Effects of restriction of activities and social isolation on risk of dementia in the community

Abstract

Objective: Social isolation and emotional isolation, i.e. loneliness, have been associated with dementia or cognitive decline. In contrast, the relationship of restriction of physical and instrumental activities of daily living to cognitive decline and dementia has been less studied. Design: We examined multiple quality of life (QoL) indicators, including isolation and restriction of activities, utilizing two validated scales in elders without dementia to determine their associations with cognitive decline and incident dementia that were followed longitudinally over 6 years. We comprehensively controlled for other symptom constellations, including depression and anergia. Setting: A large multi-ethnic prospective study was conducted in northern Manhattan, NYC. Participants: An ethnically diverse sample of 855 non-demented individuals at baseline participated. Measures: The following QoL scales were utilized: Restriction, Anergia, Isolation, Loneliness, and Affective Suffering. Results: Both Restriction (HR = 2.22, 95% CI [1.42, 3.47], P < .001) and Isolation (HR = 1.78, 95% CI [1.17, 2.70], P = 0.007) were associated with episodic memory and incident dementia, controlling for age, sex, and education. Loneliness and Affective Suffering (depression) were not associated with these outcomes (P’s > .1) with both Restriction and Isolation in the same model for the prediction of dementia, only Restriction remained significant (HR = 1.97, 95% CI [1.24, 3.14], P = 0.004). In cross-lagged panel analyses, Restriction and Isolation had reciprocal influences (P’s < .001), indicating that Restriction at the previous time point influenced current Isolation. Importantly, Restriction (but not Isolation) and Selective Reminding total recall memory demonstrated highly significant direct and reciprocal influences over time (P’s < .001). Conclusions: Restriction and Isolation were associated with incident dementia. Restriction played a more prominent role in its impact on memory decline. The development of these impairments in QoL, particularly Restriction, may provide warning signs of future cognitive decline and dementia and provide multiple and novel avenues for therapeutic interventions with the goal of delaying the development of cognitive decline and dementia.

Restriction of activities, social isolation, and dementia

“…Good social engagement, on the other hand, was protective against dementia (RR = 0.88, 95% CI 0.80-0.96) (Penninkilampi et al, 2018). The paper by Goldberg et al (2021) in this issue of the Journal supports this trend in the literature, with social isolation (HR=1.78, 95%CI 1.17-2.70) being associated with episodic memory and incident dementia.…”

“…Reduced social ties and cognitive activity, if associated with the restriction, are independent risk factors for dementia. As the Goldberg et al study shows, memory impairment leads to restrictions which in turn worsen cognition, although they showed that the latter effect was greater than the former (Goldberg et al, 2021). While episodic memory was examined in this study, it is quite likely that other cognitive domains, in particular executive function, have a similar reciprocal relationship with restriction.…”

“…In the same meta-analysis, the association of loneliness with dementia, while in the same direction, was nonsignificant (RR = 1.38; 95%CI 0.98-1.94). In the Goldberg et al (2021) study, loneliness was not associated with incident dementia or episodic memory. Another limitation is in the measures themselves, as they often rely on self-report alone, without objective measurements of contact frequency and duration, something possible with modern wearable and other new technologies (Liddle et al, 2021).…”

Association between depression and the risk of Alzheimer’s disease using the Korean National Health Insurance Service-Elderly Cohort

“…The severe depressive symptoms including depressed mood, fatigue, helplessness restrict patients from interacting with other people result in social isolation and feeling loneliness. Both social isolation and loneliness increases the risk of dementia thus depression could increase the risk of dementia 34 , 35 .…”

The “timbre” of loneliness in later life

“…The body of empirical research on loneliness among older adults goes back over half a century (Munnichs, 1964), but the past decade has seen an uptick in attention in the professional and lay-press, as well as government and public policy circles (Levine, 2018; United States Senate Special Commitee on Aging, 2020). Much of the focus over the past decade has been grounded in concern about the adverse downstream biological effects of loneliness in terms of medical comorbidity, dementia, and early mortality (Frenkel-Yosef et al, 2020;Lutzman et al, 2021;Goldberg et al, 2021). Although the biological impact of loneliness is of course important, it is at least equally if not more critical to consider the adverse effects of loneliness on quality of life and mental well-being.Loneliness by definition is a form of psychological distress, i.e.…”