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

The DOI matches its Crossref record; 64 of the 66 references it cites were found in a registry or an index; none of the 24 sources its claims cite is checked for support yet.

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

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.

Overview

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.

Verification

Claims the paper makes

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

Show all 26 claims

  • It may state two separate claims as one. 9
  • Probably not a substantial claim. 18
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

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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

Citations

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

Cited by

Sorted by citations

Items 401–421 of 421

Metadata

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
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
OpenAlex
W2961148372
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
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 › Developmental and Educational 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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