Editors' Note: Association of Self-reflection With Cognition and Brain Health in Cognitively Unimpaired Older Adults.

Abstract

Dr. Demnitz-King et al. examined the association between self-reflection and markers sensitive to Alzheimer disease in 125 older adults with subjective cognitive decline and compared them with 134 cognitively unimpaired older adults in the Age-Well clinical trial. They found that self-reflection was associated with better global cognition and higher glucose metabolism in fluorodeoxyglucose positron emission tomography scans, with weak evidence that the observed associations were independent of other health and lifestyle behaviors. They concluded that longitudinal and experimental studies are needed to clarify whether self-reflection can actually help preserve cognition and cerebral glucose metabolism vs whether a lower capacity to self-reflect is a harbinger of cognitive decline and glucose hypometabolism. In response, Dr. Daly notes that the study overlooked social determinants of brain health and behaviors including those associated with self-reflection and argues that studying such determinants is potentially a higher priority for dementia research than interventional studies. Responding to these comments, the authors note that they found a higher education (an important social determinant) was associated with better self-reflection, but that the associations between self-reflection and the study outcomes remained after adjusting for education. They also report additional analyses examining the relationship between self-reflection and loneliness as well as primary occupation. They found that loneliness was associated with self-reflection, but incorporating loneliness as an additional covariate in their models did not change the associations of self-reflection with cognition and glucose metabolism. The authors counter that these findings suggest that there is utility in targeting self-reflection but agree that there may be promise in addressing such individual risk or protective factors within the broader context of social determinants of brain health. This exchange underscores the challenges of making causal inferences about protective behaviors from studies of cognitive decline or dementia-related markers, and the complexities involved in setting priorities for dementia prevention research based on such data. Dr. Demnitz-King et al. examined the association between self-reflection and markers sensitive to Alzheimer disease in 125 older adults with subjective cognitive decline and compared them with 134 cognitively unimpaired older adults in the Age-Well clinical trial. They found that self-reflection was associated with better global cognition and higher glucose metabolism in fluorodeoxyglucose positron emission tomography scans, with weak evidence that the observed associations were independent of other health and lifestyle behaviors. They concluded that longitudinal and experimental studies are needed to clarify whether self-reflection can actually help preserve cognition and cerebral glucose metabolism vs whether a lower capacity to self-reflect is a harbinger of cognitive decline and glucose hypometabolism. In response, Dr. Daly notes that the study overlooked social determinants of brain health and behaviors including those associated with self-reflection and argues that studying such determinants is potentially a higher priority for dementia research than interventional studies. Responding to these comments, the authors note that they found a higher education (an important social determinant) was associated with better self-reflection, but that the associations between self-reflection and the study outcomes remained after adjusting for education. They also report additional analyses examining the relationship between self-reflection and loneliness as well as primary occupation. They found that loneliness was associated with self-reflection, but incorporating loneliness as an additional covariate in their models did not change the associations of self-reflection with cognition and glucose metabolism. The authors counter that these findings suggest that there is utility in targeting self-reflection but agree that there may be promise in addressing such individual risk or protective factors within the broader context of social determinants of brain health. This exchange underscores the challenges of making causal inferences about protective behaviors from studies of cognitive decline or dementia-related markers, and the complexities involved in setting priorities for dementia prevention research based on such data.