Psychological Well-Being and Cognitive Function among Older Adults in China: A Population-Based Longitudinal Study

Abstract

Objectives

This study aims to examine the relationship between psychological well-being (PWB) and cognitive function in older adults in China. Methods: Data are from the Chinese Longitudinal Healthy Longevity Survey. Analyses were restricted to 9,487 older persons (age ≥ 60) without cognitive impairment at baseline. Respondents were followed over a 12-year period. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (C-MMSE). PWB was assessed using a composite index capturing optimism, conscientiousness, neuroticism, loneliness, personal control, self-esteem, and happiness. Results: Multilevel mixed effects generalized linear models showed that respondents with greater PWB had a slower rate of cognitive decline over time, adjusting for sociodemographic and health characteristics. In addition, multilevel multinomial logistic regression models showed that greater PWB was associated with lower odds of developing cognitive impairment. Conclusions: Findings suggest that fostering PWB may prevent or delay adverse cognitive changes.

Keywords

cognitive function positive psychology longitudinal China

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References

Allerhand

Gale

C. R.

Deary

I. J.

(2014). The dynamic relationship between cognitive function and positive well-being in older people: A prospective study using the English Longitudinal Study of Aging. Psychology Aging, 29(2), 306–318. https://dx.doi.org/.1037/a0036551

Alzheimer’s Disease International (2015). The global impact of dementia. An analysis of prevalence, incidence, cost and trends. Retrieved February 1, 2021, from https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf.

Alzheimer’s Disease International (2021). Dementia statistics. Retrieved April 8, 2021, from https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/.

Boehm

J. K.

Kubzansky

L. D.

(2012). The heart’s content: The association between positive psychological well-being and cardiovascular health. Psychological Bulletin, 138(4), 655–691. https://dx.doi.org/10.1037/a0027448

Boss

Kang

D. H.

Branson

(2015). Loneliness and cognitive function in the older adult: A systematic review. International Psychogeriatrics, 27(4), 541–553. https://dx.doi.org/10.1017/s1041610214002749

Bower

Low

Moskowitz

Sepah

Epel

(2008). Benefit finding and physical health: Positive psychological changes and enhanced allostasis. Social and Personality Psychology Compass, 2(1), 223–244. https://dx.doi.org/10.1111/j.1751-9004.2007.00038.x

Boyle

P. A.

Buchman

A. S.

Barnes

L. L.

Bennett

D. A.

(2010). Effect of a purpose in life on risk of incident Alzheimer disease and mild cognitive impairment in community-dwelling older persons. Archives of General Psychiatry, 67(3), 304–310. https://dx.doi.org/10.1001/archgenpsychiatry.2009.208

Cacioppo

J. T.

Hawkley

L. C.

(2009). Perceived social isolation and cognition. Trends in Cognitive Sciences, 13(10), 447–454. https://dx.doi.org/10.1016/j.tics.2009.06.005

Chen

Liang

Zhang

Crawford

J. C.

Sakel

K. L.

Dong

(2019). Perceived Stress and cognitive decline in Chinese‐American older adults. Journal of the American Geriatrics Society, 67(S3), S519–S524. https://dx.doi.org/10.1111/jgs.15606

10.

Chida

Steptoe

(2010). Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: A meta-analysis of prospective evidence. Hypertension, 55(4), 1026–1032. https://dx.doi.org/10.1161/HYPERTENSIONAHA.109.146621

11.

Creavin

S. T.

Wisniewski

Noel‐Storr

A. H.

Trevelyan

C. M.

Hampton

Rayment

Cullum

(2016). Mini‐Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database of Systematic Reviews, 1, CD011145. https://dx.doi.org/10.1002/14651858.CD011145.pub2.

12.

Danhauer

S. C.

Legault

Bandos

Kidwell

Costantino

Vaughan

Avis

N.E.

Rapp

Coker

L.H.

Naughton

Naylor

(2013). Positive and negative affect, depression, and cognitive processes in the Cognition in the Study of Tamoxifen and Raloxifene (Co-STAR) Trial. Aging, Neuropsychology, and Cognition, 20(5), 532–552. https://dx.doi.org/10.1080/13825585.2012.747671

13.

Deichert

N. T.

Fekete

E. M.

Boarts

J. M.

Druley

J. A.

Delahanty

D. L.

(2008). Emotional support and affect: Associations with health behaviors and active coping efforts in men living with HIV. AIDS and Behavior, 72(1), 139–145. https://dx.doi.org/10.1007/s10461-007-9214-y

14.

Diener

Oishi

Lucas

R. E.

(2003). Personality, culture, and subjective well-being: Emotional and cognitive evaluations of life. Annual Review of Psychology, 54(1), 403–425. https://dx.doi.org/10.1146/annurev.psych.54.101601.145056

15.

Fan

Tao

Zhang

Wei

Chen

Zhang

(2019). The contribution of genetic factors to cognitive impairment and dementia: Apolipoprotein E gene, gene interactions, and polygenic risk. International Journal of Molecular Sciences, 20(5), 1177. https://dx.doi.org/10.3390/ijms20051177

16.

Faraco

Iadecola

(2013). Hypertension: A harbinger of stroke and dementia. Hypertension, 62(5), 810–817. https://dx.doi.org/10.1161/hypertensionaha.113.01063

17.

Folkman

(2008). The case for positive emotions in the stress process. Anxiety, Stress, and Coping, 21(1), 3–14. https://dx.doi.org/10.1080/10615800701740457

18.

Folstein

M. F.

Folstein

S. E

McHugh

P. R.

(1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://dx.doi.org/10.1016/0022-3956(75)90026-6

19.

Fratiglioni

Paillard-Borg

Winblad

(2004). An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurology, 3(6), 343–353. https://dx.doi.org/10.1016/S1474-4422(04)00767-7

20.

Fredrickson

B. L.

(2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56, 218–226. https://dx.doi.org/10.1037//0003-066x.56.3.218

21.

Gawronski

K. A. B.

Kim

E. S.

Langa

K. M.

Kubzansky

L. D.

(2016). Dispositional optimism and incidence of cognitive impairment in older adults. Psychosomatic Medicine, 78(7), 819–828. https://dx.doi.org/10.1097/PSY.0000000000000345

22.

Giebel

C. M.

Sutcliffe

Challis

(2014). Activities of daily living and quality of life across different stages of dementia: A UK study. Aging & Mental Health, 19(1), 63–71.https://dx.doi.org/10.1080/13607863.2014.915920

23.

Dupre

M. E.

Sautter

Zhu

Liu

(2009). Frailty and mortality among Chinese at advanced ages. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 64(2), 279–289. https://dx.doi.org/10.1093/geronb/gbn009

24.

Han

W. J.

Shibusawa

(2015). Trajectory of physical health, cognitive status, and psychological well-being among Chinese elderly. Archives of Gerontology and Geriatrics, 60(1), 168–177. https://dx.doi.org/10.1016/j.archger.2014.09.001

25.

L. T.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://dx.doi.org/10.1080/10705519909540118

26.

Karttunen

Karppi

Hiltunen

Vanhanen

Välimäki

Martikainen

Valtonen

Sivenuis

Soinien

Hartikainen

Suhonen

Pirttilä

ALSOVA Study Group (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer’s disease. International Journal of Geriatric Psychiatry, 26(5), 473–482. https://dx.doi.org/10.1002/gps.2550

27.

Kida

Nakajima

Shikimoto

Ochi

Noda

Tsugawa

Niimura

(2020). Approach‐oriented coping strategy level may be related to volume of the whole hippocampus in the elderly. Psychiatry and Clinical Neurosciences, 74(4), 270–276. https://dx.doi.org/10.1111/pcn.12981

28.

Kiliaan

A. J.

Arnoldussen

I. A.

Gustafson

D. R.

(2014). Adipokines: A link between obesity and dementia?. Lancet Neurology, 13(9), 913–923. https://dx.doi.org/10.1016/s1474-4422(14)70085-7

29.

Kim

J. W.

Lee

D. Y.

Lee

B. C.

Jung

M. H.

Kim

Choi

Y. S.

Choi

I. G.

(2012). Alcohol and cognition in the elderly: A review. Psychiatry Investigation, 9(1), 8–16. https://dx.doi.org/10.4306/pi.2012.9.1.8

30.

Korthauer

L. E.

Goveas

Espeland

M. A.

Shumaker

S. A.

Garcia

K. R.

Tindle

Salmoirago-Blotcher

Sink

K. M.

Vaughan

Rapp

S. R.

Resnick

S. M.

, (2018). Negative affect is associated with higher risk of incident cognitive impairment in nondepressed postmenopausal women. The Journals of Gerontology Series A: Medical Sciences, 73(4), 506–512. https://dx.doi.org/10.1093/gerona/glx175

31.

Lewis

N. A.

Turiano

N. A.

Payne

B. R.

Hill

P. L.

(2017). Purpose in life and cognitive functioning in adulthood. Aging, Neuropsychology, and Cognition, 24(6), 662–671. https://dx.doi.org/10.1080/13825585.2016.1251549

32.

Zhang

(2015). Social network types and the health of older adults: Exploring reciprocal associations. Social Science & Medicine, 130, 59–68. https://dx.doi.org/10.1016/j.socscimed.2015.02.007

33.

Llewellyn

D. J.

Lang

I. A.

Langa

K. M.

Huppert

F. A.

(2008). Cognitive function and psychological well-being: Findings from a population-based cohort. Age and Ageing, 37(6), 685–689. https://dx.doi.org/10.1093/ageing/afn194

34.

McEwen

B. S.

(2005). Stressed or stressed out: What is the difference? Journal of Psychiatry & Neuroscience, 30(5), 315–318.

35.

McEwen

B. S.

Biron

C. A.

Brunson

K. W.

Bulloch

Chambers

W. H.

Dhabhar

F. S.

Goldfarb

R. H.

Kitson

R. P.

Miller

A. H.

Spencer

R. L.

Weiss

J. M.

(1997). The role of adrenocorticoids as modulators of immune function in health and disease: Neural, endocrine and immune interactions. Brain Research Reviews, 23(1-2), 79–133. https://dx.doi.org/10.1016/s0165-0173(96)00012-4

36.

Mukadam

Sommerlad

Huntley

Livingston

(2019). Population attributable fractions for risk factors for dementia in low-income and middle-income countries: An analysis using cross-sectional survey data. The Lancet Global Health, 7(5), e596–e603. https://dx.doi.org/10.1016/S2214-109X(19)30074-9

37.

Nakanishi

Yamasaki

Nishida

Richards

(2019). Midlife psychological well-being and its impact on cognitive functioning later in life: An observational study using a female British birth cohort. Journal of Alzheimer’s Disease, 72(3), 835–843. https://dx.doi.org/10.3233/JAD-190590

38.

Nichols

Szoeke

C. E.

Vollset

S. E.

Abbasi

Abd-Allah

Abdela

Aichour

M. T. E.

Akinyemi

R. O.

Alahdab

Asgedom

S. W.

Awasthi

Barker-Collo

S. L.

Baune

B. T.

Béjot

Belachew

A. B.

Bennett

D. A.

Biadgo

Bijani

Sayeed

M. S. B.

Murray

C. J.

(2019). Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurology, 18(1), 88–106. https://dx.doi.org/10.1016/S1474-4422(18)30403-4

39.

Patnode

C. D.

Perdue

L. A.

Rossom

R.C.

Rushkin

M. C.

Redmond

Thomas

R. G.

Lin

J. S.

(2020). Screening for cognitive impairment in older adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 323(8), 764–785. https://dx.doi.org/10.1001/jama.2019.22258

40.

Patrick

J. H.

Cottrell

L. E.

Barnes

K. A.

(2001). Gender, emotional support, and well-being among the rural elderly. Sex Roles, 45(1), 15–29. https://dx.doi.org/10.1023/A:1013056116857

41.

Paulson

H. L.

Igo

(2011). Genetics of dementia. Seminars in Neurology, 31(5), 449–460. https://dx.doi.org/10.1016/s0140-6736(13)60630-3

42.

Pezzotti

Scalmana

Mastromattei

Di Lallo

(2008). The accuracy of the MMSE in detecting cognitive impairment when administered by general practitioners: A prospective observational study. BMC Family Practice, 9, 29. https://dx.doi.org/10.1186/1471-2296-9-29

43.

Pinquart

Sorensen

(2000). Influences of socioeconomic status, social network, and competence on subjective well-being in later life: A meta-analysis. Psychology and Aging, 15(2), 187–224. https://dx.doi.org/10.1037//0882-7974.15.2.187

44.

Podcasy

J. L.

Epperson

C. N.

(2016). Considering sex and gender in Alzheimer disease and other dementias. Dialogues in Clinical Neuroscience, 18(4), 437–446. https://dx.doi.org/10.31887/DCNS.2016.18.4/cepperson

45.

Pressman

S. D.

Cohen

(2005). Does positive affect influence health? Psychological Bulletin, 131(6), 925–971. https://dx.doi.org/10.1037/0033-2909.131.6.925

46.

Ryff

C. D.

(1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069–1081. https://dx.doi.org/10.1037/0022-3514.57.6.1069

47.

Samman

. (2007). Psychological and subjective well-being: A proposal for internationally comparable indicators. Oxford Development Studies, 35(4), 459–486. https://dx.doi.org/10.1080/13600810701701939

48.

Seeman

T. E.

McEwen

B. S.

Rowe

J. W.

Singer

B. H.

(2001). Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences, 98(8), 4770–4775. https://dx.doi.org/10.1073/pnas.081072698

49.

Shankar

Hamer

McMunn

Steptoe

(2013). Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine, 75(2), 161–170. https://dx.doi.org/10.1097/PSY.0b013e31827f09cd

50.

Singer

J. D.

Willett

J. B.

(2003). Applied longitudinal data analysis: Modeling change and event occurrence. Oxford University Press.

51.

Smith

Gerstorf

(2008). Psychological resources for well-being among octogenarians, nonagenarians, and centenarians: Differential effects of age and selective mortality. In: Zeng

Poston

D. L.

Vlosky

D.A.

(Eds.), Healthy longevity in China: Demographic, socioeconomic, and psychological dimensions (pp. 329–346). Springer.

52.

StataCorp (2015). Stata statistical software: Release 14. StataCorp LP.

53.

Sun

J. H.

Tan

J. T.

(2014). Post-stroke cognitive impairment: Epidemiology, mechanisms and management. Annals of Translational Medicine, 2(8), 80. https://dx.doi.org/10.3978/j.issn.2305-5839.2014.08.05

54.

Sutin

A. R.

Stephan

Terracciano

(2018). Psychological well‐being and risk of dementia. International Journal of Geriatric Psychiatry, 33(5), 743–747. https://dx.doi.org/10.1002/gps.4849

55.

Terracciano

Sutin

A. R.

O’Brien

R. J.

Ferrucci

Zonderman

A. B.

Resnick

S. M.

(2014). Personality and risk of Alzheimer’s disease: New data and meta-analysis. Alzheimer’s & Dementia, 10(2), 179–186. https://dx.doi.org/10.1016/j.jalz.2013.03.002

56.

Tsenkova

V. K.

Dienberg Love

Singer

B. H.

Ryff

C. D.

(2008). Coping and positive affect predict longitudinal change in glycosylated hemoglobin. Health Psychology, 27(Suppl. 2), S163–S171. https://dx.doi.org/10.1037/0278-6133.27.2(Suppl.).S163

57.

Turner

A. D.

James

B. D.

Capuano

A. W.

Aggarwal

N. T.

Barnes

L. L.

(2017). Perceived stress and cognitive decline in different cognitive domains in a cohort of older African Americans. The American Journal of Geriatric Psychiatry, 25(1), 25–34. https://dx.doi.org/10.1016/j.jagp.2016.10.003

58.

Turner

A. I.

Smyth

Hall

S. J.

Torres

S. J.

Hussein

Jayasinghe

S. U.

Ball

Clow

A. J.

(2020). Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence. Psychoneuroendocrinology, 114, 104599. https://dx.doi.org/10.1016/j.psyneuen.2020.104599

59.

Uchino

B. N.

(2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29(4), 377–387. https://dx.doi.org/10.1007/s10865-006-9056-5

60.

United Nations . Department of Economic and Social Affairs, Population Division (2020). World Population Ageing 2019 (ST/ESA/SER.A/444). United Nations.

61.

Vahia

I. V.

Chattillion

Kavirajan

Depp

C. A.

(2011). Psychological protective factors across the lifespan: Implications for psychiatry. Psychiatric Clinics, 34(1), 231–248. https://dx.doi.org/10.1016/j.psc.2010.11.011

62.

Wang

Hai

Liu

Y.X.

Cao

Liu

Yang

Dong

B. R.

(2019). Associations between sarcopenic obesity and cognitive impairment in elderly Chinese community-dwelling individuals. Journal of Nutrition, Health & Aging, 23(1), 14–20. https://dx.doi.org/10.1007/s12603-018-1088-3

63.

Weinstein

Lutski

Goldbourt

Tanne

(2017). C-reactive protein is related to future cognitive impairment and decline in elderly individuals with cardiovascular disease. Archives of Gerontology and Geriatrics, 69, 31–37. https://dx.doi.org/10.1016/j.archger.2016.11.002

64.

Weiss

L. A.

Westerhof

G. J.

Bohlmeijer

E. T.

(2016). Can we increase psychological well-being? The effects of interventions on psychological well-being: A meta-analysis of randomized controlled trials. Plos One, 11(6), e0158092. https://dx.doi.org/10.1371/journal.pone.0158092

65.

Wen

(2011). The effects of childhood, adult, and community socioeconomic conditions on health and mortality among older adults in China. Demography, 48(1), 153–181. https://dx.doi.org/10.1007/s13524-010-0003-2

66.

White

I. R.

Royston

Wood

A. M.

(2011). Multiple imputation using chained equations: Issues and guidance for practice. Statistics in Medicine, 30(4), 377–399. https://dx.doi.org/10.1002/sim.4067

67.

Wimo

Jönsson

Bond

Prince

Winblad

International

A. D.

(2013). The worldwide economic impact of dementia 2010. Alzheimer’s & Dementia, 9(1), 1–11. https://dx.doi.org/10.1016/j.jalz.2012.11.006

68.

World Health Organization (2012). Dementia: A public health priority. Retrieved February 1, 2021, from https://www.who.int/mental_health/publications/dementia_report_2012/en/.

69.

Schimmele

C. M.

(2006). Psychological disposition and self-reported health among the ‘oldest-old’ in China. Ageing and Society, 26(1), 135–151. https://dx.doi.org/10.1017/s0144686x0500423x

70.

Xie

Zhou

(2014). Income inequality in today’s China. Proceedings of the National Academy of Sciences, 111(19), 6928–6933. https://dx.doi.org/10.1073/pnas.1403158111

71.

Wang

Wimo

Fratiglioni

Qiu

(2017). The economic burden of dementia in China, 1990–2030: Implications for health policy. Bulletin of the World Health Organization, 95(1), 18–26. https://dx.doi.org/10.2471/BLT.15.167726

72.

Yin

Lassale

Steptoe

Cadar

(2019). Exploring the bidirectional associations between loneliness and cognitive functioning over 10 years: The English Longitudinal Study of Ageing. International Journal of Epidemiology, 48(6), 1937–1948. https://dx.doi.org/10.1093/ije/dyz085

73.

Zeng

Poston

D. L.

Vlosky

D. A.

(Eds.) (2008). Healthy longevity in China: Demographic, socioeconomic, and psychological dimensions. Springer.

74.

Zeng

Vaupel

Xiao

Zhang

Liu

(2002). Sociodemographic and health profiles of the oldest old in China. Population and Development Review, 28(2), 251–273. https://dx.doi.org/10.1111/j.1728-4457.2002.00251.x

75.

Zhang

(2006). Gender differentials in cognitive impairment and decline of the oldest old in China. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(2), S107–S115. https://dx.doi.org/10.1093/geronb/61.2.s107

76.

Zhang

Hayward

M. D.

(2010). Childhood nutritional deprivation and cognitive impairment among older Chinese people. Social Science & Medicine, 71(5), 941–949.https://dx.doi.org/10.1016/j.socscimed.2010.05.013

77.

Zhong

B. L.

Chen

S. L.

Conwell

(2017). Loneliness and cognitive function in older adults: Findings from the Chinese Longitudinal Healthy Longevity Survey. The Journals of Gerontology: Series B, 72(1), 120–128. https://dx.doi.org/10.1093/geronb/gbw037

78.

Zhong

Wang

Zhang

Guo

J. J.

Zhao

(2015). Smoking is associated with an increased risk of dementia: A meta-analysis of prospective cohort studies with investigation of potential effect modifiers. Plos One, 10(3), e0118333. https://dx.doi.org/10.1371/journal.pone.0118333

79.

Zhou

Mao

Han

Fang

(2020). Social engagement and cognitive impairment in older Chinese adults: The mediating role of psychological well-being. Journal of Aging and Health, 32(7–8), 573–581. https://doi.org/10.1177/0898264319839594

80.

Zhou

Mao

Zhang

Towne

S. D.

Wang

Fang

(2019). The association between loneliness and cognitive impairment among older men and women in China: A nationwide longitudinal study. International Journal of Environmental Research and Public Health, 16(16), 2877. https://dx.doi.org/10.3390/ijerph16162877