Loneliness Increases Dementia Risk Among the Elderly

People who feel lonely are significantly more likely to develop clinical dementia over a period of 3 years compared with those who do not feel lonely, a Dutch study of the elderly suggests.

Tjalling Jan Holwerda, ARKIN Mental Health Care and the Vrije Universiteit Medical Centre, Amsterdam, the Netherlands, and multicenter Dutch colleagues found that after adjustment for other risk factors for dementia, older individuals who expressed feelings of loneliness had a significantly greater risk of developing clinical dementia over a 3-year follow-up period than individuals who did not harbor such feelings.

In contrast, social isolation, not or no longer being married, and not having social support were not associated with a higher risk for dementia in multivariate analysis.

"Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life," investigators observe. "And [loneliness] can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention."

The study was published online December 10 in the Journal of Neurology, Neurosurgery and Psychiatry.

AMSTEL Study

For the study, investigators tested the association between social isolation, defined as living alone, being unmarried or without social support; feelings of loneliness; and incident dementia in 2173 community-living older individuals who were without dementia and who were involved in the Amsterdam Study of the Elderly (AMSTEL).

At baseline and again at follow-up 3 years later, all participants underwent a home assessment that included questions on sociodemographic items.

Participants were also assessed using the Geriatric Mental State Examination along with a structured psychiatric interview and diagnostic algorithm in the form of the Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT).

A diagnosis of clinical dementia was defined as having GMS AGECAT scores of level 3 or higher.

"Of the participants living alone at baseline, 9.3% had developed dementia at 3 years follow-up compared with 5.6% of participants living with others (P = .001)," the authors note.

Among those who were not or who were no longer married, 9.2% had developed dementia at follow-up compared with 5.3% of those who were married (P = .001), they add.

Of those without social support, 5.6% had developed dementia at follow-up compared with 11.4% of those receiving social support (P = .000).

Slightly more than 13% of participants who expressed feelings of loneliness at baseline also met criteria for dementia 3 years later compared with 5.7% of those who expressed no such feelings, a 64% greater risk of developing clinical dementia after multivariate analysis (odds ratio [OR], 1.64; 95% confidence interval, 1.05 - 2.56; P = .000).

Bivariate Analysis showed that those who lived alone as well as those who were not or were no longer married had a higher risk of meeting criteria for dementia 3 years later compared with participants living with others and those who were married.

In contrast, Bivariate Analysis indicated that not having social support was associated with a lower risk of having dementia at follow-up.

Table: Risk for Dementia by Living Situation

Category                            Risk for Dementia (OR)

Living alone                        2.52

Living with others                1.67

Not/no longer married          2.24

Married                              2.31

Not receiving social support  2.03

Receiving social support       2.47

"Further research is needed to investigate whether cognitive deterioration and dementia are a consequence of feelings of loneliness or whether feelings of loneliness are a behavioural reaction to diminished cognition," the authors observe.

They add that to develop a better understanding of how loneliness may affect the development of dementia, "we need to know whether [these feelings] are a signal of a prodromal stage of dementia or a direct result of neurodegenerative pathology affecting social skills."

The study was funded by grants from the Netherlands Health Research Promotion Programme and the Netherlands Foundation for Mental Health. The authors have disclosed no relevant financial relationships.

J Neurol Neurosurg Psychiatry. Published online December 10, 2012. Abstract.

(Source:  Medscape Medical News, 18 December 2013)