criterion validity of the resulting harmonized scores.

Methods

We statistically harmonized general and domain-specific cognitive function across the six publicly available HCAP partner studies in the United States, England, India, Mexico, China, and South Africa (N=21,141). We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies, as identified by a multidisciplinary expert panel. We generated harmonized factor scores for general and domain- specific cognitive function using serially estimated graded-response item response theory (IRT) models. We evaluated precision of the factor scores using test information plots and criterion validity using age, gender, and educational attainment.

Findings

IRT models of cognitive function in each country fit well. We compared measurement reliability of the harmonized general cognitive function factor across each cohort using test information plots; marginal reliability was high (r> 0·90) for 93% of respondents across six countries. In each country, general cognitive function scores were lower with older ages and higher with greater levels of educational attainment.

Interpretation

We statistically harmonized cognitive function measures across six large, population-based studies of cognitive aging in the US, England, India, Mexico, China, and South Africa. Precision of the estimated scores was excellent. This work provides a foundation for international networks of researchers to make stronger inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes.

Funding

National Institute on Aging (R01 AG070953, R01 AG030153, R01 AG051125, U01 AG058499; U24 AG065182; R01AG051158).

Purpose in life and accelerometer-measured physical activity among older adults

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.

Association between positive control in self-perceptions of aging and motoric cognitive risk syndrome among Chinese community-dwelling older adults: a cross-sectional study

BACKGROUND

Self-perceptions of aging (SPA) are important psychosocial factors that lead to a wide range of outcomes including dementia. However, the relationships between positive SPA and motoric cognitive risk syndrome (MCR) which is a predementia syndrome are still unknown. This study aimed to reveal the associations of positive control and aging awareness of SPA with the risk of MCR and its components.

METHODS

A cross-sectional design was conducted among 1137 Chinese community-dwelling older adults. Positive control and aging awareness were defined by two dimensions of SPA (Positive control and Timeline chronic). MCR was determined according to definition. Multivariable logistic regression was used to examine the associations.

RESULTS

The overall prevalence of MCR was 11.5% (mean age = 71.62 ± 5.22). After adjusting for depression, anxiety, and cognitive function, positive control was associated with reduced risk of MCR (OR = 0.624, 95% CI 0.402-0.969, P = 0.036), subjective cognitive complaints (SCC) (OR = 0.687, 95% CI 0.492-0.959, P = 0.027), and gait speed (GS) (OR = 0.377, 95% CI 0.197-0.720, P = 0.003), respectively. Aging awareness was merely related to increased risk of MCR (OR = 1.386, 95% CI 1.062-1.810, P = 0.016).

CONCLUSIONS

This study highlights the crucial associations of positive control and aging awareness with MCR and its components. Our results emphasize that positive belief in control and adaptive aging awareness might be promising targets for preventing MCR.

Chronic pain increases the risk of motoric cognitive risk syndrome at 4 years of follow-up: evidence from the China Health and Retirement Longitudinal Study

BACKGROUND AND PURPOSE

Slower gait speed and subjective cognitive concerns are characteristics of the motoric cognitive risk (MCR) syndrome. This study aimed to examine if changes in pain may be hallmarks of early MCR, through investigating the magnitude of the association of chronic pain and the risk of MCR at 4 years follow-up.

METHODS

In total, 3711 participants without dementia or any mobility disability aged ≥60 years were studied, including 1413 with chronic pain, enrolled in the China Health and Retirement Longitudinal Study, a prospective cohort study. MCR assessed at wave 1 (2011) and wave 3 (2015) was used as the exposure. Cox regression analysis was used to examine the longitudinal association between chronic pain and MCR after adjusting for individual factors, behaviors/physiology factors and societal factors. Four years later, the incident MCR was evaluated.

RESULTS

After adjusting for individual factors, chronic pain was found to increase the risk of MCR development over time by about 1.5 times (hazard ratio 1.562, 95% confidence interval 1.228-1.986; p < 0.001) and to be linked with incident MCR at baseline (odds ratio 1.397, 95% confidence interval 1.149-1.698; p < 0.001). These associations remained substantial when behaviors/physiology factors and societal factors were taken into account in the analytical models.

CONCLUSIONS

The findings of our study imply that incident MCR may be exacerbated by chronic pain. Further exploration is required to find out whether chronic pain is a modifiable risk factor for MCR.

Sense of Purpose in Life and Subjective Cognitive Failures

A greater sense of purpose in life is an aspect of well-being associated with markers of cognitive health across adulthood, including subjective cognition. The current research extends this work to examine how purpose is associated with cognitive failures, which are momentary lapses in cognitive function, whether this association varies by age, sex, race, or education, and whether it is accounted for by depressed affect. Adults across the United States (N=5,100) reported on their sense of purpose in life, recent cognitive failures in four domains (memory, distractibility, blunders, names), and depressed affect. Purpose was associated with fewer cognitive failures overall and within each domain (median d=.30, p<.01), controlling for sociodemographic covariates. These associations were similar across sex, education, and racial groups but were stronger at relatively older than younger ages. Depressed affect accounted for all the association between purpose and cognitive failures among adults younger than 50; the association was reduced by half but remained significant among participants 50 and older. Purpose was associated with fewer cognitive failures, especially in the second half of adulthood. Purpose may be a psychological resource that helps support subjective cognition among relatively older adults, even after accounting for depressed affect.

Prevalence of motoric cognitive risk syndrome among older adults: a systematic review and meta-analysis

OBJECTIVE

Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome. Several studies on the prevalence of MCR have been published; however, the data vary across studies with different epidemiological characteristics. Thus, this study aimed to quantitatively analyse the overall prevalence and associated epidemiological characteristics of MCR among older adults aged ≥ 60 years.

METHODS

The Cochrane Library, PubMed, Web of Science, CINAHL, Embase, Scopus, PsycInfo, China National Knowledge Infrastructure, Weipu Database, China Biology Medicine disc and Wanfang Database were searched from their inception to January 2022. A modified Newcastle-Ottawa Scale evaluated the risk of bias. Statistical heterogeneity among the included studies was analysed using Cochran's Q and I² tests. A random effect model calculated pooled prevalence owing to study heterogeneity. Begg's and Egger's tests were used to assess the publication bias. Additionally, subgroup analysis and meta-regression were performed based on different epidemiological characteristics to determine heterogeneity sources.

RESULTS

Sixty-two studies comprising 187,558 samples were obtained. The pooled MCR prevalence was 9.0% (95% confidence interval: 8.3-9.8). A higher MCR prevalence was observed in females, older adults with a low educational level, depression and cardiovascular risk factors, South American populations, and studies with small sample sizes and cross-section designs. Furthermore, subjective cognitive complaint using scale score and gait speed using instrument gait showed higher MCR prevalence.

CONCLUSION

MCR is common in older adults, and various epidemiological characteristics influence its prevalence. Thus, preventive measures are required for older adults with higher MCR prevalence.

What Quality-of-Life Dimensions Are Most Important to Older Adults from Culturally and Linguistically Diverse Backgrounds Receiving Aged Care Services? An Exploratory Study

There is little research on what aspects of quality of life (QoL) are most important to culturally and linguistically diverse (CALD) older adults. This study aimed to identify what QoL dimensions were most important to CALD older adults receiving aged care services, and therefore, how relevant a new six dimensions QoL instrument developed for use in aged care is to this population. A three-stage, mixed-methods study was undertaken. Stage 1: n = 3 focus groups with aged care providers. Stage 2: n = 30 semi-structured interviews with Italian-born older adults in ethno-specific residential aged care. Stage 3: survey of n = 63 older adults from mixed CALD backgrounds receiving community aged care services. Overall, older adults asserted the importance of the six dimensions of the new QoL instrument. The importance of 'identity' and 'purpose and meaning' were identified via the focus groups; however, the community-based CALD older adults identified these aspects of quality of life as more important than older Italians in residential care. Being in ethno-specific residential aged care where needs relating to language, food, and religion were met and they continued to live with others from their community may have meant that the meeting of cultural needs was more taken for granted.

Self-reported sense of purpose in life and proxy-reported behavioral and psychological symptoms of dementia in the last year of life

Objectives:Behavioral and psychological symptoms of dementia (BPSD) are among the most challenging aspects of dementia for individuals living with dementia and their caregivers. Identifying factors associated with resilience to BPSD may inform interventions to reduce them. The present research examines whether purpose in life is associated with BPSD in the last year of life.Method:Participants from the Health and Retirement Study were selected if they reported on their sense of purpose, had evidence of a memory impairment, died across the follow-up, and a proxy completed the End of Life survey that included BPSD (N = 2473). Self-reported sense of purpose was tested as a predictor of the sum of symptoms and each indivdual symptom in the last year of life.Results:Purpose in life was associated with fewer BPSD overall. Of the individual symptoms, purpose was associated with less risk of psychological symptoms, specfiically less depression, periodic confusion, uncontrolled temper, but not with motor or perceptual symptoms.Conclusion: These results are consistent with growing evidence that purpose is associated with better cognitive outcomes. Purpose may be a useful target of intervention to improve outcomes across the spectrum of dementia.

Facets of conscientiousness and motoric cognitive risk syndrome

Conscientiousness is related to a lower risk of motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by slow gait speed and cognitive complaints. The present study examines which facets of conscientiousness are related to concurrent and incident MCR. Participants were dementia-free older adults aged 65-99 years (N = 6001) from the Health and Retirement Study (HRS). Baseline data on conscientiousness facets and MCR (cognitive complaints and gait speed) were collected in 2008/2010, along with the covariates: demographic factors, cognition, physical activity, disease burden, depressive symptoms, and body mass index (BMI). MCR was assessed again in 2012/2014 and 2016/2018. Controlling for demographic factors, higher industriousness was related to a nearly 30% lower likelihood of concurrent MCR (Odds Ratio [OR] = 0.75, 95%CI: 0.67-0.85, p < .001) and to about 60% reduced risk of incident MCR (Hazard ratio [HR] = 0.63, 95%CI: 0.56-0.71, p < .001). Self-control, order, and responsibility were also associated with a lower likelihood of concurrent (OR range: 0.82-0.88) and incident (HR range: 0.72-0.82) MCR. Traditionalism (HR = 0.84, 95%CI: 0.75-0.93, p < .01) and virtue (HR = 0.84, 95%CI: 0.75-0.93, p < .01) were related to a lower risk of incident MCR. Cognition, physical activity, disease burden, depressive symptoms, and BMI partially accounted for these associations. Industriousness is the facet of conscientiousness with the strongest association with risk of MCR. This facet could be targeted in interventions to reduce MCR and, ultimately, dementia.

Purpose in Life in Older Adults: A Systematic Review on Conceptualization, Measures, and Determinants

Purpose in life (PIL) is a psychological construct that reflects one’s life goals and the desire or determination to pursue them. Having a purpose provides an intrinsic motivation to adopt healthy behaviors as we age, which will help us to achieve positive health outcomes. Thus, promoting PIL is the cornerstone for successful aging and better health outcomes. This systematic review aims to identify how PIL is conceptualized, measured in the existing literature and what are the determinants of PIL in older adults (≥65 years). Electronic searches were conducted in five databases (Medline, PsychInfo, Embase, CINAHL and Web of Science). A total of 44 studies were included in the review. PIL was conceptualized in six different ways: health and well-being, meaningful goals and purpose, inner strength, social relationships, mattering to others, and spirituality and religiousness. There were six main questionnaires and semi structured interviews used to capture PIL. Female gender, higher education and income, being married, ethnicity, health and well-being, inner strength, social integration and spirituality were associated with PIL. Majority of the included studies had low to moderate Risk of Bias (RoB) assuring confidence in the results. The conceptual frameworks of PIL identified in the review underscore the complexity of the construct. Several sociodemographic and other determinants of PIL were identified.

Sense of purpose in life and healthier cognitive aging

Individuals with a greater sense of purpose maintain better cognitive function and have lower dementia risk. We review evidence linking purpose in life to healthier cognitive aging across adulthood and diverse demographic groups. Experimental work is now needed to test causal mechanisms to evaluate the utility of purpose as an intervention target.

Sense of Purpose in Life Is Associated with Lower Risk of Incident Dementia: A Meta-Analysis

BACKGROUND

A sense of purpose in life has been associated with healthier cognitive outcomes across adulthood, including risk of dementia. The robustness and replicability of this association, however, has yet to be evaluated systematically.

OBJECTIVE

To test whether a greater sense of purpose in life is associated with lower risk of dementia in four population-based cohorts and combined with the published literature.

METHODS

Random-effect meta-analysis of prospective studies (individual participant data and from the published literature identified through a systematic review) that examined sense of purpose and risk of incident dementia.

RESULTS

In six samples followed up to 17 years (four primary data and two published; total N = 53,499; n = 5,862 incident dementia), greater sense of purpose in life was associated with lower dementia risk (HR = 0.77, 95%CI = 0.73-0.81, p < 0.001). The association was generally consistent across cohorts (I2 = 47%), remained significant controlling for clinical (e.g., depression) and behavioral (e.g., physical inactivity) risk factors, and was not moderated by age, gender, or education.

CONCLUSION

Sense of purpose is a replicable and robust predictor of lower risk of incident dementia and is a promising target of intervention for cognitive health outcomes.

The Association between Subjective Age and Motoric Cognitive Risk Syndrome: Results from a Population-Based Cohort Study

OBJECTIVES

The motoric cognitive risk (MCR) syndrome, characterized by cognitive complaints and slower gait speed, is a pre-dementia syndrome associated with dementia and mortality risk. The present study examined whether subjective age, that is how old or young individuals feel relative to their chronological age, is related to concurrent and incident MCR syndrome. A relation between subjective age and MCR will inform knowledge on psychological factors related to dementia risk, identify who is at greater risk, and suggest a potential target of intervention.

METHOD

The study sample was composed of 6,341 individuals aged 65 to 107 years without dementia from the Health and Retirement Study (HRS), a longitudinal study of adults aged 50 years and older. Participants completed measures of subjective age, cognitive complaints, and gait speed and provided information on demographic factors, cognition, physical activity, depressive symptoms, and body mass index (BMI) at baseline in 2008/2010. Incident MCR was assessed four and eight years later.

RESULTS

Controlling for demographic factors, an older subjective age was related to more than 60% higher likelihood of MCR at baseline and to around 50% higher risk of incident MCR over time. These associations remained significant when cognition, physical inactivity, depressive symptoms, and BMI were included in the analytic models.

CONCLUSION

This study provides evidence that how old individuals feel is related to concurrent and incident MCR beyond the effect of chronological age, other demographic factors, physical inactivity, depressive symptoms, BMI, and cognitive functioning.