Dementia Care Research and Psychosocial Factors

Attitudes toward aging influence longevity as well as physical and psychological health, yet their relationship with cognition and Alzheimer's disease (AD) remains largely unknown. We hypothesized that positive attitudes toward aging would predict better cognition and diminished risk on AD blood-based biomarker profiles in older adults at risk for AD. Understanding the influence of subjective outlook on AD risk and cognitive resilience could provide valuable insights into disease mechanisms.

A subsample of older adults (n = 54; 39 women) with a family history of AD from the PREVENT-AD longitudinal cohort participated in this study. Participants completed the Attitudes to Ageing Questionnaire (AAQ-24), which provided three scores: psychosocial loss, psychological growth, and physical change. Cognitive assessments included episodic memory (Rey Auditory Verbal Learning Test, RAVLT) and executive functions (Delis-Kaplan Executive Function System-Color Word Interference Test, D-KEFS-CWIT). The AD blood-based biomarkers p-tau217 and Aβ42/40 ratios were also measured. A Weighted Least Squares regression model was used to correct for heteroscedasticity and to test whether attitudes toward aging predicted cognitive performance and plasma biomarker profiles. All analyses were corrected for multiple comparisons using the Bonferroni method, with covariates of non-interest, including age, sex, education, depression, and APOE4 carriership status, incorporated in the model.

Positive attitudes to aging were associated with better recall and recognition (RAVLT) and improved executive function including switching and inhibitory control (D-KEFS-CWIT) (p <0.00077, Bonferroni corrected), while negative attitudes showed the opposite pattern. In addition, negative attitudes to aging were associated with a lower Aβ42/40 ratio, while positive attitudes were linked to lower p-tau217 (p <0.0167, Bonferroni corrected).

These findings indicate that positive attitudes toward aging are significantly linked to both enhanced cognitive performance and a lower risk profile in AD blood-based biomarkers. Our results suggests that life outlook could either be an early indicator of disease or, alternatively, a modifiable AD risk factor.