Purpose in life is a vital aspect of psychological well-being, because it is linked with higher cognitive outcomes in patients with dementia. A recent JAMA Network Open study evaluates changes in a person’s purpose in life before and after the onset of cognitive impairment.

Study: Change in Purpose in Life Before and After Onset of Cognitive Impairment. Image Credit: imtmphoto / Shutterstock.com

Background

Individuals with dementia often appear withdrawn from activities that they once found meaningful. An answer to this problem might be to have a purpose in life.

Purpose in life is a core component of psychological well-being and is defined as the sensation that one’s life is goal-oriented, meaningful, and has direction. Research has shown a link between purpose and cognitive ability, as those that report higher purpose also perform higher on cognitive tasks.

In dementia patients, having a purpose in life may reduce or forestall dementia-related apathy. Thus, engaging in social or creative activities, which has been encouraged across all stages of dementia and all ages, can support the general health of those individuals. 

Most research on psychological change during cognitive impairment has focused on clinical markers of mental health and trait facets of psychological function. Nevertheless, recent research has revealed that caregivers perceive significant declines in purpose in life after a dementia diagnosis.

In regards to the study

The current study used data from two large population-based longitudinal studies: the Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS). HRS data was obtained from March 2006 to May 2021, whereas NHATS data was acquired between May 2011 to November 2021.

The Purpose in Life subscale from the Ryff Measures of Psychological Well-Being was used to evaluate purpose in life in HRS. In NHATS, purpose in life was measured barely otherwise with the item “My life has meaning and purpose,” through which individuals rated this statement from one or ‘agreeing quite a bit,’ to a few, or agreeing by no means.’ 

Key findings

In each HRS and NHATS, modest reductions in purpose in life were observed before the event of cognitive impairment, with substantially greater declines reported during cognitive impairment. The aim in life decreased by about 10% of a regular deviation in the last decade before the onset of cognitive impairment. Notably, the pattern of change across each studies was similar despite any differences between the 2 study cohorts. 

Changes in apathy and purpose, which have been documented in previous studies, were different and more notable from those reported in the present study. This might be since the participants of the current study were still energetic in HRS and NHATS and will report their feelings, as their cognitive impairment was relatively low.   

The study findings suggest that alterations in self-reported purpose prior to impairment are too small to detect an imminent impairment meaningfully. This small change is unlikely to be perceived by standard clinical measures.

Nevertheless, the present study contributes to the final knowledge of purpose in life and the natural history of purpose within the context of cognitive impairment. Future studies are needed to guage how purpose could be supported as cognitive impairment commences and how one can discover and support purpose through the recovery phase.

Conclusions

Replicable declines in purpose in life were documented across preclinical and clinical stages of cognitive impairment. These reductions were significantly greater during cognitive impairment. Thus, measures to sustain purpose could support cognitive health before and through cognitive impairment.

The most important strength of the present study is using two independent samples, which ensured the robustness of the findings. The big sample sizes and repeated longitudinal assessments also contributed to the robustness of the outcomes, as similar results across two samples reduced the likelihood that the observed patterns were resulting from probability. 

Some limitations of the present study include using performance-based measures to discover cognitive impairment. The concentrate on the sooner stages of cognitive impairment may be considered a study limitation.  

Each studies were conducted in the US, which could limit the generalizability of the outcomes. The variety of assessments was also limited, especially in HRS, suggesting that some estimates needs to be interpreted cautiously.

In the long run, moderately than using self-reported data, a clinical diagnosis of mild cognitive impairment or dementia might be used. Samples from more diverse geographic locations also needs to be examined.