The COVID-19 pandemic has brought to the forefront the impact of loneliness on our health. Research literature suggests that there is a link between feelings of loneliness and the development of dementia.
The increase in life expectancy worldwide is accompanied by an increase in the prevalence of dementia. In 2050, the number of patients is expected to increase to 152 million worldwide (ADI, 2018).
The increase in life expectancy is also accompanied by an increasing number of people living alone, and this condition is known to be a risk factor for social isolation and feelings of subjective loneliness. It is now recognized that all of these affect the health and well-being of people at every stage of life. There are even studies that indicate a direct effect of subjective loneliness on the shortening of the life expectancy of a person who experiences feelings of loneliness over time.
What characterizes subjective loneliness?
Subjective loneliness is different from social isolation.
Social isolation refers to a state of absence/lack/reduction in social connections. Social isolation can be measured or assessed with reference to living arrangements (e.g., how many people live in the house) and personal status (married or not, number of children, etc.), frequency of encounters with other people during a week, etc.
In contrast, subjective loneliness refers to an internal feeling of alienation from the social environment, regardless of the number or amount of interactions with other people.
What is the impact of subjective loneliness?
It has been known for some time that subjective loneliness affects the body's systems in a way that increases the risk of: cardiovascular disease, high blood pressure, chronic inflammatory conditions, and physical reactions to ongoing stress.
Loneliness is currently considered a risk factor for mortality, even from a global perspective and taking into account cultural differences.
This position was strengthened during the global coronavirus pandemic, in which the number of people reporting loneliness and its negative impact on their health increased tenfold worldwide.
What is the connection between loneliness and dementia?
An international committee of dementia researchers and experts published an article in August 2020 summarizing the risk factors for dementia. Among other things, they cite subjective loneliness as a risk factor for cognitive changes and dementia.
Social connections serve as a protective factor against cognitive change, enriching a person's cognitive pool and encouraging health-supportive behaviors.
Longitudinal studies, epidemiological models, and brain disease studies have shown that weak social networks, low social support, and subjective feelings of loneliness increase the risk of dementia.
The hypothesis is that a broad social network serves as a protective factor against cognitive decline through intellectual and emotional stimulation, enrichment of the cognitive pool, encouragement of health-promoting behaviors, and practical support in daily life.
What does the research reveal about the link between loneliness and dementia?
A study in Sweden followed about 2,000 people aged 60+, without cognitive changes, for about 20 years and found that there was a higher chance of developing dementia, particularly Alzheimer's, in people who reported feeling lonely (Sundstrom et al., 2020). In this study, the single question "Do you often feel lonely?" was sufficient to identify the link between loneliness and cognitive decline.
The findings of this study are supported by another study that examined levels of amyloid-beta protein accumulation in the brain. Deposits and abnormal accumulation of amyloid-beta proteins are recognized as pathological markers of Alzheimer's disease. This study, which also examined people without known cognitive changes, found that there were higher amounts of amyloid-beta proteins in people who reported feeling lonely (Donovan et al., 2016).
Another large-scale study (more than ten thousand participants) conducted in the US over more than a decade found that loneliness (also according to self-report) increases the risk of dementia by up to 40% (Sutin et al., 2020. It is important to note that this is a figure that is specifically appropriate for the measurement method of this study).
Additionally, this study found no association between increased risk of dementia and sociodemographic factors such as gender, economic status, ethnicity, level of education, and more.
Is it possible that the onset of dementia and its accompanying symptoms led to feelings of loneliness?
This is one of the questions that is currently preoccupying researchers.
The studies described above are longitudinal studies, which began testing and monitoring years before the first symptoms of dementia appeared, so it seems that loneliness precedes the disease. However, there is still no unified position on this matter.
Some symptoms of dementia may prevent a person from socializing and significantly reduce social interactions, such as difficulty retrieving words, excessive repetition of questions or stories that have already been told.
Some people with dementia, especially in the early stages, are aware of these difficulties, and may avoid society due to shame, fear of humiliating situations, difficulty getting help, etc. Given the fact that dementia develops gradually and slowly, it is possible that the person was aware of the changes even before they were exposed to the environment and chose to isolate themselves from society in order to hide the difficulties that began to emerge.
what can we do?
The main goal of the Dementia Friends program is to raise awareness of dementia and Alzheimer's diseases.
When people come together to support and assist a person with dementia,
When we are patient and tolerant after hardship,
When you create a supportive community,
When we come to people with difficulties –
We are creating a better society,
More helpful,
More inclusive,
Supports and enables a person facing cognitive challenges to be a part of it over time.
Let's be a supportive community!
Sources:
- Donovan, N. Okereke, O., Vannini, P., Amariglio, V., Rentz., D. et al. (2016). Association of Higher Cortical Amyloid Burden with Loneliness in Cognitively Normal Older Adults. Journal of American Medical Association psychiatry, 73(12), 1230–1237.
- Sundstrom, A., Adolfsson, A., N., Nordin, M. & Adlofsson, R. (2020). Loneliness increases the incidence of all-cause dementia and Alzheimer's disease. Journals of Gerontology: Psychological Sciences. 75 (5), 919–926
- Sutin, A., R., Yannick, S., Luchetti, M. & Terracciano, A. (2020). Loneliness and risk of dementia. Journal of Gerontology: Psychological Sciences, 75 (7), 1414-1422.