Multidimensional Assessment of Subjective Well-Being and Risk of Dementia: Findings from the UK Biobank Study

Low life satisfaction predicts mortality in a cohort study of very old men-the Manitoba follow up study

OBJECTIVES

(1) To determine the life satisfaction (LS) of members of a cohort study of aging men; (2) to determine if LS predicts death at various ages amongst members of a cohort study.

METHODS

We analyzed a prospective cohort study of men who qualified for air crew training in the Second World War. In 2005, 860 participants with a mean age of 85, were alive and responded to the annual questionnaire - which is sent to participants living in the community. Since 2005, LS was measured annually. Kaplan-Meier plots were constructed, and median survival times were calculated. Cox proportional hazards models were constructed comparing those with 'Poor/Bad'; 'Fair'; 'Good; and 'Very Good' to 'Excellent' LS.

RESULTS

Throughout the study period from 2005 to 2024, most men were satisfied with life. Lower LS predicted mortality throughout the course of the study, even at very old ages and even after accounting for the effect of chronic diseases.

CONCLUSIONS

LS appears relatively stable in community living old men, and predicts mortality even into advanced age.

Do positive psychosocial factors contribute to the prediction of coronary artery disease? A UK Biobank-based machine learning approach

AIMS

Most prediction models for coronary artery disease (CAD) compile biomedical and behavioural risk factors using linear multivariate models. This study explores the potential of integrating positive psychosocial factors (PPFs), including happiness, satisfaction with life, and social support, into conventional and machine learning-based CAD-prediction models.

METHODS AND RESULTS

We included UK Biobank (UKB) participants without CAD at baseline. First, we estimated associations of individual PPFs with subsequent acute myocardial infarction (AMI) and chronic ischaemic heart disease (CIHD) using logistic regression. Then, we compared the performances of logistic regression and eXtreme Gradient Boosting (XGBoost) prediction models when adding PPFs as predictors to the Framingham Risk Score (FRS). Based on a sample size between 160 226 and 441 419 of UKB participants, happiness, satisfaction with health and life, and participation in social activities were linked to lower AMI and CIHD risk (all P-for-trend ≤ 0.04), while social support was not. In a validation sample, adding PPFs to the FRS using logistic regression and XGBoost prediction models improved neither AMI [area under the receiver operating characteristic curve (AUC) change: 0.02 and 0.90%, respectively] nor CIHD (AUC change: -1.10 and -0.88%, respectively) prediction.

CONCLUSION

Positive psychosocial factors were individually linked to CAD risk, in line with previous studies, and as reflected by the new European Society of Cardiology guidelines on cardiovascular disease prevention. However, including available PPFs in CAD-prediction models did not improve prediction compared with the FRS alone. Future studies should explore whether PPFs may act as CAD-risk modifiers, especially if the individual's risk is close to a decision threshold.

Psychosocial and behavioral risk patterns and risk of cardiovascular complications in people with type 2 diabetes

INTRODUCTION

Psychosocial and behavioral risk factors often co-occur in patients with type 2 diabetes (T2D). The clustering of these risk factors and their role in predisposing patients to cardiovascular complications is not well understood. This study aims to identify patient subgroups with distinct psychological and behavioral risk patterns and evaluate the long-term risk of cardiovascular complications associated with these risk patterns.

METHODS

A total of 24,467 patients with T2D were identified from the UK Biobank (mean age 59 years, 86.7 %white), used Latent Class Analysis (LCA) to distinguish risk patterns among observed psychosocial (social isolation, loneliness, high neuroticism, anxiety, and depression) and behavioral (smoking, alcohol consumption, sleep duration, diet quality, and physical inactivity) risk factors. the Cox proportional hazards model was applied to assess the association of the identified risk patterns and risk of coronary heart disease (CHD), stroke, and a composite CVD (CHD or stroke) accounting for age, age at T2D diagnosis, race, gender, Townsend Deprivation Index, anti-diabetes medications, lipid-lowering medications, and anti-hypertensive medications.

RESULTS

Three distinct latent classes were identified: a low-risk group (n = 8,227, 33.62 %), a high psychosocial risk group (n = 15,965, 65.25 %), and a high behavioral risk group (n = 275, 1.12 %). Over a median follow-up of 12 years, the fully adjusted model showed that the high psychosocial risk group had a significantly increased risk of CHD (HR = 1.16; 95 % CI 1.08, 1.24) and composite CVD (HR = 1.13; 95 % CI 1.06, 1.20).

CONCLUSION

The psychosocial risk pattern is significantly associated with the risk of CHD and CVD among patients with T2D. These findings emphasize the importance of integrating psychosocial support into tailored care strategies to mitigate cardiovascular risks in T2D patients.

Daily relationship satisfaction and markers of health: Findings from a smartphone-based assessment

Relationship satisfaction is associated consistently with better physical and mental health. Less is known about these associations in daily life, particularly the association between relationship satisfaction and cognitive health. This study examined the daily, within-person association between relationship satisfaction and subjective health markers, including cognitive health. Participants from the United States (N = 303; Mage = 51.71, SD = 7.32) in the Couples Healthy Aging Project (CHAP) completed assessments of relationship satisfaction and health markers every night for eight days. Multilevel modeling was performed by accounting for personal (sex, age, race, education), relational (relationship duration), and contextual (day in the study, weekend day) factors. Within-person, on days when participants were more satisfied with their relationship, they felt healthier, younger, more satisfied with their life, and more purposeful. They also reported a sharper mind, better memory, and clearer thinking; relationship satisfaction was unrelated to whether participants were bothered and disrupted by forgetting. Results indicated that a satisfying romantic relationship is closely associated with better physical, psychological, and cognitive health markers in daily life.

Life satisfaction and risk of dementia over 18 years: an analysis of the National Alzheimer's Coordinating Center dataset

Life satisfaction predicts lower risk of adverse health outcomes, including morbidity and mortality. Research on life satisfaction and risk of dementia has been limited by a lack of comprehensive clinical assessments of dementia. This study builds on previous research examining life satisfaction and clinically ascertained cognitive impairment and dementia. Participants (N = 23070; Meanage = 71.83, SD = 8.80) from the National Alzheimer's Coordinating Center reported their satisfaction with life at baseline. Incident dementia was ascertained through clinical assessment over up to 18 years. Life satisfaction was associated with about 72% lower risk of all-cause of dementia, an association that remained significant accounting for demographic (age, sex, race, ethnicity, education, marital and living status), psychological (depression), clinical (obesity, diabetes, hypertension), behavioral (current and former smoking), and genetic risk (APOE ϵ4) factors. The association was not moderated by demographics, depression, and APOE ε4 status groups. The association was similar when cases occurring in the first five years were excluded, reducing the likelihood of reverse causality. Life satisfaction was also linked to specific causes of dementia, with a reduced risk ranging from about 60% to 90% for Alzheimer's disease and vascular dementia to > 2-fold lower risk of Lewy Body and frontotemporal dementia. Older adults who were satisfied with their lives were also at 61% lower risk of incident mild cognitive impairment and at 22% lower risk of converting from mild cognitive impairment to dementia. Being satisfied with one's life is associated with a lower risk of dementia. Improving life satisfaction could promote better cognitive health and protect against dementia.

Correlates and Brain Substrates of Happiness in Community-Dwelling Older Adults in India

OBJECTIVES

Happiness has been shown to influence many health-related outcomes in older adults. Identifying correlates and brain substrates of happiness across countries and cultures is an important goal, as the global older adult population continues to increase.

METHODS

We used univariate and multiple regression to examine associations between happiness and several demographic, health, and lifestyle variables in 665 older adults (39% female) from Kerala, India. We also used Bayesian regression to examine associations between cortical thickness and happiness in a subsample of 188 participants that completed MRI scanning.

RESULTS

Happiness was significantly associated with several variables. In our multiple regression model, which included all significant univariate predictors, self-rated health, depression, anxiety, apathy, social network size, social network diversity, and social support significantly predicted happiness. Demographic indicators (age, sex, education, marital status, residence, and employment status/type), cognitive impairment, comorbidities, and leisure activities were not significantly associated with happiness in the multiple regression model. Cortical thickness in several brain regions was positively associated with happiness scores, including frontal, temporal, parietal, occipital, and cingulate regions.

DISCUSSION

Understanding the key correlates is critical for identifying both modifiable factors that can be targeted in well-being interventions and fixed characteristics that identify those at-risk for reduced happiness. The widespread pattern of brain regions associated with happiness is consistent with the multifactorial nature of happiness and, given that the regions identified do not overlap with those vulnerable to cortical thinning, can help explain why subjective well-being, unlike other cognitive functions, is largely resistant to age-related decline.

Impact of social wellbeing on tooth loss and cognition: A scoping review

OBJECTIVE

The proposed explanations for the association between tooth loss and cognitive function have largely focused on systemic inflammation, mechanoreceptor feedback, and nutritive deficiencies. However, the role of social wellbeing in this relationship remains unknown. The aim of this scoping review is to explore the pathways linking different aspects of social function, collectively grouped under the umbrella of social wellbeing, to tooth loss and cognitive impairment.

DATA AND SOURCES

An electronic database search was performed in PubMed, Scopus, and Embase. Reference lists of relevant articles were also searched. Data on the associations between social wellbeing, cognitive function and tooth loss was charted in an extraction form and summarised qualitatively.

STUDY SELECTION

From the initial search of 3293 records, 71 studies were included in the present review. Forty-seven studies investigated the relationship between social wellbeing and cognition, 21 studies investigated the relationship between social wellbeing and tooth loss, and only 3 studies investigated all three variables.

CONCLUSION

This review demonstrates the need for further research on tooth loss, cognition and social wellbeing in tandem and describes potential psychological, biological, cognitive, and behavioural mechanisms interlinking these factors. While substantial evidence was found for the association between social relationships and cognition, fewer studies explored the potentially bidirectional relationship of social wellbeing and tooth loss.

CLINICAL SIGNIFICANCE

The implications of this review may guide clinicians to focus on the social consequences of tooth loss, which may have broader repercussions on cognitive health. The role of social support in helping older people cope with oral disease and the benefits of fostering positive lifestyle habits should not be underestimated.

Depressive Symptoms and Cognitive Function in Older Adults: A Cross-Lagged Network Analysis

Background: Depressive symptoms commonly co-occur with cognitive decline in older adults. However, prospective interrelationships between different cognitive function domains and depressive symptoms are not well understood. This study evaluated prospective interrelationships between depressive symptoms and cognitive functioning components among individuals aged 50 years or older from a perspective of network analysis. Method: Longitudinal data from the English Longitudinal Study of Aging were analyzed. Depressive symptoms were measured with the eight-item Center for Epidemiologic Studies Short-Depression Scale. Cognitive functions assessed included memory, orientation, and executive function. Contemporaneous network analyses were conducted using mixed graphical model, while a temporal network model was assessed using cross-lagged panel network model. To identify important predictors and outcomes, centrality indices, including expected influence, out-expected influence, and in-expected influence, were calculated. Results: A total of 6,433 older adults were included in the network analysis. Baseline "Not enjoy life" (CESD-6) was negatively associated with executive function at the follow-up assessment. Moreover, improvements in "Everything was an effort" (CESD-2) and "Loneliness" (CESD-5) were related to less future decline of executive function and memory ability. Furthermore, analyses suggested targeting "Lack of happiness" (CESD-4) could be useful in reducing the co-occurrence of depression and cognitive decline among older adults. Conclusions: This network analysis study highlighted dynamic interrelationships between depressive symptoms and cognitive decline in older adults. Findings suggest that interventions targeting specific depressive symptoms may have the potential to alleviate declines in executive function and memory for this population.

Social participation, subjective well-being, and cognitive function as serial mediators between tooth loss and functional limitations in older Chinese adults

BACKGROUND

Although tooth loss appears to be related to functional limitations, the mechanisms that underpin this relationship are unknown. We sought to address this knowledge gap by examining a multiple mediation hypothesis whereby tooth loss is predicted to indirectly affect functional limitations through social participation, subjective well-being, and cognitive function.

METHODS

This study included 7,629 Chinese adults from the 2017/2018 Chinese Longitudinal Healthy Longevity Survey wave. The serial mediation effects were examined using Model 6 in the Hayes' PROCESS macro for SPSS.

RESULTS

Tooth loss was significantly related to functional limitations. There was a direct (β = - 0.0308; 95% CI, - 0.0131 to - 0.0036) and indirect (β = - 0.0068; 95% CI, - 0.0096 to - 0.0041) association between tooth loss and instrumental activities of daily living (IADL) limitations, but only an indirect correlation with activities of daily living (ADL) limitations (β = - 0.0188; 95% CI, - 0.0259 to - 0.0121). Social participation, subjective well-being, and cognitive function serially mediated the relationship between tooth loss and ADL/IADL limitations.

CONCLUSION

The association between tooth loss and functional limitations is serially mediated by social participation, subjective well-being, and cognitive function. Our findings underscore the necessity of considering psychological and social factors as integrated healthcare approaches for the functional health of older adults.

Purpose in Life and Cognitive Function: Evidence for Momentary Associations in Daily Life

Background and Objectives

Purpose in life is associated with healthier cognitive outcomes in older adulthood. This research examines within-person dynamics between momentary purpose and cognitive function to provide proof of concept that increases in purpose are associated with better cognitive performance.

Research Design and Methods

Participants (N = 303; 54% female; Mage = 51.71, SD = 7.32) completed smartphone-based momentary assessments of purpose and short cognitive tasks 3 times a day for 8 days.

Results

In moments when participants felt more purpose driven than their average, they had faster processing speed (b = -1.240, SE = 0.194; p < .001), independent of person, temporal, and contextual factors and practice effects. Momentary purpose was unrelated to visual working memory performance (b = -0.001, SE = 0.001; p = .475). In contrast to purpose, momentary hedonic affect (e.g., happiness) was unrelated to momentary cognition.

Discussion and Implications

Feeling more momentary purpose may support faster processing speed in daily life. Such evidence provides stage 0 support for a purpose-based intervention for healthier cognition, which may be particularly useful in middle adulthood and the transition to older adulthood before the onset of cognitive impairment.

The Association between Happiness and Cognitive Function in the UK Biobank

Feelings of happiness have been associated with better performance in creative and flexible thinking and processing. Less is known about whether happier individuals have better performance on basic cognitive functions and slower rate of cognitive decline. In a large sample from the UK Biobank (N=17,885; Age 40-70 years), we examine the association between baseline happiness and cognitive function (speed of processing, visuospatial memory, reasoning) over four assessment waves spanning up to 10 years of follow-up. Greater happiness was associated with better speed and visuospatial memory performance across assessments independent of vascular or depression risk factors. Happiness was associated with worse reasoning. No association was found between happiness and the rate of change over time on any of the cognitive tasks. The cognitive benefits of happiness may extend to cognitive functions such as speed and memory but not more complex processes such as reasoning, and happiness may not be predictive of the rate of cognitive decline over time. More evidence on the association between psychological well-being and different cognitive functions is needed to shed light on potential interventional efforts.

The association between personality and plasma biomarkers of astrogliosis and neuronal injury

Personality traits have been associated with the risk of dementia and Alzheimer's disease neuropathology, including amyloid and tau. This study examines whether personality traits are concurrently related to plasma glial fibrillary acidic protein (GFAP), a marker of astrogliosis, and neurofilament light (NfL), a marker of neuronal injury. Cognitively unimpaired participants from the Baltimore Longitudinal Study on Aging (N = 786; age: 22-95) were assayed for plasma GFAP and NfL and completed the Revised NEO Personality Inventory, which measures 5 domains and 30 facets of personality. Neuroticism (particularly vulnerability to stress, anxiety, and depression) was associated with higher GFAP and NfL. Conscientiousness was associated with lower GFAP. Extraversion (particularly positive emotions, assertiveness, and activity) was related to lower GFAP and NfL. These associations were independent of demographic, behavioral, and health covariates and not moderated by age, sex, or apolipoprotein E genotype. The personality correlates of astrogliosis and neuronal injury tend to be similar, are found in individuals without cognitive impairment, and point to potential neurobiological underpinnings of the association between personality traits and neurodegenerative diseases.