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Cited by 423Dementia and Cognitive Impairment ResearchHealth disparities and outcomesAging and Gerontology Research

Are loneliness and social isolation associated with cognitive decline?

Open access
Lara, Elvira, Caballero, Francisco Félix, Rico‐Uribe, Laura Alejandra, Olaya, Beatriz, Haro, Josep Maria, Ayuso‐Mateos, José Luis, Miret, Marta·2019·International Journal of Geriatric Psychiatry
DOI 10.1002/gps.5174
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Abstract

Objective: This study aimed to examine the association of loneliness and social isolation on cognition over a 3‐year follow‐up period in middle‐ and older‐aged adults. Methods: Data from a Spanish nationally representative sample were analyzed (n = 1691; aged 50 years or older). Loneliness, social isolation, and cognition (immediate recall, delayed recall, verbal fluency, forward digit span, backward digit span, and a composite cognitive score) were assessed both at baseline and at follow‐up. Adjusted generalized estimating equations models were performed. Results: Loneliness was significantly associated with lower scores in the composite cognitive score, immediate and delayed recall, verbal fluency, and backward digit span (B = −0.14 to B = −3.16; P < .05) and with a more rapid decline from baseline to follow‐up in two out of six cognitive tests. Higher social isolation was associated with lower scores in the composite cognitive score, verbal fluency, and forward digit span (B = −0.06 to B = −0.85; P < .05). The effect of loneliness and social isolation on cognition remained significant after the exclusion of individuals with depression. Conclusions: Both loneliness and social isolation are associated with decreased cognitive function over a 3‐year follow‐up period. The development of interventions that include the enhancement of social participation and the maintenance of emotionally supportive relationships might contribute to cognitive decline prevention and risk reduction.

AI snapshot

Written from the paper’s full text.

TL;DR

In a Spanish nationally representative longitudinal sample of adults aged 50+, both loneliness and social isolation were associated with lower cognitive function over a 3-year follow-up. Loneliness also predicted a more rapid decline in composite cognition and backward digit span, while social isolation did not predict faster decline.

Key findings

  • Loneliness was associated with lower scores on the composite cognitive score, immediate recall, delayed recall, verbal fluency, and backward digit span (B = −0.14 to −3.16; p < 0.05). In fully adjusted models, composite score B = −3.16 (95% CI −4.95, −1.37), immediate recall B = −0.83 (95% CI −1.29, −0.36), delayed recall B = −0.25 (95% CI −0.46, −0.03), verbal fluency B = −0.98 (95% CI −1.61, −0.34), and backward digit span B = −0.14 (95% CI −0.24, −0.04).
  • Social isolation was associated with lower scores on the composite cognitive score, verbal fluency, and forward digit span (B = −0.06 to −0.85; p < 0.05). Fully adjusted estimates were composite B = −0.85 (95% CI −1.55, −0.14), verbal fluency B = −0.34 (95% CI −0.57, −0.11), and forward digit span B = −0.06 (95% CI −0.11, −0.02).
  • Loneliness × time interactions were significant for composite cognitive score, delayed recall, forward digit span, and backward digit span (B = −0.01 to −0.11; p < 0.05), but pairwise comparisons showed significantly faster decline only for composite cognitive score and backward digit span. Social isolation × time was not statistically significant for any cognitive domain.
  • Associations remained substantively similar after excluding individuals with depression.

Methods

  • Longitudinal analysis of “Edad con Salud,” a nationally representative household survey in Spain; baseline was 2011–2012 and follow-up was 2014–2015. Final analytical sample was 1,691 respondents aged ≥50 years (mean age 64.5 years, SD 9.8; 52.8% women).
  • Cognition was assessed with CERAD immediate and delayed word recall, animal naming verbal fluency, forward and backward digit span, and a composite cognitive score transformed to 0–100. Loneliness used the 3-item UCLA Loneliness Scale, analyzed dichotomously with a cutoff of 6 and continuously as a percentile score. Social isolation used a 0–5 index based on marital/cohabiting status, contact with children, other family, friends, and organizational participation.
  • Adjusted generalized estimating equations models were constructed stepwise; the fully adjusted model included time, gender, age, education, stroke, diabetes, physical activity, disability, alcohol consumption, and mutual adjustment for loneliness or social isolation. Interaction terms evaluated loneliness × time and social isolation × time; sensitivity analyses excluded depression and used continuous loneliness.

Limitations

  • The paper states a short follow-up period reduced power to evaluate persistent loneliness and social isolation; artificial dichotomization of loneliness may bias estimates; the social isolation composite assigned equal weights to all components; reverse causality cannot be ruled out; and attrition bias may have led to underestimation of the true association.
  • The paper also reports that excluded individuals were significantly older, had lower education, higher disability, lower alcohol consumption, higher loneliness and social isolation, and lower scores on all cognitive tests, consistent with attrition bias.
  • Evident from the text: the study is observational, so causal direction cannot be established, and the authors note that some individuals with abnormal cognitive decline or dementia may have been included at baseline or follow-up.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/gps.5174

Cites

64 of 64 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 24 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Social isolation was associated with lower forward digit span in fully adjusted models.

    “Social isolation was associated with lower scores in composite cognitive score, verbal fluency and forward digit span (B=-0.06 to B=-0.85; p<0.05).”
    • Also stated in: § 3.2. The association of loneliness and social isolation with cognitive function · plain
      “Higher social isolation was also significantly related to decreased scores on composite cognitive score (B=-0.85;95% CI=-1.55,-0.14), verbal fluency (B=-0.34;95% CI=-0.57,-0.11) and forward digit span (B=-0.06;95% CI=-0.11,-0.02) in fully covariate-adjusted models (model 3).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Time has a linear relationship with cognitive change.
  • Findingown data

    The association between loneliness and social isolation with cognitive function after excluding individuals with depression led to substantively similar results.

    “The association between loneliness and social isolation with cognitive function after excluding of individuals with depression let to substantively similar results (Supplementary table 2).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Time has a linear relationship with cognitive change.
  • Findingown data

    In sensitivity analyses using loneliness as a continuous variable, significant interaction effects were observed for composite cognitive score and backward digit span.

    “Significant interactions effects were also observed for the composite cognitive score and backward digit span (data not shown).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Time has a linear relationship with cognitive change.
  • Findingown data

    The social isolation x time interaction did not reach statistical significance for any cognitive domain.

    “The social isolation x time interaction did not reach statistical significance for any of the cognitive domains, suggesting that individuals with higher levels of social isolation did not show a faster rate of decline as compared with those less socially isolated.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Time has a linear relationship with cognitive change.
  • Findingown data

    Social isolation was associated with lower verbal fluency in fully adjusted models.

    “Social isolation was associated with lower scores in composite cognitive score, verbal fluency and forward digit span (B=-0.06 to B=-0.85; p<0.05).”
    • Also stated in: § 3.2. The association of loneliness and social isolation with cognitive function · plain
      “Higher social isolation was also significantly related to decreased scores on composite cognitive score (B=-0.85;95% CI=-1.55,-0.14), verbal fluency (B=-0.34;95% CI=-0.57,-0.11) and forward digit span (B=-0.06;95% CI=-0.11,-0.02) in fully covariate-adjusted models (model 3).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Time has a linear relationship with cognitive change.
  • May combine two claims. 9
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Findingown data

    Social isolation was not associated with immediate recall, delayed recall, or backward digit span in fully adjusted models.

    “However, no effect of social isolation on the remaining cognitive tests was found.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Time has a linear relationship with cognitive change.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sensitivity analysis using continuous scores of loneliness led to comparable but not equivalent results to the main analyses.

    “Moreover, we conducted sensitivity analysis using continuous scores of loneliness, which lead to comparable but not equivalent results to those of main analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In sensitivity analyses using loneliness as a continuous variable, each additional unit increase in the UCLA loneliness scale was significantly associated with lower scores in composite cognition, immediate recall, and verbal fluency in the fully adjusted model.

    “In sensitivity analyses using loneliness as a continuous variable, each additional unit increase in the UCLA loneliness scale was significantly associated with lower scores in the composite cognition score, immediate recall and verbal fluency in the fully covariate-adjusted model (Supplementary table 3).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Time has a linear relationship with cognitive change.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Previous studies have suggested that being alone or never married, low frequency of interactions, small social network size or negative experiences of social support predict steeper cognitive decline.

    “Previous studies have suggested that being alone or never married, low frequency of interactions, small social network size or negative experiences of social support predict steeper cognitive decline.[5][6][7][8]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5]

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    • cites [6] source

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    • cites [7] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study used family-reported dementia diagnosis and trained interviewers to identify participants with severe cognitive impairment that precluded survey participation.

    “Nevertheless, we made use of family-reported dementia diagnosis and interviewers were trained to identify participants with severe cognitive function that precluded participation in the survey.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Cognitive function was assessed through five performance tests: CERAD word list immediate and delayed verbal recall, WAIS digit span forward and backward, and the animal naming task.

    “Cognitive function was assessed through the following five performance tests: word list immediate and delayed verbal recall from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD); 35 digit span forward and backwards from the Wechsler Adult Intelligence Scale; 36 and the animal naming task.35”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [35]

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    • cites [36]

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  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Loneliness was assessed by means of the Three-item UCLA Loneliness Scale.

    “Loneliness was assessed by means of the Three-item UCLA Loneliness Scale.37”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Findings from the English Longitudinal Study of Ageing revealed that social isolation was related to decreased episodic memory and verbal fluency after a 4-year follow-up, whereas loneliness was associated with poorer immediate and delayed recall over time.

    “For instance, findings from the English Longitudinal Study of Ageing revealed that social isolation was related to decreased episodic memory and verbal fluency after a 4-year follow-up period, whereas loneliness was found to be associated with poorer immediate and delayed recall over time.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The study used a set of cognitive tests assessing diverse core aspects of cognition.

    “Furthermore, we used a set of cognitive tests assessing diverse core aspects of cognition, whereas other studies only included a brief screening cognitive instrument.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Social isolation was assessed using a social isolation index based on the one proposed by Shankar et al.

    “A social isolation index, based on the one proposed by Shankar et al. 39 was computed with respondents given a point if they: a) were not married/not cohabiting with a partner; b) had less than monthly contact with children; c) had less than monthly contact with other immediate family; d) had less than monthly contact with friends; and e) did not participate in any organizations, religious groups,”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Both loneliness and social isolation are associated with decreased cognitive function over a 3-year follow-up period.

    “Both loneliness and social isolation are associated with decreased cognitive function over a 3-year follow-up period.”
    • Also stated in: § KEY POINTS · plain
      “Loneliness is associated with decreased cognitive function over a follow-up period”
    • Also stated in: § KEY POINTS · plain
      “Social isolation is related to decreased cognitive function”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Time has a linear relationship with cognitive change.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Depression in the previous 12 months was assessed with an adapted version of the Composite International Diagnostic Interview (CIDI 3.0).

    “Depression in the previous 12-months was assessed with an adapted version of the Composite International Diagnostic Interview (CIDI 3.0).44”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The social isolation composite variable was created using meaningful grouping with equal weights assigned to all index components.

    “Third, meaningful grouping was used to create a composite variable on social isolation with equal weights assigned to all index components.39”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The study used a large nationally-representative sample that allows for the simultaneous examination of multiple factors.

    “The strengths of the study include the use of a large nationally-representative sample that allows for the simultaneous examination of multiple factors.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Attrition bias may exist and might have led to an underestimation of the true association of loneliness and social isolation with cognitive function.

    “Fifth, attrition bias may exist, which might have led to an underestimation of the true association of loneliness and social isolation with cognitive function.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The equal weighting of social isolation components may have affected the results on the association of social isolation with cognition.

    “This may have affected our results on the association of social isolation with cognition, as some aspects of the social network may have more importance than others.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Studies that provided cognitive domain-specific results are scarce and have not accounted for the correlation between repeated measures on the same individual over time.

    “Studies that provided cognitive domain-specific results are scarce and have not accounted for the correlation between repeated measures on the same individual over time.10,17,32”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] source

      Not checked in the free run.

    • cites [17] source

      Not checked in the free run.

    • cites [32] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Excluded individuals were significantly older, had lower years of education and higher disability, reported lower alcohol consumption, higher feelings of loneliness and social isolation, and scored lower on all cognitive tests.

    “Excluded individuals were significantly older, had lower years of education and higher disability, reported lower alcohol consumption, higher feelings of loneliness and social isolation and scored lower on all of the cognitive tests.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The statistical approach allowed simultaneous exploration of predictors and outcomes at different time-points.

    “However, our statistical approach allowed us to simultaneously explore predictors and outcomes at different time-points.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Wilson et al. reported that loneliness was linked to a more rapid decline in semantic memory rather than episodic memory.

    “By contrast, Wilson et al.21 using data from a longitudinal cohort study of 823 older adults, reported that loneliness was linked to a more rapid decline in semantic memory rather than episodic memory.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies have demonstrated that individuals with unmet social needs are more likely to be frequent users of health care services.

    “Indeed, previous studies have demonstrated that individuals with unmet social needs are more likely to be frequent users of health care services.67”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Some individuals with abnormal cognitive decline or dementia may have been included in the study at baseline or follow-up.

    “In this regard, it is possible that some individuals with abnormal cognitive decline or even dementia may have been included in our study during the baseline or the follow-up assessments.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The analyses included individuals aged 50+ years to capture the potential prodromal phase of neurocognitive disorders.

    “Finally, our analyses included individuals aged 50+ years in order to capture the potential prodromal phase of neurocognitive disorders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A potential reverse causal direction cannot be ruled out.

    “Fourth, a potential reverse causal direction cannot be ruled out.”
    Quote in the paperNot a substantial claim
24 of 24

  • The authors state this as an assumption.

    Time has a linear relationship with cognitive change.

    “Time was added as a continuous variable coded as months, assuming a linear relationship with time (model 1).”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Social isolation is described as unchanged despite a significant test result

    Minor

    The results say social isolation remained unchanged at follow-up, but Table 2 reports p=0.033 for the baseline-to-follow-up difference. The identical displayed means may reflect rounding, but the reported test indicates a statistically significant change.

  • Model 3 adjustment for depression differs between methods and table note

    Minor

    The methods state that model 3 was adjusted for depression, while the Table 3 note lists its adjustment variables without depression. These give conflicting descriptions of the reported model.

2 of 2

Cites

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2 of the 66 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. The Psychological Corporation, 2002, The WAIS III–WMS III Updated Technical Manual
  2. World Health Organization, 2012, Global Physical Activity Questionnaire (GPAQ): analysis guide
  3. World Health Organization, 2014, Global status report on alcohol and health

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Authors
Lara, E., Caballero, F. F., Rico‐Uribe, L. A., Olaya, B., Haro, J. M., Ayuso‐Mateos, J. L., & Miret, M.
Affiliations
  • Instituto de Salud Carlos III (ES)
  • Department of Psychiatry Universidad Autónoma de Madrid Madrid Spain
Corresponding author
Miret, Marta
ORCID
Venue
International Journal of Geriatric Psychiatry
Publisher
Wiley
Published
2019-07-25
Volume
34
Issue
11
Pages
1613-1622
ISSN
  • 0885-6230 (ISSN-L)
  • 1099-1166
DOI
10.1002/gps.5174
OpenAlex
W2961148372
Semantic Scholar
217effd0500cf34d704dcdbed6b4ee476a5ab3f1
Cited by
423
References
66
Citations by year
2026: 44 · 2025: 55 · 2024: 75 · 2023: 125 · 2022: 50 · 2021: 51 · 2020: 22 · 2019: 1
FWCI
24.64
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • International Journal of Geriatric Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Biblos-e Archivo (Universidad Autónoma de Madrid) (submittedVersion)
  • Hispana (submittedVersion)
Funders
  • Instituto de Salud Carlos III (PS09/00295, PS09/01845, PI12/01490, PI13/00059)
  • Seventh Framework Programme (223071)
  • European Commission (PI13/00059, PI12/01490)
  • Centro de Investigación Biomédica en Red de Salud Mental
  • Generalitat de Catalunya (SLT006/17/00066)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Aging and Gerontology Research
Keywords
loneliness, social isolation, cognitive decline, cognitive function, middle-aged and older adults, verbal fluency, memory retrieval, digit span, social participation (health and rehabilitation), emotional support, depression
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Loneliness, Male, Middle Aged, Mental Recall, Social Isolation, Spain, Verbal Learning, Cognitive Dysfunction

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