Does losing your sense of purpose signal the onset of cognitive decline?

By Dr. Priyom Bose, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Sep 19 2023

Purpose in life is an essential aspect of psychological well-being, as it is linked with better cognitive outcomes in patients with dementia. A recent JAMA Network Open study evaluates changes in an individual’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Individuals with dementia often appear withdrawn from activities that they once found meaningful. A solution to this problem could be to have a purpose in life.

Purpose in life is a core component of psychological well-being and is defined as the feeling that one’s life is goal-oriented, meaningful, and has direction. Research has shown a link between purpose and cognitive ability, as those who report higher purpose also perform better 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 overall health of these individuals. 

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

About the study

The present 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 assess purpose in life in HRS. In NHATS, purpose in life was measured slightly differently with the item “My life has meaning and purpose,” in which individuals rated this statement from one or ‘agreeing a lot,’ to three, or agreeing not at all.’ 

Key findings

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

Changes in apathy and purpose, which have been documented in previous studies, were different and more notable from those reported in the current study. This could be because the participants of the present study were still active in HRS and NHATS and could 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 current study contributes to the general knowledge of purpose in life and the natural history of purpose in the context of cognitive impairment. Future studies are needed to evaluate how purpose can be supported as cognitive impairment commences and how to identify and support purpose during 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 during cognitive impairment.

The main strength of the current study is the use of two independent samples, which ensured the robustness of the findings. The large sample sizes and repeated longitudinal assessments also contributed to the robustness of the results, as similar results across two samples reduced the likelihood that the observed patterns were due to chance. 

Some limitations of the current study include the use of performance-based measures to identify cognitive impairment. The focus on the earlier stages of cognitive impairment could also be considered a study limitation.  

Both studies were conducted in the United States, which could limit the generalizability of the results. The number of assessments was also limited, especially in HRS, suggesting that some estimates should be interpreted cautiously.

In the future, rather than using self-reported data, a clinical diagnosis of mild cognitive impairment or dementia could be used. Samples from more diverse geographic locations should also be examined.