[en] BACKGROUND AND OBJECTIVES: Self-reflection (the active evaluation of ones thoughts, feelings, and behaviors) can confer protection against adverse health outcomes. Its effect on markers sensitive to Alzheimer disease (AD), however, is unknown. The primary objective of this cross-sectional study was to examine the association between self-reflection and AD-sensitive markers. METHODS: This study used baseline data from cognitively unimpaired older adults enrolled in the Age-Well clinical trial and older adults with subjective cognitive decline from the SCD-Well clinical trial. In both cohorts, self-reflection was measured via the reflective pondering subscale of the Rumination Response Scale, global cognition assessed via the Preclinical Alzheimer's Cognitive Composite 5, and a modified late-life Lifestyle-for-Brain-Health (LIBRA) index computed to assess health and lifestyle factors. In Age-Well, glucose metabolism and amyloid deposition were quantified in AD-sensitive gray matter regions via fluorodeoxyglucose- and AV45-PET scans, respectively. Associations between self-reflection and AD-sensitive markers (global cognition, glucose metabolism, and amyloid deposition) were assessed via unadjusted and adjusted regressions. Furthermore, we explored whether associations were independent of health and lifestyle factors. To control for multiple comparisons in Age-Well, false discovery rate-corrected p values (p (FDR)) are reported. RESULTS: A total of 134 (mean age 69.3 ± 3.8 years, 61.9% women) Age-Well and 125 (mean age 72.6 ± 6.9 years, 65.6% women) SCD-Well participants were included. Across unadjusted and adjusted analyses, self-reflection was associated with better global cognition in both cohorts (Age-Well: adjusted-β = 0.22, 95% CI 0.05-0.40, p (FDR) = 0.041; SCD-Well: adjusted-β = 0.18, 95% CI 0.03-0.33, p = 0.023) and with higher glucose metabolism in Age-Well after adjustment for all covariates (adjusted-β = 0.29, 95% CI 0.03-0.55, p (FDR) = 0.041). Associations remained following additional adjustment for LIBRA but did not survive false discovery rate (FDR) correction. Self-reflection was not associated with amyloid deposition (adjusted-β = 0.13, 95% CI -0.07 to 0.34, p (FDR) = 0.189). DISCUSSION: Self-reflection was associated with better global cognition in 2 independent cohorts and with higher glucose metabolism after adjustment for covariates. There was weak evidence that relationships were independent from health and lifestyle behaviors. Longitudinal and experimental studies are warranted to elucidate whether self-reflection helps preserve cognition and glucose metabolism or whether reduced capacity to self-reflect is a harbinger of cognitive decline and glucose hypometabolism. TRIAL REGISTRATION INFORMATION: Age-Well: NCT02977819; SCD-Well: NCT03005652.
Research center :
GIGA CRC (Cyclotron Research Center) In vivo Imaging-Aging & Memory - ULiège
Disciplines :
Neurosciences & behavior
Author, co-author :
Demnitz-King, Harriet ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Gonneaud, Julie ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Klimecki, Olga ; Université de Liège - ULiège > Département de Psychologie > Neuropsychologie ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.)
Chocat, Anne; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Collette, Fabienne ; Université de Liège - ULiège > GIGA > GIGA CRC In vivo Imaging - Aging & Memory
Dautricourt, Sophie ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Jessen, Frank; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Krolak-Salmon, Pierre ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Lutz, Antoine ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Morse, Rachel M ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Molinuevo, José Luis; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Poisnel, Géraldine ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Touron, Edelweiss ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Wirth, Miranka ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Walker, Zuzana ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Chételat, Gaël ; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Marchant, Natalie L; From the Division of Psychiatry (H.D.-K., R.M.M., Z.W., N.L.M.-A.R.G.), Faculty
Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7 (3): 280-292.
Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet (London, England). 2020; 396 (10248): 413-446.
Steptoe A, Deaton A, Stone AA,. Subjective wellbeing, health, and ageing. Lancet. 2015; 385 (9968): 640-648.
Cherbuin N, Kim S, Anstey KJ,. Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis. BMJ Open. 2015; 5 (12): e008853.
Holmquist S, Nordström A, Nordström P,. The association of depression with subsequent dementia diagnosis: a Swedish nationwide cohort study from 1964 to 2016. PLoS Med. 2020; 17 (1): e1003016.
Gimson A, Schlosser M, Huntley JD, Marchant NL,. Support for midlife anxiety diagnosis as an independent risk factor for dementia: a systematic review. BMJ Open. 2018; 8 (4): e019399.
Terracciano A, Stephan Y, Luchetti M, Albanese E, Sutin AR,. Personality traits and risk of cognitive impairment and dementia. J Psychiatr Res. 2017; 89: 22-27.
Sutin AR, Stephan Y, Terracciano A,. Psychological well-being and risk of dementia. Int J Geriatr Psychiatry. 2018; 33 (5): 743-747.
Low L-F, Harrison F, Lackersteen SM,. Does personality affect risk for dementia? A systematic review and meta-analysis. Am J Geriatr Psychiatry. 2013; 21 (8): 713-728.
Boyle PA, Buchman AS, Wilson RS, Yu L, Schneider JA, Bennett DA,. Effect of purpose in life on the relation between Alzheimer disease pathologic changes on cognitive function in advanced age. Arch Gen Psychiatry. 2012; 69 (5): 499-505.
Yoon B, Baker SL, Korman D, et al. Conscientiousness is associated with less amyloid deposition in cognitively normal aging. Psychol Aging. 2020; 35 (7): 993-999.
Arenaza-Urquijo EM, Przybelski SA, Machulda MM, et al. Better stress coping associated with lower tau in amyloid-positive cognitively unimpaired older adults. Neurology. 2020; 94 (15): e1571-e1579.
Gawronski KAB, Kim ES, Langa KM, Kubzansky LD,. Dispositional optimism and incidence of cognitive impairment in older adults. Psychosom Med. 2016; 78 (7): 819-828.
Strikwerda-Brown C, Ozlen H, Pichet Binette A, et al. Trait mindfulness is associated with less amyloid, tau, and cognitive decline in individuals at risk for Alzheimer's disease. Biol Psychiatry Glob Open Sci. Epub January 17, 2022. doi.org/10.1016/j.bpsgos.2022.01.001.
Arenaza-Urquijo EM, Vemuri P,. Resistance vs resilience to Alzheimer disease: clarifying terminology for preclinical studies. Neurology. 2018; 90 (15): 695-703.
Crane MF, Kangas M, Karin E, Searle B, Chen D,. Leveraging the experience of stressors: the role of adaptive systematic self-reflection. Anxiety Stress Coping. 2020; 33 (3): 231-247.
Miranda R, Nolen-Hoeksema S,. Brooding and reflection: rumination predicts suicidal ideation at 1-year follow-up in a community sample. Behav Res Ther. 2007; 45 (12): 3088-3095.
Crane MF, Searle BJ, Kangas M, Nwiran Y,. How resilience is strengthened by exposure to stressors: the systematic self-reflection model of resilience strengthening. Anxiety Stress Coping. 2019; 32: 1-17.
Woody A, Figueroa WS, Benencia F, Zoccola PM,. Trait reflection predicts interleukin-6 response to a social-evaluative stressor. Brain Behav Immun. 2016; 52: 27-31.
Ayduk Ö Kross E,. Enhancing the pace of recovery: self-distanced analysis of negative experiences reduces blood pressure reactivity. Psychol Sci. 2008; 19 (3): 229-231.
Arditte KA, Joormann J,. Emotion regulation in depression: reflection predicts recovery from a major depressive episode. Cogn Ther Res. 2011; 35: 536-543.
Leal CKN, Faria GGBde, DeSouza ML,. Private self-consciousness, self-reflection, insight and alcohol consumption among young people and adults. Psico USF. 2019; 24: 633-644.
Poisnel G, Arenaza-Urquijo E, Collette F, et al, Medit-Ageing Research Group. The Age-Well randomized controlled trial of the Medit-Ageing European project: effect of meditation or foreign language training on brain and mental health in older adults. Alzheimers Dement (N Y). 2018; 4: 714-723.
Jessen F, Amariglio RE, van Boxtel M, et al, Subjective Cognitive Decline Initiative SCD-I Working Group. A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's disease. Alzheimers Dement. 2014; 10 (6): 844-852.
Marchant NL, Barnhofer T, Klimecki OM, et al, SCD-WELL Medit-Ageing Research Group. The SCD-Well randomized controlled trial: effects of a mindfulness-based intervention versus health education on mental health in patients with subjective cognitive decline (SCD). Alzheimers Dement (N Y). 2018; 4: 737-745.
Schlosser M, Demnitz-King H, Whitfield T, Wirth M, Marchant NL,. Repetitive negative thinking is associated with subjective cognitive decline in older adults: a cross-sectional study. BMC Psychiatry. 2020; 20 (1): 500.
Sheikh JI, Yesavage JA,. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontologist. 1986; 5: 165-173.
Deckers K, Barbera M, Köhler S, et al. Long-term dementia risk prediction by the LIBRA score: a 30-year follow-up of the CAIDE study. Int J Geriatr Psychiatry. 2020; 35 (2): 195-203.
Deckers K, van Boxtel MPJ, Schiepers OJG, et al. Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies. Int J Geriatr Psychiatry. 2015; 30 (3): 234-246.
Franchini F, Musicco M, Ratto F, et al. The LIBRA index in relation to cognitive function, functional independence, and psycho-behavioral symptoms in a sample of non-institutionalized seniors at risk of dementia. J Alzheimers Dis. 2019; 72 (3): 717-731.
Stein D, Grant AM,. Disentangling the relationships among self-reflection, insight, and subjective well-being: the role of dysfunctional attitudes and core self-evaluations. J Psychol. 2014; 148 (5): 505-522.
Papp KV, Rentz DM, Orlovsky I, Sperling RA, Mormino EC,. Optimizing the preclinical Alzheimer's cognitive composite with semantic processing: the PACC5. Alzheimers Dement (N Y). 2017; 3 (4): 668-677.
Besson FL, La Joie R, Doeuvre L, et al. Cognitive and brain profiles associated with current neuroimaging biomarkers of preclinical Alzheimer's disease. J Neurosci. 2015; 35 (29): 10402-10411.
Müller-Gärtner HW, Links JM, Prince JL, et al. Measurement of radiotracer concentration in brain gray matter using positron emission tomography: MRI-based correction for partial volume effects. J Cereb Blood Flow Metab. 1992; 12 (4): 571-583.
Rothman KJ,. No adjustments are needed for multiple comparisons. Epidemiology. 1990; 1: 43-46.
Takano K, Tanno Y,. Self-rumination, self-reflection, and depression: self-rumination counteracts the adaptive effect of self-reflection. Behav Res Ther. 2009; 47 (3): 260-264.
Trapnell PD, Campbell JD,. Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection. J Personal Soc Psychol. 1999; 76 (2): 284-304.
Sharp ES, Reynolds CA, Pedersen NL, Gatz M,. Cognitive engagement and cognitive aging: is openness protective? Psychol Aging. 2010; 25 (1): 60-73.
Karp A, Andel R, Parker MG, Wang H-X, Winblad B, Fratiglioni L,. Mentally stimulating activities at work during midlife and dementia risk after age 75: follow-up study from the kungsholmen project. Am J Geriatr Psychiatry. 2009; 17 (3): 227-236.
Krell-Roesch J, Ruider H, Lowe VJ, et al. FDG-PET and neuropsychiatric symptoms among cognitively normal elderly persons: the mayo clinic study of aging. J Alzheimers Dis. 2016; 53 (4): 1609-1616.
Crane MF, Kho M, Kangas M, et al. Strengthening resilience in over 50's: a nested clustered-randomized controlled trial of adaptive systematic self-reflection. Anxiety Stress Coping. 2020; 33 (6): 623-641.
Bucknell KJ, Kangas M, Crane MF,. Adaptive self-reflection and resilience: the moderating effects of rumination on insight as a mediator. Personal Individual Differences. 2022; 185: 111234.
Czyżowska N, Gurba E,. Does reflection on everyday events enhance meaning in life and well-being among emerging adults? Self-efficacy as mediator between meaning in life and well-being. Int J Environ Res Public Health. 2021; 18: 9714.
Pitkethly AJ, Lau PWC, Maddison R,. Investigating the association of self-regulated learning skills and physical activity in Hong Kong Chinese and Scottish adolescents. Int J Sport Exerc Psychol. 2019; 17: 670-684.
Stewart TM, Hunter SC, Rhodes SM,. Reflective pondering is associated with executive control for emotional information: an adolescent prospective study. J Behav Ther Exp Psychiatry. 2019; 65: 101486.
Satyshur MD, Layden EA, Gowins JR, Buchanan A, Gollan JK,. Functional connectivity of reflective and brooding rumination in depressed and healthy women. Cogn Affect Behav Neurosci. 2018; 18 (5): 884-901.