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This is the 75th instalment in a series on dementia, including the research into its causes and treatment, advice for carers, and stories of hope. Purpose is defined as a sense of resolve or determination. My mother’s frequent and treatment-resistant episodes of depression eroded hers. Apathetic, she lost all her verve for life. “I am inert,” she told me once when I texted to ask how she was. It was the perfect description; depression robbed her of motivation, drive and a sense of purpose. I would often wonder afterwards if that contributed to her dementia later. Hong Kong-based clinical psychologist Dr Ritu Verma says research shows that people with a strong sense of purpose tend to have better executive functioning – sharper mental skills for planning and focus – and improved performance on processing speed and memory tests. “Having purpose helps our brains age better,” she says. Professor Angelina Sutin, in the department of behavioural sciences and social medicine at Florida State University College of Medicine, led a study which found that a sense of purpose is a “robust predictor of lower risk of dementia and is a promising target of intervention for cognitive health outcomes”. That study was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association in 2021. Sutin describes how purpose was measured in the research. While still in good cognitive health, study participants were asked, “To what extent do you feel your life to be meaningful?” They rated a response on a five-point scale from one (not at all) to five (an extreme amount). Higher ratings indicated greater feelings of meaning in life – or purpose. If you had asked my mother during one of her lengthy depressions how meaningful her life felt, she would have said, “not at all”. Sutin believes a lack of purpose might be a dementia risk for several reasons. Individuals with a lower sense of purpose, she says, “tend to have more chronic medical conditions [such as heart disease, diabetes] and more health-risk behaviours [being sedentary, smoking]”. All of these increase the risk of dementia. Dr Joshua Stott, professor of ageing and clinical psychology at University College London in the UK, co-wrote research which found that having a sense of purpose cuts the risk of cognitive impairment by 19 per cent. He speculates that increased purpose potentially leads to changes in behaviour such as eating a healthier diet, getting more exercise and having greater social engagement. These behaviours all support better brain health and reduced cognitive impairment. The study, published in the journal Ageing Research Reviews in 2022, was interesting because it found that the benefits did not flow from the positive feelings derived from having a sense of purpose. “Positive mood is more about happiness,” he explains, “but purpose is more about meaning, suggesting that being happy is not associated with reduced future cognitive decline, but meaningful living perhaps is.” Verma explains that purpose also causes physiological brain benefits. Research shows that being purposeful “releases dopamine, boosting motivation; maintains serotonin levels, promoting happiness; and also strengthens the brain’s cognitive reserve, which is key in improving resilience to age-related damage to brain tissue,” she says. A study from the University of California, Davis, published in The American Journal of Geriatric Psychiatry in October, offers more compelling evidence for the powerful Japanese concept of ikigai – your “reason for being”. It found that having a strong sense of purpose is linked to a 28 per cent reduction in the risk of developing dementia. Lead author psychiatrist Dr Aliza Wingo emphasised just how profound this protective effect is, stating that a sense of purpose was tied to a later onset and lower likelihood of developing dementia, even for people with a genetic risk for Alzheimer’s. In short: cultivating your reason for living, whether through relationships, goals or meaningful activities, may be one of the best, most accessible things you can do to keep your brain healthy as you age. How does retirement affect us and our chance of developing dementia? Is there a danger that when we stop working – given that our jobs often give us definition, drive and direction – we will feel less purposeful? “Retirement is tricky,” Sutin says. “Employment often provides meaning and fulfilment, which can decline once employment ends. From that perspective, it can be important to extend employment as long as possible.” In our senior years, she adds, “a bout of depression or anxiety can trigger … a lack of joy, motivation and purpose” – especially without a job or career to pursue. “It points to the importance of identifying and treating depression” as soon as possible, she says. “The good news is that the sense of purpose in life can be intentionally cultivated at any stage in life.” Retirement does not have to mean doing nothing. As Sutin says, it can be “a great opportunity to pursue interests and passions that may not have been prioritised while working”. Pursuing a hobby – whether joining a hiking group or a gardening or book club – can harness other brain-protective elements. Exercise, for example, is roundly declared as having the most transformative effect on your brain. Social interaction is so beneficial for our brains that it is listed as one of The Lancet’s modifiable risks for dementia. So, in developing a renewed sense of purpose, you gift yourself – your brain – other neuroprotective elements. Purpose can come in seemingly simple acts, too, Verma says. An elderly client shared with her the joy they derive from tidying cupboards – it gave them a sense of accomplishment. When Mum was suffering from depression, I often urged her to do something small, such as organising a drawer; instinctively, I knew this would help and might prompt her to do another task. But when she was unwell, tidying up any space would have been as challenging as scaling Mount Everest. Depression is independently associated with the risk of dementia, Stott says, and purpose may be just one pathway by which depression leads to dementia. Finding purpose to age gracefully To find everyday purpose in older age, Verma suggests developing these five habits. Renew old interests. Remember and return to whatever you had a passion for in the past. Did you once enjoy gardening? Colouring? Painting? Practising tai chi or yoga? Walking or cooking? Explore new interests. This could entail playing bridge, learning to play the piano or another instrument, studying a new language, going to swimming classes, singing, dancing or teaching, earning a new academic degree or travelling. Volunteer in the community. There are so many ways to do this. Help homeless animals. Tutor schoolchildren. Help at the library or community centre. Organise a beach clean-up or a clothing or food drive – or lend a hand at one. Make more meaningful social connections. Spend more time with your grandchildren. Join clubs with people whose interests are similar to yours. Show curiosity in the lives of people around you. Commit to a healthy lifestyle. Stay active, through walking or cycling or whatever you enjoy; engage in mindfulness through yoga or meditation or journaling; eat nutritious whole foods; and have quality sleep, going to bed and waking up at regular times. Like what you read? 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