Social relationships and cognitive decline: a systematic review and meta-analysis of longitudinal cohort studies

Association between formal social participation and cognitive function in middle-aged and older adults: a longitudinal study using SHARE data

Formal social participation significantly impacts health and well-being, potentially mitigating cognitive decline, although not consistently across all studies. Existing research often focuses solely on baseline participation levels, and age-related differences have primarily been explored among the Asian population. Therefore, this longitudinal study aims to assess the association between formal social participation and cognition across different age groups in individuals aged 50+ living in Europe and Israel, while capturing the dynamic nature of formal social participation. We use data from three waves (four, six, and eight) of the Survey of Health, Ageing, and Retirement in Europe (SHARE), comprising 85,601 respondents. Linear mixed-effects models were applied. The results show that participation in formal social activities mitigates cognitive decline in middle-aged and older adults, especially among those aged 70 to 79 and 80+. These findings support the need for social policies promoting formal social activities, for lasting cognitive health benefits.

The Emotion Authenticity Recognition (EAR) test: normative data of an innovative test using dynamic emotional stimuli to evaluate the ability to recognize the authenticity of emotions expressed by faces

Despite research has massively focused on how emotions conveyed by faces are perceived, the perception of emotions' authenticity is a topic that has been surprisingly overlooked. Here, we present the Emotion Authenticity Recognition (EAR) test, a test specifically developed using dynamic stimuli depicting authentic and posed emotions to evaluate the ability of individuals to correctly identify an emotion (emotion recognition index, ER Index) and classify its authenticity (authenticity recognition index (EA Index). The EAR test has been validated on 522 healthy participants and normative values are provided. Correlations with demographic characteristics, empathy and general cognitive status have been obtained revealing that both indices are negatively correlated with age, and positively with education, cognitive status and different facets of empathy. The EAR test offers a new ecological test to assess the ability to detect emotion authenticity that allow to explore the eventual social cognitive deficit even in patients otherwise cognitively intact.

The association of social networks and depression in community-dwelling older adults: a systematic review

BACKGROUND AND OBJECTIVE

Depression is a globally prevalent mental condition, particularly among older adults. Previous research has identified that social networks have a buffering effect on depression. Existing systematic reviews have either limited their research to specific geographic areas or provided evidence from over a decade ago. The vast body of recent literature particularly from the last decade emphasizes the need for a comprehensive review. This systematic review aims to analyze the association of structural aspects of social networks and depression in older adults.

METHODS

The electronic databases APA PsycINFO, ProQuest, PSYINDEX, PubMed, Scopus, SocINDEX, and Web of Science were searched from date of data base inception until 11 July 2023. Studies were eligible for inclusion if they reported on community-dwelling older adults (defined as a mean age of at least 60 years old), had an acceptable definition for depression, referred to the term social network in the abstract, and were published in English. Quality was appraised using the Newcastle Ottawa Scale for cross-sectional and longitudinal studies. Outcome data were extracted independently from each study and analyzed by direction of the relationship, social network domain and cross-sectional or longitudinal study design.

RESULTS

In total, 127 studies were included. The study categorizes structural network aspects into seven domains and finds that larger and more diverse networks, along with closer social ties, help mitigate depression. The literature on the relationships between depression and network density, homogeneity, and geographical proximity is scarce and inconclusive. DISCUSSION AND IMPLICATIONS: Despite inconsistent findings, this review highlights the importance of quantifying complex social relations of older adults. Limitations of this review include publication and language bias as well as the exclusion of qualitative research. Further research should use longitudinal approaches to further investigate the reciprocal relationship between social networks and depression. Following this review, interventions should promote the integration of older adults in larger and more diverse social settings. Other: This work was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Grant [454899704]. This systematic review was pre-registered. The review-protocol can be accessed at https://doi.org/10.17605/OSF.IO/6QDPK .

'With or without you': associations between noteworthy events and cognitive complaints across 100 days

OBJECTIVES

Daily noteworthy events have implications for physical and mental health, but less is known about the role daily events have for self-reported cognition and whether the involvement of close social partners differentiates these associations. The current study examined how daily positive and negative noteworthy events relate to subjective memory and attentional difficulties and whether close social partners moderated associations.

METHOD

We used data from a 100-day microlongitudinal web-based study of 104 older adults (Nobservations=7,051; Mage=63.13 years, SDage=7.81, 88.46% Female). Participants reported on exposure to and valence of noteworthy events, involvement of close social partners, and subjective cognitive complaints at the end of each day.

RESULTS

Logistic multilevel models revealed that days with a negative event were associated with increased odds of forgetting something and trouble concentrating whereas days with positive events were associated with decreased odds of trouble concentrating. Close social partner involvement did not moderate within-person associations.

CONCLUSION

Our results suggest that day-to-day events are correlates of cognitive complaints regardless of close social partner involvement in the events. Research should clarify the role of daily positive and negative events in personalized interventions and determine whether this person-centered approach to self-reported cognitive health helps inform diagnostic practices.

Community support, social isolation and older adults' life satisfaction: evidence from a national survey in China

OBJECTIVES

Despite the recognized importance of community social service and community built facility for enhancing older adults' life satisfaction, the mechanisms underlying their relationship have not been thoroughly examined. This study aims to complement the existing knowledge by investigating the mediating role of social disconnectedness and loneliness in the association between community support and life satisfaction among older adults.

METHODS

Using data from the 2018 China Longitudinal Aging Social Survey, the study analyzes responses from 9,874 Chinese older adults (mean age = 71.30 years, SD = 7.30). We conducted descriptive statistics and Pearson's correlation to explore the variables. This study also used Mplus 8.0 to conduct a path analysis model that evaluated both the direct and indirect effects of community social service and built facility on life satisfaction. Social disconnectedness and loneliness were included as mediating variables in this model.

RESULTS

The present study results show that both community social service and community built facility are positively associated with life satisfaction among older adults, and community social service is more imporatant for enhancing the life satisfaction. In addition, these associations are mediated by social disconnectedness and loneliness.

CONCLUSION

Our research suggests that strengthening community social service programs and improving the built environment can reduce social disconnectedness and loneliness among older adults, ultimately enhancing their life satisfaction. Specifically, policymakers can invest in targeted interventions to enhance social connectedness and reduce loneliness, with the goal of improving the overall well-being of older adults.

Exploring the associations between structural and functional aspects of social relationships and cognition in very old age

OBJECTIVES

Few studies have examined the associations between social relationships and cognition in very old adults (80+ years). Moreover, limited research has considered structural and functional aspects of social relationships together when exploring their associations with cognition. Therefore, the present study aimed to investigate the associations between structural and functional social aspects and cognition in very old age.

METHOD

The sample comprised 518 two-wave participants of the NRW80+ Study, who showed no indication of dementia and an average age of 85 years at baseline (range: 80-97 years). They were assessed twice over an approximate 2-year interval. Multilevel linear growth curve analysis was employed to model cognitive development over very old age and to examine the associations between structural and functional aspects of social relationships and cognitive development. It was controlled for demographic and health characteristics.

RESULTS

A larger social network size (ß = 0.05, 95% CI [0.02, 0.08], p = 0.002) and frequent compared with occasional, seldom, and no contact with others (ß = 0.16, 95% CI [0.03, 0.28], p = 0.013) were associated with higher global cognition in the fully-controlled model. Model comparisons further revealed that structural aspects better predicted global cognition in very old age compared to functional aspects (χ2(2) = 16.17, p < 0.001).

CONCLUSION

The findings underline the positive association between structural aspects of social relationships and global cognition in very old age. They also highlight the need for interventions promoting a socially active lifestyle to prevent cognitive decline in this vulnerable age group.

Is Formal Social Participation Associated with Cognitive Function in Middle-Aged and Older Adults? A Systematic Review with Meta-Analysis of Longitudinal Studies

This systematic review with meta-analysis aimed to explore the association between formal social participation and cognitive function in middle-aged and older adults using data from longitudinal studies. A comprehensive search was conducted in Scopus, PubMed, and Web of Science for longitudinal studies that assessed the association between formal social participation and cognitive function in middle-aged and older adults published between January 2010 to 19 August 2022. Risk of bias was judged using the RoBANS tool. Meta-analysis using a random-effects model was computed with odds ratio (OR) and 95% confidence interval (CI) for cognitive decline probability. Sensitivity analyses were made to explore any changes to the pooled statistical heterogeneity and pooled effect size. Certainty of evidence was judged using the GRADE framework. We included 15 studies comprising 136,397 participants from 5 countries. Meta-analyses showed that formal social participation was associated with reduced cognitive decline (OR = 0.78, 95% CI 0.75-0.82, p < 0.001), with very low certainty of evidence. Formal social participation appears to enhance cognition in middle-aged and older adults, but further high-quality research is needed given the very low certainty of evidence.

Empirically derived psychosocial-behavioral phenotypes in Black/African American and Hispanic/Latino older adults enrolled in HABS-HD: Associations with AD biomarkers and cognitive outcomes

INTRODUCTION

Identification of psychosocial-behavioral phenotypes to understand within-group heterogeneity in risk and resiliency to Alzheimer's disease (AD) within Black/African American and Hispanic/Latino older adults is essential for the implementation of precision health approaches.

METHODS

A cluster analysis was performed on baseline measures of socioeconomic resources (annual income, social support, occupational complexity) and psychiatric distress (chronic stress, depression, anxiety) for 1220 racially/ethnically minoritized adults enrolled in the Health and Aging Brain Study-Health Disparities (HABS-HD). Analyses of covariance adjusting for sociodemographic factors examined phenotype differences in cognition and plasma AD biomarkers.

RESULTS

The cluster analysis identified (1) Low Resource/High Distress (n = 256); (2) High Resource/Low Distress (n = 485); and (3) Low Resource/Low Distress (n = 479) phenotypes. The Low Resource/High Distress phenotype displayed poorer cognition and higher plasma neurofilament light chain; differences between the High Resource/Low Distress and Low Resource/Low Distress phenotypes were minimal.

DISCUSSION

The identification of psychosocial-behavioral phenotypes within racially/ethnically minoritized older adults is crucial to the development of targeted AD prevention and intervention efforts.

Factors Related to the Need for Informal Care Among Community-Dwelling Older Adults in Chile

PURPOSE

To identify factors contributing to the need for informal care among community-dwelling older adults with functional impairment in Chile.

METHOD

A secondary data analysis was conducted using cross-sectional data from 540 Chilean older adults aged ≥60 years (mean age = 72.2 years, SD = 6.22 years).

RESULTS

Informal care need was reported by 24.3% (n = 131) of participants. Among the variables that most influenced the need for informal care among older adults were hospitalization in the past 1 year, functionality, comorbidities, and multidimensional frailty (all p < 0.05).

CONCLUSION

This study identified factors that clinicians and nurses should be aware of when caring for this population to prevent or manage the need for informal care. [Journal of Gerontological Nursing, 50(2), 43-52.].

Associations Between Social Network Characteristics and Brain Structure Among Older Adults

INTRODUCTION

Social connectedness is associated with slower cognitive decline among older adults. Recent research suggests that distinct aspects of social networks may have differential effects on cognitive resilience, but few studies analyze brain structure.

METHODS

This study includes 117 cognitively impaired and 59 unimpaired older adults. The effects of social network characteristics (bridging/bonding) on brain regions of interests were analyzed using linear regressions and voxel-wise multiple linear regressions of gray matter density.

RESULTS

Increased social bridging was associated with greater bilateral amygdala volume and insular thickness, and left frontal lobe thickness, putamen, and thalamic volumes. Increased social bonding was associated with greater bilateral medial orbitofrontal and caudal anterior cingulate thickness, as well as right frontal lobe thickness, putamen, and amygdala volumes.

DISCUSSION

The associations between social connectedness and brain structure vary depending on the types of social enrichment accessible through social networks, suggesting that psychosocial interventions could mitigate neurodegeneration.

HIGHLIGHTS

Distinct forms of social capital are uniquely linked to gray matter density (GMD). Bridging is associated with preserved GMD in limbic system structures. Bonding is associated with preserved GMD in frontal lobe regions. Bridging is associated with increased brain reserve in sensory processing regions. Bonding is associated with increased brain reserve in regions of stress modulation.

Does social isolation mediate the association between hearing loss and cognition in adults? A systematic review and meta-analysis of longitudinal studies

Background

There has been extensive research on the relationship between hearing and cognitive impairment in older adults but little examination of the role of mediating factors. Social isolation is a potential mediator, occurring because of hearing loss, and contributing to accelerated cognitive decline. Previous systematic reviews on this topic area have not considered the temporal nature of hearing loss and cognitive impairment exclusively or examined potential mediators within a longitudinal study design.

Methods

A systematic review was conducted. Electronic searches were performed in Web of Science, PubMed (Medline), Scopus, EMBASE, PsychInfo, and ProQuest (PsychArticles and ProQuest Dissertation and Theses) based on a search string of keywords relating to hearing loss, social isolation, and cognitive impairment/dementia in June 2023. Papers were critically appraised using the CASP checklists for cohort studies. Risk of bias in the selected studies was assessed using the Item Bank for Assessment of Risk of Bias and Precision for Observational Studies of Interventions or Exposures.

Results

Eleven of the 15 included studies provide evidence of a dose-dependent association between hearing threshold (40 dB HL or greater) and later cognitive impairment or incident dementia. Only one study included social isolation as a mediator, which was found to not be a significant contributing factor. The meta-analysis of 5 studies pooled hazard ratio for cognitive impairment due to hearing loss is 1.11 (95% CI: 1.06 to 1.15, p < 0.001). The pooled hazard ratio for incident dementia due to hearing loss was HR 1.21 (95% CI: 1.11 to 1.31, p = 0.002).

Conclusion

The analysis of included studies indicate that hearing threshold level affects later cognitive status or dementia diagnosis. There is not enough evidence to determine the role of social isolation as a mediator. Future epidemiology studies need to measure different elements of social isolation and ensure that hearing and cognition are measured at multiple time points.

Cognitive Problems in Perimenopause: A Review of Recent Evidence

PURPOSE OF REVIEW

To review recent research regarding cognitive problems during perimenopause, including which menopause-related symptoms, demographic variables, stress exposures, and neural biomarkers are associated with cognitive problems and which interventions demonstrate efficacy at improving cognitive performance.

RECENT FINDINGS

Cognitive problems are common during perimenopause and have a significant impact on a substantial proportion of women. Evidence continues to indicate that verbal learning and verbal memory are the cognitive functions that are most negatively affected during perimenopause, and new research suggests that perimenopause may also be associated with deficits in processing speed, attention, and working memory. Recent research suggests that the cognitive profiles of women transitioning through perimenopause are heterogenous - with some showing strengths and others demonstrating weaknesses in particular cognitive domains. Depression, sleep problems, and vasomotor symptoms in perimenopause may be associated with cognitive difficulties. Recent neuroimaging studies are identifying changes in activity patterns within brain regions that correlate with cognitive performance in perimenopause, but future causal studies are needed to understand the neural mechanisms of cognitive problems during this time. Although clinical treatment studies for cognitive concerns have historically focused on postmenopause, some small trials in perimenopausal samples have been conducted recently but are frequently underpowered. Current guidelines from the North American Menopause Society do not support the use of hormone therapy at any age for cognitive problems. Animal research demonstrates that estradiol and levonorgestrel combined may alleviate working memory problems. Much progress has been made in understanding how perimenopause impacts cognition, and more research is needed to better identify who is at highest risk and how to meaningfully prevent and alleviate cognitive problems during this reproductive stage. Larger-scale randomized intervention trials specifically during perimenopause are urgently needed to address cognitive concerns in this population of women. More consistent reproductive staging, inclusion of covariates, and analyses examining perimenopause specifically would improve study quality and the ability to draw clear conclusions from this research.

Association of Social Isolation With Hospitalization and Nursing Home Entry Among Community-Dwelling Older Adults

Importance

Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood.

Objective

To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms.

Design, Setting, and Participants

This observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023.

Main Outcomes and Measures

Social isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time.

Results

A total of 57% of this study's 11 517 participants were female, 43% were male, 8.4% were Black, 6.7% were Hispanic or Latino, 88.1% were White, 3.5% were other ("other" includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2% were aged 65 to 74 years. Approximately 15% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95% CI, 1.06-1.28) during 2 years. With each point increase in an individual's social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates.

Conclusions and Relevance

This cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.

Relationship between social support and 7-year trajectories of cognitive decline: results from the China Health and Retirement Longitudinal Study

BACKGROUND

Social support is associated with cognitive function at an older age, but how distinct dimensions of social support affect trajectories of cognitive decline in older Chinese adults remains unclear.

METHODS

Using longitudinal data (waves 1-4) from the China Health and Retirement Longitudinal Study, 7-year trajectories of cognitive decline by various social support markers, including family support, financial support, public support and perceived support, were estimated using latent growth curve modelling for adults aged 60 and over (N=6795).

RESULTS

After adjusting for baseline sociodemographics, behaviours, body mass index and health conditions, all social support markers were associated with baseline cognitive function, except for living with spouse. Participants living with spouse experienced a slower cognitive decline (0.069 per year, 95% CI 0.006, 0.133) than those who were not. A faster cognitive decline was associated with co-residing with children (-0.053 per year, 95% CI -0.104, -0.003), receiving ≥¥5000 from children (-0.095 per year, 95% CI -0.179, -0.011), receiving financial support from others (-0.108 per year, 95% CI -0.208, -0.008) and perceived support (-0.068 per year, 95% CI -0.123, -0.013). When all markers were mutually adjusted for, the associations of living with spouse and receiving financial support from others with cognitive decline disappeared. Stratifying by rural-urban residence, medical insurance and meeting children 1-3 times per month were associated with a slower rate of cognitive decline in urban residents but not in rural residents.

CONCLUSION

Overall, our findings confirm that the effects of distinct domains of social support on cognitive decline vary. More equally good social security systems should be established in urban and rural China.

Social Health and Change in Cognitive Capability among Older Adults: Findings from Four European Longitudinal Studies

INTRODUCTION

In this study, we examine whether social health markers measured at baseline are associated with differences in cognitive capability and the rate of cognitive decline over an 11-to-18-year period among older adults and compare results across studies.

METHODS

We applied an integrated data analysis approach to 16,858 participants (mean age 65 years; 56% female) from the National Survey for Health and Development (NSHD), the English Longitudinal Study of Aging (ELSA), the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), and the Rotterdam Study. We used multilevel models to examine social health in relation to cognitive capability and the rate of cognitive decline.

RESULTS

Pooled estimates show distinct relationships between markers of social health and cognitive domains, e.g., a large network size (≥6 people vs. none) was associated with higher executive function (0.17 standard deviation [SD] [95% CI: 0.00, 0.34], I2 = 27%) but not with memory (0.08 SD [95% CI: -0.02, 0.18], I2 = 19%). We also observed pooled associations between being married or cohabiting, having a large network size, and participating in social activities with slower decline in cognitive capability. However, estimates were close to zero, e.g., 0.01 SD/year (95% CI: 0.01, 0.02) I2 = 19% for marital status and executive function. There were clear study-specific differences: results for average processing speed were the most homogenous, and results for average memory were the most heterogeneous.

CONCLUSION

Overall, markers of good social health have a positive association with cognitive capability. However, we found differential associations between specific markers of social health and cognitive domains and differences between studies. These findings highlight the importance of examining between-study differences and considering the context specificity of findings in developing and deploying interventions.

Association of social isolation and cognitive performance: a longitudinal study using a four-wave nationwide survey

BACKGROUND

This study aimed to examine the bidirectional relationship between social isolation and cognitive performance among Chinese middle-aged and older adults.

METHODS

We used four waves of data from the China Health and Retirement Longitudinal Study. A latent growth model (LGM) was applied to examine the association between social isolation and cognitive performance across different characteristics.

RESULTS

In the analysis, we ultimately included 9,367 participants after excluding respondents with missing key variables. Social isolation and cognitive performance showed significant differences across time. After adjusting for the confounders, there was a significant association between higher social isolation and poor cognitive performance (β = -1.38, p < 0.001), and higher levels of social isolation resulted in a more pronounced decline in cognition over time (β = 0.17, p < 0.001). Additionally, the path coefficient between the initial level of cognition at baseline and the slope of social isolation was - 0.07 (p < 0.001) and 0.01 (p = 0.021), respectively. For the correlation between slopes, our study found that females' cognition scores were more susceptible to social isolation (β = - 2.78, p < 0.001). Similarly, regarding cognition scores, the influence of social isolation was greater among people with education below the primary level (β = - 2.89, p = 0.002) or a greater number of chronic diseases (β = - 2.56, p = 0.001).

CONCLUSION

Our findings support the bidirectional association between social isolation and cognition. Specifically, higher baseline social isolation and its rate of increase over time contribute to an intensification of cognitive decline at follow-up. Besides, poorer cognitive performance predicted higher social isolation.

Impact of social isolation on grey matter structure and cognitive functions: A population-based longitudinal neuroimaging study

Background

Social isolation has been suggested to increase the risk to develop cognitive decline. However, our knowledge on causality and neurobiological underpinnings is still limited.

Methods

In this preregistered analysis, we tested the impact of social isolation on central features of brain and cognitive ageing using a longitudinal population-based magnetic resonance imaging (MRI) study. We assayed 1992 cognitively healthy participants (50-82years old, 921women) at baseline and 1409 participants after~6y follow-up.

Results

We found baseline social isolation and change in social isolation to be associated with smaller volumes of the hippocampus and clusters of reduced cortical thickness. Furthermore, poorer cognitive functions (memory, processing speed, executive functions) were linked to greater social isolation, too.

Conclusions

Combining advanced neuroimaging outcomes with prevalent lifestyle characteristics from a well-characterized population of middle- to older aged adults, we provide evidence that social isolation contributes to human brain atrophy and cognitive decline. Within-subject effects of social isolation were similar to between-subject effects, indicating an opportunity to reduce dementia risk by promoting social networks.

Funding

European Union, European Regional Development Fund, Free State of Saxony, LIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, German Research Foundation.

Cross sectional association between cognitive frailty and disability among community-dwelling older adults: Focus on the role of social factors

Background

This study aimed to investigate the prevalence of cognitive frailty and the influence of social factors on the association between different levels of cognitive frailty and disability.

Methods

A nationally representative survey of non-institutionalized community-dwelling older adults in Korea was used. A total, 9,894 older adults were included in the analysis. We assessed the effects of social factors using social activities, social contacts, living arrangements, emotional support, and satisfaction with friends and neighbors.

Results

The prevalence of cognitive frailty was 1.6%, which was consistent with other population-based studies. Hierarchical logistic analysis demonstrated that the association between different levels of cognitive frailty and disability was attenuated when social participation, social contact, and satisfaction with friends and community were included in the model, and the magnitude of these effects differed across the levels of cognitive frailty.

Discussion

Considering the influence of social factors, interventions to enhance social relationships can help slow down the progression of cognitive frailty to disability.

Enrichment of dementia caregiving relationships through psychosocial interventions: A scoping review

Objectives

Enrichment, defined as "the process of endowing caregiving with meaning or pleasure for both the caregiver and care recipient" can support relationships between people living with dementia (PLWD) and their caregivers. This study aims to explore (1) the types of psychosocial interventions that may enrich relationships between dementia caregiving dyads, and (2) the components within these psychosocial interventions that may contribute to enrichment.

Methods

A scoping review was conducted based on the Joanna Briggs Institute framework. We operationalized and contextualized core elements from Cartwright and colleagues' enrichment model, which was also used to guide the review. Five electronic databases were searched. Psychosocial intervention components contributing to enrichment were identified and grouped within each core element.

Results

Thirty-four studies were included. Psychosocial interventions generating enrichment among dyads mainly involved supporting dyadic engagement in shared activities, carer education or training, or structural change to the environment around PLWD. Intervention components contributing to the enrichment of dyadic relationships were identified within "acquired symbolic meaning", "performing activity", and "fine tuning". Dyadic communication support and skill-building were common contributors to enrichment.

Conclusion

Our findings may inform the planning and development of interventions to enrich dyadic relationships in the context of dementia. In formal caregiving contexts, future interventions may consider dedicating space for relationships to build and grow through positive interactions. In informal caregiving contexts, existing relationships should be considered to better support dyads engage in positive interactions.

Are social isolation and loneliness associated with cognitive decline in ageing?

Objective

Social isolation and loneliness are associated with poor health (immunity, inflammation, etc.) in ageing. The purpose of this scoping review was to investigate the link between social isolation, loneliness (as distinct constructs, in contrast to previous published work) and cognition in cognitively healthy older adults.

Method

We followed PRISMA-ScR guidelines. Our search, conducted between January 2017 and April 2021, yielded 2,673 articles, of which, twelve longitudinal studies were finally identified as meeting the inclusion criteria. Multiple cognitive functions (short-term and episodic memory, attention, and global cognitive functioning) were measured.

Results

The results showed that both social isolation and loneliness were associated with poor cognition in ageing, with depression as a possible mediator between loneliness and poor cognition. Some studies also suggested that the link between social isolation, loneliness and cognitive decline may be bidirectional.

Conclusion

We conclude that both social isolation and loneliness may have a different impact on cognition. While depression may be an important mediator between loneliness and cognitive decline, the lack of cognitive stimulation may be a greater mediator between social isolation and cognitive health.

Association between community-level social trust and the risk of dementia: A retrospective cohort study in the Republic of Korea

Introduction

It is known that biological risk factors and lifestyle behaviors are important determinants of dementia. However, there has been yet to be sufficient evidence to prove that community-level social capital is one of the determinants of dementia. This retrospective cohort study is a large, long-term, population-based study that investigated the association between community-level social trust and the risk of dementia in the Republic of Korea.

Methods

Data came from the Korean National Health Insurance Service database. The community-level social trust values were determined by the Korean Community Health Survey. The study population consisted of 1,974,944 participants over 50 years of age and was followed up from 1 January 2012 to 31 December 2019 with a latent period of 5 years from 1 January 2012 to 31 December 2016. Cox proportional hazards regression was utilized to obtain the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the risk of dementia according to social trust quintiles.

Results

Participants within the highest quintile of community-level social trust had a lower risk for overall dementia (aHR, 0.90; 95% CI, 0.86-0.94) and Alzheimer's disease (aHR, 0.90; 95% CI, 0.85-0.94) compared to those within the lowest quintile of community-level social trust. The alleviating trend association of high community-level social trust on dementia risk was maintained regardless of whether the participants had health examinations.

Conclusions

Our findings suggest that higher community-level social trust is associated with a reduced risk of dementia. Community-level social trust is a crucial indicator of dementia and improving community-level social trust may lead to a lower risk of dementia.

Assessing the role of depressive symptoms in the association between social engagement and cognitive functioning among older adults: analysis of cross-sectional data from the Longitudinal Aging Study in India (LASI)

OBJECTIVE

The present study aimed to examine the confounding effects of depressive symptoms and the role of gender in the association between social engagement and cognitive functioning among older Indian adults.

DESIGN

Large-scale cross-sectional survey data were analysed.

SETTING AND PARTICIPANTS

Data from the Longitudinal Aging Study in India (2017-2019) were used in the analysis. The sample included 23 584 individuals aged 60 years and above (11 403 men and 12 181 women).

OUTCOME MEASURES

The outcome variable was cognitive functioning, which was based on various measures including immediate and delayed word recall, orientation, executive functioning, arithmetic ability and object naming. Social engagement measure consists of marital status, living arrangement, availability of confidant, and participation in indoor games, and social and cultural functions. The Center for Epidemiological Studies-Depression Scale was used to assess depressive symptoms.

RESULTS

Significant gender differences in mean cognition scores (men: 25.8, women: 21.1; on a scale of 0-43) were observed. Two-way stratification between social engagement and depressive symptoms was significantly associated with cognitive functioning after controlling for selected explanatory factors. Older men with a low level of social engagements had significantly poor cognitive functioning (β=-1.12; 95% CI: -1.53 to -0.72) compared with men with a high level of social engagements. On the other hand, women with a higher level of social engagement performed poorly on cognitive tests (β=-1.54; 95% CI: -2.11 to -0.98) compared with men with higher social engagements. Three-way stratification between social engagement, gender and depressive symptoms suggests that social engagement's buffering effects are lower in women than in men. The Karlson-Holm-Breen method identified a significant confounding effect of depressive symptoms on the relationship between social engagement and cognitive functioning.

CONCLUSION

The positive association of social engagement with cognitive functioning was significantly confounded by depressive symptoms, suggesting the need for maintaining social relations that help improve mental health and cognitive functioning among older adults.

What Do We Know about Social and Non-Social Factors Influencing the Pathway from Cognitive Health to Dementia? A Systematic Review of Reviews

The heterogeneous and multi-factorial nature of dementia requires the consideration of all health aspects when predicting the risk of its development and planning strategies for its prevention. This systematic review of reviews provides a comprehensive synthesis of those factors associated with cognition in the context of dementia, identifying the role of social aspects and evidencing knowledge gaps in this area of research. Systematic reviews and meta-analyses from 2009–2021 were searched for within Medline, PsycINFO, CINAHL Complete, Cochrane, and Epistemonikos. Reviewers independently screened, reviewed, and assessed the records, following the PRISMA-2020 guidelines. From 314 included studies, 624 cognitive-related factors were identified, most of them risk factors (61.2%), mainly belonging to the group of ‘somatic comorbidities’ (cardiovascular disease and diabetes) and ‘genetic predispositions’. The protective factors (20%) were mainly related to lifestyle, pointing to the Mediterranean diet, regular physical activity, and cognitively stimulating activities. Social factors constituted 9.6% of all identified factors. Research on biological and medical factors dominates the reviewed literature. Greater social support and frequent contact may confer some protection against cognitive decline and dementia by delaying its onset or reducing the overall risk; however, overall, our findings are inconsistent. Further research is needed in the fields of lifestyle, psychology, social health, and the protective factors against cognitive decline and dementia.

Lower grip strength and insufficient physical activity can increase depressive symptoms among middle-aged and older European adults: a longitudinal study

Objectives

The present study aimed to identify the gender-specific trajectories of grip strength using group-based trajectories, explore the interaction between grip strength and physical activity on depression, and investigate the association of physical activity with the change in depression by different grip strength groups among middle-aged and older European adults.

Methods

A total of 14,098 participants aged 50 years or older from the Survey of Health, Ageing and Retirement in Europe 2007–2019 were included in this study. Group-based trajectory modeling was used to identify the low, middle and high group of grip strength by gender. Generalized estimated equations were fitted to analyze the interaction effect. The data of wave 2-wave 5 and wave 2-wave 7 were chosen to conduct sensitivity analyses.

Results

Significant interactions between grip strength group and physical inactivity were found (x²_interaction = 11.16, P = 0.004). Significant interactions between physical inactivity and time on depression were identified in low (x²_interaction = 27.83, P < 0.001) and moderate (x²_interaction = 23.67, P < 0.001) grip strength, but a similar result was not found in high grip strength (x²_interaction = 4.39, P = 0.495). Participants in the physical inactivity group had higher depression scores in the low and moderate grip strength groups. Sensitivity analyses yield almost similar results.

Conclusions

Grip strength and physical inactivity interact with depression. Lower grip strength and insufficient physical activity can increase depressive symptoms. People with lower grip strength and physical inactivity should pay special attention to the prevention of depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03392-x.

The role of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment among older Indian adults

Due to different nature of social engagements of older adults in South Asian countries specially attributed to the traditional family-based care and support, beneficial effects of religiosity and religious involvement on mental health and cognitive function in older age might be different than those in the Western world. Yet, there is a paucity of research in these countries on the role of religion in moderating the relationship between late life depression and cognition. This study explored the association of depressive symptoms with cognitive impairment and the moderating effects of religiosity and religious participation in those associations among older Indian adults. A cross-sectional study was conducted on data that were drawn from the Longitudinal Ageing Study in India wave-1, collected during 2017-2018. The sample size comprised of 31,464 older adults aged 60 years and above. Shortened 10-item Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Items from the Mini-Mental State Examination and the cognitive module of the China Health and Retirement Longitudinal Study and the Mexican Health and Aging Study were adapted for measuring cognitive impairment. Moderated multiple linear regression models were used to test the research hypotheses of the study. The proportion of older adults who reported religion as less important to them was 21.24%, whereas, only 19.31% of the respondents participated in religious activities. The mean score of cognitive impairment (on a scale of 0-43) in the current sample was 19.43 [confidence interval (CI): 19.32-19.53] among men and 23.55 [CI: 23.44-23.66] among women. Older adults with depressive symptoms had significantly higher likelihood of cognitive impairment [aCoef: 0.18, CI: 0.16-0.20] in comparison to older adults with no depressive symptoms. Older individuals who were religious were significantly less likely to have cognitive impairment [aCoef: - 0.43, CI: - 0.61 to - 0.25] than their non-religious counterparts. Compared to older adults who did not participate in religious activities, those who participated in religious activities were less likely [aCoef: - 0.52, CI: - 0.69 to - 0.34] to have cognitive impairment. Further, significant moderating effects of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment were observed. The current study contributes to advancing knowledge about the mental health benefits of religiosity and religious participation by focusing on older adults in India who culturally have limited chances to participate in social activities. The findings suggest that older adults with depressive symptoms may participate in religious activities which may reduce their chances of cognitive impairment. This protective effect of religiosity and religious participation on late life cognitive health has important implications for promoting alternative social support mechanisms for older adults in terms of enhancing their mental wellbeing and contributing to active aging.

Social network and the risk for developing mild cognitive impairment and dementia among older adults

BACKGROUND

This study aimed to investigate the longitudinal associations between social network (SN) and the risk of lower cognitive function, mild cognitive impairment (MCI), and dementia among cognitively normal individuals 65 years and older.

METHODS

Data from the Age, Gene/Environment Susceptibility (AGES) Reykjavik Study on 2816 participants (aged 65 to 96 years) were used to examine the associations using multiple logistic and linear regression models. SN included questions on frequency of contact with family and friends as well as information on marital status, resulting in a score ranging from 0 (poor social network) to 3 (good social network). Cognitive function outcomes included the speed of processing (SP), executive function (EF) and memory function (MF). MCI and dementia were diagnosed using a detailed assessment according to international guidelines.

RESULTS

At baseline 0.5, 7.0, 41.7 and 50.8% reported a score of 0, 1, 2 and 3, respectively. During a mean follow-up time of 5.2 years, 7.1% (n = 188) of cognitively intact participants developed MCI and 3.0% (n = 79) developed dementia. Longitudinal analyses demonstrated that participants who had low SN were significantly more likely to have declines in MF (β = - 0.533, P = 0.014) compared to high SN. Social networks were not independently associated with the decline of SP and EF during follow-up. According to fully adjusted models using logistic regression, SN was significantly associated with incidence risk of MCI (OR = 2.030, P = 0.014 and OR = 1.847 P = 0.001). These associations were largely independent of other lifestyle factors, depression and genetic disposition.

CONCLUSIONS

Community-dwelling older adults who have poor social networks have a higher risk of declining memory function as well as a higher risk of mild cognitive impairment than older adults who have a higher social network. This study included numbers of relevant covariates in the study analysis, thereby significantly contributing to the literature on cognitive aging.

Association between Frequency of Conversations and Suicidal Ideation among Medical Students during COVID-19 Pandemic in Japan

To mitigate the spread of COVID-19, universities in Japan shifted from face-to-face to online classes, which might have reduced social interaction and increased psychiatric problems among students. A self-report questionnaire was administered to fourth-year medical students in Tokyo in May 2021, during the fourth wave of the COVID-19 outbreak, to examine the association between the frequency of conversations and suicidal thoughts. The questionnaire assessed the frequency of conversations and, using part of the Mini International Neuropsychiatric Interview, suicidal ideation. Of the 113 students, 98 (86.7%) responded, of whom 20 (20.4%) had suicidal ideation. Poisson regression analysis revealed that those with less than 1 conversation per week and no conversations at all had a significantly higher risk of suicidal ideation than those with 3 conversations per week or more, after adjusting for personality, family relationship, income level, living alone, number of friends, gender, and age. These results indicate that less frequent conversations increased the risk of suicidal ideation among medical students. Mental health support for students needs to be strengthened if universities suspend face-to-face classes during a pandemic.

Determinants of Non-Participation in Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

Background

Breast cancer (BC) screening can be performed in a screening program (BCSP) or in opportunistic screening. The existing reviews on the determinants of non-participation depend on self-reported data which may be biased. Furthermore, no distinction was made between the probably different determinants of both screening strategies.

Objective

To find the determinants of non-participation in BCSP by means of a meta-analysis.

Methods

PubMed, Embase, and Web of Science were searched for observational studies which quantified factors associated with non-participation in BCSP in a general population. Studies on opportunistic screening and studies using self-reported data were excluded. A random-effect model was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Potential sources of heterogeneity were explored by stratification of the results.

Results

Twenty-nine studies with in a total of 20,361,756 women were included. Low income (OR: 1.20, 95% CI: 1.10–1.30), low education (OR: 1.18, 95% CI: 1.05–1.32), living far from an assigned screening unit (OR: 1.15, 95% CI: 1.07–1.24), being immigrant (OR: 2.64, 95% CI: 2.48–2.82), and having a male family doctor (OR: 1.43, 95% CI: 1.20–1.61) was associated with higher non-participation in screening. Reminders sent to non-attenders and estimations of ORs (adjusted or not) partly explained substantial heterogeneity.

Conclusion

In this meta-analysis excluding studies on the non-participation in opportunistic screening, or with self-reported data on non-participation, the well-known determinants for non-participation are still significant, but less strong. This analysis only supports the relevance of meta-analysis of studies with registered non-participation in a BCSP.

Systematic Review Registration

PROSPERO, CRD42020154016.

The effect of social relationships on cognitive decline in older adults: an updated systematic review and meta-analysis of longitudinal cohort studies

Background

A previous meta-analysis (Kuiper et al., 2016) has shown that multiple aspects of social relationships are associated with cognitive decline in older adults. Yet, results indicated possible bias in estimations of statistical effects due to the heterogeneity of study design and measurements. We have updated this meta-analysis adding all relevant publications from 2012 to 2020 and performed a cumulative meta-analysis to map the evolution of this growing field of research (+80% of studies from 2012-2020 compared to the period considered in the previous meta-analysis).

Methods

Scopus and Web of Science were searched for longitudinal cohort studies examining structural, functional and combined effects of social relationships. We combined Odds Ratios (OR) with 95% confidence intervals (CI) using random effects meta-analysis and assessed sources of heterogeneity and the likelihood of publication bias. The risk of bias was evaluated with the Quality of Prognosis Studies in Systematic Reviews (QUIPS) tool.

Results

The review was prospectively registered on PROSPERO (ID: CRD42019130667). We identified 34 new articles published in 2012-2020. Poor social relationships were associated with cognitive decline with increasing precision of estimates compared to previously reviewed studies [(for structural, 17 articles, OR: 1.11; 95% CI: 1.08; 1.14) (for functional, 16 articles, OR: 1.12; 95% CI: 1.05; 1.20) (for combined, 5 articles, OR: 1.15; 95% CI: 1.06; 1.24)]. Meta-regression, risk and subgroup analyses showed that the precision of estimations improved in recent studies mostly due to increased sample sizes.

Conclusions

Our cumulative meta-analysis would confirm that multiple aspects of social relationships are associated with cognitive decline. Yet, there is still evidence of publication bias and relevant information on study design is often missing, which could lead to an over-estimation of their statistical effects.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12889-022-12567-5).

Social Networks in Retirement and Assisted Living Communities: A Literature Review

Research has substantiated that social isolation and loneliness are linked to poorer health, earlier death, and reduced quality of life among older adults. Although there has been research focusing on social networks of nursing home residents and interventions to decrease loneliness and improve social interactions for older adults in varied settings, there is a gap in research relating to social networks of older adults in assisted living and retirement communities. The goal of the current review was to summarize relevant research findings related to this topic published in the past 5 years. The literature review included searching three electronic databases (CINAHL, EBSCOhost, and PubMed) for research articles published between January 2015 and March 2020. A total of 475 articles were identified, which was narrowed to 16 articles included for full review after inclusion and exclusion criteria were applied. Following analysis, three themes were identified in the literature: Social Connections Within an Assisted Living Community, Social Networks Between Residents and Their Adult Children, and Influence of Physical Structure on Social Networks of Residents. [Journal of Gerontological Nursing, 48(1), 42-46.].

Inequality in Social Support Associated With Mild Cognitive Impairment: A Cross-Sectional Study of Older (≥60 Years) Residents in Shanghai, China

Objective: Social support plays a critical role in the detection and management of mild cognitive impairment (MCI). However, socioeconomic inequalities exist in both social support and health care services. Our study aimed to compare the level of social support received by MCI patients in comparison with those without MCI and to determine its link with income. Methods: Secondary data analyses were performed. Social support was measured using the Duke Social Support Index (DSSI) and satisfaction ratings. Multivariate logistic regression models were constructed to determine the associations of personal income and MCI with social support after adjustment for variations in the sociodemographic and health characteristics of the respondents. The multiplicative and additive interaction effects of income and MCI were further examined through introducing the MCI^*Income variable to the regression models and using the relative excess risk due to interaction (RERI) analysis, respectively. Results: The logistic regression models showed that the respondents with MCI had significantly lower social support as measured by the DSSI scores (AOR = 33.03, p < 0.001) and satisfaction ratings (AOR = 7.48, p < 0.001) compared with those without MCI. Similarly, social support decreased with lower personal income (p < 0.001). There existed a significant multiplicative interaction effect between personal income and MCI on social support (AOR = 0.30-0.32, p < 0.01). The gap in social support between those with and without MCI was higher in the higher income group compared with the lower income group (p < 0.001). No significant additive interaction effects on social support were found between MCI and income. Conclusions: There are significant disparities in social support between people living with and without MCI. Such a gap is more profound in people with higher income. The inequality in social support associated with MCI may present a significant challenge to the successful implementation of community MCI detection and management.

Measuring activity engagement in old age: An exploratory factor analysis

A growing body of literature suggests that higher engagement in a range of activities can be beneficial for cognitive health in old age. Such studies typically rely on self-report questionnaires to assess level of engagement. These questionnaires are highly heterogeneous across studies, limiting generalisability. In particular, the most appropriate domains of activity engagement remain unclear. The Victoria Longitudinal Study-Activity Lifestyle Questionnaire comprises one of the broadest and most diverse collections of activity items, but different studies report different domain structures. This study aimed to help establish a generalisable domain structure of the Victoria Longitudinal Study-Activity Lifestyle Questionnaire. The questionnaire was adapted for use in a sample of UK-based older adults (336 community-dwelling adults aged 65–92 with no diagnosed cognitive impairment). An exploratory factor analysis was conducted on 29 items. The final model retained 22 of these items in a six-factor structure. Activity domains were: Manual (e.g., household repairs), Intellectual (e.g., attending a public lecture), Games (e.g., card games), Religious (e.g., attending religious services), Exercise (e.g., aerobics) and Social (e.g., going out with friends). Given that beneficial activities have the potential to be adapted into interventions, it is essential that future studies consider the most appropriate measurement of activity engagement across domains. The factor structure reported here offers a parsimonious and potentially useful way for future studies to assess engagement in different kinds of activities.

Three-year effects of neighborhood social network intervention on mental and physical health of older adults

OBJECTIVES

Although neighborhood is considered to be a crucial source of social network to promote health among older adults, current findings are mostly derived from observational study designs. This study examined whether participations in event-based community programs could increase neighborhood social network and whether such increase could lead to desirable changes in mental and physical health among older adults.

METHOD

This study employed quasi-experimental design. A baseline questionnaire survey was sent to residents of Tsurukabuto community aged 60 years or more (n = 1769); 1,068 responded. Community events were implemented approximately once a month for three years. Then, a three-year follow-up survey questionnaire was sent to the respondents of the baseline survey. The total number of respondents in the latter survey was 662; of the total, 173 participated in the intervention. Strong and weak ties with neighbors, mental well-being (Ikigai-9), health-related quality of life (HRQOL), and instrumental activity of daily living (IADL) were measured in the surveys.

RESULTS

The path analysis revealed that intervention participation was significantly associated with changes in strong ties (standardized path coefficient = 0.12) and changes in strong ties were associated with those in Ikigai-9 scores (standardized path coefficient = 0.15). The total and indirect effects of intervention participation on Ikigai-9 scores were significant. Significant intervention effects were not observed for HRQOL and IADL scores.

CONCLUSION

This study found that participation in our event-based intervention could indirectly and positively influence older adults' mental well-being through their strong ties with their neighbors.

Leisure Activities and Their Relationship With MRI Measures of Brain Structure, Functional Connectivity, and Cognition in the UK Biobank Cohort

Introduction: This study aimed to evaluate whether engagement in leisure activities is linked to measures of brain structure, functional connectivity, and cognition in early old age. Methods: We examined data collected from 7,152 participants of the United Kingdom Biobank (UK Biobank) study. Weekly participation in six leisure activities was assessed twice and a cognitive battery and 3T MRI brain scan were administered at the second visit. Based on responses collected at two time points, individuals were split into one of four trajectory groups: (1) stable low engagement, (2) stable weekly engagement, (3) low to weekly engagement, and (4) weekly to low engagement. Results: Consistent weekly attendance at a sports club or gym was associated with connectivity of the sensorimotor functional network with the lateral visual (β = 0.12, 95%CI = [0.07, 0.18], FDR q = 2.48 × 10-3) and cerebellar (β = 0.12, 95%CI = [0.07, 0.18], FDR q = 1.23 × 10-4) networks. Visiting friends and family across the two timepoints was also associated with larger volumes of the occipital lobe (β = 0.15, 95%CI = [0.08, 0.21], FDR q = 0.03). Additionally, stable and weekly computer use was associated with global cognition (β = 0.62, 95%CI = [0.35, 0.89], FDR q = 1.16 × 10-4). No other associations were significant (FDR q > 0.05). Discussion: This study demonstrates that not all leisure activities contribute to cognitive health equally, nor is there one unifying neural signature across diverse leisure activities.

Social networks and cognitive function in older adults: findings from the HAPIEE study

BACKGROUND

Social networks are associated with better cognitive health in older people, but the role of specific aspects of the social network remains unclear. This is especially the case in Central and Eastern Europe. This study examined associations between three aspects of the social network (network size of friends and relatives, contact frequency with friends and relatives, and social activity participation) with cognitive functions (verbal memory, learning ability, verbal fluency, processing speed, and global cognitive function) in older Czech, Polish, and Russian adults.

METHODS

Linear regression estimated associations between baseline social networks and cognitive domains measured at both baseline and follow-up (mean duration of follow-up, 3.5 ± 0.7 years) in 6691 participants (mean age, 62.2 ± 6.0 years; 53.7% women) from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study.

RESULTS

Cross-sectional analyses, adjusted for country, age, and sex, showed positive associations of global cognitive function with social activity participation and network size of friends and relatives, but not with contact frequency in either network. Further adjustment for sociodemographic, behavioural, and health characteristics attenuated the associations with network size of relatives (P-trend = 0.074) but not with network size of friends (P-trend = 0.036) or social activities (P-trend< 0.001). In prospective analyses, network size and social activity participation were also linked with better cognition in simple models, but the associations were much stronger for social activities (P-trend< 0.001) than for network size of friends (P-trend = 0.095) and relatives (P-trend = 0.425). Adjustment for baseline cognition largely explained the prospective associations with network size of friends (P-trend = 0.787) and relatives (P-trend = 0.815), but it only slightly attenuated the association with social activities (P-trend< 0.001). The prospective effect of social activities was largely explained by sociodemographic, health behavioural, and health covariates (P-trend = 0.233). Analyses of specific cognitive domains generally replicated the cross-sectional and prospective findings for global cognitive function.

CONCLUSIONS

Older Central and Eastern European adults with larger social networks and greater social activities participation had better cognitive function, but these associations were stronger at baseline than over the short-term follow-up.

Type 2 Diabetes Mellitus and Clinicopathological Tumor Characteristics in Women Diagnosed with Breast Cancer: A Systematic Review and Meta-Analysis

Poor prognosis caused by type 2 diabetes mellitus (T2DM) in women with breast cancer is conferred, while the association between T2DM and breast tumor aggressiveness is still a matter of debate. This study aimed to clarify the differences in breast cancer characteristics, including stage, size, lymph node status, grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (Her2), between patients with and without pre-existing T2DM. PubMed, Embase, and Web of Science were searched for studies from 1 January 2010 to 2 July 2021. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were pooled by using a random effects model. T2DM was significantly associated with tumor stages III/IV versus cancers in situ and stages I/II (pooled ORs (pOR), 95% CI: 1.19; 1.04-1.36, p = 0.012), tumor size >20 versus ≤20 mm (pOR, 95% CI: 1.18; 1.04-1.35, p = 0.013), and lymph node invasion versus no involvement (pOR, 95% CI: 1.26; 1.05-1.51, p = 0.013). These findings suggest that women with T2DM are at a higher risk of late-stage tumors, large tumor sizes, and invasive lymph nodes at breast cancer diagnosis.

The Effect of Loneliness on Cognitive Functioning Among Healthy Individuals in Mid- and Late-Adulthood: Evidence From the Canadian Longitudinal Study on Aging (CLSA)

There is a consensus that loneliness correlates with an increased risk of cognitive impairment and rapid cognitive decline. However, it has yet to be determined how loneliness influences cognitively healthy aging. This study makes use of the large, nationally representative Canadian Longitudinal Study of Aging (CLSA) to address this question. Based on the baseline and first follow-up datasets collected 3 years apart (n > 20,000 healthy individuals), we found that higher perceived loneliness predicted decreased scores in the immediate recall test at baseline and in two tests of prospective memory at first follow-up 3 years after baseline. We also examined whether a single-item measurement of loneliness widely used in the field of gerontology, including CLSA, has predictive validity, i.e., can contribute to the prognosis of a future level of cognitive functioning. We found low predictive validity and low test-retest (baseline to follow-up) reliability of this measurement type. These findings impose constraints on proposed accounts of loneliness as a risk factor and methods of examining its relation to cognitive aging.

A comprehensive overview of social network measures for older adults: A systematic review

OBJECTIVES

The size and type of older adults' social networks is associated with health, mental and social outcomes. Investigators within many disciplines are now measuring social networks, but it is not always clear what they are assessing, or which measures may best meet their objectives. To undertake a systematic review to identify (i) social network measures used for older adults, (ii) variety of social network dimensions and (iii) how measures have developed over time.

MATERIALS AND METHODS

The MEDLINE, EMBASE, CINAHL, PsycInfo and Cochrane Library databases were systematically searched to identify social network instruments, followed by categorization of the domains into quantitative, qualitative and alter domains.

RESULTS

A total of 229 studies and 21 social network measures were included, with 11 quantitative dimensions (e.g., size, frequency), 5 qualitative dimensions (e.g., support satisfaction, emotional bond) and 7 alter members (e.g., family, neighbours) of social networks identified. Measures commonly clustered on quantifiable network size (n = 19), availability of supportive networks (n = 14) and presence of family ties (n = 21). The period between 1985 and 1995 produced the greatest number of newly developed social network measures (n = 10) with a stronger focus on qualitative features.

DISCUSSION AND IMPLICATIONS

This review provides researchers with an organized summary of measures and dimensions for consideration when appraising social connections in older adults. This can enable better study design through providing information that makes explicit inevitable trade-offs between survey length, comprehensiveness of dimension coverage, and utilization of the measure for researchers. PROSPERO Registration number: CRD42016043089.

Can Neighborhood Social Infrastructure Modify Cognitive Function? A Mixed-Methods Study of Urban-Dwelling Aging Americans

Objectives: Socialization predicts cognitive aging outcomes. Neighborhoods may facilitate socially engaged aging and thus shape cognition. We investigated places where older adults socialized and whether availability of these sites was associated with cognitive outcomes. Methods: Qualitative analysis of interviews and ethnography with 125 older adults (mean age 71 years) in Minneapolis identified where participants socialized outside of home. This informed quantitative analysis of a national sample of 21,151 older Americans (mean age at baseline 67 years) from the Reasons for Geographic and Racial Differences in Stroke study. Multilevel generalized additive models described associations between access to key social places and cognitive function and decline. Results: Qualitative analysis identified eateries, senior centers, and civic groups as key places to socialize. We identified significant positive associations between kernel density of senior centers, civic/social organizations, and cognitive function. Discussion: Specific neighborhood social infrastructures may support cognitive health among older adults aging in place.

The effects of education on cognition in older age: Evidence from genotyped Siblings

A growing literature has sought to tie educational attainment with later-life cognition and Alzheimer's disease outcomes. This paper leverages sibling comparisons in educational attainment as well as genetic predictors (polygenic scores) for cognition, educational attainment, and Alzheimer's disease to estimate effects of educational attainment on cognition in older age in the United Kingdom. We find that the effects of education on cognition are confounded by family background factors (~40%) and by genetics (<10%). After adjustments, we continue to find large effects of education. College graduates have cognition scores that are approximately 0.75 SD higher than those who report no credentials. We also find evidence that educational effects on cognition are smaller for those with high polygenic scores for Alzheimer's disease.

Partnership and Cognitive Aging in Europe: Mediating Factors and Social Stratification

Objectives

Living in a partnership has been shown to benefit later life health in general and decrease the risk of cognitive impairment. Few studies have, however, examined whether different types of partnership transitions also differ with respect to their impact on cognitive trajectories, and whether financial resources, healthy behaviors, cognitive stimulation, and social integration can explain these differences.

Methods

Data came from six waves of the Survey of Health, Ageing and Retirement in Europe, which is a representative panel for the population aged 50 years or older, and were collected between 2004 and 2017 in 20 European countries. Our sample includes 215,989 valid person-year observations from 78,984 persons. The mean age at baseline is 64 years, and individuals were observed on average 2.7 times. Cognitive functioning was assessed with measures of immediate and delayed recall on a memory test and verbal fluency. Fixed effects regression models were employed to exploit individual-level variation in partnership and simultaneous cognitive changes.

Results

Partnership status was stable in most respondents (around 90%). Compared to remaining partnered and after controlling for sociodemographic factors, transition to divorce was associated with a steeper decline in immediate and delayed recall. Exploring possible mechanisms, both financial resources and social integration, explained these differences. Additional analyses suggested that effects were mostly driven by individuals with lower education.

Discussion

Partnership transitions remain infrequent events in later life, but our findings indicate that they can induce less favorable cognitive trajectories compared to partnered individuals, particularly for those with lower cognitive reserve.

Experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program

BACKGROUND

There is great need for development of feasible rehabilitation for older people with dementia. Increased understanding of this population's experiences of rehabilitation participation is therefore important. The aim of this study was to explore the experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program.

METHODS

Sixteen older people with dementia were interviewed about their experiences of participation in a person-centred multidimensional interdisciplinary rehabilitation program. The program comprised assessments by a comprehensive team of rehabilitation professionals followed by a rehabilitation period of 16 weeks, including interventions based on individualized rehabilitation goals conducted with the support of the rehabilitation team. The rehabilitation was performed in the participants' homes, in the community and at an outpatient clinic, including exercise with social interaction in small groups offered twice a week to all participants. The interviews were conducted at the end of the rehabilitation period and analysed with qualitative content analysis.

RESULTS

The analysis resulted in one overarching theme: Empowered through participation and togetherness and four sub-themes: Being strengthened through challenges; Gaining insights, motives, and raising concerns about the future; Being seen makes participation worthwhile; and Feelings of togetherness in prosperity and adversity. The participants increased their self-esteem by daring and coping in the rehabilitation. The insights about themselves and their condition motivated them to continue with their prioritized activities, but also raised concerns about how the future would play out. Collaboration in the group and being seen and acknowledged by staff strengthened their own motivation and self-efficacy.

CONCLUSION

According to community-dwelling older people with dementia, a person-centred multidimensional interdisciplinary rehabilitation program was experienced as viable and beneficial. The participants seemed empowered through the rehabilitation and expressed mostly positive experiences and perceived improvements. Providers of interdisciplinary rehabilitation programs for this group should consider aspects raised by the participants e.g. the positive experience of being challenged in both exercise and daily activities; the importance of being seen and feeling secure; the benefits and challenges of collaboration with others in the same situation; and the generation of new perspectives of current and future situation.

Associations of loneliness and social isolation with actigraph and self-reported sleep quality in a national sample of older adults

STUDY OBJECTIVES

To examine associations of social isolation and loneliness with sleep in older adults and whether associations differ for survey and actigraph sleep measures.

METHODS

This study used data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of community-dwelling older adults born 1920-1947. A random one-third of participants in 2010-2011 were invited to participate in a sleep study (N = 759) that included survey questions, 72 hours of wrist actigraphy, and a sleep log. Perceived loneliness was measured using three questions from the UCLA Loneliness Scale. An index of social isolation was constructed from nine items that queried social network characteristics and social interactions. We used ordinary least squares and ordinal logistic regression to examine whether sleep measures were associated with loneliness and social isolation adjusted for potential sociodemographic confounders.

RESULTS

Social isolation and loneliness had a low correlation (Spearman's correlation = 0.20). Both loneliness and social isolation were associated with actigraphy measures of more disrupted sleep: wake after sleep onset and percent sleep. Neither was associated with actigraph total sleep time. Increased loneliness was strongly associated with more insomnia symptoms and with shorter sleep duration assessed by a single question, but social isolation was not. More isolated individuals spent a longer time in bed.

CONCLUSIONS

We found that both loneliness and social isolation were associated with worse actigraph sleep quality, but their associations with self-reported sleep differed. Only loneliness was associated with worse and shorter self-reported sleep.

Social isolation during COVID-19 lockdown impairs cognitive function

Studies examining the effect of social isolation on cognitive function typically involve older adults and/or specialist groups (e.g., expeditions). We considered the effects of COVID‐19‐induced social isolation on cognitive function within a representative sample of the general population. We additionally considered how participants ‘shielding’ due to underlying health complications, or living alone, performed. We predicted that performance would be poorest under strictest, most‐isolating conditions. At five timepoints over 13 weeks, participants (N = 342; aged 18–72 years) completed online tasks measuring attention, memory, decision‐making, time‐estimation, and learning. Participants indicated their mood as ‘lockdown’ was eased. Performance typically improved as opportunities for social contact increased. Interactions between participant sub‐groups and timepoint demonstrated that performance was shaped by individuals' social isolation levels. Social isolation is linked to cognitive decline in the absence of ageing covariates. The impact of social isolation on cognitive function should be considered when implementing prolonged pandemic‐related restrictive conditions.

Emotional Processing in Healthy Ageing, Mild Cognitive Impairment, and Alzheimer's Disease

Emotional processing, particularly facial expression recognition, is essential for social cognition, and dysfunction may be associated with poor cognitive health. In pathological ageing conditions, such as mild cognitive impairment (MCI) and Alzheimer’s disease (AD), in which cognitive impairments are present, disturbed emotional processing and difficulty with social interactions have been documented. However, it is unclear how pathological ageing affects emotional processing and human social behaviour. The aim of this study is to provide insight into how emotional processing is affected in MCI and AD and whether this capacity can constitute a differentiating factor allowing the preclinical diagnosis of both diseases. For this purpose, an ecological emotional battery adapted from five subsets of the Florida Affect Battery was used. Given that emotion may not be separated from cognition, the affect battery was divided into subtests according to cognitive demand, resulting in three blocks. Our results showed that individuals with MCI or AD had poorer performance on the emotional processing tasks, although with different patterns, than that of controls. Cognitive demand may be responsible for the execution patterns of different emotional processing tests. Tasks with moderate cognitive demand are the most sensitive for discriminating between two cognitive impairment entities. In summary, emotional processing tasks may aid in characterising the neurocognitive deficits in MCI or AD. Additionally, identifying these deficits may be useful for developing interventions that specifically target these emotional processing problems.

Early Child-Parent Relationship Quality and Cognitive Function in Older Rural Chinese Adults: The Mediating Role of Educational Attainment

Objectives: Framed within a life course perspective and cognitive reserve theory, this study examined the mediating role of educational attainment for the association between child-parent relationships during childhood and cognitive function among older adults in rural China. Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (N = 9809). We employed latent growth curve modeling to test the association among early child-parent relationship quality, educational attainment, and cognitive function in later life. Results: Early child-mother relationship quality was associated with the level and change in cognitive function. Early child-father relationship quality was only related to baseline cognitive function. Educational attainment mediated the relationship between early child-parent relationship quality with mothers and fathers and cognitive function. Discussion: Parental relationship experience in childhood was one distal factor related to cognitive function among older adults. The findings supported the long-term impacts of childhood conditions for later life health consequences.

Cognitive health risks posed by social isolation and loneliness in older Korean Americans

BACKGROUND

This study examines associations among social isolation, loneliness, and cognitive health risks in older Korean Americans, focusing on the mediating role of loneliness in the relationship between social isolation and objective and subjective measures of cognitive impairment.

METHODS

Data are from 2061 participants in the Study of Older Korean Americans, a multi-state survey of Korean immigrants age 60 and older (Mage = 73.2, SD = 7.93). Social isolation was indexed with the Lubben Social Network Scale- 6; loneliness, with the short-form UCLA Loneliness Scale. Objective and subjective measures of cognitive impairment included the Mini-Mental State Examination and a single-item self-rating of cognitive health.

RESULTS

In the logistic regression model for objective cognitive impairment, social isolation was significantly associated, but loneliness was not. In the model for subjective cognitive impairment, both social isolation and loneliness were significant factors. However, the effect of social isolation became non-significant when loneliness was considered, suggesting a potential mediating role of loneliness. The subsequent mediation analysis confirmed that the indirect effect of social isolation on subjective cognitive impairment through loneliness was significant (B = .20, SE = .03, 95% CI = .12, .28).

CONCLUSION

Our analyses provide evidence for the proposed mediating effect of loneliness in the relationship between social isolation and subjective cognitive impairment. Intervention efforts should focus on reducing feelings of loneliness experienced by older immigrants, possibly by engaging them in socially meaningful and cognitively stimulating activities.

Dual-Task Exercise to Improve Cognition and Functional Capacity of Healthy Older Adults

Background

It has been suggested that physical inactivity and lack of stimulating cognitive activity are the two most significant modifiable risk factors to impair cognitive function. Although many studies that investigated the cognitive effects of physical exercise and cognitive stimuli in dual-task conditions showed improved cognitive performance, others have not confirmed these findings. The main aim of the present work is to analyze the effects of a dual-task multimodal physical exercise training, at moderate intensity, and cognitive stimulation on cognitive and physical function in healthy older adults.

Methods

This clinical trial was registered on the Brazilian Registry of Clinical Trials (RBR-9zrx3d). Here we tested the effects of a dual-task multimodal physical exercise training, at moderate intensity, on cognitive and physical function and quality of life in community dwelling older adults. The training protocol included 24 group sessions, 2/week, per 75 min. Cognition was assessed using CANTAB automated neuropsychological tests and Functional Capacity to Exercise tests. Performance was compared from baseline to post intervention and to a non-exercise control group using Mixed Linear Model for repeated measures.

Results

Control (CG) and dual-task (DTEx) groups progressed differentially over time on performance of episodic memory, sustained visual attention, functional mobility, cardiorespiratory fitness, lower limbs strength resistance, agility, quality of life and dual-task performance with significant improved DTEx performance. Control group did not show any significant changes on these tests except for showing a reduction in dual-task performance.

Conclusion

We suggest that the dual-task combination of multisensory cognitive stimulation and multimodal moderate physical exercise training, twice a week, may be adopted as an effective program to reduce progression of age-related cognitive decline and improve physical fitness and quality of life on healthy older adults.

Clinical Trial Registration

Brazilian Registry of Clinical Trials: https://ensaiosclinicos.gov.br/rg/RBR-9zrx3d -UTN code: U1111-1233-6349.

All-cause mortality and three aspects of social relationships: an eight-year follow-up of older adults from one entire Korean village

Various aspects of social relationships have been examined as risk factors for mortality. In particular, most research has focused on either loneliness or social disengagement. We aimed to extend the current research by adding a group-level segregation measure utilizing the whole social network of one entire village in South Korea. The analyses were based on the Korean Social Life, Health and Aging Project data collected over eight years across five waves. Of the 679 old adults who participated throughout the entire project (to wave 5), 63 were confirmed as deceased. All three aspects of social relationships examined, loneliness, social disengagement, and group-level segregation, were associated with mortality in the traditional Cox proportional hazard model without considering health-related time-varying covariates. However, a Cox marginal structural model, a counterfactual statistical measure that is designed to control for censoring bias due to sample attrition over the eight years and time-varying confounding variables, revealed that only group-level segregation was associated with mortality. Our results strongly suggest that more attention is needed on group-level segregation for mortality studies, as well as on well-known individual-level risk factors, including social disengagement and loneliness. All methods were carried out in accordance with relevant guidelines and regulations.

The Mediating Effect of Physical Function Decline on the Association Between Social Activity and Cognitive Function in Middle and Older Korean Adults: Analyzing Ten Years of Data Through Multivariate Latent Growth Modeling

Purpose

This study aimed to examine the long-term association between social activity, physical function decline and cognitive function, as well as verify the long-term mediating effect of physical function decline on the relationship between social activity and cognitive function.

Methods

Data from the Korean Longitudinal Study of Aging (KLoSA) that was collected over 10 years was analyzed. The sample included 10,240 adults aged 45–93 years (Mean age = 61.66 [SD = 11.061]). Multivariate latent growth modeling (LGM) was applied to verify the long-term effect of social activity and physical function on cognitive function.

Results

The results revealed that social activity had a positive impact on cognitive function and negative impact on physical function decline after controlling for age and education level. Additionally, physical function decline negatively influenced cognitive function. Finally, social activity indirectly affected cognitive function through physical function decline.

Conclusion

The contribution of this study was to test the long-term effect social activity on physical and cognitive function.