Well-Being Declines Before Mild Cognitive Impairment

Psychological well-being waned in the years before mild cognitive impairment, a study of older adults in the Chicago area showed.

Among 910 cognitively normal older adults who were followed for up to 14 years, those who developed incident mild cognitive impairment had a faster decline in well-being than others (β = -0.015), according to Jie Guo, PhD, of the Aging Research Center at the Karolinska Institute in Stockholm, and co-authors.

Compared with older adults who remained cognitively intact, those who developed mild cognitive impairment had faster downturns in two well-being components — purpose in life (β = -0.126) and personal growth (β = -0.139) — the researchers reported in the Journal of Neurology, Neurosurgery, and Psychiatry.

A decline in purpose started 3 years before diagnosis; lower personal growth started 6 years before. Positive relations with others decreased faster after mild cognitive impairment diagnosis than before (β = -0.042).

Well-being has been linked with cognitive decline and dementia, but the trajectories of psychological well-being and its components along the dementia course aren’t clear, Guo noted. Some studies have suggested the relationship between well-being and cognitive decline may be bi-directional.

“Understanding how psychological well-being changes throughout the progression of dementing disorders could better inform its potential role as a predictor of dementia risk and provide relevant information for healthcare planning after diagnosis,” Guo noted in an email to MedPage Today.

For people with mild cognitive impairment in this study, well-being declined in similar patterns regardless of whether they eventually developed dementia or not, she pointed out.

Reduced psychological well-being may be a predictor for impaired cognitive function, Guo suggested. “Post-diagnostic psychological support should be planned for people diagnosed with dementing disorders,” she wrote.

Guo and colleagues explored changes in psychological well-being before and after diagnoses of mild cognitive impairment and dementia in 910 cognitively intact older adults in the long-running Rush Memory and Aging Project cohort in Chicago. Participants had annual follow-up assessments that included neurological examination, cognitive tests, medical history, and psychological well-being assessments. The researchers adjusted findings for age, vascular disease and vascular risk factors, lifestyle, social activities, and loneliness.

Well-being was measured with Ryff Scales of Psychological Well-Being, which assessed self-acceptance, autonomy, environmental mastery, purpose in life, positive relations with others, and personal growth.

Baseline mean age was 79.9 and 76.9% of participants were female. Median follow-up duration was 6 years. During the follow-up period, 265 people developed mild cognitive impairment and 89 developed dementia.

Compared with those who remained cognitively intact, participants who developed mild cognitive impairment were older, weighed less, and had lower levels of psychological well-being. Those who developed dementia were older, more likely to carry an APOE4 allele, and had a lower level of well-being than those who did not have dementia.

Why certain well-being components were linked with mild cognitive impairment in this study and others wasn’t clear, the researchers noted. “Our findings indicate that personal growth and purpose in life may be more cognitively demanding than other components of well-being, and therefore may serve as more sensitive indicators of cognitive aging,” they wrote.

“Moreover, we found that positive relations with others declined rapidly after mild cognitive impairment diagnosis,” they added. “People with impaired cognitive function may be less likely to engage in social and leisure activities than they were previously, which can cause further deterioration in their relationships with friends or others.”

The Ryff scales assess each well-being component with only three items, which may introduce measurement error, Guo and colleagues noted. The study population consisted of volunteers who had a high level of education; most were white and female, and results may not apply to others. While effect sizes were significant, many were not substantial, possibly due to the inclusion of healthy volunteers.

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