This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2023 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
