Why are we here and what are we living for? At some point in life we find ourselves asking questions that are often inspired by our deep thoughts, aspirations, and goals. Establishing and pursuing a sense of purpose in life can have powerful beneficial effects on both our brain and our body. Purpose is defined as deriving meaning from daily experiences, having goals that are attainable, and a sense that life is important and worth living.
At our NeuroGrow Brain Fitness Center, we incorporate “purpose in life” in our treatment program. In this multidisciplinary program, elderly patients first see a neurologist to help identify the causes for their cognitive decline with aging and receive treatment of those conditions aggressively, along with sessions for cognitive stimulation, neurofeedback, and brain coaching. In the coaching sessions, they describe and receive encouragement about what motivates them to attain better memory, attention, or organizational skills. This seemingly simple intervention has had profound outcomes for our patients.
For example, one of our patients with cognitive decline was a 73-year-old woman who was brought to us for evaluation of Alzheimer’s disease. Her work-up revealed that along with sleep apnea, depression, and taking several sedative pain medications, she had lost her sense of purpose in life. Her retirement had taken away the sense of joy she had when she was helping people as a nurse. We treated her medical conditions and started her in our Brain Fitness Program. We often reminded her that if she worked hard during her training sessions, she could perhaps return to doing what she loved. Knowing that she could reengage in the purpose in her life gave her motivation to excel in the program. After three months, she was able to obtain a part-time job at a local medical center.
Purpose in life is one of the main components of positive wellbeing. It is commonly measured by a series of questions developed by Ryff and colleagues called Ryff’s Scales of Psychological Well-Being.1 These questions include, “How do you view your life? Is there meaning in your life? Do you set goals for yourself? Do you feel like you are able to reach those goals?” People who score their sense of purpose highly in this questionnaire appear to have better cognitive function, longevity, sleep, cardiovascular fitness, and mood. Below we have highlighted some of the studies that provide scientific evidence for the biological benefits of having a purpose in life.
Alzheimer’s Disease
Alzheimer’s disease is one of the most important public health issues of our time, and having a purpose in life may lessen the risk and symptoms in this debilitating condition. Recent studies at Rush University in Chicago show that elderly with a positive sense of purpose in life may be able to reduce their cognitive decline by 50 percent;2 in fact, elderly who score in the 90th percentile are 2.4 times less likely to develop Alzheimer’s disease, as compared to those who score in the 10th percentile. They found similar results for patients with mild cognitive impairment. This association persisted even after adjustments were made for negative affect, neuroticism, and chronic medical conditions. Another study conducted at the University of Stirling, UK found that positive well-being which includes a sense of purpose in life had significant associations with gray matter volume in the insular cortex.3 Those with a high score had less cortical atrophy.
Dr. Michelle Carlson and her colleagues at Johns Hopkins recently examined the importance of civic engagement, a prominent feature of having a purpose in life, in a prospective randomized study.4 They assigned a group of elderly to participate in a tutoring program for children in underprivileged elementary schools in Baltimore. These elderly individuals took pleasure and experienced a meaningful satisfaction in helping children improve their academic performance. They underwent brain MRIs and cognitive evaluation at the beginning, at one year, and at two years. As compared with the control group, the “civic engagement” group had better cognitive function and their hippocampus had less atrophy. In fact, some elderly men in the intervention group had expanded the volume of their hippocampus by 1.6 percent.4
Strokes
Increasing evidence suggests that having purpose can serve as a powerful intervention to reduce the burden of stroke. Findings from a study conducted at the University of Michigan indicated that finding meaning in life is associated with a 22 percent reduced risk of clinical strokes.5 Another study of older adults with a high sense of purpose showed that they are better able to recover their cognitive function after a stroke.6 Examining the link between valuing life and post-mortem changes in the brain reveals that having a purpose in life is associated with a 50 percent reduction in the number of macroscopic cerebral infarcts.7 The factor that mediates this strong protective effect can be attributed to better blood pressure, better cardiovascular condition, and/or better sleep.
Sleep
Between 40 and 70 percent of older adults have some form of sleep problems, which in turn are associated with several medical conditions such as high blood pressure, myocardial infarction, stroke, cognitive decline, and depression.8 Changing outlook in life and setting goals can be a way to remedy sleep disturbances and its associated dire consequences. For example, one study found that a strong sense of purpose in life is associated with a 16 percent reduced odds of developing sleep disturbances.9 The protective effect for insomnia may be in part due to lower stress levels in individuals who set and achieve meaningful goals.
Frailty and Mortality
Frailty is defined as impairments in multiple body systems, decreased physiological reserves, and a decline in ability to maintain homeostasis.10 Physical criteria include unintentional weight loss, weakness, self-reported exhaustion, slow walking speed, and low physical activity. Elderly with a sense of purpose in life are less likely to develop frailty.10 The association persists even when the results are adjusted for household wealth, depressive symptoms, cognitive functions, BMI, smoking, and chronic medical conditions. The exact mediating factor is not known and may be related to lower levels of inflammation in individuals with a higher sense of purpose. Higher well-being is associated with lower blood concentrations of the inflammatory marker such as C-reactive protein, plasma sIL-6R, and fibrinogen.10,11
Evaluation of data from 1,238 older adults showed that, during a five-year period, those with the highest sense of purpose in life have 57 percent lower risk of mortality.12 The biological benefits that underlie this correlation may include better cardiovascular health, lessen chance of chronic diseases, and better ability to deal with stress.13
Purpose: A Powerful Therapy
Imagine if there were a drug that would reduce the risk of Alzheimer’s by 2.4 fold, cut the number of macroscopic strokes in the brain by 50 percent, lower the risk of different forms of sleep disturbances by 16 percent, decrease levels of inflammatory markers, and lessen the risk of mortality by 57 percent. Clearly, having a purpose in life is a powerful tool that can improve the quality of life for our patients and lessen the burden of several chronic medical conditions in our society. The challenge for us is to find a way to educate the public on how they can tailor an approach to life that incorporates finding meaning in day-to-day activities, setting goals, and enjoying life by conquering small victories along the way. n
Majid Fotuhi, MD, PhD is Chairman of NeuroGrow Brain Fitness Center and an affiliate at Johns Hopkins Howard County General Hospital.
Sara Mehr is a student at the University of Maryland and an intern at NeuroGrow Brain Fitness Center.
1. Keyes CL, Shmotkin D, Ryff CD. Optimizing well-being: the empirical encounter of two traditions. Journal of personality and social psychology. 2002;82(6):1007-22. Epub 2002/06/08.
2. Boyle PA, Buchman AS, Barnes LL, Bennett DA. 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. 2010;67(3):304-10. Epub 2010/03/03.
3. Lewis GJ, Kanai R, Rees G, Bates TC. Neural correlates of the ‘good life’: eudaimonic well-being is associated with insular cortex volume. Soc Cogn Affect Neurosci. 2014;9(5):615-8.
4. Carlson MC, Kuo JH, Chuang YF, Varma VR, Harris G, Albert MS, et al. Impact of the Baltimore Experience Corps Trial on cortical and hippocampal volumes. Alzheimer’s & dementia : the journal of the Alzheimer’s Association. 2015. Epub 2015/04/04.
5. Kim ES, Sun JK, Park N, Peterson C. Purpose in life and reduced incidence of stroke in older adults: ‘The Health and Retirement Study’. Journal of psychosomatic research. 2013;74(5):427-32. Epub 2013/04/20.
6. Ostir GV, Berges IM, Ottenbacher ME, Clow A, Ottenbacher KJ. Associations between positive emotion and recovery of functional status following stroke. Psychosom Med. 2008;70(4):404-9.
7. Yu L, Boyle PA, Wilson RS, Levine SR, Schneider JA, Bennett DA. Purpose in life and cerebral infarcts in community-dwelling older people. Stroke; a journal of cerebral circulation. 2015;46(4):1071-6. Epub 2015/03/21.
8. Ancoli-Israel S. Sleep and its disorders in aging populations. Sleep medicine. 2009;10 Suppl 1:S7-11. Epub 2009/08/04.
9. Kim ES, Hershner SD, Strecher VJ. Purpose in life and incidence of sleep disturbances. Journal of behavioral medicine. 2015;38(3):590-7. Epub 2015/03/31.
10. Gale CR, Cooper C, Deary IJ, Aihie Sayer A. Psychological well-being and incident frailty in men and women: the English Longitudinal Study of Ageing. Psychological medicine. 2014;44(4):697-706. Epub 2013/07/05.
11. Friedman EM, Hayney M, Love GD, Singer BH, Ryff CD. Plasma interleukin-6 and soluble IL-6 receptors are associated with psychological well-being in aging women. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2007;26(3):305-13. Epub 2007/05/16.
12. Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine. 2009;71(5):574-9. Epub 2009/05/06.
13. Feller S, Teucher B, Kaaks R, Boeing H, Vigl M. Life satisfaction and risk of chronic diseases in the European prospective investigation into cancer and nutrition (EPIC)-Germany study. PloS one. 2013;8(8):e73462. Epub 2013/08/27.
