Psychological well-being trajectories preceding incident mild cognitive impairment and dementia.

ABSTRACT

BACKGROUND: Poorer psychological well-being has been related to an increased dementia risk, but changes in psychological well-being along the dementia course are unclear. We explored psychological well-being trajectories before and after the diagnosis of mild cognitive impairment (MCI) and dementia. METHODS: Within the Rush Memory and Aging Project, 910 cognitively intact older adults were followed annually for up to 14 years to detect incident MCI and dementia. Psychological well-being and its six components (self-acceptance, autonomy, environmental mastery, purpose in life, positive relation with others, and personal growth) were annually measured based on Ryff's Scales of Psychological Well-Being. Data were analysed using mixed-effect models with a backward timescale. RESULTS: Compared with participants who remained cognitively intact, those who developed incident MCI had a faster decline in psychological well-being (ß -0.015, 95% CI -0.027 to -0.003), leading to lower well-being 2 years before MCI diagnosis (mean difference at year -2, -0.099, 95% CI -0.187 to -0.012). Considering different well-being components, those who developed MCI had lower levels of purpose in life and personal growth beginning 3 years (-0.126, 95% CI -0.251 to -0.001) and 6 years (-0.139, 95% CI -0.268 to -0.009) before MCI, respectively. The slope of psychological well-being decline was similar before and after MCI diagnosis for each component except for positive relation with others, which had an accelerated decline after MCI (ß -0.042, 95% CI-0.075 to -0.009). Well-being trajectories remained similar for individuals with MCI regardless of whether they later developed dementia. CONCLUSIONS: Psychological well-being (specifically purpose in life and personal growth) became significantly lower before MCI diagnosis.