Damian Sendler: Among our society’s most pressing public health issues is Alzheimer’s disease and associated dementias (ADRD). Adverse drug reactions (ADRD) are a major problem in low-income countries around the world [1]. As treatment options for ADRD are limited, the best course of action is prevention [1]. In order to meet this challenge, new intervention targets are urgently required. Purpose in life is an underappreciated but intriguing target for intervention.. Study findings suggest that a sense of purpose may be a powerful protective factor for healthy cognitive aging [2] and protects against ADRD risk factors that can be modified [3]. (e.g., physical inactivity, problems sleeping, elevated body weight [3]). Developing a stronger sense of purpose in life may have long-term benefits, such as reducing the risk of developing dementia.
Damian Jacob Sendler: It’s possible for a person to have a strong sense of purpose while also having a strong sense of triviality, and vice versa [4]. For example, two people may engage in the same behavior, but only one of them considers it to be meaningful. It’s possible to measure a person’s sense of purpose, despite the fact that it’s subjective. Having a sense of purpose can lead to feelings of motivation, drive, and direction in one’s life [4]. In terms of health outcomes, people who have a greater sense of purpose live longer and are less likely to develop diseases. An active life is linked to better cognitive health, according to recent research.
Dr. Sendler: The concept of a meaningful life encompasses a wide range of sub-concepts, including purpose, and it is important to remember this. Although there is a theoretical difference between meaning in life and purpose in life, the cognitive correlates are similar [6]. Purpose in life and healthy cognitive aging are our primary goals. If you are looking for a sense of purpose in your life, you may want to look for a sense of meaning in your life.
To better understand how a sense of purpose in life is linked to various aspects of dementia, including behavioral and clinical risk factors in adulthood before dementia, markers of cognitive health prior to dementia, markers of cognition during the transition to dementia, and better outcomes after diagnosis.
Older adults with a greater sense of purpose in life tend to perform better on tasks measuring episodic memory and verbal fluency before they become impaired [6]. To put it another way, they are able to remember more words (episodic memory) and quickly list examples of a category (e.g., animals; verbal fluency). Key indicators of cognitive health are the ability to remember and organize information, which is critical in older adults’ ability to maintain their independence. Additionally, how people perceive their cognition is a significant predictor of cognitive decline. Individuals may notice a decline in their cognitive abilities before deficits on standard cognitive tests are detected. Individuals with a higher sense of purpose, like those with a lower one, perceive their memory function to be better than those with a lower one, and these perceptions persist over time [7]. When combined with a slow walking speed, poor memory takes on a greater significance. A person is more likely to develop incident dementia if they have both motoric cognitive risk syndrome (MCR) and normal cognitive decline (NCD). Again, purpose serves as a powerful protective factor: People with a greater sense of purpose are less likely to develop MCR over the course of a decade [8].
To conclude, it’s no surprise that those who have more purpose in life are less likely to suffer from Alzheimer’s disease [9] and dementia [10] as they age. Indeed, a recent meta-analysis of six prospective studies found that even after accounting for sociodemographic, clinical, and behavioral risk factors, a greater sense of purpose is consistently associated with lower risk of developing dementia [10]. Anyone, even those with the lowest risk profiles, can develop ADRD at some point in their lives. It’s important to remember that having a goal in mind even after impairment has set in is associated with better outcomes. One of the most challenging aspects of caring for someone with dementia is dealing with the behavioral and psychological symptoms (BPSD) (e.g., uncontrolled temper, confusion). A knowledgeable proxy reports that people in their final year of life who self-reported having a greater sense of purpose before the onset of cognitive impairment have fewer BPSD [11]. People with dementia who report feeling a sense of meaning in their lives are more dedicated to achieving their goals, which in turn increases their feelings of momentary meaning [12].
Damian Jacob Markiewicz Sendler: Cognitive outcomes may be influenced by greater engagement, which is at the heart of a sense of purpose. Through better clinical and behavioral profiles, better cognitive outcomes can often be achieved (e.g., fewer chronic diseases, greater physical activity). While clinical and behavioral factors are linked to such profiles, they only account for a small portion of the relationship between dementia risk and these factors [9, 10]. People who are actively involved in their daily lives have higher levels of emotional resilience, persistence, attention, effort, and social integration [4], all of which may help protect their brains from damage. To maintain cognitive function in older adulthood, these different forms of engagement may help build both the brain reserve (e.g., stronger neuronal connections and synapses) as well as cognitive reserve (e.g., the ability of the brain to cope with changes caused by age and pathology) [13].
Damian Jacob Sendler
Research on purpose in life and cognition has relied heavily on samples from the United States and Europe. Many more studies are needed to see if purpose has the same protective associations in non-Western countries, such as cultures that are more collectivistic, practice different religions and have a different political structure, etc. However, emerging evidence from Western cultures shows that purpose is widely protective. However, studies that look for moderators show that the cognitive outcomes associated with purpose are similar across age, sex/gender and ethnic groups [9–10].
This suggests that a strong sense of purpose may be more protective in environments with a lower level of economic resources. There was a positive association between purpose and episodic memory in 30 countries in a meta-analysis of 32 countries, and the association was slightly stronger in lower-income countries as measured by GDP. Individuals with a greater sense of purpose were found to be more adept at mental tasks such as memory recall, even in economically challenging circumstances. According to this preliminary study, purpose appears to provide protection for people of all demographic groups, but it appears to provide even greater protection for the most vulnerable, suggesting that its benefits are not restricted to those with the greatest financial means.
Damian Sendler
Damien Sendler: People who have a strong sense of purpose in life are more likely to have better cognitive outcomes. Basic science knowledge on an attractive target is required to begin developing behavioral interventions, and this evidence is consistent with Stage 0 of the Stage Model for Behavioral Intervention Development. Following the development or adaptation of behavioral interventions for a sense of purpose and the initial testing of these interventions, the next step is the development of basic experimental work. There is evidence that purpose can be temporarily increased and that such manipulations have an effect when compared to control conditions [14] in other domains of research. They could be modified and expanded to show proof of concept in terms of cognitive outcomes (e.g., whether participants perform better on cognitive tasks after induced to feel more purposeful).
Early evidence suggests that cancer patients’ sense of purpose (and meaning) grows as a result of intervention [15]. There is still room for more research into the best methods for increasing meaning and purpose in life (e.g., life story interventions, mindfulness interventions, etc.), as well as whether this effect extends to other populations, particularly those who are at high risk of cognitive impairment (i.e., intervention studies typically include both meaning and purpose in the outcome measurement, and the two could be differentiated better). Such interventions could then be tested to see if increased purpose sustains a better cognitive function over time.
ADRD risk can be reduced while supporting healthy cognitive aging through behavioral interventions. It is our hope that by bringing together the promising observational evidence for a sense of purpose in life, high-quality research will be galvanized to examine experimentally whether purpose in life has a causal effect on cognition. Using such evidence could then lead to the development of an evidence-based intervention for better cognitive outcomes for seniors, given the demand for new behavioral interventions to decrease cognitive decline and the risk of dementia.