How Does Psychosocial Behavior Contribute to Cognitive Health in Old Age?

Abstract

With the aging of the U.S. population, the number of cognitively disabled persons is expected to substantially increase in coming decades, underscoring the urgent need for effective interventions. Here, we review the current evidence linking psychosocial factors to late-life cognitive loss and consider the study design needed to illuminate the biologic bases of the associations. We then examine an ongoing study that includes several of the key design elements, the Rush Memory and Aging Project. In this longitudinal clinical-pathological cohort study, indicators of personality, social connectedness, and psychological well-being were shown to predict late-life cognitive outcomes. Participants who died underwent a uniform neuropathologic examination to quantify common dementia-related pathologies. Some psychosocial indicators were associated with cerebral infarction; some indicators modified the association of neurodegenerative pathologies with cognitive loss; and the association of some indicators with cognitive outcomes appears to be independent of the pathologies traditionally associated with late-life dementia. These findings suggest that psychosocial behavior influences late-life cognitive health through multiple neurobiologic mechanisms. A better understanding of these mechanisms may lead to novel strategies for preserving cognitive health in old age.

Meaning in life: resilience beyond reserve

“…In accordance with the conceptualization that PiL buffers against stressors, thereby providing an alternative compensatory mechanism to protect cognition, Wilson and Bennett [ 83 ] concluded, after reviewing the findings of the Rush Memory and Aging Project, that ‘for the most part, psychosocial measures have not been correlated with neuropathologic changes traditionally associated with dementia in old age’. However, greater levels of PiL have been reported to be associated with fewer subcortical gray matter lacunar infarcts in older adults.…”

“…According to this concept, anxiety, depression, sleep disorders, and repetitive negative thinking represent proxies of ‘cognitive debt’ that deplete resilience to brain diseases with advancing age [ 48 ]. Several studies have also reviewed the impact of the psychosocial aspects of life experience on cognitive health in aging, concluding that there is solid evidence linking some personality traits (e.g., neuroticism or conscientiousness) and social connectedness measures (particularly loneliness) with cognitive and clinical measures as well as putative biological mechanisms [ 83 ].…”

Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways

“…Psychosocial factors such as social connectedness protect against age‐related decline in cognitive function, probably through multiple neurobiological mechanisms. In the Rush Memory and Aging Project, an ongoing longitudinal clinical‐pathologic cohort study that began in 1997, a wide array of psychosocial behaviours were independently associated with the subsequent rate of cognitive decline and/or risk for incident cognitive diagnoses . These include trait and state measures of psychological distress, social isolation, social capital, emotional isolation and purpose in life.…”

The Barcelona Brain Health Initiative: A Cohort Study to Define and Promote Determinants of Brain Health

“…It has been estimated that several modifiable risk factors, such as physical activity, socialization, weight and blood pressure control, psychological well-being and cognitive activity across the lifespan could prevent more than 30% of the diagnosed cases of dementia ( Livingston et al, 2017 ). Similarly, it has been proposed that specific dietary patterns (e.g., Mediterranean diet; Guasch-Ferré et al, 2017 , see Loughrey et al, 2017 for a review) good sleep quality ( Sexton et al, 2014 ; Fung et al, 2016 ), and definition of a clear purpose in life ( Ryff et al, 2016 ; Wilson and Bennett, 2017 ) have a positive effect on brain health in aging and may reduce the incidence of brain diseases.…”