Change in Purpose in Life Before and After Onset of Cognitive Impairment.
Change in Purpose in Life Before and After Onset of Cognitive Impairment.
复制标题
DOI：
10.1001/jamanetworkopen.2023.33489
复制
发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Terracciano, Antonio
中科院分区：
文献类型：
--
作者：
Sutin, Angelina R.;Luchetti, Martina;Stephan, Yannick;Terracciano, Antonio
这项队列研究使用来自健康与退休研究和国家健康与老龄化趋势研究的数据来评估认知障碍发作前后生活目的的变化。在认知障碍发作前后，生活目的是否发生了变化？这项队列研究分析了健康与退休研究（HRS）中22668名参与者的50985项生活目的评估，以及国家健康与老龄化趋势研究（NHATS）中10786名参与者的53880项评估。目的性在HRS认知功能障碍发作前后显著下降，发作后下降幅度更大，这一模式在NHATS中得到了复制。研究结果表明，在认知障碍的早期阶段，生活目的有一个小但加速的下降。生活目的是心理健康的一个重要方面，与痴呆症连续体的更好认知结果相关。据我们所知，目的与认知障碍发作的自然史尚未得到评估。评估认知障碍发作前后生活目的的变化。这项队列研究使用了2006年3月至2021年5月的健康与退休研究（HRS）和2011年5月至2021年11月的国家健康与老龄化趋势研究（NHATS）的生活目的和认知状态评估。基于HRS和NHATS中确定的阈值，每个波的认知功能障碍。主要结果是生活目的，用HRS中的心理健康Ryff测量方法和NHATS中的验证项目测量。在HRS中，22668名参与者在所有波中提供了50985份目的评估。在NHATS中，10 786名参与者提供了53 880份所有波浪的目的评估。在HRS中，58.3%的受试者为女性，基线时平均（SD）年龄为64.76（10.41）岁;在NHATS中，57.4%的受试者为女性，基线时平均（SD）年龄为76.82（7.71）岁。在各波中，6794名HRS参与者（30%）和4446名NHATS参与者（41.2%）处于认知障碍范围内。考虑到人口统计学协变量和目标的规范性变化，多水平模型表明，标准化的生活目标在认知障碍发作前显著下降HRS（B = −0.12; 95% CI，−0.17至−0.07; P < .001）和NHATS（B = −0.10; 95% CI，−0.20至−0.01; P = .03）中的（10年估计值）。在认知障碍发作后，目的性下降明显更快，HRS组的标准化下降幅度是认知障碍发作前的近3倍（B =-0.35; 95% CI，-0.41至-0.29; P < .001），NHATS组的标准化下降幅度是认知障碍发作前的4倍（B =-0.44; 95% CI，-0.53至-0.34; P < .001）。在这项队列研究中，生活目的随着认知障碍的出现而下降。发病前的下降太小，在临床环境中检测即将发生的损害是有用的。受损后的急剧下降表明，个人意识到他们的目标正在下降。目的可能是认知障碍后的干预目标，以维持幸福感并减少或减缓与低目的相关的行为症状的出现。
This cohort study uses data from the Health and Retirement Study and the National Health and Aging Trends Study to assess changes in purpose of life before and after onset of cognitive impairment. Is there a change in purpose in life before and after onset of cognitive impairment? This cohort study analyzed 50 985 assessments of purpose in life from 22 668 participants in the Health and Retirement Study (HRS) and 53 880 assessments from 10 786 participants in the National Health and Aging Trends Study (NHATS). Purpose declined significantly before and after the onset of cognitive impairment in HRS, with a greater decline after onset, a pattern that was replicated in NHATS. The findings suggest that purpose in life has a small but accelerating decline during the early stages of cognitive impairment. 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. To evaluate changes in purpose in life prior to and after onset of cognitive impairment. 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). Cognitive impairment at each wave based on established thresholds in HRS and NHATS. The main outcome was purpose in life, measured with the Ryff Measures of Psychological Well-Being in HRS and a validated item in NHATS. 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). 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.
登录
查看更多内容
DOI：
10.1093/gerona/glad117
发表时间：
2023-05-04
影响因子：
5.1
作者：
Smith, Jason R.;Huang, Alison R.;Deal, Jennifer A.
通讯作者：
Deal, Jennifer A.
DOI：
10.3233/jad-201184
发表时间：
2021
期刊：
Journal of Alzheimer's disease : JAD
影响因子：
--
作者：
Ismail Z;McGirr A;Gill S;Hu S;Forkert ND;Smith EE
通讯作者：
Smith EE
影响因子：
3.4
作者：
Dyer, Adam H.;Murphy, Claire;Kennelly, Sean P.
通讯作者：
Kennelly, Sean P.
影响因子：
4
作者：
通讯作者：
--
DOI：
10.1093/geronb/gbq092
发表时间：
2011-03-01
影响因子：
6.2
作者：
Mak, Wingyun
通讯作者：
Mak, Wingyun