Here’s what could be a sign of future cognitive decline
People who developed mild cognitive impairment had lower levels of purpose in life and of personal growth starting three and six years, respectively, before their diagnosis, compared with participants who remained cognitively intact, according to a study published Tuesday in the Journal of Neurology Neurosurgery & Psychiatry. Mild cognitive impairment, in which a person goes through an early stage of loss of memory or other cognitive abilities but still maintains the ability to independently do most activities of daily living, is often a precursor to dementia.
The study “is a strong test of the changes in psychological well-being that may occur during the earliest stages of the development of cognitive impairment,” said Dr. Angelina Sutin, professor of behavioral sciences and social medicine at the Florida State University College of Medicine, via email. Sutin wasn’t involved in the study.
More than 55 million people worldwide have dementia, which is a leading cause of death and is expected to affect nearly three times that many people by 2050. There is no cure for the disease, but the authors think the long period between when the disease biologically begins and when symptoms appear “may provide a critical time window for implementing (interventions) to prevent or delay its onset,” they wrote.
Poorer psychological well-being has been previously associated with higher risk of dementia, but both how wellness changes along the course of disease and which aspects of well-being are most influential haven’t been clear, according to the authors. And knowing these answerscould be helpful for managing risk or symptoms after diagnosis.
The research team used data from 910 cognitively intact older adults from the Illinois-based Rush Memory and Aging Project, or MAP, an ongoing study that began in 1997. For up to 14 years starting in 2008, participants — most of whom were women and White — underwent annual assessments regarding neurological, cognitive, medical and psychological health. Psychological well-being was based on six components: self-acceptance, autonomy, purpose in life, personal growth, positive relation with others and ability to manage one’s immediate environment.
Compared with participants who remained cognitively intact, psychological well-being declined faster in older adults who ultimately developed cognitive impairment, and their well-being was lower two years before diagnosis — indicating poorer wellness, especially purpose and personal growth, could be a predictor for future cognitive impairment, the authors said.
Positive relations with others declined rapidly after diagnosis, while the rate of decline for other well-being components remained the same before and after diagnosis.
Though “not surprising,” the study “highlights the importance of wellness potentially both as a way to stave off dementia but also, when worsening, as a possible warning sign of dementia,” said Dr. Glen R. Finney, director of the Geisinger Memory and Cognition Program in Pennsylvania, via email. Finney wasn’t involved in the study.
Well-being and cognitive decline
More research is needed due to the lack of diversity in this study, which also includes the fact that participants were volunteers from communities with higher levels of education, the study authors said.
But “given that the findings are broadly similar to the few other studies that have used more diverse samples, I am not that concerned about these limitations,” Sutin said.
It’s possible that poor well-being may lead to cognitive impairment and vice versa. On one hand, greater well-being may lower risk for cognitive impairment and dementia by mitigating the effects of Alzheimer’s disease processes on cognition, the authors said. Positive well-being has been associated with lower levels of inflammatory cytokines and lower cardiovascular risk, which can reduce risk of cognitive impairments.
But on the other, there may be “a vicious cycle where neurodegenerative disease in the brain like Alzheimer’s disease, some of which starts years or even decades before cognitive symptoms and signs, could decrease function in the brain networks that help you maintain your wellness and initiative causing apathy a lack of drive to do or achieve,” Finney said. “This study suggests that could be happening even before some of the cognitive changes are picked up even when being actively monitored for cognitive changes.”
Participants’ social lives declined after being diagnosed with mild cognitive impairment, and the study authors said that could be because the condition can make it harder to stay socially engaged.
Compared with participants who remained cognitively intact, those who developed cognitive impairment were more likely to be older and have lower body mass index (BMI) and lower psychological well-being. Those diagnosed with dementia were more likely to be older and have the APOE ε4 allele, a gene that makes people more at risk for Alzheimer’s.
Enrich your life, protect your brain
Maintaining wellness, seeking purpose and continuing personal growth are always important and make life better in general, but in older age, in some ways these endeavors are more critical than ever, Finney said.
“Seek out socialization to keep your brain healthy and to support your wellness (and) find things that are meaningful to you to participate in, but also seek out new ways to learn and grow as a person,” he added.
Those activities can be everyday things, Sutin said — they don’t have to be new or complicated to be helpful or meaningful. They can include strategy games, high-level reading material or learning how to approach a typical task more effectively, according to the Alzheimer’s Association, which has resources on ways to preserve brain health. Formal education is another way to stay cognitively and socially adept, and some schools offer scholarships for older students.
You can also make new friends (or keep up with old ones) by participating in clubs, volunteering or joining a fitness group in your community.
READ MORE: Asking yourself ‘What’s the meaning of life?’ may extend it
If you’re finding it’s hard to stay socially or mentally active, talk with your doctor about whether that could be a sign of neurodegenerative disease, Finney recommended.
“Addressing risk factors proactively helps lower risk for dementia, helps preserve function in the face of dementia and can at least in part help reverse some mild symptoms early on before dementia takes hold,” he said.
The authors suggest that the long period between the onset of the disease and symptom appearance in mild cognitive impairment could be a critical time window for implementing interventions to prevent or delay the onset of dementia, due to the association between poorer psychological well-being and a higher risk of dementia. Engaging in activities that seek purpose, personal growth, and socialization can be beneficial for preserving brain health and wellness, according to the Alzheimer's Association.
