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Cynicism Linked to Dementia
Medscape Medical News
May 28, 2014

A high level of cynical distrust ? for example, believing that no one cares much what happens to you and that it's safer not to trust anybody ? is associated with a higher risk for dementia, and the association is not entirely explained by depressive symptoms, a new study shows.

Although researchers also found a link between cynical distrust and mortality, this was nonsignificant after adjustment for behavioral factors, self-reported health status, and especially socioeconomic background.

Along with previous evidence, the current results suggest that life view and personality can affect a person's health.

"The findings of this study propose that psychosocial and behavioral risk factors may be modifiable targets for prevention of dementia," the researchers, with senior author Anna-Maija Tolppanen, PhD, Department of Neurology, University of Eastern Finland, Kuopio, conclude. "It may thus be possible to improve life quality by attempting to change people's attitudes to a more positive direction."

The study, with first author Elisa Neuvonen, also with the Department of Neurology at the same institution, was published online May 28 in Neurology.

Cognitive Status
The analysis included participants in the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study, which was derived from 4 separate random population samples (in 1972, 1977, 1982, and 1987), who had a mean age of 71.3 years at the beginning of the study. Researchers gathered data on cynical distrust for 1240 participants and dementia data for 622 participants.

Cognitive status was determined with a 3-step process that included screening, a clinical phase, and a diagnostic phase. In 1998, those who scored 24 or lower on the Mini-Mental State Examination (MMSE) at screening were referred for further investigation.

In 2005, participants who scored 24 or less on the MMSE and had a decrease of 3 or more points since 1998; who had less than 70% delayed recall in the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) Word List; or for whom there was informant concern about the patient's cognition were referred to the clinical phase, which included detailed neurologic, cardiovascular, and neuropsychological examinations.

Researchers assessed cynical distrust using the 8-item Cynical Distrust Scale, which asks participants to somewhat or completely agree or disagree with sentences such as: "I think most people would lie to get ahead," "most people are honest chiefly through fear of being caught," and "most people will use somewhat unfair reasons to gain profit or advantage rather than lose it." Scores on this scale can range from 0 to 24 points. Researchers categorized results into tertiles.

The mean follow-up duration was 8.4 years for the dementia analysis and 10.4 years for the mortality analysis. Altogether, 361 participants died and dementia was diagnosed in 46.

The study showed that cynical distrust was not associated with incident dementia when the results were adjusted for age and sex only. But after the analysis also accounted for other confounders, people with the highest level of cynical distrust had a higher risk for dementia (relative risk [RR], 3.13; 95% confidence interval [CI], 1.15 - 8.55) compared with those with low cynical distrust.

Some participants may have already had prodromal dementia at the time of assessment of cynical distrust, so the results may reflect the role of impending dementia on one's attitude. "Thus, although we excluded those persons who had dementia at the time of cynical distrust assessment, we cannot entirely rule out reverse causality," write the authors.

In the fully adjusted model, which included depressive symptoms, a high level of cynical distrust was still associated with higher risk for dementia, although the CI was wide and included the null value (RR, 2.90; 95% CI, 0.97 - 8.70), they report.

Mortality Risk
Those with the highest level of cynical distrust had on average a 40% higher risk for death compared with those who had the lowest cynical distrust. The association remained essentially the same after adjustment for cardiovascular risk factors, but when socioeconomic factors, smoking, alcohol consumption, and self-reported health were also considered, "the association was abolished," said the authors.

However, they pointed out that the study population was fairly aged and that if the measurement had been performed at a younger age, the association with mortality might be more evident.

"One potential subject for further investigations is to assess whether long-standing cynical attitude has more ominous outcomes than later acquired cynicism and whether the change of attitude to more positive has influence on mortality."
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