Positive Age Beliefs Protect Against Dementia Even Among Elders with High Risk Gene

[JML]

Abstract
One of the strongest risk factors for dementia is the ε4 variant of the APOE gene. Yet, many who carry it never develop dementia. The current study examined for the first time whether positive age beliefs that are acquired from the culture may reduce the risk of developing dementia among older individuals, including those who are APOE ε4 carriers. The cohort consisted of 4,765 Health and Retirement Study participants who were aged 60 or older and dementia-free at baseline. As predicted, in the total sample those with positive age beliefs at baseline were significantly less likely to develop dementia, after adjusting for relevant covariates. Among those with APOE ε4, those with positive age beliefs were 49.8% less likely to develop dementia than those with negative age beliefs. The results of this study suggest that positive age beliefs, which are modifiable and have been found to reduce stress, can act as a protective factor, even for older individuals at high risk of dementia.

My brother sent me this article. If this is true, I think I'll change my screen name to ILoveAging!

(But I wonder if by age 60, the people who have developed negative age beliefs have done so because they already have experienced some cognitive decline that doesn't show up on the test? Is it possible to control for this?)

[Orangeblossom]

Abstract
One of the strongest risk factors for dementia is the ε4 variant of the APOE gene. Yet, many who carry it never develop dementia. The current study examined for the first time whether positive age beliefs that are acquired from the culture may reduce the risk of developing dementia among older individuals, including those who are APOE ε4 carriers. The cohort consisted of 4,765 Health and Retirement Study participants who were aged 60 or older and dementia-free at baseline. As predicted, in the total sample those with positive age beliefs at baseline were significantly less likely to develop dementia, after adjusting for relevant covariates. Among those with APOE ε4, those with positive age beliefs were 49.8% less likely to develop dementia than those with negative age beliefs. The results of this study suggest that positive age beliefs, which are modifiable and have been found to reduce stress, can act as a protective factor, even for older individuals at high risk of dementia.

My brother sent me this article. If this is true, I think I'll change my screen name to ILoveAging!

(But I wonder if by age 60, the people who have developed negative age beliefs have done so because they already have experienced some cognitive decline that doesn't show up on the test? Is it possible to control for this?)

Wow, that is a lot! "Among those with APOE ε4, those with positive age beliefs were 49.8% less likely to develop dementia than those with negative age beliefs." And when you read in full, the impact was higher in those with E4 that the others!

I wonder why, does worrying and being negative raise risk...

Yes it seems so..

"The mechanism by which age beliefs could influence dementia likely involves stress. The evidence to support this mechanism comes from both experimental and longitudinal research. One set of studies found that negative age beliefs can exacerbate stress; in contrast, positive age beliefs can help buffer against the deleterious effects of stress [15–17]. Another set of studies suggests that stress can contribute to the development of dementia"

The problem is, due to knowing our E4 that might make us more worried about ageing! So I guess the key message is to bear in mind our mindset can make a difference. Not easy though! But maybe knowing of this research will make the difference

I wonder if it could be linked in with depression too, as that would lead to negative beliefs. I have noticed that in looking at some lifestyle changes such as exercise, for example well this raises endorphins and serotonin, can be linked into BDNF...and also depression ca be linked with inflammation. So it does make sense...but it is positive to see that some lifestyle changes can positively impact mood. and also the food we eat.

This part I found especially interesting, when thinking about epigenetic changes...

"The results suggest that positive age beliefs among those with APOE ε4 could be capable of helping to offset the influence of this genetic risk factor. For APOE ε4 carriers with positive age beliefs had a risk of developing dementia that is similar to the risk of their same-aged peers without APOE ε4, regardless of age beliefs.

Positive age beliefs may impact the same causal pathway responsible for the excess genetic risk of APOE ε4. If positive age beliefs lessen the influence of APOE ε4, it would likely occur as a later-life epigenetic process. In this process, the positive age beliefs, which can reduce stress levels [16], could alter gene expression."

[SusanJ]

Yep, I posted that over in Drae's one positive thought thread. Another example is the placebo effect. No doubt the influence of one's mind is very powerful!

[rrmolo]

It would seem that this is very true. Before I looked at all of this so "scientifically" I was well into my habits of meditation, playing raquetball, traveling, enjoying family and taking my "yellow stuff" daily. Now that everything is going so "factual" I find myself worrying more. Sometimes a little knowledge is enough!

[Fiver]

Thanks for posting. This is an interesting and refreshingly simple study. From the start I want it to be true. I mean I guess I could be happy if I had to.

I do wonder, however, in spite of the author's arguments in the discussion section if there aren't other, more physiological correlations between aging-related beliefs and the incidence of dementia. Those with poorer beliefs about aging might have watched family members struggle in older age - maybe with dementia - and those folks would probably be from E4 lineages. That would skew the results. Also, if people more likely to develop AD were also more likely to have cardio-vascular disease, depression, anxiety, etc. (or their family members) that seems like it would give them a poorer view of aging. Also if AD really starts decades before symptoms are recognized I'd have to believe that individuals might perceive and report lower health levels - even without specifically knowing why. In short, it seems that folks four years prior to being diagnosed could very well be feeling health effects. Maybe it is my current way of thinking about AD - I tend to think of it as a sort of syndrome many people "have" at birth, that emerges in some many years later, but also probably has health risks along the way.

Having said all that I do believe reducing stress is an incredibly important part of lowering inflammation. So I believe a positive outlook can help. But that more I read the study the more problems I find with the experimental approach. I'll re-read this again tonight. And in the meanwhile I will try to keep a very positive outlook (for a Monday morning, of course).

[NF52]

Those with poorer beliefs about aging might have watched family members struggle in older age - maybe with dementia - and those folks would probably be from E4 lineages. That would skew the results. Also, if people more likely to develop AD were also more likely to have cardio-vascular disease, depression, anxiety, etc. (or their family members) that seems like it would give them a poorer view of aging.

I came across this study again last night and had the same question as Tom. So I looked up an analysis of covariates for neophytes like me--not easy to find!
Basically it said that covariates are factors that you want to check to rule out another possible explanation for your results.

Having a lot of unexplained variation makes it pretty tough to see the actual effect of the [variable]–it gets lost in all the noise.

https://www.theanalysisfactor.com/confu ... covariate/

For example, to see if a math-skills training program results in higher math test scores vs. a math-attitude-adjustment program, you should "control" or "adjust" for what individual students' pre-training math test scores are. If both high and low-math students given skills training improve by a statistically significant percent over high-math and low-math students without skills training, even if one group benefits more than another, then skills training is likely to be the significant factor in the improvement in each group, regardless of their pre-existing "risk factors".
I think that's what this sentence is saying:

positive age beliefs protected older individuals from developing dementia among APOE ε4 carriers, RR = .69, 95% CI = .50, .94, p = .018, adjusting for the covariates of age, education, sex, race, cardiovascular disease, diabetes, and baseline cognitive performance.

If "family experience with dementia" was a significant, and un-checked variable that leads to negative aging beliefs (an interesting hypothesis!) then it would seem reasonable that ApoE 4 carriers might have more of that experience (although my 3/3 husband would beg to disagree). If that experience also led to negative beliefs, then it would be reasonable to predict that many more ApoE 4 carriers would convert to dementia. Since population studies suggest that E4 lowers the age for diagnosis, the median age of 72 would seem to skew the likelihood of converting among ApoE4 carriers up regardless of whether they had positive or negative beliefs about aging.
Yet there's this happy result:

Total sample participants holding [positive age] beliefs at baseline had a 43.6% lower risk of developing dementia over the course of 4 years, compared to those holding negative age beliefs at baseline. Moreover, among those with APOE ε4, there was a 49.8% lower risk of dementia for those holding positive age beliefs at baseline, compared to those holding negative age beliefs at baseline.These significant patterns existed after adjusting for a number of important covariates, including age and baseline cognitive performance.

[Emphasis added.]
I do think that people with depression are likely to have been "captured" by the "negative beliefs" questionnaire, but research on cognitive behavioral therapy supports that negative beliefs are modifiable, even late in life.

Speaking personally, I have pretty extensive family history of early cardiac death and dementia, and a sizable sprinkling of anxiety, depression, and hoarding. But I choose to follow the strategies of Martin Seligman's book Learned Optimism. Seligman argues that we can learn to be optimists and view events or conditions as specific, temporary, and external-- and therefore within our ability to cope with them and modify their effects.

And articles like this one, and the vast range of N=1 experiences on this site can counter the what Seligman views as the pessimistic mindset: that conditions are "personal, pervasive and permanent".

So here's a great prospective experiment for those researchers who want to partner with us: Do registered members on the Apoe4.info site, due to their positive attitudes towards ApoE 4 and aging, and controlling for covariate risk and protective factors, show a statistically significant delay in conversion from normal cognition to MCI and AD?

[Searcher]

Before I looked at all of this so "scientifically" I was well into my habits of meditation, playing raquetball, traveling, enjoying family and taking my "yellow stuff" daily. Now that everything is going so "factual" I find myself worrying more.

That sounds like a life you loved, rrmolo.

Few would argue in favor of fear. Life-enriching steps, yes. Life-diminishing pre-occupations, perhaps not.

Few would consider that the purpose of life is to optimize biomarkers. Healthy living is great because it enables us to do more of what we consider to be important and good. It's probably useful to remain constantly aware of why we're bothering with biomarkers at all.

AD and cardiovascular disease can seriously interfere with a full and meaningful life in future years. Excessive fear of AD and cardiovascular disease can seriously interfere with life right now. Paradoxically, excessive fear might help bring on the very things that we fear.

But we have a say in all of that. Anyone can learn how to live with more calm confidence, doing more of what matters. Let tomorrow bring what it will, this moment can be embraced. Life can be made more fulfilling right now.

The systems in our body might be like the instruments of an orchestra, but we are the conductor who rehearses them to play music that delights us and others. I find this approach really effective and life-enhancing.