Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-19T15:57:50.476Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  28 June 2021

Terry E. Goldberg Open the ORCID record for Terry E. Goldberg [Opens in a new window] ,
Jongwoo Choi ,
Seonjoo Lee ,
Barry Gurland  and
Davangere P. Devanand
Terry E. Goldberg*
Affiliation:
Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA Department of Psychiatry, Columbia University Medical Center, New York, NY, USA Department of Anesthesiology, Columbia University, Irving Medical Center, New York, NY, USA
Jongwoo Choi
Affiliation:
Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, New York, NY, USA
Seonjoo Lee
Affiliation:
Department of Psychiatry, Columbia University Medical Center, New York, NY, USA Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA Department of Biostatistics, Columbia University, New York, NY, USA
Barry Gurland
Affiliation:
Stroud Center, Columbia University, New York, NY, USA
Davangere P. Devanand
Affiliation:
Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA Department of Psychiatry, Columbia University Medical Center, New York, NY, USA Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, New York, NY, USA
*
Correspondence should be addressed to: Terry Goldberg, Division of Geriatric Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 126, New York, NY 10032, USA. Email: [email protected].
Get access

Abstract

Objective:

Social isolation and emotional isolation, i.e. loneliness, have been associated with dementia or cognitive decline. In contrast, the relationship of restriction of physical and instrumental activities of daily living to cognitive decline and dementia has been less studied.

Design:

We examined multiple quality of life (QoL) indicators, including isolation and restriction of activities, utilizing two validated scales in elders without dementia to determine their associations with cognitive decline and incident dementia that were followed longitudinally over 6 years. We comprehensively controlled for other symptom constellations, including depression and anergia.

Setting:

A large multi-ethnic prospective study was conducted in northern Manhattan, NYC.

Participants:

An ethnically diverse sample of 855 non-demented individuals at baseline participated.

Measures:

The following QoL scales were utilized: Restriction, Anergia, Isolation, Loneliness, and Affective Suffering.

Results:

Both Restriction (HR = 2.22, 95% CI [1.42, 3.47], P < .001) and Isolation (HR = 1.78, 95% CI [1.17, 2.70], P = 0.007) were associated with episodic memory and incident dementia, controlling for age, sex, and education. Loneliness and Affective Suffering (depression) were not associated with these outcomes (P’s > .1) with both Restriction and Isolation in the same model for the prediction of dementia, only Restriction remained significant (HR = 1.97, 95% CI [1.24, 3.14], P = 0.004). In cross-lagged panel analyses, Restriction and Isolation had reciprocal influences (P’s < .001), indicating that Restriction at the previous time point influenced current Isolation. Importantly, Restriction (but not Isolation) and Selective Reminding total recall memory demonstrated highly significant direct and reciprocal influences over time (P’s < .001).

Conclusions:

Restriction and Isolation were associated with incident dementia. Restriction played a more prominent role in its impact on memory decline. The development of these impairments in QoL, particularly Restriction, may provide warning signs of future cognitive decline and dementia and provide multiple and novel avenues for therapeutic interventions with the goal of delaying the development of cognitive decline and dementia.

Keywords

restrictiondementiamemorylonelinessdepression
Type
Original Research Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 11: Issue Theme: Advances in Assessment and Diagnosis of Dementia , November 2021 , pp. 1207 - 1215
Copyright
© International Psychogeriatric Association 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baltes, M. M. and Carstensen, L. L. (2003). The process of successful aging: selection, optimization and compensation. In: Staudinger, U. M. and Lindenberger, U. (Eds.), Understanding Human Development: Dialogues with Lifespan Psychology (pp 81–104). New York: Kluwer Academic Publishers.CrossRefGoogle Scholar
Brown, P. J., Devanand, D. P., Liu, X., Caccappolo, E. and Alzheimer’s Disease Neuroimaging Initiative (2011). Functional impairment in elderly patients with mild cognitive impairment and mild Alzheimer disease. Archives of General Psychiatry, 68, 617–626.CrossRefGoogle ScholarPubMed
Byers, A. L. and Yaffe, K. (2011). Depression and risk of developing dementia. Nature Reviews Neurology, 7, 323–331.CrossRefGoogle ScholarPubMed
Cheng, H., Gurland, B. J. and Maurer, M. S. (2008). Self-reported lack of energy (anergia) among elders in a multiethnic community. Journal of Gerontology Series A Biological Sciences and Medical Sciences, 63, 707–714.CrossRefGoogle Scholar
Devanand, D. P. et al. (1996). Depressed mood and the incidence of Alzheimer’s disease in the elderly living in the community. Archives of General Psychiatry, 53, 175–182.CrossRefGoogle ScholarPubMed
Devanand, D. P. et al. (2008). Combining early markers strongly predicts conversion from mild cognitive impairment to Alzheimer’s disease. Biological Psychiatry, 64, 871–879.CrossRefGoogle ScholarPubMed
Devanand, D. P. et al. (2015). Olfactory deficits predict cognitive decline and Alzheimer dementia in an urban community. Neurology, 84, 182–189.CrossRefGoogle Scholar
Devanand, D. P., Liu, X. and Brown, P. J. (2017). Impact of functional deficits in instrumental activities of daily living in mild cognitive impairment: a clinical algorithm to predict progression to dementia. Alzheimer Disease and Associated Disorders, 31, 55–61.CrossRefGoogle Scholar
Golden, R. R., Teresi, J. A. and Gurland, B. J. (1984). Development of indicator scales for the comprehensive assessment and referral evaluation (CARE) interview schedule. Journal of Gerontology, 39, 138–146.CrossRefGoogle ScholarPubMed
Gurland, B. J. and Gurland, R. V. (2009). The choices, choosing model of quality of life: description and rationale. International Journal of Geriatric Psychiatry, 24, 90–95.CrossRefGoogle ScholarPubMed
Gurland, B. J. and Wilder, D. E. (1984). The CARE interview revisited: development of an efficient, systematic clinical assessment. Journal of Gerontology, 39, 129–137.CrossRefGoogle ScholarPubMed
Hamaker, E. L., Kuiper, R. M. and Grasman, R. P. (2015). A critique of the cross-lagged panel model. Psychological Methods, 20, 102–116.CrossRefGoogle ScholarPubMed
Hawkley, L. C. and Cacioppo, J. T. (2010). Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40, 218–227.CrossRefGoogle ScholarPubMed
Hoogendijk, E. O., Afilalo, J., Ensrud, K. E., Kowal, P., Onder, G. and Fried, L. P. (2019). Frailty: implications for clinical practice and public health. Lancet, 394, 1365–1375.CrossRefGoogle ScholarPubMed
Jorm, A. F. (2000). Is depression a risk factor for dementia or cognitive decline? A review. Gerontology, 46, 219–227.CrossRefGoogle ScholarPubMed
Kuznetsova, A., Brockhoff, P. B. and Christensen, R. H. B. (2017). lmerTest package: tests in linear mixed effects models. Journal of Statistical Software, 82, 1–26.CrossRefGoogle Scholar
La Rue, A. (2010). Healthy brain aging: role of cognitive reserve, cognitive stimulation, and cognitive exercises. Clinics in Geriatric Medicine, 26, 99–111.CrossRefGoogle ScholarPubMed
Lee, J. and Cagle, J. G. (2017). Validating the 11-item revised university of California Los Angeles scale to assess loneliness among older adults: an evaluation of factor structure and other measurement properties. American Journal of Geriatric Psychiatry, 25, 1173–1183.CrossRefGoogle ScholarPubMed
Livingston, G. et al. (2017). Dementia prevention, intervention, and care. Lancet, 390, 2673–2734.CrossRefGoogle ScholarPubMed
O’Luanaigh, C. et al. (2012). Loneliness and cognition in older people: the Dublin healthy ageing study. Aging and Mental Health, 16, 347–352.CrossRefGoogle ScholarPubMed
Rosseel, Y. (2012). Lavaan: an R package for structural equation modeling. Journal of Statistical Software, 48, 1–36.CrossRefGoogle Scholar
Stern, Y. et al. (1992). Diagnosis of dementia in a heterogeneous population. Development of a neuropsychological paradigm-based diagnosis of dementia and quantified correction for the effects of education. Archives of Neurology, 49, 453–460.CrossRefGoogle Scholar
Sutin, A. R., Stephan, Y., Luchetti, M. and Terracciano, A. (2018). Loneliness and Risk of Dementia. Journal of Gerontology Series B, Psychological Sciences and Social Sciences, 75, 1414–1422.CrossRefGoogle Scholar
Tabert, M. H. et al. (2002). Functional deficits in patients with mild cognitive impairment: prediction of AD. Neurology, 58, 758–764.CrossRefGoogle ScholarPubMed
Teresi, J. A., Golden, R. R., Gurland, B. J., Wilder, D. E. and Bennett, R. G. (1984). Construct validity of indicator-scales developed from the Comprehensive Assessment and Referral Evaluation interview schedule. Journal of Gerontology, 39, 147–157.CrossRefGoogle ScholarPubMed
Therneau, T. (2014). A package for survival analysis in S. R package version 2.37-7. https://cran.r-project.org/web/packages/survival/index.html.Google Scholar
Tilvis, R. S., Kahonen-Vare, M. H., Jolkkonen, J., Valvanne, J., Pitkala, K. H. and Strandberg, T. E. (2004). Predictors of cognitive decline and mortality of aged people over a 10-year period. Journal of Gerontology Series A Biological Science and Medical Science, 59, 268–274.CrossRefGoogle ScholarPubMed
Tomas, J. M., Pinazo-Hernandis, S., Oliver, A., Donio-Bellegarde, M. and Tomas-Aguirre, F. (2019). Loneliness and social support: differential predictive power on depression and satisfaction in senior citizens. Journal of Community Psychology, 47, 1225–1234.CrossRefGoogle ScholarPubMed
Wilson, R. S. et al. (2007). Loneliness and risk of Alzheimer disease. Archives of General Psychiatry, 64, 234–240.CrossRefGoogle ScholarPubMed
Woods, B., Aguirre, E., Spector, A. E. and Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews, CD005562.Google ScholarPubMed
Supplementary material: File

Goldberg et al. supplementary material

Goldberg et al. supplementary material

Download Goldberg et al. supplementary material(File)
File 37.8 KB