Cognition Boosted by Thinking Positively About Aging

Older adults with mild cognitive impairment were more likely to regain normal cognition if they held positive beliefs about aging, a cohort study showed.

Across 1,716 participants with mild cognitive impairment and a mean baseline age of 78, those with positive age beliefs had a 30.2% greater likelihood of recovery than those with negative age beliefs, reported Becca Levy, PhD, of the Yale School of Public Health, and Martin Slade, PhD, of the Yale School of Medicine, both in New Haven, Connecticut.

This recovery advantage persisted regardless of how severe mild cognitive impairment was at baseline, they said in a JAMA Network Open research letter.

People with positive age beliefs also had a faster transition from mild cognitive impairment to normal cognition (HR 1.26, 95% CI 1.08-1.46, P=0.003) and recovered cognition up to 2 years earlier than people with negative age beliefs.

Nearly half of older adults with mild cognitive impairment can regain normal cognition. “Little is known about why some recover while others don’t,” Levy said in a statement. “That’s why we looked at positive age beliefs, to see if they would help provide an answer.”

“Our previous research has demonstrated that age beliefs can be modified,” she added. “Therefore, age-belief interventions at the individual and societal levels could increase the number of people who experience cognitive recovery.”

Participants came from the national longitudinal Health and Retirement Study (HRS), were 65 or older, and had mild cognitive impairment. They had at least one follow-up cognition assessment measured by the Telephone Interview for Cognitive Status (TICS) and a positive age-belief measure assessed by a subscale of the Philadelphia Geriatric Center Morale Scale, which gauged disagreement with the statement “the older I get, the more useless I feel.”

Levy and Slade dichotomized participants based on whether they had positive or negative age beliefs. Age, sex, race, education, marital status, smoking history, APOE status, depression, cardiovascular or diabetes diagnosis, social isolation, sleep issues, and physical inactivity were covariates in their analysis.

The primary outcome was cognitive recovery, defined as the first transition from mild cognitive impairment to normal cognition based on TICS cut points. Seven data collection waves were performed in the study, every 2 years from 2008-2020.

Of 1,716 participants in the primary analysis, 55.5% were women. Most participants (74.2%) were white; 21.5% were Black and 11.5% were Hispanic. About half (51.6%) were married at baseline.

A total of 609 (35.5%) people were in the positive age-belief group and 1,107 (64.5%) were in the negative age-belief group. At baseline, participants in the positive age-belief group were less likely to have chronic disease (77.3% vs 83%), depression (8.3% vs 24.0%), or to often feel isolated (2.4% vs 10.9%) than those in the negative age-belief group (all P<o.05).

In a secondary analysis that included a wider sample of HRS participants with normal cognition at baseline, those with positive age beliefs were less likely to develop mild cognitive impairment over the next 12 years than those with negative age beliefs, regardless of baseline age and physical health.

A limitation is that the study did not examine mechanisms of positive age beliefs and cognitive recovery, Levy and Slade acknowledged. “However, previous studies have reported that cognition is predicted by stress levels and health behaviors, both of which can be improved by positive age beliefs,” they noted.