Purpose in life: Mechanisms to support healthier cognitive aging and reduce risk of Alzheimer's disease

点击翻译按钮获取中文摘要

Project Summary Purpose in life is the belief that one’s life and activities are goal-oriented, directed, and worthwhile. This belief is associated consistently with better outcomes, including greater engagement in health promoting behavior (e.g., less smoking, more physical activity), fewer chronic diseases (e.g., cardiovascular disease, diabetes), and ultimately greater longevity. Independent of behavioral and clinical factors, purpose in life is associated with better cognitive outcomes, including lower risk of Alzheimer’s disease and related dementias (ADRD). ADRD remains a significant challenge to patients, their families, and the healthcare system, as it is one of the leading causes of death that lacks disease-modifying treatments or cures. There is a growing literature that shows that purpose in life is protective across the arc of the ADRD disease spectrum: It is associated with better performance on cognitive tasks and less cognitive decline prior to dementia onset, it is protective against cognitive impairments, both mild and severe, and, even after diagnosis, it is associated with fewer behavioral and psychological symptoms of dementia. In a parallel literature, there is consistent evidence from randomized controlled trials that purpose in life is malleable and can be increased through intervention. Purpose in life is thus poised to be a powerful target of intervention to improve cognitive outcomes, from maintaining cognitive function in middle adulthood to improving outcomes in dementia care. The next step in intervention development is to identify the putative mechanisms of action hypothesized to change in response to the intervention and explain the relation between purpose and better cognitive outcomes. Once these mechanisms are identified, interventions that increase purpose to improve cognitive outcomes can be developed and tested. As a step toward this long-term goal, the present study will use ecological momentary assessments (EMA) to identify the daily mechanisms responsible for the association between purpose in life and healthier cognitive outcomes. In particular, we will test the hypothesis that purpose in life is associated with greater momentary engagement and better momentary cognition, which will support healthier cognitive function over time. We will address these associations in three groups considered critical populations for intervention: older adults with subjective cognitive impairment, older adults with healthy cognition, and middle-aged adults. This research will provide much needed information on putative mechanisms of action that explain how purpose protects cognition. Such information is critical to develop purpose interventions that promote healthier cognitive aging.