Lack of motivation and personal growth in older adults may precede mild cognitive impairment

Feelings that your life lacks meaning and that there are few opportunities for personal growth in old age may precede the development of mild cognitive impairment (MCI), a common precursor to dementia, suggests research published online in the Journal of the American Academy of Pediatrics. Journal of Neurology, Neurosurgery and Psychiatry.

These aspects of psychological well-being decline significantly 2 to 6 years before MCI is diagnosed, even in the absence of obvious signs, and regardless of whether affected people develop dementia, the findings indicate.

There is growing evidence linking psychological well-being to brain aging, including the development of dementia. But most published research focuses on a sense of purpose in life, excluding other aspects of well-being, the researchers explain.

These include self-acceptance, autonomy, a sense of ability to manage one’s immediate environment, having meaningful relationships with others, and personal growth.

To strengthen the evidence base, researchers explored changes over time in psychological well-being before and after MCI and dementia diagnoses in 910 cognitively intact older adults (mean age 79 years) participating in the Rush Memory and Aging Project.

This project is an ongoing, long-term study that began in 1997. It includes older adults living in assisted living and retirement communities, continuing care communities, social service agencies, religious groups, and single-family homes in northeastern Illinois, USA.

Study participants undergo annual examinations that include neurological exams, cognitive testing, medical history, and an assessment of psychological well-being, which as of 2008 included all six components.

During a mean follow-up period of 14 years, 265 (29%) developed MCI, of whom 89 (34%) subsequently developed dementia. The final analysis is based on 229 participants with complete pre-post data, of whom 73 developed dementia.

Compared with participants who remained cognitively intact, those who developed MCI were more likely to be older, weigh less, and have lower levels of depressive symptoms and psychological well-being.

Similarly, compared with those who did not develop dementia, those who did were more likely to be older, female, carry the dementia-related gene (APOE ε4), and have lower levels of psychological well-being.

After accounting for potentially influential factors, such as age, vascular disease and its risk factors, lifestyle, social activities, and feelings of loneliness, those who developed MCI experienced a more rapid decline in their psychological well-being, leading to a lower level of it 2 years before diagnosis, than those who remained cognitively intact.

In particular, these individuals exhibited lower levels of meaning in life and personal growth, beginning 3 and 6 years before their diagnosis, respectively.

The speed of decline in psychological well-being was similar before and after diagnosis for each component, except for meaningful connections with others, which declined more rapidly thereafter.

Well-being trajectories were similar for all participants with MCI, whether or not they later developed dementia, prompting the researchers to suggest that their findings “indicate that reduced psychological well-being, even without apparent cognitive impairment, may be a predictor of later dementia.”

This is an observational study, so no definitive conclusions can be drawn about cause and effect. The study participants were well-educated, which may introduce selection bias due to the “healthy volunteer” effect, and most were white and female, which may limit the generalizability of the results, the researchers acknowledge.

And the mechanisms underlying the association between well-being and cognitive function are not well understood, they add.

The two might be bidirectional: In other words, lower cognition might influence psychological well-being as well as the other way around; greater well-being and better cognitive function might also share some protective factors, they suggest.

And the gaps between the different components of well-being may stem from differences in the level of cognitive processing required, they say.

“Our results indicate that personal growth and purpose in life may be more cognitively demanding than other components of well-being and may therefore serve as more sensitive indicators of cognitive aging,” they write.

“In addition, we found that positive relationships with others declined rapidly after MCI diagnosis. People with impaired cognitive function may be less likely to engage in social and leisure activities than before, which may lead to further deterioration in their relationships with friends or others,” they add.

Psychological support should be provided for people diagnosed with dementia, they recommend.