Social isolation, loneliness, and their joint effects on cognitive decline and incident Alzheimer's disease: Findings from the Chicago health and aging project - 01/01/25

Doi : 10.1016/j.tjpad.2024.100046

Ted K.S. Ng ^a,^⁎ , Todd Beck ^a, Kyle R. Dennis ^a, Pankaja Desai ^a, Kristin Krueger ^a, Klodian Dhana ^a, Robert S. Wilson ^b, Denis A. Evans ^a, Kumar B. Rajan ^a
^a Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, 1700W Van Buren, Suite 245, Chicago, IL, 60612, United States
^b Department of Neurological Sciences, Department of Psychiatry and Behavioral Sciences & Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, United States

^⁎Corresponding author.

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Abstract

Background

There has been contradictory evidence on the prospective associations between social isolation/loneliness (SI/L) and cognitive decline (CD). There is also a scarcity of large and diverse population-based cohort studies examining SI/L that have confirmed clinical diagnoses of Alzheimer's Disease (AD). Notably, beyond individual associations, whether the effects of SI/L compound and accelerate CD and incident AD are not known.

Objectives

We hypothesized that SI and L, independently, would be associated with CD and incident AD to a similar extent, and the association of SI with CD and incident AD would be higher in lonely older adults.

Design

Prospective cohort study.

Setting

Urban Chicago areas.

Participants

We analyzed data in the Chicago Health and Aging Project (CHAP), which comprised 7,760 biracial community-dwelling older adults [mean age (standard deviation (SD))=72.3 (6.3); 64 % Black & 63 % women; mean (SD) of follow-up=7.9 (4.3) years].

Intervention (if any)

Measurements

Linear mixed and logistic regression models were used to regress CD and incident AD separately on the SI index/L.

Results

SI index and L were significantly associated with CD, with one-point increase of beta estimate (SE, p-value) = -0.002 (0.001,0.022) and -0.012 (0.003,<0.001), respectively. Given that the SI index ranges from 0 to 5 and the L from 0 to 1, they had similar effect sizes. Similarly, there were significant associations between SI index and incident AD, odds ratio (95 % CI, p-value) = 1.183 (1.016–1.379,0.029), and between L and incident AD, 2.117 (1.227–3.655,0.006). When stratified by loneliness status, compared to older adults who were not isolated and not lonely, older adults who reported being socially isolated and not lonely experienced accelerated CD, -0.003 (0.001,0.004), despite no significantly increased odds of incident AD.

Conclusions

SI/L had significant associations with CD and incident AD. Notably, socially isolated older adults who reported not being lonely appeared to be most socially vulnerable to CD. These findings suggest a specific at-risk subgroup of socially vulnerable older adults for future targeted interventions to improve cognitive health.

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Keywords : Social determinants of health, Vulnerable, Social isolation, Loneliness