Becca R. Levy, PhD

Credit: ysph.yale.edu

Older adults with mild cognitive impairment (MCI) have greater improvement in cognition over time if they have positive age beliefs as opposed to negative, according to new findings.¹

While it is well-known that many older adults experience cognitive declines, as many as half of this population that have MCI end up regaining normal cognition.²

This fact, coupled with prior findings that positive age beliefs lowered stress caused by cognitive challenges in this same age group, influenced the investigators’ decision to pursue the topic.³ The research was authored by Becca R. Levy, PhD, from the Department of Social and Behavioral Sciences at Yale School of Public Health.

“We therefore hypothesized that older persons with positive age beliefs would be more likely to recover from MCI and would do so sooner compared with individuals with negative age beliefs,” Levy and colleagues wrote.

Background and Findings

The investigators conducted the cohort study with individuals who had been included in the prior Health and Retirement Study, which was a national longitudinal survey. They included adults with the following criteria:

• Aged 65 years or older, with a specified baseline MCI
• A minimum of 1 follow-up cognition assessment that was determined by using the Telephone Interview for Cognitive Status (TICS)
• A positive age-belief measure, determined through the Attitude Toward Aging subscale of the Philadelphia Geriatric Morale Scale. This was defined as disagreement with the item, “The older I get, the more useless I feel.”

The research team grouped the participants based on positive (<15) and negative (≥15) age beliefs, which were determined by dichotomizing at the age-belief median. Overall, the cohort study ended up with 1716 total participants, 55.5% female, with an average age of 77.8 years.

Covariates that the team took into consideration for their analysis of cognitive recovery as the primary outcome and age beliefs included baseline age, sex, smoking history, apolipoprotein E status, self-reported race, education, depression, cardiovascular and/or diabetes diagnosis, marital status, social isolation, physical inactivity, and sleep issues.

The investigators utilized validated TICS cut points to define the first transition from MCI (Mild Cognitive Impairment) to the point of normal cognitive ability. The study consisted of 7 data collection periods, which were performed every 2 years in the span between 2008 to 2020.

The research team confirmed their hypothesis that those with reported MCI who held positive age beliefs were more likely to experience cognitive recovery than those with negative age beliefs. The respondents put into the positive age-belief group showed a 30.2% higher likelihood of recovery compared to the negative age-belief group, regardless of baseline MCI severity.

Additionally, those with positive age beliefs showed a faster transition from MCI to normal cognition, with a 2-year recovery advantage over those in the negative age-belief group. A sensitivity analysis led to confirmation of these results after adjusting for the number of participant responses.

The investigators’ major findings and the confirmation of their hypothesis indicates the importance of cultural influences and their relationship to age beliefs. While the team did not evaluate what the mechanism of these positive beliefs was, this leaves the door open for future research into cognitive recovery.

“Considering that positive age beliefs can be strengthened, our findings suggest that age-belief interventions at individual and societal levels could increase the number of people who experience cognitive recovery,” they wrote.

References

1. ^{Levy BR, Slade MD. Role of Positive Age Beliefs in Recovery From Mild Cognitive Impairment Among Older Persons. JAMA Netw Open. 2023;6(4):e237707. doi:10.1001/jamanetworkopen.2023.7707.}
2. ^{Angevaare MJ, Vonk JMJ, Bertola L, et al. Predictors of incident mild cognitive impairment and its course in a diverse community-based population. Neurology. 2022;98(1):e15-e26. doi:10.1212/WNL.0000000000013017.}
3. ^{Meisner BA. A meta-analysis of positive and negative age stereotype priming effects on behavior among older adults. J Gerontol B Psychol Sci Soc Sci. 2012;67(1):13-17. doi:10.1093/geronb/gbr062}