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Psychological Well-being and Risk of Dementia
Abstract
Objective:
Well-being is a psychological resource that buffers against age-related disease. We test whether this protective effect extends to dementia and whether it is independent of distress.
Methods:
Participants (N = 10,099) were from the Health and Retirement Study. Five aspects of positive psychological functioning (life satisfaction, optimism, mastery, purpose in life, and positive affect) were tested as predictors of incident dementia over 6 to 8 years.
Results:
Purpose in life was associated with a 30% decreased risk of dementia, independent of psychological distress, other clinical and behavioral risk factors, income/wealth, and genetic risk. After controlling for distress and other risk factors, the other aspects of well-being were not associated with dementia risk.
Conclusions:
After considering psychological distress, we found that measures of well-being were generally not protective against risk of dementia. An exception is purpose in life, which suggests that a meaningful and goal-driven life reduces risk of dementia.
... Finally, other aspects of well-being may also be associated with cognitive function. Previous work has tested life satisfaction, optimism, positive affect, and mastery, as well as purpose, as predictors of incident dementia (Sutin et al., 2018). Other than purpose, these aspects of well-being generally did not have independent associations with dementia risk, particularly after accounting for symptoms of depression. ...
... Finally, we extend these associations to life satisfaction, optimism, positive affect, and mastery and test whether purpose and these aspects of well-being have associations with the cognitive and informant outcomes independent of each other and depressive symptoms. Based on previous work with dementia risk (Sutin et al., 2018), we expect purpose to have independent associations. ...
... These associations are consistent with previous research that found life satisfaction (Zhu et al., 2022), optimism (Estrella et al., 2021), and positive affect (Castro-Schilo et al., 2019) to be associated with better cognitive function. Also consistent with previous research (Sutin et al., 2018), purpose had independent associations with most outcomes. In contrast, life satisfaction, optimism, positive affect, and mastery had few independent associations. ...
Objective:
To examine (1) the association between purpose in life and multiple domains of cognitive function and informant-rated cognitive decline, affect, and activities; (2) whether these associations are moderated by sociodemographic factors, cognitive impairment, or depression; (3) whether the associations are independent of other aspects of well-being and depressive symptoms.
Method:
As part of the 2016 Harmonized Cognitive Assessment Protocol from the Health and Retirement Study, participants completed a battery of cognitive tests and nominated a knowledgeable informant to rate their cognitive decline, affect, and activities. Participants with information available on their purpose in life from the 2014/2016 Leave Behind Questionnaire were included in the analytic sample (N = 2,812).
Results:
Purpose in life was associated with better performance in every cognitive domain examined (episodic memory, speed-attention, visuospatial skills, language, numeric reasoning; median β =.10, p <.001; median d =.53). Purpose was likewise associated with informant-rated cognitive decline and informant-rated affective and activity profiles beneficial for cognitive health (median β =.18, p < .001; median d =.55). There was little evidence of moderation by sociodemographic or other factors (e.g., depression). Life satisfaction, optimism, positive affect, and mastery were generally associated with cognition. When tested simultaneously with each other and depressive symptoms, most dimensions were reduced to non-significance; purpose remained a significant predictor.
Conclusions:
Purpose in life is associated with better performance across numerous domains of cognition and with emotional and behavioral patterns beneficial for cognitive health that are observable by knowledgeable others. These associations largely generalize across demographic and clinical groups and are independent of other aspects of well-being.
... Higher levels of well-being plausibly attenuate the risk for accelerated cognitive decline or incident dementia via physiological and behavioral pathways, including the reduction of neuroinflammation and cardiovascular dysfunction (Allerhand et al., 2014) and the enabling of more effective emotional coping or management of medical comorbidities associated with dementia risk. In particular, recent longitudinal work has highlighted the protective role of two well-studied PWB constructs, showing that lower life satisfaction increases the 5-year risk for dementia (Peitsch et al., 2016), and purpose in life predicts incident dementia at 6-8 years (Sutin et al., 2018). ...
... Inclusive studies that explore downstream protective factors such as well-being can offer crucial evidence for additional, later-life intervention loci. However, the literature on late-life well-being and cognition is generally lacking in diversity, with many studies using overwhelmingly white samples, combining racial groups into a "non-white" category, or not reporting participant race (e.g., Peitsch et al., 2016;Sutin et al., 2018;Merten et al., 2021). Data from American Indian or Alaska Native (AI/AN) samples are near absent. ...
... This finding adds to a growing body of work in predominantly white samples demonstrating relationships between this domain of hedonic well-being and cognitive outcomes in older age, including the rate of decline over time (Gerstorf et al., 2007) and incident dementia (Peitsch et al., 2016). Drawing from the nationally representative and population-based Health and Retirement Study, Sutin and colleagues found that associations between life satisfaction and risk for dementia were attenuated by adjustment for depressive symptoms (Sutin et al., 2018). This is consistent with life course research suggesting that mental disorder is both upstream and downstream of life satisfaction (Fergusson et al., 2015). ...
Background
The NIH Toolbox was designed to provide brief, reliable, and valid measures of neurological and behavioral functions. Emotion assessment using the NIH Toolbox Emotion Battery has recently received significant attention given emerging evidence that emotional health is predictive of physical health and overall well‐being. The purpose of this study is to examine whether the modified emotion toolbox model is associated with cognition in sample of cognitively healthy adults.
Method
Participants were 529 enrollees in the Wisconsin ADRC who had normal cognition. The majority of participants were female (65.8%) and White (78.3%). Average age was 63.69 (SD = 8.37). NIH Toolbox Emotion Battery factors and a measure of executive function, Trail Making Test (TMT) Parts A & B were examined using SEM. To evaluate the overall goodness‐of‐fit, we used the following criteria: χ ² nonsignificant, χ ² /df between1‐3, comparative fit index (CFI)>0.95, Tucker–Lewis index (TLI)>0.95, standardized root mean square residual (SRMR)<0.05, and the root mean square error of approximation (RMSEA)<0.08.
Result
The initial SEM results indicated a non‐acceptable fit for the data: χ ² (51,N = 529) = 275.99, p<.01 (should be not significant), χ ² /df = 5.41 (<3), CFI = 0.92(>.95), TLI = 0.90 (>.95), SRMR = 0.05, and RMSEA = 0.09 (<.08), 90% confidence interval (CI) = [0.08, 0.10] based on previously reported goodness‐of‐fit criteria. Based on modification indices, conceptually and statistically meaningful correlated error terms were added to the model (e,g., proximity between emotional support and friendship; emotional support and instrumental support; stress and sadness). After correlating some error terms based on theoretical background and modification indices, the modified SEM results indicated an acceptable fit for the data: χ ² /df = 2.52 (<3), CFI = 0.98, TLI = 0.97, SRMR = 0.03 and RMSEA = 0.05, 90% confidence interval (CI) = [0.04,0.06].
Conclusion
Our modified model using the NIH Toolbox Emotion Battery had an acceptable fit for the data in a cognitively healthy cohort. Although we did not include all emotion toolbox variables, our modified model still had a great fit to the data. We specifically found that positive emotions including social satisfaction measures were correlated with cognition. We did not find any correlation between negative affect and cognition, which could be due to limited sample size. Measuring and identifying positive and negative emotions are important in clinical and research practice.
... Well-being-defined broadly as living in accordance with one's potential and experiencing one's life as enjoyable and satisfying-is a promising prevention target. Prior research has shown that well-being is amenable to intervention (Bolier et al., 2013) and is associated with better cognitive health (Dewitte et al., 2020;Gerstorf et al., 2007;Hittner et al., 2020;Kim et al., 2019;Windsor et al., 2015) and lower dementia risk (Boyle et al., 2010(Boyle et al., , 2022Peitsch et al., 2016;Rawtaer et al., 2017;Sutin et al., 2018). The present paper reviews empirical evidence linking well-being to cognitive functioning, cognitive decline, dementia diagnosis, and dementia-related neuropathology. ...
... Three studies found that global life satisfaction predicted lower risk of MCI and dementia (Peitsch et al., 2016;Rawtaer et al., 2017;Zhu et al., 2022), whereas one study did not find an association between global life satisfaction and later cognitive impairment (Kim et al., 2021). A handful of studies, including two small meta-analyses, found that higher purpose or meaning in life predicted lower incidence of cognitive impairment or dementia (Bell et al., 2022;Boyle et al., 2010Boyle et al., , 2022Sutin et al., 2018Sutin et al., , 2020Sutin et al., , 2021. ...
... Relatively few studies have directly compared associations between different components of well-being and cognitive outcomes such as dementia risk. One notable exception examined associations between five components of well-being (i.e., life satisfaction, optimism, mastery, purpose in life, and positive affect) and dementia risk (Sutin et al., 2018). Positive affect, life satisfaction, and sense of purpose all predicted lower dementia risk, but only the effect of sense of purpose remained after adjusting for depressive symptoms and other risk factors (Sutin et al., 2018). ...
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, non-invasive 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 three key areas for future research.
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 don't yet understand when in the lifespan 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.
... Higher levels of well-being plausibly attenuate the risk for accelerated cognitive decline or incident dementia via physiological and behavioral pathways, including the reduction of neuroinflammation and cardiovascular dysfunction (Allerhand et al., 2014) and the enabling of more effective emotional coping or management of medical comorbidities associated with dementia risk. In particular, recent longitudinal work has highlighted the protective role of two well-studied PWB constructs, showing that lower life satisfaction increases the 5-year risk for dementia (Peitsch et al., 2016), and purpose in life predicts incident dementia at 6-8 years (Sutin et al., 2018). ...
... Inclusive studies that explore downstream protective factors such as well-being can offer crucial evidence for additional, later-life intervention loci. However, the literature on late-life well-being and cognition is generally lacking in diversity, with many studies using overwhelmingly white samples, combining racial groups into a "non-white" category, or not reporting participant race (e.g., Peitsch et al., 2016;Sutin et al., 2018;Merten et al., 2021). Data from American Indian or Alaska Native (AI/AN) samples are near absent. ...
... This finding adds to a growing body of work in predominantly white samples demonstrating relationships between this domain of hedonic well-being and cognitive outcomes in older age, including the rate of decline over time (Gerstorf et al., 2007) and incident dementia (Peitsch et al., 2016). Drawing from the nationally representative and population-based Health and Retirement Study, Sutin and colleagues found that associations between life satisfaction and risk for dementia were attenuated by adjustment for depressive symptoms (Sutin et al., 2018). This is consistent with life course research suggesting that mental disorder is both upstream and downstream of life satisfaction (Fergusson et al., 2015). ...
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.
... Drawing from this model, psychological well-being measures have been conceived as positive health assets, which may confer benefits through biological (e.g., healthier biomarkers), behavioral (e.g., health behavior engagement), and psychosocial (e.g., stress buffer) pathways . Wellbeing in particular is recognized as a resource for cognitive health (Gerstorf et al., 2007): Higher well-being is associated with better cognitive functioning (Allerhand et al., 2014), less cognitive decline over time (Gerstorf et al., 2007), and lower risk of dementia (Sutin et al., 2018). ...
... Three studies have analyzed a 5-item measure of LS in the Health and Retirement Study (~80% White). One study found no unique association of LS with dementia risk after accounting for depressive symptoms (Sutin et al., 2018). A second machine learning study found that low LS ranked seventh among 52 risk factors examined for incident dementia, while emotional distress (a composite score encompassing depression) ranked second (Aschwanden et al., 2020). ...
... Personal happiness and staying independent and positive well into older adulthood, for example, tend to be more expected in North American cultural contexts, whereas interdependence, social embeddedness, and adjusting to age-graded norms are emphasized in East Asian contexts (Kitayama et al., 2020;Uchino et al., 2018). As noted, evidence from the U.S. population suggests that the association of LS with risk of dementia is mainly driven by more satisfied individuals having fewer depressive symptoms (Sutin et al., 2018). It is not clear whether this will be the case in the Korean population. ...
Objectives
Life satisfaction is increasingly viewed as an asset associated with better general health, but its association with cognitive health and risk of dementia is less examined. We tested the hypothesis that higher life satisfaction would be associated with lower risk of dementia.
Method
Participants were a nationally representative sample of adults (n = 8,021; age range: 45-93 years) from the Korean Longitudinal Study of Aging (KLoSA) assessed every two years for up to 12 years. Multilevel modeling analysis examined whether life satisfaction is associated with cognitive functioning and decline. The primary analysis used Cox regression to examine the association between baseline life satisfaction and risk of incident dementia.
Results
Between-person differences and within-person changes in life satisfaction were associated with cognitive functioning, but life satisfaction was unrelated to the rate of cognitive decline. Higher life satisfaction was also associated with lower risk of dementia, even after accounting for demographic factors, depressive symptoms, cardiovascular and functional risk factors, health behaviors, and social contact.
Discussion
Satisfaction with life may function as a positive psychological resource for maintaining cognitive functioning and protecting against risk of dementia.
... Initial work on purpose and Alzheimer's disease indicated it is protective against poor cognitive outcomes [4]. Subsequent work has found that a sense of purpose is associated with a range of healthier cognitive outcomes across adulthood: Individuals who report more purpose perform better on cognitive tasks [5], show less age-related cognitive decline over time [6], are at lower risk of developing motoric cognitive risk syndrome [7], and, ultimately, have lower risk of developing Alzheimer's disease [4] or dementia [8]. Sense of purpose is thus emerging as a robust modifiable factor that promotes healthier cognition. ...
... Cognitive status was assessed at every two-year wave from baseline through 2018 (the most recent wave with data available). We previously published the association between purpose and dementia risk in the HRS through 2014 [8]. ...
... The lack of moderation indicated that purpose was similarly protective across age, gender, and level of education. The systematic review of the literature (Fig. 1) identified three published studies on purpose and incident dementia risk [4,8,29]. We excluded one of these studies [8] because it overlapped with the current HRS sample. ...
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.
... In addition, there are also studies on discrimination related to physical appearance and weight [20][21][22]. In general, research has focused on showing the negative effects of discrimination on variables of different types, such as academic performance associated with racial/ethnic discrimination [23] or psychological variables such as the greater perception of distress associated with ethnic discrimination [18], the relationship with depression in Black adolescents [24] or, in general, ethnic discrimination [17] and suicide among those discriminated due to weight [25]. Additionally, its impact has been seen to affect psychophysiological variables, demonstrating negative effects on pubertal development [16] and increased cortisol associated with unfair treatment due to a person's ethnicity [26]. ...
... Therefore, the sample includes a wide variety of different experiences. Documenting all these instances of discrimination supports the possibility that they may impact and justify the existence of high rates of depression in adolescents discriminated against due to their ethnic background [17,24] or suicide when perceived as overweight by others [25]. This influence extends even to chemical, physiological, and psychological levels [16,[26][27][28]. ...
Objectives: to examine the nature and context of discriminatory experiences among adolescents in Spain. Methods: A mixed study of discourse content analysis in 1000 randomly selected Spanish adolescents aged 12 to 16 years stratified by age, gender and territorial distribution. Data were analyzed to identify perpetrators, actions, and locations of discrimination. Results: Overall, 66% of adolescents reported witnessing or experiencing discrimination, primarily manifested through teasing, insults, and harassment. Peers were identified as the main perpetrators (73.9%), with schools being the primary context (69.4%) where discrimination occurs. Discrimination often lacked clear reasons (27.78%), but ethnicity (23.83%) and physical appearance (22.51%) were the most common factors, followed by gender (5.99%) or academic/ability issues (5.99%) or having an illness or developmental disorder (5.41%). Conclusions: Discrimination among adolescents is frequent, with racism and rejection of minority groups as the main causes. The findings underscore the need for interventions to address discriminatory behaviors in schools and broader society, with implications for adolescent well-being and mental health.
... This indicates the novelty of the term. The first mention the literature of psychological reserve took place in 2018 (Breccia et al., 2018;Sutin et al., 2018). Breccia et al. (2018) referred to the challenge to psychological reserve in elderly cancer patients, without elaborating. ...
... Breccia et al. (2018) referred to the challenge to psychological reserve in elderly cancer patients, without elaborating. Sutin et al. (2018) referred to the concept among the key words, without mentioning it in the text of the article, which was on psychological well-being and the risk for dementia. Thompson et al. (2020) found that orthopedic knee pain patients showed reduced psychological reserve. ...
Young developed a Neo-Piagetian/Neo-Eriksonian 25-step lifespan developmental model that describes, respectively, (sub)stages in cognitive and socioaffective development. The first paper of the two in the series presents and justifies the model, which consists of five stages X five cyclically recurring substages, and over both cognitive and socioaffective development. In his modeling, Young had addressed gaps in prior Neo-Piagetian modeling, and how the gaps were accommodated in his work. The model allows for much individual differences in cognition, as constructed, which had been accentuated further with further additions in the model. Innovatively, here, the Neo-Piagetian cognitive steps are described in terms of positive and negative poles, working from a biopsychosocial model of the influences on cognitive activity. The Neo-Piagetian poles are differentiated according to the concept of psychological reserve, and whether it is depleted negatively or can support directed cognitive activity positively. The present approach emphasizes network theory as a means to test the model empirically, including its concept of neo-stage. This model is consistent with a section of the literature review that emphasizes the importance of grand theories in psychology. That said, the article points out limitations of the model. It concludes with presentation of a cognitive change causal model that includes activation-inhibition coordination.
... Previous research has found that multiple aspects of wellbeing are associated with better cognitive function (Bell et al., 2022;Dewitte et al., 2021;Gerstorf et al., 2007;Hittner et al., 2020;G. Kim et al., 2019;Windsor et al., 2015;Wingo et al., 2020), lower incident cognitive impairment and dementia (Bell et al., 2022;Boyle et al., 2010;Peitsch et al., 2016;Rawtaer et al., 2017;Sutin et al., 2018), and greater cognitive resilience to dementia-related neuropathology (Boyle et al., 2012;Willroth et al., 2022). These effects have been observed at the between-and within-person levels, in cross-sectional and longitudinal studies, and when adjusting for potential confounders such as sociodemographic characteristics and apolipoprotein E (APOE) genotype. ...
... However, positive psychology approaches are commonly believed to be preventative strategies that lower the risk of developing dementia among cognitively healthy older adults rather than interventions that can still be relevant and effective even after the onset of MCI (Folkman & Moskowitz, 2000;Pressman & Cohen, 2005). For instance, purpose in life was found to be independently associated with a 19%-30% decreased risk of dementia (Bell et al., 2022;Sutin et al., 2018). Our study highlights that the onset of cognitive impairment may not necessarily hinder older adults from experiencing positive emotions. ...
Introduction: Emotional functioning in older adults is influenced by normal aging and cognitive impairment, likely heterogeneous across positive versus negative aspects of emotional functioning. Little is known about positive emotional experiences at the early stages of cognitive impairment. Methods: We assessed different aspects of emotional functioning among 448 participants aged 65+ (Normal Control (NC) = 276, Mild Cognitive Impairment (MCI) = 103, and mild dementia of the Alzheimer type (mild DAT) = 69) and tested moderators. Results: Compared to NC, older adults with MCI and mild DAT have maintained many positive aspects of emotional functioning, despite higher levels of negative affect, sadness, and loneliness. Among the oldest-old, the mild DAT group experienced higher fear and lower self-efficacy. Discussion: Older adults at early stages of cognitive impairment can experience positive aspects of emotional functioning, such as positive affect, purpose, and life satisfaction, all of which are important buildable psychological resources for coping.
... The big-five personality traits; openness to experience, conscientiousness, extraversion, agreeableness and neuroticism are widely accepted and extensively researched constructs in the field of personality psychology (5) . However, their impact on the risk perception of female investors in emerging markets like India is still largely unexplored. ...
... Having a purpose in life can be considered part of the cognitive realm and is also a component of wellbeing (Baltes et al., 2006). Having a purpose in life was shown to be associated with lower risk of developing dementia Sutin et al., 2018). Cognitive functioning is considered to be a mechanism of adaptation to life's conditions (Baltes et al., 2006) because it provides instrumental resources and has behavioural and motivational effects (Drewelies & Gerstorf, 2020). ...
Similar to physical ageing, cognitive ageing is mostly associated with decline and loss (e.g. in terms of memory, executive functions, visual and linguistic abilities) making it hard to envision positive changes. Both negative stereotypes (e.g. older people suffering from dementia) and positive stereotypes of ageing (e.g. wise older individuals) influence cognitive evolution across the later stages of life. Understanding both gains and losses associated with cognitive ageing and proposing interventions that foster strengths rather than prevent deficits represents an interesting challenge. This chapter explores cognitive ageing and development from a positive psychology perspective. First, it examines the potential meanings of cognitive development in midlife and older age, as proposed by theoretical models and the perspectives of ageing individuals. Then, it goes on to summarize a few instruments that can help measure cognitive improvement in older age. Next, it explores the relevance of cognitive development and how it is linked to other forms of development in midlife and older age (i.e. emotional growth, social skills improvement, physical and personality change). Finally, the chapter provides information on how to foster cognitive development among older individuals and prevent dementia by using positive psychology principles and a developmental assets approach.
... In general, positive emotions tend to expand people's way of thinking and foster creativity for problem-solving (Layous et al., 2014;Fredrickson, 2001;Lyubomirsky et al., 2005). In contrast, frequent negative emotions can lead to cognitive decline and even the onset of dementia (Sutin et al., 2018;Boyle et al., 2010). ...
Emotions play an important role in our daily lives, helping us communicate with others and increase our self-knowledge. Older age is often associated with negative feelings (e.g. sadness, regret, anxiety, etc.). However, research points out that older people can experience increased positive emotions compared to young individuals. The present chapter aims to provide some answers regarding whether people become happier as they grow older, by examining the meanings and characteristics of emotional ageing and emotional development in midlife and older age. The chapter also explores how emotional development is linked to other developmental areas (i.e. social, cognitive, physical, and personality). Finally, the chapter applies a positive psychology perspective to illustrate some general principles concerning how to foster emotional growth in midlife and older age. Other chapters in the present book examine in more detail how to promote happiness in older age (Chap. 13), how to foster love in midlife and older age (Chap. 11), and how to intervene to prevent or reduce loneliness (Chap. 14) and prevent anxiety (Chap. 17) and depression (Chap. 18) among older individuals.
... crosswords) was shown to promote well-being among older individuals (Oerlemans et al., 2011). In contrast, lower subjective well-being was associated with risk for cognitive decline and dementia (Sutin et al., 2018;Boyle et al., 2010). Happy people were also shown to be less likely to engage in rumination (e.g. ...
Happiness represents an important driving force for individuals at any life stage and continues to be so in midlife and older age. While ageing is usually associated with experiencing less happiness, research findings show that people tend to be happier as they grow older (i.e. the positivity effect). In this chapter, I will examine happiness in midlife and older age, including attempts to explain the age-related positivity effect. In this sense, I will describe how happiness is defined in midlife and older age and what factors can influence it. Additionally, I will examine how happiness can be measured objectively by using various scales and how middle-aged and older individuals describe happiness from their point of view. Next, I will consider the existing links between happiness and personal growth in all life domains (i.e. cognitive, emotional, social, personality, physical). Starting from the existing evidence-base and theoretical models concerning happiness in midlife and older age, I will then go on to examine how can positive psychology principles and developmental assets be applied to design interventions to promote happiness among middle-aged and older adults.
... Despite this difference, the end behavioral phenotype appears similar with the animal disengaging from the problem. In humans previous research has shown an increased risk of cognitive decline in individuals experiencing a high degree of negative affective states (41). In this study, it is difficult to interpret if this state is representative of despair or defeat in dogs, however, this could be analyzed by measuring engagement with the impossible task in dogs before and after administration of an anti-depressant medication, or by inclusion of a test of affect such as the judgement bias task. ...
Introduction
The aim of this study was to evaluate the engagement of aging dogs with a cognitively challenging and potentially frustrating task (the impossible task). Based on previous observations, we predicted that dogs showing signs of cognitive impairment in other cognitive tests and owner-completed questionnaires would show reduced engagement with the task.
Methods
In this task, dogs were shown a piece of food in a clear container that they could not open; time spent interacting with the container and the experimenter was measured. While the impossible task has not been used as a measure of frustration, the parameters of the test design creates a potential frustrate state, making this assessment appropriate. Thirty-two dogs enrolled in a longitudinal aging study participated in the study. Owners were asked to complete two cognitive dysfunction screening questionnaires (Canine Dementia Scale [CADES] and Canine Cognitive Dysfunction Rating Scale [CCDR]) as well a questionnaire assessing general frustration. Dogs participated in multiple measures of cognitive function as well the impossible task.
Results
Latency to disengage from the impossible task was faster for dogs with higher total (more impaired) CADES (p = 0.02) and total CCDR (p = 0.04) scores. Latency to disengage also correlated with decreased performance in cognitive tests observing social cues (p = 0.01), working memory (p ≤ 0.001), spatial reasoning and reversal learning (p = 0.02), and sustained attention (p = 0.02).
Discussion
The high correlation with several cognitive measures and the ease of administration of this test makes it a useful tool in evaluating canine cognitive dysfunction syndrome, however it is unclear if increased frustration or other cognitive processes are contributing to the observed changes.
... Furthermore, an absence of purpose in life has been linked to hopelessness and existential frustration or emptiness (Huamaní & Ccori, 2016;Schimmoeller & Rothhaar, 2021). ere is a general consensus that a lack of purpose is associated with mental health problems including depression and suicidality (Heisel & Flett, 2004;Laird et al., 2019;Nkyi & Ninnoni, 2020;Straus et al., 2019;Sutin et al., 2018), and even a risk factor for mortality in older adults (Boyle et al., 2009;Hill & Turiano, 2014;Krause, 2009;Pinquart, 2002). In sum, across numerous studies, purpose in life is a protective factor for physical and psychological wellness, and a lack of purpose is a risk factor for worse mental health. ...
The distinction between meaning and purpose in life remains an ongoing debate in the empirical and theoretical literature; even so, there is general consensus in defining purpose in life as goal-directedness towards living a more meaningful life. Scales measuring this goal-directedness, specifically, rather than broad measures of meaning, are necessary to further this vein of research. The Purpose in Life Test (PIL), developed by Crumbaugh and Maholick in the 1960s, has been shown to be a valid instrument for
measuring meaning and purpose. Four of the 20 items composing the PIL comprise the English Purpose in Life Test-Short Form (PIL-SF; Schulenberg et al., 2011), which have demonstrated greater internal coherence and greater precision for evaluating goal-directed purpose in life, specifically. This study aimed to evaluate the reliability and factor structure of the Spanish PIL-SF. This validation involved two different samples of university students: sample A (N = 368) and sample B (N = 336). Confirmatory factor
analysis (CFA) supported a 1-factor model, and reliability of the items was excellent. Results suggest that the Spanish PIL-SF is a valid and reliable measure of purpose in life, comparable to the English language PIL-SF.
... Previous studies reported that self-e cacy is positively correlated with retirement preparation, meaning that self-e cacy positively in uences social retirement preparation activities and thus increases self-respect and con dence, which in turn leads to better social retirement preparedness [21,22]. ...
Background
This study was conducted to evaluate the association of self-efficacy, awareness of aged life and retirement preparation with psychological well-being among middle-aged and elderly people.
Methods
This study used 285 men and women aged 40 to 65 years old, including public officials and public enterprise employees who participated in retirement education hosted by public institutions living in Seoul and Gyeonggi Province, as research data. The survey period was conducted from November 10, 2020 to February 28, 2021, and the collected data were analyzed using SPSS 22.0 as frequency analysis, t-test, ANOVA, regression and Sobel Test.
Result
Self-efficacy, perception of old life, retirement preparation, and psychological well-being according to social demographic characteristics differed significantly in civil servants and professionals, and the higher income and educational background. Correlation between the sense of self-efficacy, awareness of aged life, retirement preparation, and psychological well-being of middle-aged and elderly people. The perception of old life and self-efficacy have a positive impact on retirement preparation, and the perception of old life through retirement showed significant differences in psychological well-being, confirming that it is a variable that can improve psychological well-being.
Conclusion
Self-efficacy and perception of old life are highly related to improving psychological well-being, so continuous research should be needed to improve self-efficacy and old life awareness through retirement preparation and health promotion programs using public pensions.
... Existing research in this nascent field has primarily focused on negative psychological factors (e.g., depression, 5,6 anxiety, 7 and neuroticism 8 ), but evidence suggests that some psychological characteristics may confer protection against AD. For example, purpose in life 9 and the personality characteristic conscientiousness 10 have been associated with markedly reduced AD incidence. Novel neuroimaging and clinicopathologic findings have demonstrated that purpose in life 11 and conscientiousness, 12 among other psychological characteristics (e.g., resilience to stress, 13 optimism, 14 and trait mindfulness 15 ), may bestow protective benefit. ...
Background and Objectives
Self-reflection (the active evaluation of ones thoughts, feelings and behaviours) can confer protection against adverse health outcomes. Its impact on markers sensitive to Alzheimer’s disease (AD), however, is unknown. The primary objective of this cross-sectional study was to examine the association between self-reflection and AD-sensitive markers.
Methods
This study utilised baseline data from cognitively unimpaired older adults enrolled in the Age-Well clinical trial and older adults with subjective cognitive decline from the SCD-Well clinical trial. In both cohorts, self-reflection was measured via the reflective pondering subscale of the Rumination Response Scale, global cognition assessed via the Preclinical Alzheimer’s Cognitive Composite 5, and a modified late-life Lifestyle-for-Brain-Health (LIBRA) index computed to assess health and lifestyle factors. In Age-Well, glucose metabolism and amyloid deposition were quantified in AD-sensitive grey matter regions via FDG- and AV45-PET scans, respectively. Associations between self-reflection and AD-sensitive markers (global cognition, glucose metabolism, and amyloid deposition) were assessed via unadjusted and adjusted regressions. Further, we explored whether associations were independent of health and lifestyle factors. To control for multiple comparisons in Age-Well, false discovery rate corrected p -values ( p FDR ) are reported.
Results
A total of 134 (mean age 69.3 ± 3.8 years, 61.9% female) Age-Well and 125 (mean age 72.6 ± 6.9 years, 65.6% female) SCD-Well participants were included. Across unadjusted and adjusted analyses self-reflection was positively associated with global cognition in both cohorts (Age-Well: adjusted- β = 0.22, 95% confidence interval [CI] 0.05-0.40, p FDR = 0.041; SCD-Well: adjusted- β = 0.18 , 95% CI 0.03-0.33, p = 0.023) and with glucose metabolism in Age-Well after adjustment for all covariates (adjusted- β = 0.29, 95% CI 0.03-0.55, p FDR = 0.041). Associations remained following additional adjustment for LIBRA but did not survive FDR correction. Self-reflection was not associated with amyloid deposition (adjusted- β = 0.13, 95% CI -0.07-0.34, p FDR = 0.189).
Discussion
Self-reflection was associated with better global cognition in two independent cohorts and with higher glucose metabolism after adjustment for covariates. There was weak evidence that relationships were independent from health and lifestyle behaviours. Longitudinal and experimental studies are warranted to elucidate whether self-reflection helps preserve cognition and glucose metabolism, or whether reduced capacity to self-reflect is a harbinger of cognitive decline and glucose hypometabolism.
Trial Registration
Age-Well: NCT02977819 ; SCD-Well: NCT03005652
... A number of longitudinal studies found that a higher sense of meaning (Sutin et al. 2020) or purpose in life (e.g., Wilson et al. 2013;Kim et al. 2019) were predictive of level or change in cognition over time. Some studies even suggest that adults with higher levels of purpose have a smaller risk of developing a cognitive disorder (Boyle et al. 2010;Sutin et al. 2018). ...
Studies show the importance of the personal experience of meaning in life for older adults, but adults with dementia have been largely excluded from this research. The current study examined the longitudinal predictive effect of meaning in life for the psychological and cognitive functioning of older adults with Alzheimer’s disease and whether cognitive decline predicted presence of meaning in life. On three yearly measurement occasions, presence of meaning in life, depressive symptoms, life satisfaction, and cognitive functioning were assessed in structured interviews with a convenience sample of 140 older adults with Alzheimer’s disease from nine nursing homes in Belgium. Cross-lagged panel and latent growth curve models were used to analyze the longitudinal relationships between the variables. Over the three measurement waves, participants with higher presence of meaning reported lower depressive symptoms one year later. Presence of meaning and life satisfaction predicted each other over time, but only between the first and second wave. The analyses showed no strong evidence for a longitudinal association between meaning in life and cognitive functioning in either direction. The findings emphasize the importance of the experience of meaning in life for the psychological functioning of older adults with Alzheimer’s disease. The lack of evidence for associations between meaning and cognitive functioning questions the prevailing view that intact cognitive abilities are a necessity for experiencing meaning. More attention to the potential of meaning interventions for persons with dementia is warranted.
... The concept is rarely mentioned in the literature. A PsychInfo search found only one reference to it, and the article barely mentioned it (Sutin et al., 2018). The same applies to the few articles in which it is mentioned in the scientific and medical data engine searches (Pubmed, Scopus, Web of Science, e.g., Thompson et al., 2020). ...
The study of change mechanisms in psychotherapy needs to be integrated with the causality of behavior, which leads to the concept of causal psychotherapy. Causal psychotherapy is posited as a useful adjunct to standard, evidence based psychotherapies for child and youth victims of abuse and trauma. The article illustrates six processes that could be involved in causal psychotherapy in this context, from the distal to the proximal. They include the distal mechanism of activation-inhibition coordination. The most proximal one relates to executive function. The intermediate levels include ones related to co-regulation (e.g., self control), analysis-synthesis, objectivity-subjectivity, and psychological reserve, which is a new concept in the domain of psychological change mechanisms. Each of the variables can vary from high to low, with the low end being more problematic. Psychotherapy can aim to bring the patient toward adaptive levels. The literature review focuses on psychotherapeutic change mechanisms, and standard psychotherapies for child/youth abuse/trauma, especially trauma-focused cognitive behavior therapy (TF-CBT). Then, it considers causal aspects of child/youth abuse and trauma, including PTSD. The discussion relates causal therapy to the question of unifying psychology and psychotherapy under the rubric of causality as a core integrative mechanism.
... Our findings are consistent with prior studies in Western countries reporting beneficial effects of specific dimensions of positive psychology on cognitive function-including purpose in life (Boyle et al., 2010;Lewis et al., 2017), resilience (Vahia et al., 2011), optimism (Gawronski et al., 2016), and positive affect (Danhauer et al., 2013)-as well as the few studies incorporating multiple dimensions of PWB (e.g., Korthauer et al., 2018;Llewellyn et al., 2008;Terracciano et al., 2014). Our results also corroborate the longitudinal association observed between PWB and cognitive change in earlier studies (Danhauer et al., 2013;Nakanishi et al., 2019;Sutin et al., 2018). While a few studies in China have examined the association between PWB and cognitive function in older adults (Zhong et al., 2017;Zhou et al., 2019Zhou et al., , 2020, this study is-to our knowledge-the first to examine the association over a relatively lengthy follow-up period using a measure that encompasses multiple aspects of PWB. ...
Objectives
This study aims to examine the relationship between psychological well-being (PWB) and cognitive function in older adults in China. Methods: Data are from the Chinese Longitudinal Healthy Longevity Survey. Analyses were restricted to 9,487 older persons (age ≥ 60) without cognitive impairment at baseline. Respondents were followed over a 12-year period. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (C-MMSE). PWB was assessed using a composite index capturing optimism, conscientiousness, neuroticism, loneliness, personal control, self-esteem, and happiness. Results: Multilevel mixed effects generalized linear models showed that respondents with greater PWB had a slower rate of cognitive decline over time, adjusting for sociodemographic and health characteristics. In addition, multilevel multinomial logistic regression models showed that greater PWB was associated with lower odds of developing cognitive impairment. Conclusions: Findings suggest that fostering PWB may prevent or delay adverse cognitive changes.
Life satisfaction predicts lower risk of adverse health outcomes, including morbidity and mortality. Research on life satisfaction and risk of dementia has been limited by a lack of comprehensive clinical assessments of dementia. This study builds on previous research examining life satisfaction and clinically ascertained cognitive impairment and dementia. Participants (N = 23070; Meanage = 71.83, SD = 8.80) from the National Alzheimer's Coordinating Center reported their satisfaction with life at baseline. Incident dementia was ascertained through clinical assessment over up to 18 years. Life satisfaction was associated with about 72% lower risk of all-cause of dementia, an association that remained significant accounting for demographic (age, sex, race, ethnicity, education, marital and living status), psychological (depression), clinical (obesity, diabetes, hypertension), behavioral (current and former smoking), and genetic risk (APOE ϵ4) factors. The association was not moderated by demographics, depression, and APOE ε4 status groups. The association was similar when cases occurring in the first five years were excluded, reducing the likelihood of reverse causality. Life satisfaction was also linked to specific causes of dementia, with a reduced risk ranging from about 60% to 90% for Alzheimer’s disease and vascular dementia to > 2-fold lower risk of Lewy Body and frontotemporal dementia. Older adults who were satisfied with their lives were also at 61% lower risk of incident mild cognitive impairment and at 22% lower risk of converting from mild cognitive impairment to dementia. Being satisfied with one’s life is associated with a lower risk of dementia. Improving life satisfaction could promote better cognitive health and protect against dementia.
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.
Background and Purpose
The emotions of people at various stages of dementia need to be effectively utilized for prevention, early intervention, and care planning. With technology available for understanding and addressing the emotional needs of people, this study aims to develop speech emotion recognition (SER) technology to classify emotions for people at high risk of dementia.
Methods
Speech samples from people at high risk of dementia were categorized into distinct emotions via human auditory assessment, the outcomes of which were annotated for guided deep-learning method. The architecture incorporated convolutional neural network, long short-term memory, attention layers, and Wav2Vec2, a novel feature extractor to develop automated speech-emotion recognition.
Results
Twenty-seven kinds of Emotions were found in the speech of the participants. These emotions were grouped into 6 detailed emotions: happiness, interest, sadness, frustration, anger, and neutrality, and further into 3 basic emotions: positive, negative, and neutral. To improve algorithmic performance, multiple learning approaches were applied using different data sources—voice and text—and varying the number of emotions. Ultimately, a 2-stage algorithm—initial text-based classification followed by voice-based analysis—achieved the highest accuracy, reaching 70%.
Conclusions
The diverse emotions identified in this study were attributed to the characteristics of the participants and the method of data collection. The speech of people at high risk of dementia to companion robots also explains the relatively low performance of the SER algorithm. Accordingly, this study suggests the systematic and comprehensive construction of a dataset from people with dementia.
Previous studies have examined how various aspects of positive psychological well‐being (PPWB) independently relate to healthy aging, yet a notable gap remains in understanding the effects of their overlap (i.e., shared variance). We used data from two longitudinal cohorts, the Midlife Development in the United States Study and the Health and Retirement Study ( N = 3,302 and 7,209), each of which assessed hedonic and eudaimonic facets of PPWB (positive affect, purpose in life, personal growth, and self‐acceptance) and tracked mortality status across 14–15 years of follow‐up. We derived a global factor identifying elements common across PPWB facets and also specific PPWB factors from a bifactor model. Then, we examined if higher PPWB levels (global and specific) are associated with mortality risk. Across cohorts, higher global well‐being factor levels were associated with reduced mortality risk, even after adjusting for a range of potential confounders. Fewer independent associations were evident with the specific PPWB factors. Findings suggest that variance common across hedonic and eudaimonic facets of PPWB is associated with lower mortality risk. Considering the shared versus unique effects of different PPWB facets can offer valuable insights for theorizing mechanisms underlying health benefits of PPWB and guiding decisions about intervention targets.
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 three times a day for eight 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.
Objectives
Life enjoyment, linked to the ability to engage pleasurably with one’s environment, may be related to the risk of developing dementia. This prospective cohort study examined the association between level of life enjoyment and disabling dementia incidence among Japanese community residents.
Methods
The participants were Japanese, aged 45–74 years old at 5-years follow-up, in the Japan Public Health Center–based Study (N = 38,660). Psychological conditions and other confounding variables were identified through self-administered questionnaires. Incident disabling dementia registered based on the Japan’s Long-Term Care Insurance system from 2006 to 2016. Hazard ratios [95% confidence intervals] were assessed using Cox proportional hazards models.
Results
Over a median follow-up period of 9.4 years, a total of 4,642 cases of disabling dementia developed. Level of life enjoyment was inversely associated with the risk of disabling dementia: the multivariable hazard ratios were 0.75 [0.67–0.84] (p < .001) and 0.68 [0.59–0.78] (p < .001) with medium and high life enjoyment, respectively, compared to low life enjoyment. Furthermore, the association between greater life enjoyment and low risk for disabling dementia was strongest in the subgroup with low–medium mental stress. In the high mental stress group, this association was evident for poststroke disabling dementia, but not for disabling dementia without a history of stroke.
Discussion
A higher level of life enjoyment was associated with a lower risk of disabling dementia, particularly in the low–medium mental stress group. This finding suggests the importance of having life enjoyment by managing mental stress for reducing risk of disabling dementia.
Importance
Purpose in life is a critical aspect of psychological well-being that is associated with better cognitive outcomes across the continuum of dementia. To our knowledge, the natural history of purpose with onset of cognitive impairment has yet to be evaluated.
Objective
To evaluate changes in purpose in life prior to and after onset of cognitive impairment.
Design, Setting, and Participants
This cohort study used assessments of purpose in life and cognitive status from March 2006 to May 2021 in the Health and Retirement Study (HRS) and from May 2011 to November 2021 in the National Health and Aging Trends Study (NHATS).
Exposure
Cognitive impairment at each wave based on established thresholds in HRS and NHATS.
Main Outcomes and Measures
The main outcome was purpose in life, measured with the Ryff Measures of Psychological Well-Being in HRS and a validated item in NHATS.
Results
In HRS, 22 668 participants provided 50 985 assessments of purpose across all waves. In NHATS, 10 786 participants provided 53 880 assessments of purpose across all waves. In HRS, 58.3% of participants were female, with mean (SD) age of 64.76 (10.41) years at baseline; in NHATS, 57.4% were female, with mean (SD) age of 76.82 (7.71) years at baseline. Across waves, 6794 HRS participants (30%) and 4446 NHATS participants (41.2%) were in the cognitive impairment range. Accounting for demographic covariates and normative change in purpose, multilevel modeling indicated that standardized purpose in life declined significantly prior to onset of cognitive impairment (estimate for 10 years) in both HRS (b = −0.12; 95% CI, −0.17 to −0.07; P < .001) and NHATS (b = −0.10; 95% CI, −0.20 to −0.01; P = .03). Purpose declined significantly more rapidly following onset of cognitive impairment, with a standardized decline nearly 3 times larger compared with prior to impairment in HRS (b = −0.35; 95% CI, −0.41 to −0.29; P < .001) and 4 times larger in NHATS (b = −0.44; 95% CI, −0.53 to −0.34; P < .001).
Conclusions and Relevance
In this cohort study, purpose in life declined with emergence of cognitive impairment. The decline before onset was too small to be useful to detect impending impairment in clinical settings. The steeper decline following impairment suggests that individuals are aware that their purpose is declining. Purpose may be an intervention target following cognitive impairment to maintain well-being and to reduce or slow emergence of behavioral symptoms associated with low purpose.
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.
Mild cognitive impairment (MCI) and dementia are associated with lifestyle risk factors, making lifestyle medicine a potentially viable intervention for people with MCI and dementia. The present study aims to examine the effectiveness of lifestyle medicine on cognitive functions among people with MCI and dementia, by performing a systematic review and meta-analysis on randomized controlled trials (RCT). A systematic literature search was conducted to extract RCTs adopting lifestyle interventions of diet, exercise, and stress management or emotional well-being. Results showed that 65 studies were eligible. Exercise was the most promising lifestyle intervention that improved various cognitive functions among people with MCI and dementia, and was more effective in MCI than in dementia. Interventions on stress management or emotional well-being did not show a significant effect on people with MCI, and the evidence for people with dementia was insufficient to conclude. Similarly, due to the lack of RCTs on a healthy dietary pattern, the effectiveness of diet interventions was not examined. In conclusion, the exercise component of lifestyle medicine can be an effective and clinically significant intervention for protecting people with MCI and dementia against cognitive declines, especially when served as an early intervention at the stage of MCI.
Not all older adults with dementia-related neuropathology in their brains experience cognitive decline or impairment. Instead, some people maintain relatively normal cognitive functioning despite neuropathologic burden, a phenomenon called cognitive resilience. Using a longitudinal, epidemiological, clinical-pathologic cohort study of older adults in the United States (N = 348), the present research investigated associations between well-being and cognitive resilience. Consistent with preregistered hypotheses, results showed that higher eudaimonic well-being (measured via the Ryff Psychological Well-Being Scale) and higher hedonic well-being (measured via the Satisfaction with Life Scale) were associated with better-than-expected cognitive functioning relative to one's neuropathological burden (i.e., beta-amyloid, neurofibrillary tangles, Lewy bodies, vascular pathologies, hippocampal sclerosis, and TDP-43). The association of eudaimonic well-being in particular was present above and beyond known cognitive resilience factors (i.e., socioeconomic status, education, cognitive activity, low neuroticism, low depression) and dementia risk factors (i.e., apolipoprotein E [ApoE] genotype, medical comorbidities). This research highlights the importance of considering eudaimonic well-being in efforts to prevent dementia.
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.
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.
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 = 5100) 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 = 0.30, 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.
Background
Happiness is one variable of subjective well-being, which has been increasingly shown to have protective effects on health. Although the association between happiness and cognition has been established, the mechanism by which happiness leads to cognition remains unclear. Since happiness, depression, and physical activity may all be related to cognition, and happiness is related to depression and physical activity, this study explored the effect of depression and physical activity on the relationship between happiness and cognition among middle and old-aged individuals in China.
Methods
Data on 14,344 participants above 45 years of age were obtained from the 2018 China Family Panel Studies survey. A multiple linear regression analysis was performed to identify the correlation factors of cognition. The conditional process analysis was used to assess the mediatory effect of depression and physical activity on the relationship between happiness and cognition.
Results
Residence, age, sex, income level, social status, smoking, napping, reading, education, exercise times, satisfaction, happiness, and depression had associations with cognition. When other variables were held constant, cognition score increased by 0.029 standard deviation(SD) for every 1 SD increased in happiness. Mediation analysis showed that happiness had a significant positive total effect on cognition. The direct effect of happiness was significant and accounted for 57.86% of the total effect. The mediatory effect of depression (path of happiness→depression→cognition) accounted for 38.31% of the total effect, whereas that of physical activity (path of happiness→exercise times→cognition) accounted for 3.02% of the total effect.
Conclusion
Happiness has a positive correlation with cognitive function, and depression and physical activity play mediatory roles in this association. Effective interventions to improve happiness levels of middle and old-aged population will not only improve their subjective well-being but also improve their cognitive function, which carries great potential for reducing public health burdens related to cognitive aging.
Background
Large households/families may create more happiness and offer more comprehensive healthcare among the members. We correlated household size to dementia mortality rate at population level for analysing its protecting role against dementia mortality.
Methods
This is a retrospective cross-sectional study. Dementia specific mortality rates of the 183 member states of World Health Organization were calculated and matched with the respective country data on household size, Gross Domestic Product (GDP), urban population and ageing. Scatter plots were produced to explore and visualize the correlations between household size and dementia mortality rates. Pearson’s and nonparametric correlations were used to evaluate the strength and direction of the associations between household size and all other variables. Partial correlation of Pearson’s approach was used to identify that household size protects against dementia regardless of the competing effects from ageing, GDP and urbanization. Multiple regression was used to identify significant predictors of dementia mortality.
Results
Household size was in a negative and moderately strong correlation (r = -0.6034, p < 0.001) with dementia mortality. This relationship was confirmed in both Pearson r (r = - 0.524, p<0.001) and nonparametric (rho = -0.579, p < 0.001) analyses. When we controlled for the contribution of ageing, socio-economic status and urban lifestyle in partial correlation analysis, large household was still in inverse and significant correlation to dementia mortality (r = −0.331, p <0.001). This suggested that, statistically, large household protect against dementia mortality regardless of the contributing effects of ageing, socio-economic status and urban lifestyle. Stepwise multiple regression analysis selected large household as the variable having the greatest contribution to dementia mortality with R² = 0.263 while ageing was placed second increasing R² to 0.259. GDP and urbanization were removed as having no statistically significant influence on dementia mortality.
Conclusions
While acknowledging ageing, urban lifestyle and greater GDP associated with dementia mortality, this study suggested that, at population level, household size was another risk factor for dementia mortality. As part of dementia prevention, healthcare practitioners should encourage people to increase their positive interactions with persons from their neighbourhood or other fields where large household/family size is hard to achieve.
Understanding factors associated with dementia risk is important for informing future interventions aimed at dementia prevention. There is accumulating evidence for the association between depression and risk of dementia, however less is known about the association between positive psychological factors and dementia incidence. This review aims to synthesise evidence regarding the association between positive psychological constructs (PPCs) and later risk of MCI and dementia in adults aged 50 and over. Literature searches were conducted in Medline, PsycINFO, and Scopus until March 2021. Papers reporting on the association between at least one PPC and later risk of MCI or dementia in people aged 50+ without cognitive impairment at baseline were included. Results from the meta-analyses revealed that purpose in life was significantly associated with a reduced risk of dementia (HR = 0.81, 95% CI [0.78, 0.85], p <.001), however results for positive affect were non-significant (HR = 0.94, 95% CI [0.76, 1.15], p =.54). Results for other PPCs are described narratively. Mixed findings for different PPCs highlight the importance of investigating these factors individually. Understanding which factors may play a protective role in their association with risk of mild cognitive impairment and dementia could have important implications for informing dementia prevention interventions.
This chapter covers relevant psychological aspects of ageing that practitioners should be cognizant of when caring for this population. It discusses both normal and abnormal changes in mental health and cognitive function in older adulthood as well as interventions that can help with adapting to these changes and maintaining function. Attention to normal personality development also offers insight to those caring for older adults. Psychological Interventions are effective in the elderly with behavioural and mental health disorders, and it appears the older adult population prefers psychotherapy to psychiatric medications. Currently available interventions can be divided into pharmacologic and non‐pharmacologic categories. A past literature review suggested that non‐pharmacologic interventions for mild cognitive impairment and dementia can essentially be divided into four categories: restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic interventions.
Objectives
To test the hypothesis that higher level of purpose in life is associated with lower likelihood of dementia and mild cognitive impairment (MCI) in older Brazilians.
Methods
As part of the Pathology, Alzheimer’s and Related Dementias Study (PARDoS), informants of 1,514 older deceased Brazilians underwent a uniform structured interview. The informant interview included demographic data, the Clinical Dementia Rating scale to diagnose dementia and MCI, the National Institute of Mental Health Diagnostic Interview Schedule for depression, and a 6-item measure of purpose in life, a component of well-being.
Results
Purpose scores ranged from 1.5 to 5.0 with higher values indicating higher levels of purpose. On the Clinical Dementia Rating Scale, 940 persons (62.1%) had no cognitive impairment, 121 (8.0%) had MCI, and 453 (29.9%) had dementia. In logistic regression models adjusted for age at death, sex, education, and race, higher purpose was associated with lower likelihood of MCI (odds ratio = .58; 95% confidence interval [CI]: .43, .79) and dementia (odds ratio = .49, 95% CI: .41, .59). Results were comparable after adjusting for depression (identified in 161 [10.6%]). Neither race nor education modified the association of purpose with cognitive diagnoses.
Conclusions
Higher purpose in life is associated with lower likelihood of MCI and dementia in older black and white Brazilians.
There are individual differences in the phenomenological re-experiencing of autobiographical memories. We examine whether sense of purpose in life and cognitive function are associated with the phenomenology of a recent memory related to the coronavirus pandemic. Participants reported on their sense purpose and completed tasks that measured processing speed and visuospatial ability before the pandemic in January-February 2020 and subsequently retrieved and rated a memory related to the pandemic in July 2020 (N=796; Mage=58.05, SD=14.14, range 19-85). Participants with a greater sense of purpose reported memories that were more phenomenologically rich (e.g., more vivid, coherent, accessible), whereas cognitive function was primarily related to greater perceived accessibility of the memory but not to most other aspects of phenomenology. The pattern of associations was similar when accounting for depressive symptoms, and none of the associations was moderated by age. The present research suggests that individuals with a higher sense of purpose in life have autobiographical memories with richer phenomenology. To the extent that memories function to sustain well-being, social connections, and cognitive health, rich phenomenology may be one pathway through which purpose leads to these better outcomes.
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
Purpose in life is associated with greater engagement in physical activity. The present research ( N = 3473) addresses whether motivations and barriers to physical activity mediate this relation concurrently and prospectively early in the coronavirus pandemic. Higher purpose was associated with greater intrinsic, identified, and external motivation for physical activity and fewer barriers. Intrinsic motivation was a robust mediator of the relation between purpose and more physical activity and less sedentary behavior reported concurrently and prospectively; identified motivation mediated the relation with physical activity. Purpose in life is associated with being more physically active through both greater enjoyment and valuing its benefits.
Objective
Observational studies have suggested that subjective wellbeing and personality traits link to risk of Alzheimer’s disease (AD), but it is unclear if these associations are causal. Methods: We performed two-sample Mendelian randomization to assess potential causality. Genetic associations were obtained from the largest genome-wide association studies in Social Science Genetic Association Consortium (N = 298,420), Genetics of Personality Consortium (N =81,036), and four independent consortia of AD (N = 455,258). We run the inverse variance weighted (IVW) approach as one primary analysis. A Bonferroni-corrected threshold of p < 8.33×10⁻³ was considered significant, and p values between 8.33×10⁻³ and 0.05 were considered to be suggestive of an association.
Results
The suggestive association with decreased risk of AD was noted for a genetically predicted 1-SD increase in subjective wellbeing (odds ratio = 0.963, 95% confidence interval = 0.930-0.997; p = 0.032). Genetically predicted greater neuroticism was significantly associated with lower subjective wellbeing (β = -0.077; p = 0.004). No putative personality traits were significantly associated with AD risk after correction for multiple tests, including agreeableness (β = -0.0010; p = 0.477), conscientiousness (β = 0.0018; p = 0.270), openness (β = 0.0004; p = 0.738), neuroticism (β = -0.0098; p = 0.262), or extraversion (β = 0.0120; p = 0.262).
Conclusions
Subjective wellbeing may independently reduce the risk of AD. Residual confounding is likely to be responsible for the previous observational relationships between personality traits and AD.
Epidemiologischer Hauptrisikofaktor eines Demenzsyndroms ist das Alter. Die Ursachen der Demenzen sind sehr heterogen und reichen von vermeidbaren zu behandelbaren Erkrankungen bis zu neurodegenerativen Demenzformen, deren Manifestation durch eine Reihe behandelbarer Faktoren zu beeinflussen ist. Die wichtigste Demenzursache in der westlichen Welt ist die sog. Alzheimer-Krankheit mit charakteristischen Eiweißablagerungen im Gehirn (Plaques und Neurofibrillen). Die mit Abstand häufigste Demenzform ist die gemischte Demenz mit einer Kombination von Alzheimer- und vaskulären Hirnveränderungen. Für Prävention und Gesundheitsförderung kommt den folgenden bekannten Risikofaktoren in der Europäischen Union eine hohe Bedeutung zu: Depression, Bewegungsmangel, Adipositas, Hypertonus, Diabetes mellitus und Nikotinismus. Daneben gibt es eine Reihe von Faktoren, deren Bedeutung erst in den letzten Jahren untersucht wurde, z. B. Lebensereignisse, Beruf, Umweltverschmutzung, Wahrnehmungsstörungen, Einsamkeit, Zahnhygiene, Schlaf u. v. a. Häufig übersehen werden potenzielle Demenzursachen, die im Vorfeld zu behandeln oder ganz zu vermeiden sind wie Infektionen und Schädel-Hirn-Verletzungen.
With an increasingly aging population, more work is needed to identify factors which may promote the maintenance of normal cognitive functioning. The current study tested the concurrent association between sense of purpose in life and the cognitive variables of episodic memory, executive functioning, and composite cognitive functioning in adults (N = 3489, Mage = 56.3 years, SD = 12.27, Range = 32–84 years) from the Midlife in the United States study (MIDUS). Correlational analyses suggested that purpose in life was associated with higher scores for memory, executive functioning, and overall cognition. Bootstrapping tests of moderation found no evidence for a moderating effect of age on purpose and the cognitive variables. Future studies should attempt to explain the mechanisms behind this relationship and explore the potential for interventions to promote healthy cognitive and purposeful aging.
This research synthesis integrates findings from 150 experimental, ambulatory and longitudinal studies that tested the impact of well-being on objective health outcomes. Results demonstrated that well-being positively impacts health outcomes (r=0.14). Well-being was found to be positively related to short-term health outcomes (r=0.15), long-term health outcomes (r=0.11), and disease or symptom control (r=0.13). Results from the experimental studies demonstrated that inductions of well-being lead to healthy functioning, and inductions of ill-being lead to compromised health at similar magnitudes. Thus, the effect of subjective well-being on health is not solely due to ill-being having a detrimental impact on health, but also to well-being having a salutary impact on health. Additionally, the impact of well-being on improving health was stronger for immune system response and pain tolerance, whereas well-being was not significantly related to increases in cardiovascular and physiological reactivity. These findings point to potential biological pathways, such that well-being can directly bolster immune functioning and buffer the impact of stress.
Reigning measures of psychological well-being have little theoretical grounding, despite an extensive literature on the contours of positive functioning. Aspects of well-being derived from this literature (i.e., self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth) were operationalized. Three hundred and twenty-one men and women, divided among young, middle-aged, and older adults, rated themselves on these measures along with six instruments prominent in earlier studies (i.e., affect balance, life satisfaction, self-esteem, morale, locus of control, depression). Results revealed that positive relations with others, autonomy, purpose in life, and personal growth were not strongly tied to prior assessment indexes, thereby supporting the claim that key aspects of positive functioning have not been represented in the empirical arena. Furthermore, age profiles revealed a more differentiated pattern of well-being than is evident in prior research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]).
Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS.
The cognitive tests in HRS predict the ADAMS diagnosis in 74% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84% and 93%, respectively.
Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.
Depression may be associated with an increased risk for dementia, although results from population-based samples have been inconsistent. We examined the association between depressive symptoms and incident dementia over a 17-year follow-up period.
In 949 Framingham original cohort participants (63.6% women, mean age = 79), depressive symptoms were assessed at baseline (1990-1994) using the 60-point Center for Epidemiologic Studies Depression Scale (CES-D). A cutpoint of > or = 16 was used to define depression, which was present in 13.2% of the sample. Cox proportional hazards models adjusting for age, sex, education, homocysteine, and APOE epsilon4 examined the association between baseline depressive symptoms and the risk of dementia and Alzheimer disease (AD).
During the 17-year follow-up period, 164 participants developed dementia; 136 of these cases were AD. A total of 21.6% of participants who were depressed at baseline developed dementia compared with 16.6% of those who were not depressed. Depressed participants (CES-D >/=16) had more than a 50% increased risk for dementia (hazard ratio [HR] 1.72, 95% confidence interval [CI] 1.04-2.84, p = 0.035) and AD (HR 1.76, 95% CI 1.03-3.01, p = 0.039). Results were similar when we included subjects taking antidepressant medications as depressed. For each 10-point increase on the CES-D, there was significant increase in the risk of dementia (HR 1.46, 95% CI 1.18-1.79, p < 0.001) and AD (HR 1.39, 95% CI 1.11-1.75, p = 0.005). Results were similar when we excluded persons with possible mild cognitive impairment.
Depression is associated with an increased risk of dementia and AD in older men and women over 17 years of follow-up.
Emerging data suggest that psychological and experiential factors are associated with risk of Alzheimer disease (AD), but the association of purpose in life with incident AD is unknown.
To test the hypothesis that greater purpose in life is associated with a reduced risk of AD.
Prospective, longitudinal epidemiologic study of aging.
Senior housing facilities and residences across the greater Chicago metropolitan area.
More than 900 community-dwelling older persons without dementia from the Rush Memory and Aging Project.
Participants underwent baseline evaluations of purpose in life and up to 7 years of detailed annual follow-up clinical evaluations to document incident AD. In subsequent analyses, we examined the association of purpose in life with the precursor to AD, mild cognitive impairment (MCI), and the rate of change in cognitive function.
During up to 7 years of follow-up (mean, 4.0 years), 155 of 951 persons (16.3%) developed AD. In a proportional hazards model adjusted for age, sex, and education, greater purpose in life was associated with a substantially reduced risk of AD (hazard ratio, 0.48; 95% confidence interval, 0.33-0.69; P < .001). Thus, a person with a high score on the purpose in life measure (score = 4.2, 90th percentile) was approximately 2.4 times more likely to remain free of AD than was a person with a low score (score = 3.0, 10th percentile). This association did not vary along demographic lines and persisted after the addition of terms for depressive symptoms, neuroticism, social network size, and number of chronic medical conditions. In subsequent models, purpose in life also was associated with a reduced risk of MCI (hazard ratio, 0.71; 95% confidence interval, 0.53-0.95; P = .02) and a slower rate of cognitive decline (mean [SE] global cognition estimate, 0.03 [0.01], P < .01).
Greater purpose in life is associated with a reduced risk of AD and MCI in community-dwelling older persons.
The concept of reserve has been proposed to account for the disjunction between the degree of brain damage and its clinical outcome. This paper attempts to produce a coherent theoretical account the reserve in general and of cognitive reserve in particular. It reviews epidemiologic data supporting the concept of cognitive reserve, with a particular focus of its implications for aging and dementia. It then focuses on methodologic issues that are important when attempting to elucidate the neural underpinnings of cognitive reserve using imaging studies, and reviews some of our group's work in order to demonstrate these issues.
Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.
Subjective well-being (SWB), people's emotional and cognitive evaluations of their lives, includes what lay people call happiness, peace, fulfillment, and life satisfaction. Personality dispositions such as extraversion, neuroticism, and self-esteem can markedly influence levels of SWB. Although personality can explain a significant amount of the variability in SWB, life circumstances also influence long-term levels. Cultural variables explain differences in mean levels of SWB and appear to be due to objective factors such as wealth, to norms dictating appropriate feelings and how important SWB is considered to be, and to the relative approach versus avoidance tendencies of societies. Culture can also moderate which variables most influence SWB. Although it is challenging to assess SWB across societies, the measures have some degree of cross-cultural validity. Although nations can be evaluated by their levels of SWB, there are still many open questions in this area.
We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and "cognitive impairment, not demented" (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data.
The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals age 70 or older who were participants in the ongoing HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g. Alzheimer's disease, vascular dementia) were assigned to denote the etiology of cognitive impairment.
Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia.
Numerous studies show that happy individuals are successful across multiple life domains, including marriage, friendship, income, work performance, and health. The authors suggest a conceptual model to account for these findings, arguing that the happiness-success link exists not only because success makes people happy, but also because positive affect engenders success. Three classes of evidence--crosssectional, longitudinal, and experimental--are documented to test their model. Relevant studies are described and their effect sizes combined meta-analytically. The results reveal that happiness is associated with and precedes numerous successful outcomes, as well as behaviors paralleling success. Furthermore, the evidence suggests that positive affect--the hallmark of well-being--may be the cause of many of the desirable characteristics, resources, and successes correlated with happiness. Limitations, empirical issues, and important future research questions are discussed.
This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is Suited for use with different age groups, and other potential uses of the scale are discussed.
The internal structure of the revised Life Orientation Test (LOT-R, German version; M. F. Scheier, C. S. Carver, & M. W. Bridges, 1994) was analyzed in a sample of 46,133 participants who ranged in age from 18 years to 103 years. Confirmatory factor analysis showed that dispositional optimism, as measured by the LOT-R, is bidimensional, consisting of an Optimism and a Pessimism factor. Consistent with previous results, there were small to moderate negative correlations between Optimism and Pessimism, but the strength of the association continuously decreased with age. The relative independence of the 2 dimensions occurred in both genders and across different age groups of patients with different medical disorders.
The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the US and other high-income countries suggest that the age-specific risk of dementia may have declined over the last 25 years. Clarifying current and future population trends in dementia prevalence and risk has important societal implications.
We used data from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of US adults to compare the prevalence of dementia in the US in 2000 and 2012. Our sample included individuals aged 65 or older from the 2000 (N = 10,675) and 2012 (N = 10,627) waves of the HRS. Dementia was identified in each year using HRS cognitive measures and validated diagnostic classifications.
Dementia prevalence decreased from 11.7% in 2000 to 9.0% (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.7 to 12.7 years; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile among older US adults.
The prevalence of dementia in the US declined significantly between 2000 and 2012. An increase in educational attainment among older adults was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain.
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality rates, costs of care, and the overall impact on caregivers and society. The Special Report examines how the use of biomarkers may influence the AD diagnostic process and estimates of prevalence and incidence of the disease. An estimated 5.5 million Americans have Alzheimer's dementia. By mid-century, the number of people living with Alzheimer's dementia in the United States is projected to grow to 13.8 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops Alzheimer's dementia every 66 seconds. By 2050, one new case of Alzheimer's dementia is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year. In 2014, official death certificates recorded 93,541 deaths from AD, making AD the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age ≥65 years. Between 2000 and 2014, deaths resulting from stroke, heart disease, and prostate cancer decreased 21%, 14%, and 9%, respectively, whereas deaths from AD increased 89%. The actual number of deaths to which AD contributes is likely much larger than the number of deaths from AD recorded on death certificates. In 2017, an estimated 700,000 Americans age ≥65 years will have AD when they die, and many of them will die because of the complications caused by AD. In 2016, more than 15 million family members and other unpaid caregivers provided an estimated 18.2 billion hours of care to people with Alzheimer's or other dementias. This care is valued at more than 259 billion. In recent years, efforts to develop and validate AD biomarkers, including those detectable with brain imaging and in the blood and cerebrospinal fluid, have intensified. Such efforts could transform the practice of diagnosing AD from one that focuses on cognitive and functional symptoms to one that incorporates biomarkers. This new approach could promote diagnosis at an earlier stage of disease and lead to a more accurate understanding of AD prevalence and incidence.
Importance:
The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.
Objective:
To compare the prevalence of dementia in the United States in 2000 and 2012.
Design, setting, and participants:
We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.
Main outcomes and measures:
Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.
Results:
The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.
Conclusions and relevance:
The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.
Objective:
Higher levels of optimism have been linked with positive health behaviors, biological processes, and health conditions that are potentially protective against cognitive impairment in older adults. However, the association between optimism and cognitive impairment has not been directly investigated. We examined whether optimism is associated with incident cognitive impairment in older adults.
Methods:
Data are from the Health and Retirement Study. Optimism was measured by using the Life Orientation Test-R and cognitive impairment with a modified version of the Telephone Interview for Cognitive Status derived from the Mini-Mental State Examination. Using multiple logistic regression models, we prospectively assessed whether optimism was associated with incident cognitive impairment in 4624 adults 65 years and older during a 4-year period.
Results:
Among participants, 312 women and 190 men developed cognitive impairment during the 4-year follow-up. Higher optimism was associated with decreased risk of incident cognitive impairment. When adjusted for sociodemographic factors, each standard deviation increase in optimism was associated with reduced odds (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.61-0.81) of becoming cognitively impaired. A dose-response relationship was observed. Compared with those with the lowest levels of optimism, people with moderate levels had somewhat reduced odds of cognitive impairment (OR = 0.78, 95% CI = 0.59-1.03), whereas people with the highest levels had the lowest odds of cognitive impairment (OR = 0.52, 95% CI = 0.36-0.74). These associations remained after adjusting for health behaviors, biological factors, and psychological covariates that could either confound the association of interest or serve on the pathway.
Conclusions:
Optimism was prospectively associated with a reduced likelihood of becoming cognitively impaired. If these results are replicated, the data suggest that potentially modifiable aspects of positive psychological functioning such as optimism play an important role in maintaining cognitive functioning.
The concept of reserve has been proposed to account for the disjunction between the degree of brain damage and its clinical outcome. After reviewing epidemiologic data supporting the concept of cognitive reserve, this chapter focuses on methodologic approaches for imaging studies intended to delineate the neural underpinnings of cognitive reserve (CR). It suggests three interrelated questions that can guide this research: Do old and young individuals use the same or different networks to mediate task performance? If they use the same network, can CR be related to individual differences in network efficiency and capacity? If they use different networks, can CR be related to this compensatory activation? Finally it raises the possibility that CR might be mediated by a generalized network that is independent of the specific demands of the task at hand.
This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is suited for use with different age groups, and other potential uses of the scale are discussed.
Knowledge of psychological well-being persistently lags behind knowledge of psychological dysfunction. The imbalance is evident in magnitude of research-studies of psychological problems dwarf the literature on positive psychological functioning-and in the meaning of basic terms (e.g., typical usage equates health with the absence of illness). A person is viewed as mentally sound if he or she does not suffer from anxiety, depression, or other forms of psychological symptomatology. This prevailing formulation never gets to the heart of wellness; to do so, we must define mental health as the presence of the positive. To explicate the positive is, however, to grapple with basic values and ideals of the human experience. These values are no less evident in definitions of human suffering, although consensus in identification of the negative is somehow easier to achieve. Despite these challenges, much has been written, within the field of psychology and outside it, regarding the contours of positive psychological functioning.
Background:
We examine whether broad factors and specific facets of personality are associated with increased risk of incident Alzheimer's disease (AD) in a long-run longitudinal study and a meta-analysis of published studies.
Methods:
Participants (n = 1671) were monitored for up to 22 years from a baseline personality assessment. The meta-analysis pooled results from up to five prospective studies (n = 5054).
Results:
Individuals with scores in the top quartile of neuroticism (hazard ratio = 3.1; 95% confidence interval = 1.6-6.0) or the lowest quartile of conscientiousness (hazard ratio = 3.3; 95% confidence interval = 1.4-7.4) had a threefold increased risk of incident AD. Among the components of these traits, self-discipline and depression had the strongest associations with incident AD. The meta-analysis confirmed the associations of neuroticism (P = 2 × 10(-9)) and conscientiousness (P = 2 × 10(-6)), along with weaker effects for openness and agreeableness (P < .05).
Conclusions:
The current study and meta-analysis indicate that personality traits are associated with increased risk of AD, with effect sizes similar to those of well-established clinical and lifestyle risk factors.
The authors examined social class differences in 2 aspects of the sense of control (mastery and perceived constraints) in 3 national probability samples of men and women ages 25-75 years (N1 = 1,014; N2 = 1,195; N3 = 3,485). Participants with lower income had lower perceived mastery and higher perceived constraints, as well as poorer health. Results of hierarchical multiple regression analyses showed that for all income groups, higher perceived mastery and lower perceived constraints were related to better health, greater life satisfaction, and lower depressive symptoms. However, control beliefs played a moderating role; participants in the lowest income group with a high sense of control showed levels of health and well-being comparable with the higher income groups. The results provided some evidence that psychosocial variables such as sense of control may be useful in understanding social class differences in health.
Personality and risk of Alzheimer's disease: new data and meta‐analysis
- A Terracciano
- Y An
- AR Sutin
- M Thambisetty
- SM Resnick
Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem)-a reevaluation of the Life Orientation Test
- Scheier