Action Points
- Explain to interested patients that among the elderly, having a purpose in life has been associated with a variety of physical and mental health benefits. This study showed that older people with a greater sense of purpose in life were less likely to develop Alzheimer's disease.
- Point out that this study cannot establish a causal link between purpose in life and Alzheimer's disease.
Patients who maintain a greater sense of purpose in life as they age may have greater protection against Alzheimer's disease, researchers have found.
Those with a purpose had more than a 50% reduced risk of the disease (HR 0.48, 95% CI 0.33 to 0.69,P<0.001), Patricia A. Boyle, PhD, of Rush University Medical Center in Chicago, and colleagues reported in the March Archives of General Psychiatry.
"The tendency to derive meaning from life's experiences and to possess a sense of intentionality and goal directedness are associated with a substantially reduced risk of Alzheimer's disease and a less rapid rate of cognitive decline in older age," the researchers wrote.
Some data have suggested that psychological factors such as extraversion and neuroticism, as well as experiential factors including social networks, are associated with risk of Alzheimer's disease.
Purpose -- which the researchers define as a "psychological tendency to derive meaning from life's experiences and to possess a sense of intentionality and goal directedness that guides behavior" -- has long been hypothesized to protect against adverse health outcomes.
For example, it was recently reported to be associated with longevity, they noted.
But there was little information on the association of purpose with Alzheimer's disease.
So the researchers conducted a prospective, longitudinal study of 951 community-dwelling older patients without dementia who participated in the Rush Memory and Aging Project. At baseline, the mean age of the participants was 80.4 years.
Each had a baseline evaluation about purpose in life, which incorporated a 10-item scale that included agree/don't-agree statements such as "I feel good when I think of what I have done in the past and what I hope to do in the future" and "I enjoy making plans for the future and working them to a reality."
Patients were followed for up to seven years, with a mean follow-up of about four years.
During that time, 155 patients developed Alzheimer's disease.
The researchers found that those who developed the disease were older and reported lower purpose in life than those who did not.
Greater purpose in life was associated with a substantially reduced risk of disease (HR 0.48, 95% CI 0.33 to 0.69, P<0.001).
And a person with a high score on the purpose in life measurement was 2.4 times more likely to remain disease- free than a low-scorer.
The association persisted after controlling for several factors, including depressive symptoms, neuroticism, social network size, and number of chronic medical conditions, the researchers found. (HR 0.60, 95% CI 0.39 to 0.92, P=0.02).
Similarly, those who developed mild cognitive impairment (MCI) were older and reported lower purpose in life scores. They also had a higher number of depressive symptoms.
Having a greater sense of purpose was associated with reduced MCI risk of almost 30% (HR 0.71, 95% CI 0.53 to 0.95, P=0.02), as well as a 1.5-fold increased likelihood of remaining MCI-free, compared with someone with a low score.
These patients also had a significantly slower rate of cognitive decline, the researchers reported (P<0.01).
They said they are unsure of the biological mechanisms involved in the association, but other studies have found sense of purpose to be negatively associated with immune markers, including cortisol and inflammatory cytokines.
Sense of purpose also been positively associated with high-density lipoprotein (HDL), or "good," cholesterol, and negatively correlated with waist-hip ratios.
The findings may have important public health implications, the researchers added, as they potentially provide a new treatment target for interventions aimed at enhancing health and well-being in older adults.
"Purpose in life is a potentially modifiable factor that may be increased via specific behavioral strategies that can help older persons identify personally meaningful activities and engage in goal-directed behaviors," they wrote.
"Even small behavioral modifications ultimately may translate into an increased sense of intentionality, usefulness, and relevance."
Among the limitations of the study, the authors said, were possibly limited generalizability, and inability to determine causation.
In addition they noted that "there are factors that we did not measure (e.g., apathy, motivation, and spirituality or religiosity) that may affect the associations of purpose in life with health outcome."
The study was supported by grants from the National Institute on Aging, the Illinois Department of Public Health, and the Robert C. Borwell Endowment Fund.
The researchers reported no conflicts of interest.
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