Article

Importance of loneliness in behavioral and psychological symptoms of dementia

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Abstract

Objectives: Loneliness is considered to be a crucial factor in mental health of elderly people. However, the effects of loneliness on behavioral and psychological symptoms of dementia (BPSD) have not been fully examined. The aim of this study was to investigate whether loneliness in patients with dementia is related to BPSD. Methods: A total of 152 patients with dementia were assessed using the Neuropsychiatric Inventory (NPI-12) and the revised University of California at Los Angeles (UCLA) loneliness scale. Spearman correlation analysis and Mann-Whitney U-tests were used to examine factors associated with the revised UCLA loneliness scale. Logistic regression analysis with a forced entry method was performed to identify risk factors for BPSD. Results: The revised UCLA loneliness scale score was not significantly associated with age, years of education, mini-mental state examination (MMSE) score, gender, living status, visual impairment, hearing impairment, and marital status. However, this score was a significant predictor of NPI delusion and hallucination subscale scores and Geriatric Depression Scale-15 score. The MMSE score was a significant predictor of NPI anxiety and apathy subscale scores. Conclusions: Loneliness is a risk factor for BPSD, especially for depressive symptoms and psychosis. Paying attention to loneliness in patients with dementia will help medical staff to intervene in psychiatric symptoms of these patients at an early stage.

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... A neuroimaging study suggested that loneliness in older people may be linked to atrophy of the left hippocampus, left entorhinal cortex, and bilateral thalamus [19], while loneliness in cognitively normal older people has been associated with cortical amyloid burden [20,21] and tau burden in the right entorhinal cortex [21]. Loneliness in older people is also associated with psychiatric symptoms, including depressive symptoms [22][23][24][25][26][27][28], anxiety [24], hallucinations [26,29], and delusions [26]. ...
... A neuroimaging study suggested that loneliness in older people may be linked to atrophy of the left hippocampus, left entorhinal cortex, and bilateral thalamus [19], while loneliness in cognitively normal older people has been associated with cortical amyloid burden [20,21] and tau burden in the right entorhinal cortex [21]. Loneliness in older people is also associated with psychiatric symptoms, including depressive symptoms [22][23][24][25][26][27][28], anxiety [24], hallucinations [26,29], and delusions [26]. ...
... A neuroimaging study suggested that loneliness in older people may be linked to atrophy of the left hippocampus, left entorhinal cortex, and bilateral thalamus [19], while loneliness in cognitively normal older people has been associated with cortical amyloid burden [20,21] and tau burden in the right entorhinal cortex [21]. Loneliness in older people is also associated with psychiatric symptoms, including depressive symptoms [22][23][24][25][26][27][28], anxiety [24], hallucinations [26,29], and delusions [26]. ...
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Background: Mild behavioral impairment (MBI) and loneliness are associated with cognitive decline and an increased risk of dementia. Objective: Our aim was to examine the validity of the Japanese version of the MBI checklist (MBI-C) and investigate the relationship between loneliness and MBI. Methods: The participants in this cross-sectional study included 5 cognitively normal persons and 75 persons with mild cognitive impairment. MBI-C and the revised University of California at Los Angeles loneliness scale (LS) were used to assess MBI and loneliness, respectively. Diagnostic performance of MBI-C was examined using receiver operating characteristic analysis. The relationship between MBI-C and LS was examined using multiple linear regression in 67 subjects who were assessed with both scales, with MBI-C total or domain score as the dependent variable and LS as the independent variable, adjusted for age, gender, living situation, presence of visual and hearing impairment, and Mini-Mental State Examination score. Results: Per the Youden index, in this mostly MCI sample, the optimal MBI-C cut-off score was 5.5 with sensitivity 0.917 and specificity 0.949. In multiple linear regression analysis, LS score was detected as a significant predictor of MBI-C total scores, and MBI-C decreased motivation, affective dysregulation, and abnormal thought and perception scores. Conclusions: The caregiver-rated Japanese MBI-C has excellent diagnostic performance. Loneliness is associated with a greater MBI burden, especially in the decreased motivation, affective dysregulation, and abnormal thought and perception domains. Interventions for loneliness in older people may have the potential to improve MBI.
... Despite difficulties in ascertaining whether people with cognitive impairment can accurately evaluate their loneliness [33][34][35], individuals with dementia report feeling lonelier than older adults without dementia [33][34][35][36][37]. The few studies exploring potential associations between loneliness and general cognitive functioning, BPS and QoL in people with dementia have found loneliness to be related to depressive symptoms [38,39] and QoL [38,41], but not to general cognitive functioning [38][39][40][41]. A few studies have focused on the association between loneliness and the frequency of BPS characteristics of dementia [39,40]. ...
... Despite difficulties in ascertaining whether people with cognitive impairment can accurately evaluate their loneliness [33][34][35], individuals with dementia report feeling lonelier than older adults without dementia [33][34][35][36][37]. The few studies exploring potential associations between loneliness and general cognitive functioning, BPS and QoL in people with dementia have found loneliness to be related to depressive symptoms [38,39] and QoL [38,41], but not to general cognitive functioning [38][39][40][41]. A few studies have focused on the association between loneliness and the frequency of BPS characteristics of dementia [39,40]. ...
... The few studies exploring potential associations between loneliness and general cognitive functioning, BPS and QoL in people with dementia have found loneliness to be related to depressive symptoms [38,39] and QoL [38,41], but not to general cognitive functioning [38][39][40][41]. A few studies have focused on the association between loneliness and the frequency of BPS characteristics of dementia [39,40]. However, no associations have emerged between loneliness and the frequency of BPS [40], although some evidence has pointed to loneliness being related to the frequency of certain psychotic symptoms (delusions, hallucinations) [39]. ...
Article
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Background Loneliness is a major health issue among older adults. The aim of this study was to assess the relationship between loneliness, in its social and emotional facets, and the cognitive (language), and behavioral/psychological functioning as well as quality of life (QoL) in people with mild and moderate dementia, i.e., considering dementia severity as an individual characteristic. Methods This cross-sectional study involved 58 people with mild dementia and 55 people with moderate dementia. Participants completed the Social and Emotional Loneliness scale, along with measures assessing their language skills, the frequency and severity of their behavioral and psychological symptoms, and their QoL. Results Socio-demographic characteristics and depression, but not loneliness or its social and emotional facets, contributed to explain participants’ behavioral and psychological symptoms, regardless of dementia severity. Loneliness explained, though to a small extent (8% of variance), language skills in people with moderate dementia, with social loneliness only accounting for language skills (18% of variance) in this group. Loneliness also modestly accounted for dysphoria symptoms in both the mildly and moderately impaired (6% and 5% of variance, respectively) individuals with social loneliness predicting dysphoric mood in the former group only (7% of variance). Loneliness also explained, to a larger extent, QoL in both the mildly impaired and moderately impaired individuals (27% and 20% of variance, respectively), its social facet predicting QoL in the mildly impaired (30% of variance), and its emotional facet in the moderately impaired (21% of variance) group. Conclusion These findings suggest that loneliness and its facets have a clear impact on perceived QoL, and influence the language skills and dysphoria symptoms of people with dementia, to a degree that depends on dementia severity. The assessment of loneliness and its facets in people with dementia considering dementia severity, and the promotion of social inclusion to reduce it should be considered by professionals.
... Psychosocial factors are related to depressive symptoms in elderly people, including social isolation [6], loneliness [7,8], and QOL [9]. Psychosocial factors such as economic hardship, injury, loneliness, migration, caregiving, and bereavement might lead to physiological changes, including abnormalities in the limbic structures and frontostriatal circuit, and increase susceptibility to depression or cause depression in elderly people who are already fragile [3]. ...
... A few studies have assessed visual or hearing loss using a visual acuity test [13] or audiometry [15,21], while many have assessed these impairments by interview or questionnaire [14,[16][17][18][19][22][23][24]. In our previous study [8], visual and hearing impairment assessed retrospectively were found not to be related to depressive symptoms in people with dementia, and only loneliness was involved in these symptoms. However, this may be due to inaccurate evaluation of visual and hearing impairment. ...
... Loneliness remains as an influential factor for depressive symptoms after controlling for demographic covariates, marital status, and psychosocial factors such as perceived stress, low social support, and hostility [33]. Our previous study identified loneliness as the only predictor for depressive symptoms in patients with dementia, while living alone, visual and hearing impairments, marital status, age, gender, years of education, and cognitive impairment were not predictors [8]. Loneliness can also mediate the relationship between social networks and depressive symptoms: a small social network has an effect on depression only in individuals who feel lonely; and similarly, loneliness is related to having a small social network, particularly among individuals who are depressed [7]. ...
Article
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Reduction of the incidence of depression and improvement of quality of life (QOL) of elderly people have become important subjects. Various factors are related to depressive symptoms in elderly people, and sensory impairment is a key to health, QOL, and depressive symptoms. In this cross-sectional study, a visual acuity test and audiometry were used to examine the relationships of visual and hearing impairment and other factors with depressive symptoms in elderly people. A group of 490 community-dwelling people aged over 65 years old underwent vision and hearing tests, the Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination (MMSE), and questionnaires on social isolation, QOL, and physical condition. Logistic regression analysis was used to examine factors affecting CES-D. Multivariate logistic regression analysis indicated that hearing impairment, pain score, and satisfaction with human relationships and activities of daily living (ADL) were independent predictors of CES-D scores. Satisfaction with human relationships and ADL can reduce depressive symptoms in elderly people. Hearing impairment, pain, and social contact are also important. Therefore, improvement of social networks, interpersonal relationships, ADL, and hearing impairment may be effective in improving these symptoms in elderly people.
... These physiological dysregulations included heightened low-grade systemic inflammation, renal injury, and deregulated metabolic health [26]. Furthermore, loneliness is a risk factor for neuropsychiatric symptoms, especially for depressive symptoms and psychosis, including delusions and hallucinations [27]. ...
... On the other hand, the progression of dementia can lead to increased loneliness, as patients may become more withdrawn and less able to participate in conversations and social activities. This was consistent with other recent studies on the same topic [26,27]. Indeed, Freak-Poli and colleagues [28] conducted a study based on data from two longitudinal studies that highlighted a correlation between loneliness and cognitive decline measured by the MMSE, as well as an increased risk of dementia. ...
Article
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Background: Neurocognitive disorders (NCDs) have a variable decline in cognitive function, while loneliness was associated with cognitive impairment and increased dementia risk. In the present study, we examined the associations of loneliness with functional and cognitive status in patients with minor (mild cognitive impairment) and major NCDs (dementia). Methods: We diagnosed mild NCD (n = 42) and major NCD (n = 164) through DSM-5 criteria on 206 participants aged > 65 years using the UCLA 3-Item Loneliness Scale (UCLA-3) to evaluate loneliness, the activities of daily living (ADL) and the instrumental activities of daily living (IADL) scales to measure functional status, and Mini-Mental State Examination (MMSE) to assess cognitive functions. Results: In a multivariate regression model, the effect of loneliness on cognitive functions was negative in major (β = -1.05, p < 0.0001) and minor NCD (β = -0.06, p < 0.01). In the fully adjusted multivariate regression model (sex-age-education-multimorbidity-depressive symptoms-antidementia drug treatment), the effect of loneliness remained negative for major NCD and became positive for minor NCD (β = 0.09, p < 0.001). The effect of loneliness on IADL (β = -0.26, p < 0.0001) and ADL (β = -0.24, p < 0.001) showed a negative effect for major NCD across the different models, while for minor NCD, the effect was positive (IADL: β = 0.26, p < 0.0001; ADL: β = 0.05, p = 0.01). Minor NCD displayed different levels of MMSE (β = 6.68, p < 0.001) but not ADL or IADL, compared to major NCD for the same levels of loneliness. MANOVA pill test suggested a statistically significant and different interactive effect of loneliness on functional and cognitive variables between minor and major NCDs. Conclusions: We confirmed the relationships between loneliness and cognitive and functional status in major NCD, observing a novel trend in minor NCD.
... 32 But, in a cross-sectional study on patients with dementia, UCLA loneliness scale scores were not related to the apathy subscale of the Neuropsychiatric Inventory. 33 Even though depression, apathy, and loneliness were strong correlated, depression can be considered an affective disorder, apathy relates to disorders of motivation, and loneliness has a social dimension. Loneliness is a complex socioemotional trait with a specific construct that can be reliably measured 9 and distinguished from affective disorders and behavioral symptoms. ...
... 7 Albeit inconsistently, loneliness was found to be a significant predictor of neuropsychiatric symptoms, including psychosis and depression, in people with dementia. 33 In ALS, longitudinal studies are warranted to verify if loneliness can be considered a risk factor for the development of behavioral impairment. Our results indicated that loneliness may be a risk factor for severe symptoms of apathy and behavioral changes ( Table 4). ...
Article
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Objective In elderly people loneliness represents a risk factor for dementia and may negatively impact on mental and physical health. The specific contribute of loneliness to cognitive and behavioral functioning have not yet been determined in amyotrophic lateral sclerosis (ALS). Our hypothesis was that loneliness may be related to motor dysfunction with a negative impact on cognitive and behavioral decline, possibly related to specific cortical involvement. Methods In 200 ALS patients (ALSpts) and 50 healthy controls (HCs) we measured loneliness, mood, and quality of life (QoL). ALSpts underwent comprehensive clinical, genetic, and neuropsychological assessment to define phenotypes. Seventy‐seven ALSpts performed 3T MRI scans to measure cortical thickness. Between‐group, partial correlation and regression analyses were used to examined clinical, neuropsychological, and cortical signatures of loneliness. Results Feelings of loneliness were documented in 38% of ALSpts (ALS/L+pts) and in 47% of HCs. In both groups loneliness was associated with anxiety (P < 0.001), depression (P ≤ 0.005), and poor QoL (P < 0.001). ALS/L+pts had similar motor dysfunctions and cognitive abilities than non‐lonely ALSpts, but distinct behavioral profiles (P ≤ 0.005) and frontoparietal involvement (P < 0.05). Loneliness in ALS is related to behavioral changes, apathy, and emotional dysregulation (P < 0.001). Interpretation Our cross‐sectional study indicates that, in ALS, the satisfaction of social environment is associated with a sense of life well‐being that is not limited to the motor status, proving instead that loneliness can impact on disease‐related neurobehavioral changes with a possible flashback on brain architecture. This suggests that sociality could promote personal resilience against behavioral and affective decline in ALS.
... However, research results differ on the influence of sensory loss on dementia mediated by loneliness [83,84]. ...
... In the course of dementia, behavioral and psychological symptoms in dementia (BPSD) including agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes may be present [85]. Research shows that elderly people with high emotional loneliness experience depressive symptoms and hallucinations [80,83,[86][87][88]. The correlation with the latter seems to occur among individuals with Alzheimer's disease or dementia as well; however, some studies deny it [89]. ...
Article
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This review describes associations between dementia and loneliness on the neurobiological and epidemiological levels according to the recent body of literature. The aim of this study was to highlight major lines of research in this field. Sociocognitive skills and social interactions present complex interdependencies with dementia which may be explained by two theories. According to the first one, not sufficiently engaging in social or cognitive activities results in brain atrophy. The second one claims that brain neurogenesis and synaptic density are being increased by social connections. The relationship between loneliness and dementia could be mediated by sensory loss, including hearing and visual impairment, as well as depression and psychotic symptoms. Loneliness itself might cause a depletion in sensory and cognitive stimulation which results in a decrease in neural reserve. Certain changes in the structures of the brain caused by loneliness were found in imaging examination. Loneliness appears to be a crucial risk factor for dementia in recent times due to the modern lifestyle and consequences of the outbreak of COVID-19. Additional studies are required to understand more completely the key tenets of this topic and therefore to improve the prevention and treatment of dementia.
... [1][2][3] Isolation and loneliness are also associated with psychotic symptoms in healthy older adults, AD patients, 8 and patients with unspecified dementia. 9 A psychological study of healthy young people has also shown that paranoia is influenced and induced by manipulated subjective feelings of loneliness. 10 Older adults lacking communication with others or self-expression may also attempt to fulfill these needs by generating internal stimulation, leading to hallucinations. ...
Article
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Background Very late‐onset schizophrenia‐like psychosis (VLOSLP) is a psychotic disorder with an age of onset ≥60 years, and social isolation is a risk factor. Reports on the impact of interventions for isolation and loneliness on psychiatric symptoms in VLOSLP are limited. Case Presentation An 87‐year‐old woman, widowed and living alone, developed psychosis, including paranoia, erotomania, and visual hallucinations, at 84 years old during a period when her interactions with others were limited by the COVID‐19 pandemic and osteoarthritis. She was eventually brought to our hospital with a local dementia outreach team. She was admitted and diagnosed with VLOSLP with mild cognitive decline through imaging and neuropsychological tests confirming the absence of dementia. Immediately after admission, her psychotic symptoms became inactive. She was transferred to another psychiatric hospital to prepare for her move to a long‐term care facility because her psychosis was alleviated. During admission, she enjoyed the company of others and occupational therapy, and her score on the UCLA Loneliness Scale Version 3 improved from 44 at admission to 35 at discharge. Conclusion The admission itself improved the patient's psychosis, which seemed to be related to the alleviation of isolation and loneliness.
... For example, AI-powered mental health apps can provide therapeutic exercises, guided meditation, and cognitive-behavioural therapy (CBT) exercises tailored to the individual's needs (Sun et al., 2020). Such interventions are crucial for maintaining mental well-being, especially for older adults facing cognitive decline or chronic illness. ...
Chapter
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The integration of Artificial Intelligence (AI) in geriatric care is transforming how physical and mental health challenges are addressed among older adults. As the global population ages, the demand for innovative solutions to enhance care delivery, improve health outcomes, and support independent living grows. This chapter, explores the ways AI is revolutionising geriatric care, focusing on its applications in both physical and mental health. The chapter delves into AI-powered diagnostics, personalised treatment plans, robotic assistance, and AI-driven mental health support tools designed for older adults. It also examines ethical considerations, potential risks, and the future role of AI in geriatric care. By evaluating case studies and research, this chapter provides insights into the practical benefits and challenges of implementing AI technologies to enhance the quality of life for older adults, optimise healthcare delivery, and address the physical and mental health needs of an ageing population.
... 6 Loneliness can contribute to the development and progression of dementia and depressive symptoms, and lead to elderly institutionalization and worsening of chronic diseases. 7,8 Because of this, we feel it is important to use online communication tools during the period of mandatory restrictions to reduce loneliness and social isolation. ...
Article
Background/Purpose: The aim of study is to assess the feeling of loneliness and quality of life among older adults in Third Age University (3AU) compared to those who are not in 3AU. Methods: Between February 1 and March 29, 2022, a case-control study of 311 older adults was conducted; 91 older adults were in 3AU group, and 220 community dwelling individuals were in control group. The Loneliness Scale for Elderly (LSE) and the World Health Organization Quality of Life Instrument Older Adults Module (WHOQOL-OLD) were administered to all participants. Results: 311 older adults completed an anonymous online self-reported survey. Adjusted model analysis showed that the attending 3AU is independently associated with higher WHOQOL-OLD score and lower LSE score (for WHOQOL-OLD β = 4.40 95% CI = 1.22–7.58, p ≤ 0.05, and for LSE β = -1.29, 95% CI = -2.38–0.20, p ≤ 0.05). Conclusion: The attending 3AU has the potential to positive impact on the quality of life and loneliness of older adults.
... Older adults who are lonely are 1.64 times more likely to develop dementia than those who are not [9]. Furthermore, loneliness can exacerbate the behavioral and psychological symptoms of dementia [10]. As one ages, the likelihood of experiencing loneliness increases, with 30-40% of older adults reporting feelings of loneliness [11]. ...
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Background Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by COVID-19. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. This study aims to assess the impact of a virtual reality (VR)-based open-air bath program on depression and loneliness in elderly individuals with Subjective Cognitive Decline/Mild Cognitive Impairment (SCD/MCI) attending our Dementia Medical Centre and evaluate the feasibility (participant recruitment and adherence) and measuring program enjoyment and satisfaction. Methods The study design is a crossover trial with a 1:1 ratio wherein 12 participants will be randomly assigned to Groups 1 and 2, with Group 2 serving as a waitlist control, and the VR program will be conducted six times (monthly). Group 1 will participate from the program's commencement and continue for 6 months, followed by an observation period from months 7 to 12. Group 2 will participate from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the UCLA loneliness scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated measures ANOVA. Head MRI and SPECT scans will be performed pre- and post-VR program to evaluate changes and effects on brain regions. Recruitment began in September 2023, and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. Discussion The study examines the preliminary effects of VR on loneliness in predementia seniors through open-air bath simulations. Virtual reality experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR's impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. Trial registration : The protocol and informed consent were approved by the Ethical Review Board of Kyoto Prefectural University of Medicine on October 31, 2023 (ERB-C-2978). The study has been registered in the University Hospital Medical Information Network (UMIN) on November 1, 2023 (Trial Registration Number: 000052667).
... 12 A study revealed that loneliness in PwD was associated with hallucinations and delusions. 13 Increasing communication is advised to prevent older people from experiencing loneliness. 11 Communication has more advantages than preventing loneliness; it is also useful for detecting cognitive dysfunctions. ...
Article
Background: Cognitive assessment through communication has been the focus of recent studies because the conventional cognitive tests are often considered invasive for older people. Although the Conversational Assessment of Neurocognitive Dysfunction is designed to assess cognitive function non-invasively, inter-rater reliability remains unclear. The current study investigated the Conversational Assessment of Neurocognitive Dysfunction's reliability. Methods: The Conversational Assessment of Neurocognitive Dysfunction was used by four clinical psychologists, who evaluated 38 older people with and without cognitive dysfunction. One clinical psychologist evaluated the assessment based on face-to-face communication with participants, while the other clinical psychologists evaluated it according to the audio data in the digital voice recorder. All clinical psychologists were blind to the results of other conventional cognitive tests and details surrounding participants' daily living activities. Results: The univariate correlation scores of the Conversational Assessment of Neurocognitive Dysfunction among evaluators ranged from 0.61 to 0.79, all of which were significant (P < 0.001). The intraclass correlation coefficient was 0.64 (P < 0.001, 95% CI: 0.53-0.79 for agreement) and 0.67 (P < 0.001, 95% CI: 0.45-0.77 for consistency). The Conversational Assessment of Neurocognitive Dysfunction score of all evaluators was significantly associated with conventional cognitive tests like the Mini-Mental State Examination (P < 0.001). Conclusions: The findings suggested that the Conversational Assessment of Neurocognitive Dysfunction has moderate to good inter-rater reliability and high concurrent validity as a cognitive assessment tool, and it would be useful in clinical practice.
... 20 Lonely people generally have poorer mental health, are more susceptible to mental illnesses such as depression, 18 and have exacerbated behavioral and psychological symptoms of dementia. 21 Loneliness is also known to possibly increase the risk of dementia 22 and older adults who are lonely are 1.64 times more likely to develop clinical dementia than those who are not. 9 Penninkilampi's review revealed that loneliness does not increase the risk of dementia, but many of the studies included in this review used single items or unvalidated measures of loneliness. ...
Article
Objectives: Loneliness has been shown to increase the risk of dementia. However, it is unclear why greater loneliness is associated with greater susceptibility to dementia. Herein, we aimed to examine the morphological characteristics of the brain associated with loneliness in older people concerned about cognitive dysfunction. Methods: In this retrospective study, 110 participants (80 with amnestic mild cognitive impairment, and 30 cognitively healthy individuals) were included. Participants were assessed using the revised University of California at Los Angeles (UCLA) loneliness scale and had undergone magnetic resonance imaging. Spearman correlation analysis and Mann-Whitney U tests were used to examine the clinical factors associated with loneliness. Multiple regression was performed to examine the relationship between the revised UCLA loneliness scale score and regional gray matter (GM) volume on voxel-based morphometry. Results: The revised UCLA loneliness scale scores were not significantly correlated with age, sex, or mini-mental state examination (MMSE) scores. Multiple regression using age, sex, MMSE score, and total brain volume as covariates showed negative correlations of the revised UCLA loneliness scale scores with the grey matter volume in regions centered on the bilateral thalamus, left hippocampus and left parahippocampal gyrus, and left entorhinal area. Conclusions: Subjective loneliness was associated with decreased GM volume in the bilateral thalamus, left hippocampus, and left entorhinal cortex of the brain in the older people, thereby providing a morphological basis for the increased risk of dementia associated with greater loneliness.
... For instance, it is important to detect fluctuations of cognitive performance within a neuropsychological assessment (expected in an examinee with depression) and to identify other qualitative aspects of an examinee's performance which may contribute to exclude a diagnosis of clinical dementia (Formánek, Csajbók, Wolfová, et al. 2020). A person with dementia, differently from pseudodementia, is typically characterised by lack of awareness of their own cognitive performance, and a focus on feelings of solitude and dissatisfaction (Sun et al., 2021). ...
... They contribute to the ill health of countless patients, and these symptoms are the most complex and expensive aspects of care. Studies have shown that one-third of dementia care costs are due to the management of these symptoms, such as the need for additional medical resources, the cost of care, and the cost of additional care [8,9]. The emergence of BPSD not only noticeably increases the cost of care and treatment but also has a close relationship with the decline in the quality of life, income, stress, and depression of caregivers. ...
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Objective: To systematically assess the safety and efficacy of olanzapine versus clozapine when treating senile dementia and to provide evidence-based medicine basis for its promotion and use. Methods: PubMed, Embase, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) online database were searched for randomized controlled trials (RCT) of olanzapine and clozapine when treating senile dementia. The retrieval time limit is from the establishment of the database to the present. The data were extracted independently by two researchers, and the bias risk of each contained literature was analyzed in accordance with the standard of Cochrane Handbook 5.3. RevMan 5.4 statistical software was used to analyze the collected data by meta-analysis. Results: Finally, 6 randomized controlled trial articles were included, with a total of 490 samples. Meta-analysis of clinical efficacy showed that the clinical efficacy was similar and there was no significant difference (P > 0.05). Two articles used Alzheimer's disease pathological behavior rating scale (BEHAVE-AD) to compare the pathological behavior of different stages after treatment. Statistical analysis showed that there was no significant difference between the total score of BEHAVE-AD and the scores of each factor in each week after treatment. The non-treatment adverse reaction scale (TESS) of the study group and the control group was analyzed by meta-analysis. The TESS score of the study group after treatment was significantly lower than that of the control group. The BPRS scores of different stages after treatment were analyzed by meta-analysis, and there was no significant difference in the total score and factor scores of BPRS in each week after treatment. Two clinical trials reported the incidence of neurological symptoms after treatment. Olanzapine and clozapine treatment can effectively reduce the risk of aging. There was no significant difference in the incidence of neurological symptoms in patients with dementia (P > 0.05). According to the analysis of meat products, the incidence of adverse reactions in the study group was significantly lower than that in the control group (P < 0.05). Conclusion: Olanzapine and clozapine have similar efficacy when treating mental and behavioral disorders in patients with senile dementia, in which olanzapine is more effective in improving the symptoms of patients with Alzheimer's disease (AD), with less adverse reactions and high safety, which is worth popularizing in clinical practice. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify.
... Victor et al. (39) found that 30.1% of 1,547 dementia patients reported feeling moderately lonely. Loneliness is also a risk factor for psychiatric behavioral problems in patients with dementia (40). Chinese scholars have also conducted studies on the psychological problems of dementia patients and their caregivers (41,42), but have not yet intervened using the Montessori approach. ...
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Background: Patients with dementia experience a variety of neuropsychiatric symptoms and behavioral disturbances. The Montessori method is a type of non-pharmacological intervention to care for people with dementia. However, there are few bibliometric studies on the application of Montessori methods. We aimed to analyze the hotspots and trends of research on the application of Montessori methods to the care of dementia patients. Methods: Microsoft Office Excel, Co-Occurrence 9.9, and CiteSpace were used to analyze the articles on Montessori intervention in patients with dementia from 2000 to 2021 in China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, Web of Science core collection database, PubMed, and Scopus. Results: A total of 23 Chinese language publications and 113 English language publications were included. The number of English language publications was on the rise, while the number of Chinese language publications was low. There are many issuing institutions which published articles in this field, mostly concentrated in universities. English language publication sources were more than Chinese language publication sources. The hot research topic in Chinese language publications and English language publications was the care of agitated behavior of dementia patients based on the Montessori method. The psychological problems of dementia patients are likely to become a hot issue of concern for scholars in Chinese. There will be a lot of research focusing on dementia patients and their family caregivers in this field. Conclusion: The bibliometric and visualization analysis helps us understand the current research status and hotspots of Montessori intervention in dementia patients in Chinese language publications and English language publications.
... Social isolation might cause the feeling of loneliness, which can exacerbate behavior alterations. These conclusions align with those found in a very recent work, which assessed the NPI and the revised University of California at Los Angeles (UCLA) loneliness scale [34]. The revised UCLA loneliness scale score was not significantly associated with age, education, Mini-Mental state examination score, gender, physical impairments and marital status. ...
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SARS-COV-2 is a severe medical condition. Old patients are very vulnerable, but they have been studied only as institutionalized patients. During the lock-down, little attention is dedicated to old, demented patients who lived at home. This study wants to examine their behavioral reactions by video-phone follow-up. We conducted a longitudinal study in subcortical vascular dementia (sVAD) patients. We enrolled 221 sVAD, not institutionalized patients. We divided sVAD patients into low-medium grade sVAD (A) and severe sVAD (B), based on neuroimaging severity degree and executive alterations. At baseline, at the end of lock-down, and two months later, global behavioral symptoms were recorded for each patient. We found significantly higher scores of general behavioral deterioration, anxiety, delusions, hallucinations and apathy after controlling for sVAD severity. The direct consequence was a drastic increment of psychotropic drugs prescribed and employed during the lock-down. Moreover, caregivers’ stress has been evaluated, together with their anxiety and depression levels. During the lock-down, their scores increased and reflected a severe worsening of their behavior. Our data demonstrate that social isolation induces a severe perception of loneliness and abandonment; these fears can exacerbate behavior disturbances in old-aged frail persons. Thus, these can be considered as indirect victims of SARS-COV-2.
... Although longitudinal studies cannot establish causal directionality, these studies consistently demonstrate an association between loneliness and subsequent cognitive decline [63]. Loneliness has reliably been associated with increased risk of Alzheimer's disease and related dementias [66][67][68][69], in addition to worse behavioral and psychological symptoms of dementia [70]. Moreover, this increase in dementia risk seems to be most relevant for individuals with persistent loneliness compared to individuals with transient loneliness in whom dementia risk remains unchanged [67]. ...
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Social distancing has been a critical public health measure for the COVID-19 pandemic, yet a long history of research strongly suggests that loneliness and social isolation play a major role in several cognitive health issues. What is the true severity and extent of risks involved and what are potential approaches to balance these competing risks? This review aimed to summarize the neurological context of social isolation and loneliness in population health and the long-term effects of social distancing as it relates to neurocognitive aging, health, and Alzheimer’s disease and related dementias. The full scope of the underlying causal mechanisms of social isolation and loneliness in humans remains unclear partly because its study is not amenable to randomized controlled trials; however, there are many detailed experimental and observational studies that may provide a hypothesis-generating theoretical framework to better understand the pathophysiology and underlying neurobiology. To address these challenges and inform future studies, we conducted a topical review of extant literature investigating associations of social isolation and loneliness with relevant biological, cognitive, and psychosocial outcomes, and provide recommendations on how to approach the need to fill key knowledge gaps in this important area of research.
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Background Behavioural and psychological symptoms of dementia (BPSD) negatively impact the quality of life of patients with dementia and their surrounding caregivers. Therefore, identifying modifiable factors to prevent BPSD is crucial. This cross‐sectional study investigated the association between hearing impairment (HI), social relationships, and BPSD. Methods A survey involving 179 patients who attended a memory clinic was conducted between July 2023 and March 2024. Pure‐tone audiometry and questionnaire interviews were conducted, while medical records were reviewed. HI was defined as an average hearing level ≥ 40 dB, measured by pure‐tone audiometry using the better‐hearing ear. BPSD presence and severity were assessed using the BPSD25Q‐based questionnaire. Multiple regression analysis was used for calculating partial regression coefficients to assess the association between HI, social relationship indicators, and BPSD presence and severity, adjusting for confounders. Results Among the 144 participants included in the analysis, the mean age was 82.7 years, and 96 (66.7%) were female individuals. Using multiple regression analysis, individuals with HI, whether living with others (β = 1.49, P = 0.038) or living alone (β = 2.23, P = 0.044) had a higher presence of BPSD, compared with those without HI who live with others. Additionally, those with HI who regularly engaged in conversations (β = 1.51, P = 0.027) or did not participate in social interactions (β = 2.02, P = 0.020) also had a higher presence of BPSD, compared with individuals without HI in similar circumstances. Similarly, those with HI and living alone (β = 4.54, P = 0.033) and lacking social interaction (β = 3.89, P = 0.020) experienced increased BPSD severity. Conclusion Our findings indicated that living alone and lacking social interaction with having HI were linked to both the presence and severity of BPSD. Additionally, increased verbal communication through conversations with cohabiting family members and others in patients with HI was associated with a higher presence of BPSD. Reducing communication stress and maintaining social connections are essential for managing these challenges.
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Background Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. Objective This study aims to assess the impact of a virtual reality (VR)–based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction. Methods The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions. Results Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. Conclusions This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR’s impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. Trial Registration University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5 International Registered Report Identifier (IRRID) DERR1-10.2196/57101
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Purpose: Differences in depression and loneliness, during the COVID-19 pandemic, for older adults with mild to moderate dementia living in residential care after interacting with a robotic companion dog or cat were explored. Experiences of family members and professional caregivers were also examined. Design: This study used a mixed research design with pre- and post-questionnaires on depression and loneliness. Method: Quantitative data exploring the impact of companion pets on depression and loneliness were collected from participants pre-intervention and at 3- and 6-week intervals. Qualitative data were collected during the 6-week study period, permitting researchers to explore the impact of robotic companion pets on participants, family members, and professional caregivers. Findings: Results indicated depression (χ2F(2) = 21.29, p < 0.001) and loneliness (χ2F(2) = 21.11, p < 0.001) improved. Moreover, participants were engaged with their companion pet, providing meaningful, activity and positive experiences. Conclusions: Robotic companion pet therapy, a holistic, nonpharmacologic animal-assisted therapy (AAT), changed the AAT landscape at the study site and provided an alternative option to live pet therapy during COVID-19. Participant interactions with their robotic companion pets enhanced their well-being and quality of life, especially during stringent COVID-19 restrictions and social isolation.
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Objectives: The objectives of this study were to evaluate the relationship between sensory impairment (hearing loss only, vision loss only and dual sensory impairment (DSI)) and depression, loneliness, quality of life and cognitive performance among older adults. Methods: A total of 229 community dwelling older adults aged 60 years or older participated in this study. Variables were measured using the Geriatric Depression Scale (GDS-15), Revised University of California at Los Angeles Loneliness Scale (R-UCLA), Satisfaction with Life Scale (SWLS) and Mini-Mental State Examination (MMSE), respectively. Results: There is an independent association between DSI and quality of life (p< 0.05), and between DSI and hearing loss alone and cognitive function (p< 0.05) among older adults. In addition, higher education is reported to have better quality of life and cognitive function. Conclusions: DSI is a significant factor affecting the quality of life and cognitive function among older adults. Sociodemographic such as education plays an important role in improving the quality of life and cognitive function. Thus, afford in increasing the awareness of this disability is important to insure that older adults receive the necessary support service and rehabilitation to improve their level of independence.
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Background Little is known about whether and to what extent loneliness impacts the lives of people with visual impairment (VI). Thus, the aim of this study was to examine the prevalence of and factors associated with loneliness in adults with VI, and to examine its association with life satisfaction. Methods This cross-sectional interview study included a probability sample of 736 adults (≥18 years old) with VI who were members of the Norwegian Association of the Blind and Partially Sighted. The interviews took place from January to May 2017, collecting information about sociodemographics, VI characteristics, adverse life events, loneliness (Three Item Loneliness Scale), and life satisfaction (Cantril’s Ladder of Life Satisfaction). The prevalence of loneliness was compared to data obtained from the general Norwegian population (N = 14,884; mean age 46.4 years; 50.7% females). Results The prevalence of moderate and severe loneliness in the VI population was 28.7% (95% CI: 25.4, 32.1) and 19.7% (95% CI: 16.9, 22.8), respectively. The rates were consistently higher across age groups compared to the general population. Loneliness was associated with younger age, blindness, having other impairments, unemployment, and a history of bullying or abuse. In addition, higher scores on loneliness were associated with lower levels of life satisfaction (fully adjusted β = − 0.48, 95% CI: − 0.55, − 0.41). Conclusions Loneliness is common in adults with VI. Strategies capable of reducing loneliness could improve life satisfaction among people who are blind or visually impaired. Electronic supplementary material The online version of this article (10.1186/s12955-019-1096-y) contains supplementary material, which is available to authorized users.
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Objective: To examine the longitudinal association of dual and single (vision and hearing) sensory loss on symptoms of depression and anxiety in older adults. Methods: Two thousand eight hundred ninety adults aged 60 years or over who participated in the longitudinal population-based Tromsø Study, Norway, were included. The impact of objective vision loss, self-report hearing loss, or dual sensory loss on symptoms of depression and anxiety, as assessed by the Hopkins Symptom Checklist 10, was examined at baseline and 6-year follow-up using linear mixed models. Results: Hearing loss had a cross-sectional relationship with increased depression (b = 0.1750, SE = 0.07, P = .02) and anxiety symptoms (b = 0.1765, SE = 0.08, P = .03); however, these relationships were not significant at the 6-year follow-up. Both vision loss only and dual sensory loss predicted increased depression scores at follow-up (b = 0.0220, SE = 0.01, P = .03; and b = 0.0413, SE = 0.02, P = .01, respectively). Adjustment for social isolation did not attenuate the main depression results. Conclusion: Dual sensory loss resulted in increased depression symptomatology over time and posed an additional long-term risk to depression severity beyond having a single sensory loss only. Only hearing loss is associated with anxiety symptoms. Older adults with vision, hearing, and dual sensory loss have different mental health profiles. Therefore, management and intervention should be tailored to the type of sensory loss.
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KEY POINTS ➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts. ➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond. ➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood. ➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions. Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research.
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Introduction: Cognitive and functional compromise, as frequently observed in Alzheimer’s disease (AD), hinders communication and social interactions. One consequence of this hindrance may be a feeling of loneliness. Moreover, emptiness and boredom, as observed in social isolation and loneliness, may thus be compensated for by creating imagined stimuli. Conditions of loneliness may be viewed as potentially generating hallucinatory experiences. To assess this assumption, the present study explored the relationship between social isolation, loneliness, and hallucinations in a sample of 22 mild AD participants and 24 elderly, healthy controls. Methods: Participants were assessed using the Launay–Slade Hallucination Scale, the UCLA Loneliness Scale, and a scale exploring contact with others and social participation. Results: More hallucinatory experiences, social isolation, and loneliness were found in the AD group than in the healthy control group. Moreover, significant correlations were observed between hallucinations and loneliness and between hallucinations and social isolation in both groups. Finally, hallucinations were predicted by social isolation. Discussion: Hallucinations may constitute a compensatory mechanism that aims to fulfil communication needs in lonely, elderly participants. Hallucinations may also be regarded as experiences that allow certain participants to escape the cycle of boredom, emptiness, and affective deprivation caused by social isolation.
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The development of an adequate assessment instrument is a necessary prerequisite for social psychological research on loneliness. Two studies provide methodological refinement in the measurement of loneliness. Study 1 presents a revised version of the self-report UCLA (University of California, Los Angeles) Loneliness Scale, designed to counter the possible effects of response bias in the original scale, and reports concurrent validity evidence for the revised measure. Study 2 demonstrates that although loneliness is correlated with measures of negative affect, social risk taking, and affiliative tendencies, it is nonetheless a distinct psychological experience.
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Objective measures of loneliness and poor social contacts are associated with negative health outcomes. However, the influence of subjective loneliness among elderly persons is poorly documented. We hypothesized that loneliness among persons aged 70-90 years is associated with subsequent decline in health, function, and longevity. Mortality data for subjects aged 70-90 years were obtained; subjective loneliness, health, comorbidity, depression, and functional status were assessed through the Jerusalem Longitudinal Cohort Study (1990-2010), a prospective longitudinal study. A representative sample of 407, 661, and 1,113 participants born 1920-1921 were assessed at home at ages 70, 78, and 85, respectively. Participants were asked how often they felt lonely, with answers dichotomized to never versus rarely/often/very often. In the age group of 70, 78, and 85, we excluded 67, 141, and 408 depressed participants from the study sample, which, thus, comprised 340, 520, and 705 participants, respectively. At age 70, 78, and 85, prevalence of loneliness was 27.9% (n = 95), 23.8% (n = 124), and 24% (n = 169), respectively. The only factor consistently associated at all ages with increased likelihood of loneliness was not being married. After adjusting for baseline variables, we found no association between loneliness and subsequent deterioration 7 years later in functional status, mood, cognition, chronic pain, or rising comorbidity between ages 70 and 78 or 78 and 85. Loneliness was not associated with mortality among the participants aged 70-78, 78-85, and 85-90. We repeated all data analysis, without excluding depressed participants, without any change in overall findings. Our findings do not support the hypothesis that subjective loneliness is associated with increased morbidity or mortality from age 70 to 90.
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Background: Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce. Methods: We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status. Results: After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis. Conclusions: Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.
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This paper is a report of an analysis of the concept of social isolation as experienced by older adults. Social isolation is a serious problem with older adults that is expected to increase in the future. Although strong correlations exist between social isolation and negative health consequences, few interventions exist. One contributing factor to this is a lack of conceptual clarity. The CINAHL, PsycINFO and Medline databases and the Web of Science were searched using the key terms social isolation, social networks, older adults, elderly and social integration for publications between 1983 and 2007. An evolutionary concept analysis was undertaken. References were read in their entirety and analysed based on the summary of surrogate terms, related concepts, attributes, antecedents and consequences. Five attributes were identified: number of contacts, feeling of belonging, fulfilling relationships, engagement with others and quality of network members. Antecedents included: lack of relationships, psychological barriers, physical barriers, low financial and resource exchange, and prohibitive environment. Roy's Adaptation Model is proposed as a theoretical context into which social isolation fits. Numerous definitions are used to describe social isolation, but they lack uniformity, consistency and clarity; this impairs the further development and refinement of the concept. This concept analysis can offer additional understanding and a starting point for future research related to social isolation.
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To determine whether functional and psychosocial outcomes associated with hearing impairment are a direct result or stem from prevalent comorbidity, we analyzed the impact of two levels of reported hearing impairment on health and psychosocial functioning one year later with adjustments for baseline chronic conditions. Physical functioning, mental health, and social functioning decreased in a dose-response pattern for those with progressive levels of hearing impairment compared with those reporting no impairment. Our results demonstrate an independent impact of hearing impairment on functional outcomes, reveal increasing problems with higher levels of impairment, and support the importance of preventing and treating this highly prevalent condition.
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Social isolation in old age has been associated with risk of developing dementia, but the risk associated with perceived isolation, or loneliness, is not well understood. To test the hypothesis that loneliness is associated with increased risk of Alzheimer disease (AD). Longitudinal clinicopathologic cohort study with up to 4 years of annual in-home follow-up. A total of 823 older persons free of dementia at enrollment were recruited from senior citizen facilities in and around Chicago, Ill. Loneliness was assessed with a 5-item scale at baseline (mean +/- SD, 2.3 +/- 0.6) and annually thereafter. At death, a uniform postmortem examination of the brain was conducted to quantify AD pathology in multiple brain regions and the presence of cerebral infarctions. Clinical diagnosis of AD and change in previously established composite measures of global cognition and specific cognitive functions. During follow-up, 76 subjects developed clinical AD. Risk of AD was more than doubled in lonely persons (score 3.2, 90th percentile) compared with persons who were not lonely (score 1.4, 10th percentile), and controlling for indicators of social isolation did not affect the finding. Loneliness was associated with lower level of cognition at baseline and with more rapid cognitive decline during follow-up. There was no significant change in loneliness, and mean degree of loneliness during the study was robustly associated with cognitive decline and development of AD. In 90 participants who died and in whom autopsy of the brain was performed, loneliness was unrelated to summary measures of AD pathology or to cerebral infarction. Loneliness is associated with an increased risk of late-life dementia but not with its leading causes.
Article
Objective: This study aimed to examine the association of loneliness and social isolation on cognition over a three-year follow-up period in middle- and older-aged adults. Methods: Data from a Spanish nationally representative sample were analysed (n=1691; aged 50+ years). Loneliness, social isolation and cognition (immediate recall, delayed recall, verbal fluency, forward digit span, backward digit span and a composite cognitive score) was assessed both at baseline and at follow-up. Adjusted generalised 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<0.05) and with a more rapid decline from baseline to follow-up in two out of six cognitive tests. 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). 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.
Article
Objectives Modifiable lifestyle risk factors are of great interest in the prevention and management of Alzheimer's disease (AD). Loneliness and social networks may influence onset of AD, but little is known about this relationship in people with AD. The current study aimed to explore the relationship between loneliness and social networks (social measures) and cognitive and psychopathology decline (AD outcomes) in people with AD. Methods Ninety‐three participants with mild‐moderate AD were recruited from memory clinics, in a cross‐sectional study. Social networks (measured by the Lubben Social Network Scale), feelings of loneliness (measured by De Jong Loneliness Scale), cognition (measured by the Standardized Mini Mental State Examination) and psychopathology (measured by the Neuropsychiatric Inventory) were assessed in an interview setting. Two multiple regressions with Bootstrap were conducted on cognition and psychopathology as outcome variables. Family and Friends subsets of social networks and loneliness were entered as predictors and age, gender and depression as covariates. Results The friendship subset of social networks was significantly related to cognition (independent of age, gender, depression, loneliness and family subset of social network): B = .284, p = .01. Neither loneliness nor social networks predicted psychopathology (ps > .05). Conclusions Maintaining or developing a close friendship network could be beneficial for cognition in people with AD. Alternatively, greater dementia severity may lead to fewer friends. More research on the direction of this relationship in people with AD is needed.
Article
Objective: The objective is to summarise recent findings from the 2010 Australian Survey of High Impact Psychosis (SHIP) and examine their implications for future policy and planning to improve mental health, physical health and other circumstances of people with a psychotic disorder. Methods: Survey of High Impact Psychosis collected nationally representative data on 1825 people with psychotic illness. Over 60 papers have been published covering key challenges reported by participants: financial problems, loneliness and social isolation, unemployment, poor physical health, uncontrolled symptoms of mental illness, and lack of stable, suitable housing. Findings are summarised under the rubric of participant-ranked top challenges. Results: The main income source for the majority (85%) of participants was a government benefit. Only one-third was employed, and the most appropriate employment services for this group were under-utilised. High rates of loneliness and social isolation impacted mental and physical health. The rate of cardiometabolic disease was well above the general population rate, and associated risk factors were present from a very young age. Childhood abuse (30.6%), adult violent victimisation (16.4%) and alcohol and substance abuse/dependence (lifetime rates of 50.5% and 54.5%, respectively) complicated the clinical profile. Treatment with medication was suboptimal, with physical health conditions undertreated, a high rate of psychotropic polypharmacy and underutilisation of clozapine in chronic persistent psychotic illness. Only 38.6% received evidence-based psychosocial therapies. In the previous year, 27.4% had changed housing and 12.8% had been homeless, on average for 155 days. Conclusion: Money, social engagement and employment are the most important challenges for people with psychotic illness, as well as good physical and mental health. An integrated approach to recovery is needed to optimise service delivery and augment evidence-based clinical practice with measures to improve physical health and social circumstances. Meeting these challenges has the potential to reduce costs to government and society, as well as promote recovery.
Article
The health and well-being consequences of social isolation and loneliness in old age are increasingly being recognised. The purpose of this scoping review was to take stock of the available evidence and to highlight gaps and areas for future research. We searched nine databases for empirical papers investigating the impact of social isolation and/or loneliness on a range of health outcomes in old age. Our search, conducted between July and September 2013 yielded 11,736 articles, of which 128 items from 15 countries were included in the scoping review. Papers were reviewed, with a focus on the definitions and measurements of the two concepts, associations and causal mechanisms, differences across population groups and interventions. The evidence is largely US-focused, and loneliness is more researched than social isolation. A recent trend is the investigation of the comparative effects of social isolation and loneliness. Depression and cardiovascular health are the most often researched outcomes, followed by well-being. Almost all (but two) studies found a detrimental effect of isolation or loneliness on health. However, causal links and mechanisms are difficult to demonstrate, and further investigation is warranted. We found a paucity of research focusing on at-risk sub-groups and in the area of interventions. Future research should aim to better link the evidence on the risk factors for loneliness and social isolation and the evidence on their impact on health.
Article
The present study examined the reliability and validity of the short form of the Geriatric Depression Scale (GDS), and examined the cutoff points for the scale. The reliability of the GDS was confirmed, with a Cronbach's alpha of 0.83. To confirm the validity, the GDS data was compared with the Epidemiologic Studies Depression Scale (CES-D), and two factors were extracted. The correlation between the GDS and CES-D for the first factor, named “Depression, Loneliness and Anxiety” was 0.60. There were two cutoff points on the GDS; the first was between 5 and 6, and the second was between 9 and 12.
Article
The purpose of this study is to examine the reliability and validity of the revised UCLA Loneliness Scale (Russell, Peplau & Cutrona, 1980), based on several criteria. Nine hundred and seventy-five subjects were administered the revised scale along with other instruments for measuring loneliness.The main results obtained here were as follows:1) Chronic alcoholics showed the highest loneliness scores. The middle-aged were more lonely, on the average, than college students.2) A significant sex difference was found only in the case of college freshmen; male freshmen show higher loneliness than female freshmen.3) The UCLA Loneliness Scale has high internal consistency, with a coefficient alpha of. 871 and a test-retest correlation over a 6-month period of. 546. The reliability coefficient assessed by the split-half method was also very high (r=. 829). Accordingly, the results appear to provide clear evidences of the reliability of the revised measure.4) The validity of the revised UCLA loneliness scale was assessed in several ways. The relationship between scores on this scale and measures of social activities and relations were examined as the main test of concurrent validity. Lonely people reported more limited social activities and relations, and they tended to regard their parents as being disagreeable, cold, and untrustworthy. Substantial correlation (-. 42) was found between loneliness scores and the measure of self-esteem. Lonely people had lower self-esteem than people who were not lonely. Furthermore, lonely people had more medical and psychological problems than their less lonely peers.Overall, these findings lend support to the validity of the revised Loneliness Scale.
Article
Objective The aim of this study was to evaluate the association between loneliness in elderly people with the use of psychotropic drugs.MethodsA subsample of 3111 participants (ages 55–85) of the large population-based German ESTHER study was included in the study. Loneliness was measured by using a three-item questionnaire. Two subgroups were defined according to their degrees of loneliness. Psychotropic drugs were categorized by study doctors. Logistic regression analyses were conducted to determine the association between loneliness subgroups and the use of psychotropic drugs adjusted for psychosocial variables, multimorbidity, depression, anxiety, and somatic symptom severity.ResultsOf the participants 14.1% (95%-CI = [12.9; 15.4]) were estimated to have a high degree of loneliness (women > men); 19% (95%-CI = [17.6; 20.4]) of the participants used psychotropic drugs, 8.4% (95%-CI = [7.5; 9.5]) antidepressants. Logistic regression analysis showed that more lonely participants had significantly higher odds for using psychotropic drugs (OR: 1.495; 95%-CI = [1.121; 1.993]). Depression severity, somatic symptom severity, and female gender were also positively associated with the use of psychotropic drugs.ConclusionA high degree of subjective loneliness in the elderly is associated with the use of psychotropic drugs, even after adjustment for somatic and psychological comorbidities and psychosocial variables. Copyright © 2014 John Wiley & Sons, Ltd.
Article
Late-onset psychosis (LOP) has become increasingly prevalent in the clinical setting, especially in the highly aged society, due to the increasing numbers of older people and its disruptive impact on the lives of patients and caregivers. Although previous studies have identified some of the features of LOP (Webster and Grossberg, 1998; Mitford et al. , 2010; Tan and Seng, 2012), some of the previous studies did not include patients with dementia and mood disorders. This study addresses the features of LOP in consecutive outpatients to provide information that supports the differential diagnosis.
Article
Loneliness has long been known to have strong association with depression. The relationship between loneliness and depression, however, has been associated with other risk factors including social support. The aim of this paper is to describe the role of social support in the association between loneliness and depression. This cross-sectional study examined the mediating effects of social support among 161 community-based elderly in agricultural settlement of a rural area in Sungai Tengi, Malaysia. Subjects were investigated with De Jong Gierveld Loneliness Scale, Geriatric Depression Scale and Medical Outcome Survey Social Support Survey. Data were analyzed using Pearson correlation, linear and hierarchical regression. Results indicated that social support partially mediated the relationship between loneliness and depression. This suggests that social support affects the linear association between loneliness and depression in the elderly.
Article
Objectives: This study conceptualized loneliness as a mediator in the relation between social engagement and depressive symptoms and explored gender differences in the mediation model. Various indices of social engagement were considered including living arrangement, social network, and activity participation. Method: Using data from 674 community-dwelling Korean American older adults, we first examined the mediation effect of loneliness in the relation between each of 3 indices of social engagement (not living alone, social network, and activity participation) and depressive symptoms. Subsequently, gender differences in the mediation model were examined. Results: As hypothesized, loneliness was found to mediate the relation between each of the indices of social engagement and depressive symptoms in both men and women. We also observed gender differences in the strength of mediating effects; the effect of living alone was more likely to be mediated by loneliness among men, whereas women showed greater levels of mediation in the models with social network and activity participation. Discussion: Our findings suggest that loneliness may explain the mechanism by which deficits in social engagement exerts its effect on depressive symptoms and that gender differences should be considered in interventions targeting social engagement for mental health promotion.
Article
Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing, behavioural rating, and various combinations of simpler psychometric and behavioural evaluations. The Clinical Dementia Rating (CRD), a global rating device, was developed for a prospective study of mild senile dementia--Alzheimer type (SDAT). Reliability, validity, and correlational data are discussed. The CRD was found to distinguish unambiguously among older subjects with a wide range of cognitive function, from healthy to severely impaired.
Article
We developed a new instrument, the Neuropsychiatric Inventory (NPI), to assess 10 behavioral disturbances occurring in dementia patients: delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, and aberrant motor activity. The NPI uses a screening strategy to minimize administration time, examining and scoring only those behavioral domains with positive responses to screening questions. Both the frequency and the severity of each behavior are determined. Information for the NPI is obtained from a caregiver familiar with the patient's behavior. Studies reported here demonstrate the content and concurrent validity as well as between-rater, test-retest, and internal consistency reliability; the instrument is both valid and reliable. The NPI has the advantages of evaluating a wider range of psychopathology than existing instruments, soliciting information that may distinguish among different etiologies of dementia, differentiating between severity and frequency of behavioral changes, and minimizing administration time.
Article
Neuropsychiatric disturbances are common and burdensome symptoms of dementias. Assessment and measurement of neuropsychiatric disturbances are indispensable to the management of patients with dementia and for clinical research. No standardized instruments have been developed for these purposes in Japan. The Neuropsychiatric Inventory (NPI), developed by Cummings et al., is a standardized, validated, and reliable tool to assess a wide range of neuropsychiatric derangements in patients with dementia, and has been used in clinical studies in North America. In this study, we prepared a Japanese version of the NPI and tested its reliability and usefulness in dementia patients. The subjects were 174 patients with dementia, including Alzheimer's disease (140), frontotemporal dementia (12), vascular dementia (19), and normal pressure hydrocephalus (3), whose diagnosis was made on the basis of the results of extensive examinations including MRI and PET/SPECT of the brain and appropriate clinical diagnostic criteria for each disorder. The subjects consisted of 133 women and 41 men; their mean age was 72.6 +/- 7.7 years (S.D.; range: 49 to 88) years. An examiner (neurologist) used the NPI to interview a caregiver familiar with the patient's everyday behavior. In 24 randomly selected patients interview was repeated by another examiner (psychiatrist) one month later, and test-retest reliability was evaluated. The Clinical Dementia Rating (CDR), the Mini-Mental State Examination (MMSE), and the Alzheimer's Disease Assessment Scale (ADAS) were used to assess the severity of the dementia and cognitive impairment. The MMSE scores ranged from 5 to 29 (mean +/- SD = 19.0 +/- 4.8) and the ADAS scores ranged from 7 to 63 (24.3 +/- 10.9). The CDR score was 0.5 in 17 patients, 1 in 95 patients, 2 in 52 patients, and 3 in 10 patient. Test-retest reliability of each score was acceptably high, and the correlation coefficient for each score obtained by repeated assessments in this study was similar to the coefficient in the original report. Apathy was the most common behavior in the ten abnormal behavioral domains, and euphoria was the least common. The prevalence of abnormal findings was also comparable to the results in the original report. The total NPI scores and many of the NPI subscale scores were significantly correlated with both the severity of dementia and cognitive impairment. This Japanese version of NPI, whose reliability and competency are comparable to those of the original version, is a reliable and useful tool for measuring neuropsychiatric disturbances in dementia patients.
Article
The search for preventable and remediable risk conditions of cognitive decline is ongoing, but results have thus far been inconsistent. According to the hypothesis of our 10-year prospective study, the predictive values of different risk indicators change over time in a general 75+ population. A population-based sample of 75-, 80-, and 85-year-old individuals (n=650) underwent comprehensive clinical examinations in 1990 in Helsinki, Finland. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and/or Clinical Dementia Rating (CDR) at baseline and after 1, 5, and 10 years. At baseline, a low MMSE score was associated with age, history of stroke, apolipoprotein E allele epsilon4 (APOE4), and intermittent claudication. After 1 year, cognitive decline was typical of participants suffering from vascular diseases, e.g., heart failure and intermittent claudication. Five-year decline was predicted by the presence of atrial fibrillation (RR [relative risk] 2.8), APOE4 (RR 2.4), elevated C-reactive protein (CRP) (RR 2.3), diabetes mellitus (RR 2.2), and heart failure (RR 1.8). They also tended to increase 5-year all-cause mortality. At 10 years, the decline associated with APOE4 (RR 3.3), slightly elevated serum ionized calcium (RR 3.3), and feelings of loneliness (RR 3.0). Long follow-up of a general aged population explains several inconsistencies of earlier reports. In 75+ individuals, general ill health is a strong associate of cognitive deficits. The strongest predictors of both cognitive decline and mortality are age, APOE4, manifest vascular diseases, and diabetes. The role of new potential predictors, feelings of loneliness and hypercalcemia, needs clinical testing.
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The dementia with Lewy bodies (DLB) Consortium has revised criteria for the clinical and pathologic diagnosis of DLB incorporating new information about the core clinical features and suggesting improved methods to assess them. REM sleep behavior disorder, severe neuroleptic sensitivity, and reduced striatal dopamine transporter activity on functional neuroimaging are given greater diagnostic weighting as features suggestive of a DLB diagnosis. The 1-year rule distinguishing between DLB and Parkinson disease with dementia may be difficult to apply in clinical settings and in such cases the term most appropriate to each individual patient should be used. Generic terms such as Lewy body (LB) disease are often helpful. The authors propose a new scheme for the pathologic assessment of LBs and Lewy neurites (LN) using alpha-synuclein immunohistochemistry and semiquantitative grading of lesion density, with the pattern of regional involvement being more important than total LB count. The new criteria take into account both Lewy-related and Alzheimer disease (AD)-type pathology to allocate a probability that these are associated with the clinical DLB syndrome. Finally, the authors suggest patient management guidelines including the need for accurate diagnosis, a target symptom approach, and use of appropriate outcome measures. There is limited evidence about specific interventions but available data suggest only a partial response of motor symptoms to levodopa: severe sensitivity to typical and atypical antipsychotics in approximately 50%, and improvements in attention, visual hallucinations, and sleep disorders with cholinesterase inhibitors.
A study of the feeling of loneliness (1): the reliability and validity of the revised UCLA Loneliness Scale
  • T Kudo
  • M Nishikawa
Kudo T, Nishikawa M. A study of the feeling of loneliness (1): the reliability and validity of the revised UCLA Loneliness Scale. JPN J Exp Soc Psychol. 1983;22(2):99-108. (In Japanese).
The impact of sensory impairment on cognitive performance, quality of life, depression, and loneliness in older adults
  • D Harithasan
  • Szs Mukari
  • W S Ishak
  • S Shahar
  • W L Yeong
Harithasan D, Mukari SZS, Ishak WS, Shahar S, Yeong WL. The impact of sensory impairment on cognitive performance, quality of life, depression, and loneliness in older adults. Int J Geriatr Psychiatry. 2020;35(4):358-364.
The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia
  • J L Cummings
  • M Mega
  • K Gray
  • S Rosenberg-Thompson
  • D A Carusi
  • J Gornbein
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12): 2308-2314.