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Patricia A. Boyle, PhD; Aron S. Buchman, MD; Lisa L. Barnes, PhD; David A. Bennett, MD

Arch Gen Psychiatry. 2010;67(3):304-310.

Context  Emerging data suggest that psychological and experiential factors are associated with risk of Alzheimer disease (AD), but the association of purpose in life with incident AD is unknown.

Objective  To test the hypothesis that greater purpose in life is associated with a reduced risk of AD.

Design  Prospective, longitudinal epidemiologic study of aging.

Setting  Senior housing facilities and residences across the greater Chicago metropolitan area.

Participants  More than 900 community-dwelling older persons without dementia from the Rush Memory and Aging Project.

Main Outcome Measures  Participants underwent baseline evaluations of purpose in life and up to 7 years of detailed annual follow-up clinical evaluations to document incident AD. In subsequent analyses, we examined the association of purpose in life with the precursor to AD, mild cognitive impairment (MCI), and the rate of change in cognitive function.

Results  During up to 7 years of follow-up (mean, 4.0 years), 155 of 951 persons (16.3%) developed AD. In a proportional hazards model adjusted for age, sex, and education, greater purpose in life was associated with a substantially reduced risk of AD (hazard ratio, 0.48; 95% confidence interval, 0.33-0.69; P < .001). Thus, a person with a high score on the purpose in life measure (score = 4.2, 90th percentile) was approximately 2.4 times more likely to remain free of AD than was a person with a low score (score = 3.0, 10th percentile). This association did not vary along demographic lines and persisted after the addition of terms for depressive symptoms, neuroticism, social network size, and number of chronic medical conditions. In subsequent models, purpose in life also was associated with a reduced risk of MCI (hazard ratio, 0.71; 95% confidence interval, 0.53-0.95; P = .02) and a slower rate of cognitive decline (mean [SE] global cognition estimate, 0.03 [0.01], P < .01).

Conclusion  Greater purpose in life is associated with a reduced risk of AD and MCI in community-dwelling older persons.

Author Affiliations: Rush Alzheimer's Disease Center (Drs Boyle, Buchman, Barnes, and Bennett) and Departments of Behavioral Sciences (Drs Boyle and Barnes) and Neurological Sciences (Drs Buchman, Barnes, and Bennett), Rush University Medical Center, Chicago, Illinois.

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