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

项目摘要 生活的目的是相信一个人的生活和活动是有目标的、有方向的、有价值的。这种信念是 与更好的结果相关联，包括更多地参与促进健康的行为(例如， 更少的吸烟，更多的体力活动)，更少的慢性病(例如心血管疾病，糖尿病)，以及 最终会更长寿。与行为和临床因素无关，生活目标与 更好的认知结果，包括降低阿尔茨海默病和相关痴呆(ADRD)的风险。ADRD 仍然是对患者、他们的家人和医疗保健系统的重大挑战，因为它是领先的 缺乏改善疾病的治疗或治愈的死因。有越来越多的文献表明 生活的目的是在ADRD疾病谱的弧线上提供保护：它与更好的 在认知任务中的表现和痴呆症发作前较少的认知衰退，它可以预防 认知障碍，无论是轻微的还是严重的，即使在诊断后，它也与较少的行为有关 以及痴呆症的心理症状。在一篇平行文献中，有一致的证据来自随机 以生活为目的的对照试验是可塑性的，可以通过干预来增加。人生的目标是这样的 准备成为一个强有力的干预目标，以改善认知结果，从维持认知功能 在成年中期改善痴呆症护理的结果。干预发展的下一步是 确定假设因干预而发生变化的行动机制，并解释 目的与更好的认知结果之间的关系。一旦确定了这些机制， 可以开发和测试旨在提高认知结果的干预措施。作为一个步骤 为了实现这一长期目标，本研究将使用生态瞬时评估(EMA)来确定 日常机制负责生活目标和更健康的认知结果之间的联系。在……里面 特别是，我们将检验这一假设，即生活目标与更多的瞬间投入和 更好的瞬间认知，随着时间的推移，这将支持更健康的认知功能。我们将解决这些问题 被认为需要干预的关键人群中的三组关联：患有主观认知的老年人 有障碍的老年人、认知健康的老年人和中年人。这项研究将提供急需的 关于解释目的如何保护认知的假定行动机制的信息。这样的信息是 关键是制定有目的的干预措施，促进更健康的认知老化。

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.