Purpose in life, personal growth, life satisfaction and risk of cognitive impairment among older women

Objectives: Cognitive impairment is a major public health concern among older adults. This study examined the associations of purpose in life (PIL), personal growth (PG), and life satisfaction (LS) with cognitive impairment risk, as well as potential underlying pathways. Methods: The study population comprised 1,179 U.S. women (aged 77–93 years) from the Women’s Health Initiative Memory Study–Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO) cohort who completed psychological well-being assessments in 2012 and were followed until 2021. Cognitive status was evaluated annually using standardized assessments and central adjudication. Results: Over an average of 5.4 years of follow-up, 355 participants were classified with MCI (175) or dementia (180). The association between PIL and cognitive impairment was largely mediated by lower perceived stress and higher physical activity (61%), rendering the direct effect non-significant. Women in the highest PG quartile had a 33% lower risk of impairment (HR = 0.67, 95% CI: 0.46–0.96). Mediation analyses showed both direct and indirect effects of PG. No association was found for LS. Conclusions: PG and PIL were linked to lower cognitive impairment risk, primarily via stress reduction and physical activity. Targeting these factors may promote cognitive health among aging populations.